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Sample records for reduces medical costs

  1. Gauging the feasibility of cost-sharing and medical student interest groups to reduce interview costs.

    PubMed

    Lieber, Bryan A; Wilson, Taylor A; Bell, Randy S; Ashley, William W; Barrow, Daniel L; Wolfe, Stacey Quintero

    2014-11-01

    Indirect costs of the interview tour can be prohibitive. The authors sought to assess the desire of interviewees to mitigate these costs through ideas such as sharing hotel rooms and transportation, willingness to stay with local students, and the preferred modality to coordinate this collaboration. A survey link was posted on the Uncle Harvey website and the Facebook profile page of fourth-year medical students from 6 different medical schools shortly after the 2014 match day. There were a total of 156 respondents to the survey. The majority of the respondents were postinterview medical students (65.4%), but preinterview medical students (28.2%) and current residents (6.4%) also responded to the survey. Most respondents were pursuing a field other than neurosurgery (75.0%) and expressed a desire to share a hotel room and/or transportation (77.4%) as well as stay in the dorm room of a medical student at the program in which they are interviewing (70.0%). Students going into neurosurgery were significantly more likely to be interested in sharing hotel/transportation (89.2% neurosurgery vs 72.8% nonneurosurgery; p = 0.040) and in staying in the dorm room of a local student when on interviews (85.0% neurosurgery vs 57.1% nonneurosurgery; p = 0.040) than those going into other specialties. Among postinterview students, communication was preferred to be by private, email identification-only chat room. Given neurosurgery resident candidates' interest in collaborating to reduce interview costs, consideration should be given to creating a system that could allow students to coordinate cost sharing between interviewees. Moreover, interviewees should be connected to local students from neurosurgery interest groups as a resource. PMID:25363428

  2. Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson’s Disease

    PubMed Central

    Hacker, Mallory L.; Currie, Amanda D.; Molinari, Anna L.; Turchan, Maxim; Millan, Sarah M.; Heusinkveld, Lauren E.; Roach, Jonathon; Konrad, Peter E.; Davis, Thomas L.; Neimat, Joseph S.; Phibbs, Fenna T.; Hedera, Peter; Byrne, Daniel W.; Charles, David

    2016-01-01

    Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson’s disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT). Objective: The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs. Methods: Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS. Results: Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p <  0.05; OR = 0.2; 95% CI: 0.04–0.97). Conclusions: STN-DBS in early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD. PMID:26967937

  3. An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

    PubMed

    Polinski, Jennifer M; Moore, Janice M; Kyrychenko, Pavlo; Gagnon, Michael; Matlin, Olga S; Fredell, Joshua W; Brennan, Troyen A; Shrank, William H

    2016-07-01

    Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care. PMID:27385237

  4. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    ERIC Educational Resources Information Center

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  5. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

    PubMed Central

    Finnie, Ramona K.C.; Acharya, Sushama D.; Jacob, Verughese; Proia, Krista K.; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

    2015-01-01

    Introduction Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients’ adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. Methods We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Results Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of −$127 per person per year. Conclusion ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence. PMID:26605708

  6. Estimated Cost Savings from Reducing Errors in the Preparation of Sterile Doses of Medications

    PubMed Central

    Schneider, Philip J.

    2014-01-01

    Abstract Background: Preventing intravenous (IV) preparation errors will improve patient safety and reduce costs by an unknown amount. Objective: To estimate the financial benefit of robotic preparation of sterile medication doses compared to traditional manual preparation techniques. Methods: A probability pathway model based on published rates of errors in the preparation of sterile doses of medications was developed. Literature reports of adverse events were used to project the array of medical outcomes that might result from these errors. These parameters were used as inputs to a customized simulation model that generated a distribution of possible outcomes, their probability, and associated costs. Results: By varying the important parameters across ranges found in published studies, the simulation model produced a range of outcomes for all likely possibilities. Thus it provided a reliable projection of the errors avoided and the cost savings of an automated sterile preparation technology. The average of 1,000 simulations resulted in the prevention of 5,420 medication errors and associated savings of $288,350 per year. The simulation results can be narrowed to specific scenarios by fixing model parameters that are known and allowing the unknown parameters to range across values found in previously published studies. Conclusions: The use of a robotic device can reduce health care costs by preventing errors that can cause adverse drug events. PMID:25477598

  7. Fitness costs of animal medication: antiparasitic plant chemicals reduce fitness of monarch butterfly hosts.

    PubMed

    Tao, Leiling; Hoang, Kevin M; Hunter, Mark D; de Roode, Jacobus C

    2016-09-01

    The emerging field of ecological immunology demonstrates that allocation by hosts to immune defence against parasites is constrained by the costs of those defences. However, the costs of non-immunological defences, which are important alternatives to canonical immune systems, are less well characterized. Estimating such costs is essential for our understanding of the ecology and evolution of alternative host defence strategies. Many animals have evolved medication behaviours, whereby they use antiparasitic compounds from their environment to protect themselves or their kin from parasitism. Documenting the costs of medication behaviours is complicated by natural variation in the medicinal components of diets and their covariance with other dietary components, such as macronutrients. In the current study, we explore the costs of the usage of antiparasitic compounds in monarch butterflies (Danaus plexippus), using natural variation in concentrations of antiparasitic compounds among plants. Upon infection by their specialist protozoan parasite Ophryocystis elektroscirrha, monarch butterflies can selectively oviposit on milkweed with high foliar concentrations of cardenolides, secondary chemicals that reduce parasite growth. Here, we show that these antiparasitic cardenolides can also impose significant costs on both uninfected and infected butterflies. Among eight milkweed species that vary substantially in their foliar cardenolide concentration and composition, we observed the opposing effects of cardenolides on monarch fitness traits. While high foliar cardenolide concentrations increased the tolerance of monarch butterflies to infection, they reduced the survival rate of caterpillars to adulthood. Additionally, although non-polar cardenolide compounds decreased the spore load of infected butterflies, they also reduced the life span of uninfected butterflies, resulting in a hump-shaped curve between cardenolide non-polarity and the life span of infected butterflies

  8. Long-Term Care Benefits May Reduce End-of-Life Medical Care Costs

    PubMed Central

    Evered, Sharrilyn R.; Center, Bruce A.

    2014-01-01

    Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan (“claimants”) to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332–339) PMID:24784144

  9. The Parity Paradigm: Can Legislation Help Reduce the Cost Burden of Oral Anticancer Medications?

    PubMed

    Kircher, Sheetal M; Meeker, Caitlin R; Nimeiri, Halla; Geynisman, Daniel M; Zafar, S Yousuf; Shankaran, Veena; de Souza, Jonas; Wong, Yu-Ning

    2016-01-01

    Over the last decade, there has been increased development and use of oral anticancer medications, which sometimes leads to high cost sharing for patients. Drug parity laws require insurance plans to cover oral anticancer medications with the same cost sharing as intravenous/injected chemotherapy or have a capped limit on out-of-pocket costs. There are currently 36 enacted state laws (plus the District of Columbia) addressing drug parity, but no federal laws. In this policy perspective piece, we discuss the history, opportunities, and limitations of drug parity laws in oncology. We also discuss the implications of provisions of the Affordable Care Act and other proposed policy reforms on financing oral chemotherapy. PMID:26797241

  10. Increased Use Of Prescription Drugs Reduces Medical Costs In Medicaid Populations.

    PubMed

    Roebuck, M Christopher; Dougherty, J Samantha; Kaestner, Robert; Miller, Laura M

    2015-09-01

    We used data on more than 1.5 million Medicaid enrollees to examine the impact of changes in prescription drug use on medical costs. For three distinct groups of enrollees, we estimated the effects of aggregate prescription drug use-and, more specifically, the use of medications to treat eight chronic noncommunicable diseases-on total nondrug, inpatient, outpatient, and other Medicaid spending. We found that a 1 percent increase in overall prescription drug use was associated with decreases in total nondrug Medicaid costs by 0.108 percent for blind or disabled adults, 0.167 percent for other adults, and 0.041 percent for children. Reductions in combined inpatient and outpatient spending from increased drug utilization in Medicaid were similar to an estimate for Medicare by the Congressional Budget Office. Moving forward, policy makers evaluating proposed changes that alter medication use among the nearly seventy million Medicaid recipients should consider the net effects on program spending to ensure that scarce federal and state health care dollars are allocated efficiently. PMID:26355062

  11. Reducing medical waste.

    PubMed

    Conrardy, Julie; Hillanbrand, Mary; Myers, Sandra; Nussbaum, George F

    2010-06-01

    Medical waste is a necessary by-product of any hospital environment; however, the majority of regulated medical waste is produced in the OR from the use of disposable surgical supplies (eg, drapes, gowns, basins, gloves, sponges). We conducted a concept comparison project in the ORs of two large medical centers in Bethesda, Maryland, and Washington, DC, to evaluate the effects of using reusable surgical basins, gowns, and table and Mayo stand covers in place of disposable products. Survey results indicated that surgeons and surgical technologists found the reusable products to be preferable to the disposable products currently in use. In addition, using reusable products provided a means to decrease regulated medical waste generated in the OR by an average of 65% as well as reduce the cost of waste disposal. AORN recommends evaluating the environmental effects of using reusable, reposable, and disposable products; our findings provide evidence that may be useful to surgical facilities that seek to adopt a "green" approach. PMID:20510944

  12. Medical groups can reduce costs by investing in improved quality of care for patients with diabetes.

    PubMed

    Kralewski, John E; Dowd, Bryan E; Xu, Yi Wendy

    2012-08-01

    A major feature of many new contracts between providers and payers is shared savings programs, in which providers can earn a percentage of the savings if the cost of the care they provide is lower than the projected cost. Unless providers are also held accountable for meeting quality benchmarks, some observers fear that these programs could erode quality of care by rewarding only cost savings. We estimated the effects on Medicare expenditures of improving the quality of care for patients with diabetes. Analyzing 234 practices that provided care for 133,703 diabetic patients, we found a net savings of $51 per patient with diabetes per year for every one-percentage-point increase in a score of the quality of care. Cholesterol testing for all versus none of a practice's patients with diabetes, for example, was associated with a dramatic drop in avoidable hospitalizations. These results show that improving the quality of care for patients with diabetes does save money. PMID:22869662

  13. Reduced medical costs and hospital days when using oral arsenic plus ATRA as the first-line treatment of acute promyelocytic leukemia.

    PubMed

    Jiang, Hao; Liang, Gong-Wen; Huang, Xiao-Jun; Jiang, Qian; Han, Sheng; Shi, Lu-Wen; Zhu, Hong-Hu

    2015-12-01

    We have demonstrated that oral arsenic (Realgar-Indigo naturalis formula, RIF) plus all-trans retinoic acid (ATRA) is not inferior to intravenous arsenic trioxide (ATO) plus ATRA as the first-line treatment of acute promyelocytic leukemia (APL). To compare the cost-effectiveness of oral and intravenous arsenic, we analyzed the results of 30 patients in each group involved in a randomized controlled trial at our center. The median total medical costs were $13,183.49 in the RIF group compared with $24136.98 in the ATO group (p<0.0001). This difference primarily resulted from the different costs of induction therapy (p=0.016) and maintenance treatment (p<0.0001). The length of hospitalization for the RIF group was significantly lower than that for the ATO group (24 vs. 31 days, p<0.0001) during induction therapy. During maintenance treatment, the estimated medical costs were $2047.14 for each patient in the RIF group treated at home compared with $11273.81 for each patient in the ATO group treated in an outpatient setting (p<0.0001). We conclude that oral RIF plus ATRA significantly reduced the medical costs and length of hospital stay during induction and remission therapy compared with ATO plus ATRA in APL patients. PMID:26403986

  14. Reducing Life-Cycle Costs.

    ERIC Educational Resources Information Center

    Roodvoets, David L.

    2003-01-01

    Presents factors to consider when determining roofing life-cycle costs, explaining that costs do not tell the whole story; discussing components that should go into the decision (cost, maintenance, energy use, and environmental costs); and concluding that important elements in reducing life-cycle costs include energy savings through increased…

  15. Leveraging Technology to Reduce Patient Transaction Costs.

    PubMed

    Edlow, Richard C

    2015-01-01

    Medical practices are under significant pressure to provide superior customer service in an environment of declining or flat reimbursement. The solution for many practices involves the integration of a variety of third-party technologies that conveniently interface with one's electronic practice management and medical records systems. Typically, the applications allow the practice to reduce the cost of each patient interaction. Drilling down to quantify the cost of each individual patient interaction helps to determine the practicality of implementation. PMID:26665478

  16. Strategy Reduces Construction Costs.

    ERIC Educational Resources Information Center

    Flynn, Jim; Petters, Walt

    2000-01-01

    Reveals how a Florida school district had success when switching from a design-bid-build approach for school construction to a construction management (CM) at risk. The CM at risk process involving project delivery options, maximum price guarantees, and the school district's benefits in cost savings accrued are addressed. (GR)

  17. Reducing coal transportation costs

    SciTech Connect

    Rosenberg, R.D. )

    1990-10-11

    Ten years ago, the Staggers Rail Act of 1980 became law. This act significantly altered the landscape against which the freight rates paid by electric utilities and other shippers for transporting coal and other goods by rail are determined. Among the most significant changes was the creation of the Rail Cost Adjustment Factor (RCAF), a special mechanism to enable railroads to recoup increases in their costs through expedited rate increases. The RCAF has generated much controversy between shippers and railroads, especially over the treatment of changes in rail productivity, that is, whether the RCAF should track only changes in the prices paid by railroads for raw inputs or should instead measure changes in the actual cost of rail production by reflecting increases in the amount of output achieved per unit of input. Shippers last year won a major battle when the Interstate Commerce Commission (ICC) added a productivity adjustment to the RCAF, although that decision is still subject to judicial review and possible modification by the ICC. The railroads have responded to the productivity adjustment by pursuing other means of raising their rates, thus creating new issues and choices for utilities. This article reviews the role and significance of the RCAF, explains the nature and impact of the new productivity adjustment, and analyzes the implications of the productivity adjustment for the pricing of rail transportation services in the future. These matters are of major importance for coal-burning utilities and their ratepayers, especially as the cost of coal transportation in many areas exceeds the cost of the coal itself.

  18. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    PubMed

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. PMID:25702076

  19. Non-medical costs of colonoscopy

    PubMed Central

    Kempiński, Radosław; Michałowicz, Jerzy; Poniewierka, Elżbieta

    2014-01-01

    Colorectal cancer is one of the most common malignancies in Europe and North America. Colonoscopy done every 10 years beginning at age 50 is the preferred method of screening. In Poland and some other countries examinations are offered to subjects free of charge. However, as well as direct medical costs there are direct non-medical costs, which include the cost of transportation and costs related to caregivers’ time, and indirect costs, which are costs related to patients’ time. These costs essentially augment the total societal costs of colonoscopy. PMID:25396000

  20. Reduce costs with vacuum excavation

    SciTech Connect

    Vitale, S.A.

    1983-09-01

    Although vacuum excavation equipment and methods are in their infancy, this developing technology offers tremendous promise for the future. The author explains Brooklyn Union Gas Co.'s experience with five vacuum trucks and the procedures that are used. In recent years, the higher cost of natural gas has increased the need for gas utilities to reduce their operating expenses. One way, which has been successful at Brooklyn Union Gas, is the use of vacuum excavation. Although vacuum excavation equipment and techniques are in their infancy, this developing technology offers substantial savings today and tremendous promise for the future. Brooklyn Union started its vacuum digging program by locating keyhole cutoffs--small surface openings ranging from 1 ft by 1 ft to 1 1/2 ft by 1 1/2 ft (0.3 m to 0.45 m square). It is no easy task to accurately locate a service that was installed 60 years ago. Reading the street indications, locating an existing curb valve or repair opening, gaining access to the building, making a physical lineup, and using an M-scope, plus any other tools available, have produced a high success rate.

  1. Current & future medical costs of childhood obesity in Alaska.

    PubMed

    Guettabi, Mouhcine

    2014-09-01

    This study examines the medical costs of childhood obesity in Alaska, today and in the future. We estimate that 15.2 percent of those ages 2 to 19 in Alaska are obese. Using parameters from published reports and studies, we estimate that the total excess medical costs due to obesity for both adults and children in Alaska in 2012 were $226 million, with medical costs of obese children and adolescents accounting for about $7 million of that total. And those medical costs will get much higher over time, as today's children transition into adulthood. Aside from the 15.2 percent currently obese, another estimated 20 percent of children who aren't currently obese will become obese as adults, if current national patterns continue. We estimate that the 20-year medical costs--discounted to present value--of obesity among the current cohort of Alaska children and adolescents will be $624 million in today's dollars. But those future costs could be decreased if Alaskans found ways to reduce obesity. We consider how reducing obesity in several ways could reduce future medical costs: reducing current rates of childhood obesity, rates of obese children who become obese adults, or rates of non-obese children and adolescents who become obese adults. We undertake modest reductions to showcase the potential cost savings associated with each of these channels. Clearly the financial savings are a direct function of the obesity reductions and therefore the magnitude of the realized savings will vary accordingly. Also keep in mind that these figures are only for the current cohort of children and adolescents; over time more generations of Alaskans will grow from children into adults, repeating the same cycle unless rates of obesity decline. And finally, remember that medical costs are only part of the broader range of social and economic costs obesity creates. PMID:26043494

  2. Reducing energy costs in nursing homes

    SciTech Connect

    Not Available

    1981-01-01

    The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryers to gas was analyzed. (MCW)

  3. Costs and implications of discarded medication in hospice.

    PubMed

    Speer, Nathan D; Dioso, Jhanina; Casner, Paul R

    2013-08-01

    Symptom control for hospice patients frequently involves the use of pharmacologic agents for control of pain, dyspnea, and anxiety. Other troubling symptoms that will often require pharmacologic agents include nausea, vomiting, constipation, and delirium. While the Medicare requirement for hospice is a prognosis of six months or less, accurately predicting prognosis is very difficult. Because of this, medications for symptom control will often have to be prescribed and refilled without knowing exactly how much the hospice patient may require. The objective of the current study was to determine the amount of medication discarded at death. Additionally we wanted to estimate the cost related to discarded medication. We reviewed the records of 296 patients over a three-year period in a community hospice to characterize the medications that were discarded at death. Seventeen patients were not eligible for evaluation because of lack of complete information, leaving 279 study subjects. Cost calculations were used using a website cost calculator (HealthTrans.com). Fifty-six percent of the decedents were female and the majority were Hispanic (62%). The five most common diagnoses were cancer (36%); dementia (22%); and COPD, CVA, and congestive heart failure (CHF) (8%). The median length of stay in hospice was 16 days. The most frequent medication unused at the time of death was morphine solution followed by lorazepam. The cost of discarded morphine including tablets as well as solution totaled over $6,000 for the study period. The next highest medication cost was lorazepam for both solution and tablets, which came to over $1,600. The total estimated cost for all medications for the study period amounted to $14,980. The results of this study indicate that hospice patients have variable amounts of discarded medication at the time of death and that the cost involved of these unused medications can be significant. Hospice organizations should investigate creative ways to reduce

  4. Reducing pharmacy costs through improved utilization.

    PubMed

    Bates, Cinda; Richards, Barton S

    2013-06-01

    Strategies Trinity Regional Health System in Rock Island, III., used to reduce pharmacy expenses included: Leveraging benchmarking information to identify opportunities for cost savings. Implementing change management techniques, bolstered by well-presented and coherent data, to promote acceptance of change. Forming a multidisciplinary team of clinical and financial leaders to address quality, outcomes, and cost issues and collaborate on solutions. PMID:23795386

  5. Strategies for Reducing Text Book Costs

    ERIC Educational Resources Information Center

    Board of Governors, State University System of Florida, 2008

    2008-01-01

    In recent years, the price of college textbooks has become a growing concern for students and others who care about keeping college costs affordable. As policymakers and higher education systems explore the issue further, there are actions that can be taken immediately on college campuses to reduce the cost of textbooks. This brief presents…

  6. Reducing the cost of HIV antibody testing.

    PubMed

    Tamashiro, H; Maskill, W; Emmanuel, J; Fauquex, A; Sato, P; Heymann, D

    1993-07-10

    Available tests to detect antibody to human immunodeficiency virus (HIV) have a range of applications, and injudicious selection and inappropriate use can add a significant financial burden to budgets for AIDS programmes in developing countries. There are several ways by which the cost of HIV antibody testing can be reduced; they include use of tests appropriate for existing laboratory capabilities; adoption of cost-effective testing strategies; pooling of serum samples before testing; and ensuring best possible purchase prices. Each approach can significantly reduce the cost of HIV antibody testing alone or in combination, which increases the potential sustainability of antibody testing programmes, even in settings of limited resources. PMID:8100916

  7. The cost of asthma: can it be reduced?

    PubMed

    Mellis, C M; Peat, J K; Woolcock, A J

    1993-03-01

    Asthma is a major public health problem in developed countries, where it consumes a large and increasing share of scarce health resources. Ideally, medical management should be both optimal in terms of improving the patient's quality of life, and cost-effective for society. At present, there is very little information relating to costs and economic efficiency of current asthma management. Although the true total cost of asthma is unknown, current estimates suggest it is high. The main value of recent total cost estimates is that they identify the most expensive areas of asthma costs, and ideally, formal cost-effectiveness analyses should be concentrated on these areas. Asthma is still under- or inappropriately diagnosed, and undertreated. Several national and international consensus plans for the optimal management of asthma in children and adults have been published. If these inadequacies in asthma management were corrected, using current treatment recommendations, the overall cost of asthma from both the community and patient perspective should fall. The situation requires increased use of preventative medications {sodium cromoglycate (cromolyn sodium) or inhaled corticosteroids}, more widespread use of written crisis plans, more proactive medical consultations (rather than reactive or urgent consultations), further expansion of asthma education programmes, and further education of medical practitioners about the optimum management of both long term asthma and the acute exacerbation of asthma in the patient's home, the doctor's office, the hospital emergency room and the hospital inpatient setting. The increased costs associated with these measures would be more than offset by reduced expenditure on bronchodilator drugs, less widespread use of nebulisers at home and in hospitals, reduced antibiotic usage, reduced need for expensive emergency medical care and particularly reduced utilisation of hospital resources. To ensure that resources are being directed into

  8. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    SciTech Connect

    Kickuth, Ralph Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-12-15

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization.

  9. Prospective payment for hospital costs using diagnosis-related groups: will cost inflation be reduced?

    PubMed

    Keith, S N

    1983-06-01

    In response to rapidly rising costs in the medical care industry, especially for inpatient hospital charges, the Reagan administration has sent the first component of a plan for prospective payment of medical care to Congress. This first phase would involve changing reimbursement for hospital charges under Medicare using a system of predetermined rates for particular illnesses. Reimbursement rates have been set for 467 patient-illness categories, or diagnosis-related groups (DRGs), in an attempt to eliminate the variance in hospital costs and stem inflation under Medicare for patients with similar illnesses. But such a system is still subject to manipulation by hospitals that seek to increase reimbursement either to meet costs not covered by the appropriate DRG or to increase profit. The DRG reimbursement system does not prevent cost shifting to private insurance patients and does not involve physicians in efforts to improve cost efficiency. Although the DRG approach may seem conceptually appropriate, implementation will be difficult and the dampening effect on rapidly rising medical care costs may be overestimated. An alteration in the reimbursement mechanism for all medical care may be indicated to reduce significantly the inflation in medical care costs. PMID:6410079

  10. Reduce generating costs and eliminate brownouts

    SciTech Connect

    Nogaja, R.; Menezes, M.

    2007-06-15

    Improving the manoeuverability of a coal-fired plant to allow it to participate in primary frequency support will reduce generation cost and minimize brownouts. The challenge is to do so without compromising efficiency or emissions. This article describes an approach - activation of stored energy - that is cost-effective and applicable to both greenfield and brownfield installations. It requires a new control philosophy, plus the correct application of new level and flow measurement 'best practices'. 4 refs., 1 tab.

  11. Cascaded Microinverter PV System for Reduced Cost

    SciTech Connect

    Bellus, Daniel R.; Ely, Jeffrey A.

    2013-04-29

    In this project, a team led by Delphi will develop and demonstrate a novel cascaded photovoltaic (PV) inverter architecture using advanced components. This approach will reduce the cost and improve the performance of medium and large-sized PV systems. The overall project objective is to develop, build, and test a modular 11-level cascaded three-phase inverter building block for photovoltaic applications and to develop and analyze the associated commercialization plan. The system will be designed to utilize photovoltaic panels and will supply power to the electric grid at 208 VAC, 60 Hz 3-phase. With the proposed topology, three inverters, each with an embedded controller, will monitor and control each of the cascade sections, reducing costs associated with extra control boards. This report details the final disposition on this project.

  12. New system reduces sludge management costs

    SciTech Connect

    Roll, R.R. ); Koser, M.R. )

    1993-06-01

    This article describes a recently completed a $2.7-million project to upgrade the sludge dewatering and stabilizing system at a 48-mgd wastewater treatment facility in Niagara Fall, New York. The work was necessitated by the deteriorated condition of the plant's original vacuum filters and increasing costs to landfill the dewatered sludge. The new equipment has restored sludge production capacity while reducing the final material's moisture content. The Niagara Falls plant is one of the few municipal physical-chemical treatment plants built in this country, and is the largest still functioning. Constructed in the mid-1970s, it was designed to treat a combination of domestic sewage and industrial wastes. One third of the flow and one half of the solids are industrial in nature. The changes made reduced electrical power consumption and sanitary landfill costs.

  13. ESTIMATED SAVINGS IN MEDICAL COSTS RESULTING FROM ASTHMA MANAGEMENT PROGRAMS

    EPA Science Inventory

    The purpose of this project is to estimate the direct medical costs of asthma to HMOs and health insurers. The study will estimate full medical costs and the subset of these full medical costs that is borne by HMOs/insurers. Next, the study will estimate the potential savings to ...

  14. Endogenous Technology Adoption and Medical Costs.

    PubMed

    Lamiraud, Karine; Lhuillery, Stephane

    2016-09-01

    Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare spending covered by basic health insurance whilst controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. These results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare spending, whilst increased availability of percutaneous transluminal coronary angioplasty facilities is associated with reductions in per capita spending. However, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies that did not control for the possible endogeneity of the availability of technologies. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27492052

  15. Reducing Financing Costs for Federal ESPCs

    SciTech Connect

    Hughes, P.J.

    2005-01-28

    This report documents the recommendations of a working group commissioned by the Federal Energy Management Program (FEMP) in 2002 to identify ways to reduce financing costs in federal energy savings performance contract (ESPC) projects. The working group is part of continuing efforts launched by FEMP since the award of the Department of Energy's (DOE's) Super ESPCs in 1998 and 1999 to ensure that practical, flexible, and cost-effective alternative financing for energy-efficiency improvements is available to all federal agencies. During FY 2002-2004, the working group pursued extensive fact finding, consulted with government and private-sector finance experts, and analyzed data from federal and local government ESPC programs. The working group observed that both competition and transparency were lacking in federal ESPCs. The working group also found that the government often falls short of full compliance with certain provisions of the final rule that codifies the federal ESPC authority into regulation (10 CFR 436), which speak to due diligence in determining fair and reasonable pricing. Based on these findings, the working group formulated their short-term recommendations of actions that agencies can take immediately to reduce ESPC financing costs. The working group recommended requiring competitive solicitation of offers from prospective financiers of ESPC projects, standardization of processes to keep the playing field level and reduce energy service companies (ESCOs) project development costs, and assuring transparency by specifying that the government will see and review all bids. The reforms are intended to enable the government to determine quickly and reliably whether the portion of price related to financing is fair and reasonable and to provide auditable records of the transaction. The working group's recommendations were incorporated into modifications to the Super ESPCs and requirements to be included in the Super ESPC delivery order request for proposal

  16. Factors That Influence the Financing and Cost of Medical Education.

    ERIC Educational Resources Information Center

    McPheeters, Harold L.

    Financing and cost factors in medical education and the effect of the many missions of a medical school on funding issues are discussed. The teaching mission of medical schools includes undergraduate medical education (preparation for the MD degree), graduate medical education (training of resident physicians), biomedical specialist education,…

  17. Reducing home heating and cooling costs

    SciTech Connect

    Not Available

    1994-07-01

    This report is in response to a request from the House Committee on Energy and Commerce that the Energy Information Administration (EIA) undertake a neutral, unbiased analysis of the cost, safety, and health and environmental effects of the three major heating fuels: heating oil, natural gas, and electricity. The Committee also asked EIA to examine the role of conservation in the choice of heating and cooling fuel. To accommodate a wide audience, EIA decided to respond to the Committee`s request in the context of a report on reducing home heating and cooling costs. Accordingly, this report discusses ways to weatherize the home, compares the features of the three major heating and cooling fuels, and comments on the types of heating and cooling systems on the market. The report also includes a worksheet and supporting tables that will help in the selection of a heating and/or cooling system.

  18. Reduced cost mission design using surrogate models

    NASA Astrophysics Data System (ADS)

    Feldhacker, Juliana D.; Jones, Brandon A.; Doostan, Alireza; Hampton, Jerrad

    2016-01-01

    This paper uses surrogate models to reduce the computational cost associated with spacecraft mission design in three-body dynamical systems. Sampling-based least squares regression is used to project the system response onto a set of orthogonal bases, providing a representation of the ΔV required for rendezvous as a reduced-order surrogate model. Models are presented for mid-field rendezvous of spacecraft in orbits in the Earth-Moon circular restricted three-body problem, including a halo orbit about the Earth-Moon L2 libration point (EML-2) and a distant retrograde orbit (DRO) about the Moon. In each case, the initial position of the spacecraft, the time of flight, and the separation between the chaser and the target vehicles are all considered as design inputs. The results show that sample sizes on the order of 102 are sufficient to produce accurate surrogates, with RMS errors reaching 0.2 m/s for the halo orbit and falling below 0.01 m/s for the DRO. A single function call to the resulting surrogate is up to two orders of magnitude faster than computing the same solution using full fidelity propagators. The expansion coefficients solved for in the surrogates are then used to conduct a global sensitivity analysis of the ΔV on each of the input parameters, which identifies the separation between the spacecraft as the primary contributor to the ΔV cost. Finally, the models are demonstrated to be useful for cheap evaluation of the cost function in constrained optimization problems seeking to minimize the ΔV required for rendezvous. These surrogate models show significant advantages for mission design in three-body systems, in terms of both computational cost and capabilities, over traditional Monte Carlo methods.

  19. Impact of omalizumab on medical cost of childhood asthma in Japan.

    PubMed

    Yoshikawa, Hideki; Iwata, Mihoko; Matsuzaki, Hiroshi; Ono, Rintaro; Murakami, Yoko; Taba, Naohiko; Honjo, Satoshi; Motomura, Chikako; Odajima, Hiroshi

    2016-05-01

    Omalizumab is effective in children with severe asthma, but its impact on medical cost in Japan is not clear. We evaluated the impact of omalizumab on medical cost by comparing the pre- vs post-omalizumab-initiation medical costs of 12 children with severe asthma who received omalizumab for 2 years, and calculating incremental cost-effectiveness ratio for omalizumab therapy. Health outcome was measured as hospital-free days (HFD). The median total medical costs and medication fee per patient increased significantly after omalizumab initiation because of the high cost of omalizumab. The median hospitalization fee per patient, however, decreased significantly after omalizumab initiation due to reduction in hospitalization. Omalizumab led to an estimated increase of 40.8 HFD per omalizumab responder patient per 2 years. The cost was JPY 20 868 per additional HFD. Omalizumab can therefore reduce hospitalization cost in children with severe asthma in Japan. PMID:27173421

  20. Affordable housing: Reducing the energy cost burden

    SciTech Connect

    Lee, A.D.; Chin, R.I.; Marden, C.L.

    1995-01-01

    Residential energy expenditures are a key determinant of housing affordability, particularly for lower Income households. For years, federal, state and local governments and agencies have sought to defray energy expenses and Increase residential energy efficiency for low Income households through legislative and regulatory actions and programs. Nevertheless, household energy costs continue to place a major burden on lower Income families. This issue paper was written to help formulate national energy policy by providing the United States Department of Energy`s (DOE`s) Office of Energy Efficiency and Renewable Energy (EE) with Information to help define the affordable housing issue; Identify major drivers, key factors, and primary stakeholders shaping the affordable housing issue; and review how responding to this Issue may impact EE`s goals and objectives and Influence the strategic direction of the office. Typically, housing affordability is an Issue associated with lower income households. This issue paper adopts this perspective, but it is important to note that reducing energy utility costs can make {open_quotes}better{close_quote} housing affordable to any household regardless of income. As energy efficiency is improved throughout all sectors of the economy, special consideration must be given to low income households. Of all households, low income households are burdened the most by residential energy costs; their residences often are the least energy-efficient and have the greatest potential for efficiency improvements, but the occupants have the fewest resources to dedicate to conservation measures. This paper begins with a definition of {open_quotes}affordability{close_quotes} as it pertains to total housing costs and summarizes several key statistics related to housing affordability and energy use by lower income households.

  1. Cost in Medical Education: One Hundred and Twenty Years Ago

    ERIC Educational Resources Information Center

    Walsh, Kieran

    2015-01-01

    The first full paper that is dedicated to cost in medical education appears in the "BMJ" in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons…

  2. Reducing costs through electronic data interchange.

    PubMed

    Chapin-Strike, S

    1994-01-01

    The times have never been riper for an investment in EDI to pay off for healthcare providers. As suppliers attain their implementation goals for electronic purchase orders, they are expanding their EDI capabilities. One area which seems to be attracting considerable attention is the entire contracting cycle, where there are numerous opportunities for reducing administrative costs and improving accuracy. A detailed example using a buying group's contract cycle shows how EDI can be used at every step of the way, from request for quotation to funds transfer and monthly purchase summaries. EDI can be implemented at any level, from PC to mainframe. Implementation is not cheap and integration may not be easy, but the benefits can justify the cost. The first step to successful implementation is to identify and quantify, throughout the entire organization, reengineering opportunities in which EDI can be used. Two industry organizations, the Health Industry Distributors Association (HIDA) and the Healthcare EDI Corporation (HEDIC) have taken leadership roles in simplifying the implementation process. PMID:10131505

  3. Can managed care reduce employers' retiree medical liability?

    PubMed

    Taylor, R S; Newton, B

    1991-01-01

    The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future. PMID:10116958

  4. Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden.

    PubMed

    Skaer, Tracy L

    2014-05-01

    Fibromyalgia (FM) primarily affects women, and it is increasingly recognized by health care providers as more patients seek assistance for their chronic pain conditions. FM patients suffer from reduced quality of life, daily functioning and productivity. A single FM patient can cost society tens of thousands of dollars each year, with the overall expense increasing alongside disease severity. Indirect costs account for the majority of total expenditures and involve losses in productivity, reduced work hours, absenteeism, disability, unemployment, early retirement, informal care and other out-of-pocket costs. Health care utilization increases in concert with the severity of illness. Moreover, FM patients often have several comorbid illnesses (e.g. depression, anxiety and sleep disturbances), resulting in extreme escalation of overall health care expenditures. Medications with the best efficacy in the treatment of FM include the tricyclic antidepressants amitriptyline and nortriptyline, cyclobenzaprine (a skeletal muscle relaxant), tramadol, duloxetine, milnacipran, pregabalin and gabapentin. Corticosteroids, nonsteroidal anti-inflammatory drugs, benzodiazepines and opioid analgesics, with the exception of tramadol, are not considered efficacious. Medication selection should be individualized and influenced by the severity of illness and the presence of comorbidities and functional disabilities. PMID:24504852

  5. Finding Low-Cost Medical Care

    MedlinePlus

    ... costs and insurance requirements before you get care. Free and Low-Cost Clinics and Health Centers If ... in school), you may be able to find free or low-cost health clinics in your neighborhood. ...

  6. Landfill mining reduces site redevelopment costs

    SciTech Connect

    Weston, K.J.; White, J.R.; Mudhar, T.S.

    1994-12-31

    California-based Clean-Up Technology, Inc. teamed with property owners and agencies to execute one of the largest industrial landfill reclamation projects in the US. Site assessments indicated that the 10 acre site in Commerce, California, was used as an uncontrolled landfill from 1941 to 1953 before it was operated as a trucking terminal until the late 1980`s. Beneath a cover layer of soil and asphalt was 200,000 cubic years of a heterogeneous mixture of soil, concrete, rubber, wood, scrap metal, asphalt and other debris. In addition to the unstable nature of the fill, localized contamination of hydrogen and led made the site unsuitable for redevelopment without remediation. Clean-Up Technology designed, engineered and operated a plant to segregate debris by type, size and contamination level. This reduced the amount of contaminated material by as much as 60% and reduced costs by an estimated $5 million. The semi-automated plant performed multiple screening operations, size reduction of oversize material and separation of wood, metal, concrete and soil. The plant was designed to process the material in one pass at an average of 200 tons per hour.

  7. Activity Analysis and Cost Analysis in Medical Schools.

    ERIC Educational Resources Information Center

    Koehler, John E.; Slighton, Robert L.

    There is no unique answer to the question of what an ongoing program costs in medical schools. The estimates of program costs generated by classical methods of cost accounting are unsatisfactory because such accounting cannot deal with the joint production or joint cost problem. Activity analysis models aim at calculating the impact of alternative…

  8. Autonomous exoskeleton reduces metabolic cost of walking.

    PubMed

    Mooney, Luke M; Rouse, Elliott J; Herr, Hugh M

    2014-01-01

    We developed an autonomous powered leg exoskeleton capable of providing large amounts of positive mechanical power to the wearer during powered plantarflexion phase of walking. The autonomous exoskeleton consisted of a winch actuator fasted to the shin which pulled on fiberglass struts attached to a boot. The fiberglass struts formed a rigid extension of the foot when the proximal end of the strut was pulled in forward by the winch actuator. This lightweight, geometric transmission allowed the electric winch actuator to efficiently produce biological levels of power at the ankle joint. The exoskeleton was powered and controlled by lithium polymer batteries and motor controller worn around the waist. Preliminary testing on two subjects walking at 1.4 m/s resulted in the exoskeleton reducing the metabolic cost of walking by 6-11% as compared to not wearing the device. The exoskeleton provided a peak mechanical power of over 180 W at each ankle (mean standard ± deviation) and an average positive mechanical power of 27 ± 1 W total to both ankles, while electrically using 75-89 W of electricity. The batteries (800 g) used in this experiment are estimated to be capable of providing this level of assistance for up to 7 km of walking. PMID:25570638

  9. Cost in medical education: one hundred and twenty years ago.

    PubMed

    Walsh, Kieran

    2015-10-01

    The first full paper that is dedicated to cost in medical education appears in the BMJ in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons can be gleaned from the paper about the cost and other aspects of nineteenth century medical education. Cost is viewed almost exclusively from the domain of the male gender. Cost is viewed not just from the perspective of a young man but of a young gentleman. There is a strong implication that medicine is a club and that you have to have money to join the club and then to take part in the club's activities. Cost affects choice of medical school and selection into schools. The paper places great emphasis on the importance of passing exams at their first sitting and progressing through each year in a timely manner-mainly to save costs. The subject of cost is viewed from the perspective of the payer-at this time students and their families. The paper encourages the reader to reflect on what has and has not changed in this field since 1893. Modern medical education is still expensive; its expense deters students; and we have only started to think about how to control costs or how to ensure value. Too much of the cost of medical education continues to burden students and their families. PMID:25134666

  10. Methods Reduce Cost, Enhance Quality of Nanotubes

    NASA Technical Reports Server (NTRS)

    2009-01-01

    For all the challenges posed by the microgravity conditions of space, weight is actually one of the more significant problems NASA faces in the development of the next generation of U.S. space vehicles. For the Agency s Constellation Program, engineers at NASA centers are designing and testing new vessels as safe, practical, and cost-effective means of space travel following the eventual retirement of the space shuttle. Program components like the Orion Crew Exploration Vehicle, intended to carry astronauts to the International Space Station and the Moon, must be designed to specific weight requirements to manage fuel consumption and match launch rocket capabilities; Orion s gross liftoff weight target is about 63,789 pounds. Future space vehicles will require even greater attention to lightweight construction to help conserve fuel for long-range missions to Mars and beyond. In order to reduce spacecraft weight without sacrificing structural integrity, NASA is pursuing the development of materials that promise to revolutionize not only spacecraft construction, but also a host of potential applications on Earth. Single-walled carbon nanotubes are one material of particular interest. These tubular, single-layer carbon molecules - 100,000 of them braided together would be no thicker than a human hair - display a range of remarkable characteristics. Possessing greater tensile strength than steel at a fraction of the weight, the nanotubes are efficient heat conductors with metallic or semiconductor electrical properties depending on their diameter and chirality (the pattern of each nanotube s hexagonal lattice structure). All of these properties make the nanotubes an appealing material for spacecraft construction, with the potential for nanotube composites to reduce spacecraft weight by 50 percent or more. The nanotubes may also feature in a number of other space exploration applications, including life support, energy storage, and sensor technologies. NASA s various

  11. Medical cost offsets from prescription drug utilization among Medicare beneficiaries.

    PubMed

    Roebuck, M Christopher

    2014-10-01

    This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P  less than  0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension. PMID:25278321

  12. Processor Units Reduce Satellite Construction Costs

    NASA Technical Reports Server (NTRS)

    2014-01-01

    As part of the effort to build the Fast Affordable Science and Technology Satellite (FASTSAT), Marshall Space Flight Center developed a low-cost telemetry unit which is used to facilitate communication between a satellite and its receiving station. Huntsville, Alabama-based Orbital Telemetry Inc. has licensed the NASA technology and is offering to install the cost-cutting units on commercial satellites.

  13. Reducing the Cost of Solar Cells

    SciTech Connect

    Scanlon, B.

    2012-04-01

    Solar-powered electricity prices could soon approach those of power from coal or natural gas thanks to collaborative research with solar startup Ampulse Corporation at the National Renewable Energy Laboratory. Silicon wafers account for almost half the cost of today's solar photovoltaic panels, so reducing or eliminating wafer costs is essential to bringing prices down. Current crystalline silicon technology converts energy in a highly efficient manner; however, that technology is manufactured with processes that could stand some improvement. The industry needs a method that is less complex, creates less waste and uses less energy. First, half the refined silicon is lost as dust in the wafer-sawing process, driving module costs higher. Wafers are sawn off of large cylindrical ingots, or boules, of silicon. A typical 2-meter boule loses as many as 6,000 potential wafers during sawing. Second, the wafers produced are much thicker than necessary. To efficiently convert sunlight into electricity, the wafers need be only one-tenth the typical thickness. NREL, the Oak Ridge National Laboratory and Ampulse have partnered on an approach to eliminate this waste and dramatically lower the cost of the finished solar panels. By using a chemical vapor deposition process to grow the silicon on inexpensive foil, Ampulse is able to make the solar cells just thick enough to convert most of the solar energy into electricity. No more sawdust - and no more wasting refined silicon materials. NREL developed the technology to grow high-quality silicon and ORNL developed the metal foil that has the correct crystal structure to support that growth. Ampulse is installing a pilot manufacturing line in NREL's Process Development Integration Laboratory, where solar companies can work closely with lab scientists on integrated equipment to answer pressing questions related to their technology development, as well as rapidly overcoming R and D challenges and risk. NREL's program is focused on

  14. Analysis of the Children's Hospital Graduate Medical Education Program Fund Allocations for Indirect Medical Education Costs.

    ERIC Educational Resources Information Center

    Wynn, Barbara O.; Kawata, Jennifer

    This study analyzed issues related to estimating indirect medical education costs specific to pediatric discharges. The Children's Hospital Graduate Medical Education (CHGNE) program was established to support graduate medical education in children's hospitals. This provision authorizes payments for both direct and indirect medical education…

  15. Medical cost-offset following treatment referral for alcohol and other drug use disorders in a group model HMO.

    PubMed

    Polen, Michael R; Freeborn, Donald K; Lynch, Frances L; Mullooly, John P; Dickinson, Daniel M

    2006-07-01

    The purpose of this study was to determine whether specialty alcohol and other drug (AOD) treatment is associated with reduced subsequent medical care costs. AOD treatment costs and medical costs in a group model health maintenance organization (HMO) were collected for up to 6 years on 1,472 HMO members who were recommended for specialty AOD treatment, and on 738 members without AOD diagnoses or treatment. Addiction Severity Index measures were also obtained from a sample of 293 of those recommended for treatment. Changes in medical costs did not differ between treatment and comparison groups. Nor did individuals with improved treatment outcomes have greater reductions in medical costs. AOD treatment costs were not inversely related to subsequent medical costs, except for a subgroup with recent AOD treatment. In the interviewed sample, better treatment outcomes did not predict lower subsequent medical costs. Multiple treatment episodes may hold promise for producing cost-offsets. PMID:16752110

  16. An anesthesia medication cost scorecard--concepts for individualized feedback.

    PubMed

    Malapero, Raymond J; Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Philip, Beverly K; Bates, David W; Urman, Richard D

    2015-05-01

    There is a growing emphasis on both cost containment and better quality health care. The creation of better methods for alerting providers and their departments to the costs associated with patient care is one tool for improving efficiency. Since anesthetic medications used in the OR setting are one easily monitored factor contributing to OR costs, anesthetic cost report cards can be used to assess the cost and, potentially the quality of care provided by each practitioner. An ongoing challenge is the identification of the most effective strategies to control costs, promote cost awareness and at the same time maximize quality. To test the scorecard concept, we utilized existing informatics systems to gather and analyze drug costs for anesthesia providers in the OR. Drug costs were analyzed by medication class for each provider. Individual anesthesiologist's anesthetic costs were collected and compared to the average costs of the overall group and individual trends over time were noted. We presented drug usage data in an electronic report card format. Real-time individual reports can be provided to anesthesiologists to allow for anesthetic cost feedback. Data provided can include number of cases, average case time, total anesthetic medication costs, and average anesthetic cost per case. Also included can be subcategories of pre-medication, antibiotics, hypnotics, local anesthetics, neuromuscular blocking drugs, analgesics, vasopressors, beta-blockers, anti-emetics, volatile anesthetics, and reversal agents. The concept of anesthetic cost report card should be further developed for individual feedback, and could include many other dimensions. Such a report card can be utilized to encourage lower anesthetic costs, quality improvement among anesthesia providers, and for cost containment in the operating room. PMID:25732076

  17. Manual for Reducing Educational Unit Costs in Latin American Countries.

    ERIC Educational Resources Information Center

    Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

    Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

  18. Chilled water storage system reduces energy costs

    SciTech Connect

    Fiorino, D.P. )

    1993-04-01

    This article describes the conversion of an industrial central chiller plant from conventional live-load operation to full-shift thermal energy storage. The topics of the article include project design, project implementation, interactive pressure/temperature control, energy efficiency, operations and maintenance and cost effectiveness.

  19. Integrated Design Tools Reduce Risk, Cost

    NASA Technical Reports Server (NTRS)

    2012-01-01

    Thanks in part to a SBIR award with Langley Research Center, Phoenix Integration Inc., based in Wayne, Pennsylvania, modified and advanced software for process integration and design automation. For NASA, the tool has resulted in lower project costs and reductions in design time; clients of Phoenix Integration are experiencing the same rewards.

  20. Hummingbird: Dramatically Reducing Interplanetary Mission Cost

    NASA Astrophysics Data System (ADS)

    Wertz, J. R.; Van Allen, R. E.; Sarzi-Amade, N.; Shao, A.; Taylor, C.

    2012-06-01

    The Hummingbird interplanetary spacecraft has an available delta V of 2 to 4 km/sec and a recurring cost of 2 to 3 million, depending on the payload and configuration. The baseline telescope has a resolution of 30 cm at a distance of 100 km.

  1. A cost-effectiveness analysis of an in-house corporate occupational medical department.

    PubMed

    Fitko, J; Kalina, C M; Fisher, A M; Mitchell, J H

    1994-02-01

    There is a current trend for corporations to switch from in-house medical departments to outside contract organizations for provision of occupational health services. Although this may be driven by a desire to reduce expenses, there is little objective data on which to base this decision. This study compares the costs to a corporation of an in-house medical department with the costs for the same services if rendered by outside providers. Costs of the in-house department were obtained from company records. Prevailing charges for outside provider services were determined by an invoice survey and from other sources. We found that the cost for the in-house medical department was 42% less than that of the outside providers at the prevailing rates. Thus, the in-house medical department is more cost-effective than the outside providers. We also discuss other advantages of an in-house department that are more difficult to quantify. PMID:8176514

  2. Welsh Trust sees energy costs reduce.

    PubMed

    Churches, Wayne

    2009-02-01

    Working closely with Honeywell Building Solutions, a division of Honeywell International, under two long-term Energy Performance Contracts, should bring Gwent Healthcare NHS Trust in South Wales guaranteed annual savings of over pounds 1.1 million in energy costs over at least the next 15 years, as the Trust's estates manager, Wayne Churches, explained to delegates at the Healthcare Facilities Consortium (HFC) 2008 Annual Conference. PMID:19297847

  3. Research requirements to reduce maintenance costs of civil helicopters

    NASA Technical Reports Server (NTRS)

    Million, D. J.; Waters, K. T.

    1978-01-01

    The maintenance problems faced by the operators of civil helicopters that result in high costs are documented. Existing technology that can be applied to reduce maintenance costs and research that should be carried out were identified. Good design practice and application of existing technology were described as having a significant impact on reducing maintenance costs immediately. The research and development that have potential for long range reduction of maintenance costs are presented.

  4. A Flexible Model for Correlated Medical Costs, with Application to Medical Expenditure Panel Survey Data

    PubMed Central

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T.; Zhang, Daowen; Severini, Thomas A.

    2016-01-01

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines is used to estimate unknown functions, and a modification to Akaike Information Criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey (MEPS) dataset. Simulation studies are conducted to assess the performance of our method. PMID:26403805

  5. A flexible model for correlated medical costs, with application to medical expenditure panel survey data.

    PubMed

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T; Zhang, Daowen; Severini, Thomas A

    2016-03-15

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines are used to estimate unknown functions, and a modification to Akaike information criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey dataset. Simulation studies are conducted to assess the performance of our method. PMID:26403805

  6. Reducing reconditioning costs using computerized CP technology

    SciTech Connect

    Rizzo, M.E.; Wildman, T.A.

    1997-12-01

    New data collection technology and improved data interpretation diminish the need to spend hundreds of thousands or even millions of dollars to recondition poorly coated pipelines without compromising safety. Application of alternative cathodic protection criteria rewards companies with additional resources to remain competitive. This paper examines the results of applying a combination of technologies that matured throughout the 1980`s: Global Positioning Satellites, rugged field computers, fast analog-to-digital converters, solid state interruption devices, and interpretation of oscillographic cathodic protection waveprints. Cost effective application of sound engineering principles assure safe pipeline operation, exceed the letter and the spirit of NACE and DOT requirements, and yield significant financial returns.

  7. Research requirements to reduce civil helicopter life cycle cost

    NASA Technical Reports Server (NTRS)

    Blewitt, S. J.

    1978-01-01

    The problem of the high cost of helicopter development, production, operation, and maintenance is defined and the cost drivers are identified. Helicopter life cycle costs would decrease by about 17 percent if currently available technology were applied. With advanced technology, a reduction of about 30 percent in helicopter life cycle costs is projected. Technological and managerial deficiencies which contribute to high costs are examined, basic research and development projects which can reduce costs include methods for reduced fuel consumption; improved turbine engines; airframe and engine production methods; safety; rotor systems; and advanced transmission systems.

  8. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

    ERIC Educational Resources Information Center

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-01-01

    Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

  9. Cost-reducing multipurpose microfilm card

    NASA Technical Reports Server (NTRS)

    Smith, A. V.

    1970-01-01

    Microfilm-aperture card is printed in the same format on both sides which enables the use of one card for mounting films that are ''right reading'' on both the base side and the emulsion side. This reduces the number of microfilm-card formats.

  10. Increasing Density and Reducing Costs of Data Acquisition

    NASA Technical Reports Server (NTRS)

    Schmalzel, J. L.; Krchnavek, R. R.; Figueroa, J. Fernando; Solano, Wanda

    2001-01-01

    There are a number of reasons why it is important to increase the density of data acquisition functions. Sensor fusion seeks to integrate large numbers of sensors into a decision network. Addition of health monitoring functions may incur additional sensor requirements. But at the same time, it is important to reduce the per-channel costs of data acquisition systems. Often the most significant cost is the management of data acquisition networks, which incurs substantial costs associated with transducer installation, configuration, calibration, and maintenance. Alternatives that lower the cost of the transducer system and reduce the data acquisition system channel count will directly impact initial system costs. Other techniques that affect maintenance and operating costs will contribute to reducing life cycle costs. This paper describes work undertaken to explore alternative architectures for lowering the cost per transducer function using a MEMS-based accelerometer as the model.

  11. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  12. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems. PMID

  13. FMEA: a model for reducing medical errors.

    PubMed

    Chiozza, Maria Laura; Ponzetti, Clemente

    2009-06-01

    Patient safety is a management issue, in view of the fact that clinical risk management has become an important part of hospital management. Failure Mode and Effect Analysis (FMEA) is a proactive technique for error detection and reduction, firstly introduced within the aerospace industry in the 1960s. Early applications in the health care industry dating back to the 1990s included critical systems in the development and manufacture of drugs and in the prevention of medication errors in hospitals. In 2008, the Technical Committee of the International Organization for Standardization (ISO), licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. Here we describe the main steps of the FMEA process and review data available on the application of this technique to laboratory medicine. A significant reduction of the risk priority number (RPN) was obtained when applying FMEA to blood cross-matching, to clinical chemistry analytes, as well as to point-of-care testing (POCT). PMID:19298799

  14. Reducing the Risk of Harm From Medication Errors in Children

    PubMed Central

    Neuspiel, Daniel R.; Taylor, Melissa M.

    2013-01-01

    Medication errors affect the pediatric age group in all settings: outpatient, inpatient, emergency department, and at home. Children may be at special risk due to size and physiologic variability, limited communication ability, and treatment by nonpediatric health care providers. Those with chronic illnesses and on multiple medications may be at higher risk of experiencing adverse drug events. Some strategies that have been employed to reduce harm from pediatric medication errors include e-prescribing and computerized provider order entry with decision support, medication reconciliation, barcode systems, clinical pharmacists in medical settings, medical staff training, package changes to reduce look-alike/sound-alike confusion, standardization of labeling and measurement devices for home administration, and quality improvement interventions to promote nonpunitive reporting of medication errors coupled with changes in systems and cultures. Future research is needed to measure the effectiveness of these preventive strategies. PMID:25114560

  15. Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

    PubMed Central

    2012-01-01

    Background Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens. The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective. Material and methods A decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). Results Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (€3,062), followed by risperidone (€3,194), haloperidol (€3,322), olanzapine (€3,893), amisulpride (€4,247) and aripiprazole (€4,712). In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were €23,621/QALY gained, €91,584/QALY gained and €94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. Conclusions Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia. Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain

  16. Methods of Reducing the Cost of Public Housing. Revised Edition.

    ERIC Educational Resources Information Center

    Callender, John H.; Aureli, Giles

    An in-depth study of public housing in New York focuses almost exclusively upon the cost analysis aspect of decision. The costs of various construction techniques, design arrangements, and materials have been collected and analyzed. The stated aim of the report is to reduce cost as much as possible, with user comfort being a secondary…

  17. Cost-Effectiveness of a Computerized Provider Order Entry System in Improving Medication Safety Ambulatory Care

    PubMed Central

    Forrester, Sara H.; Hepp, Zsolt; Roth, Joshua A.; Wirtz, Heidi S.; Devine, Emily Beth

    2014-01-01

    Background Computerized provider order entry (CPOE) is the process of entering physician orders directly into an electronic health record. Although CPOE has been shown to improve medication safety and reduce health care costs, these improvements have been demonstrated largely in the inpatient setting; the cost-effectiveness in the ambulatory setting remains uncertain. Objective The objective was to estimate the cost-effectiveness of CPOE in reducing medication errors and adverse drug events (ADEs) in the ambulatory setting. Methods We created a decision-analytic model to estimate the cost-effectiveness of CPOE in a midsized (400 providers) multidisciplinary medical group over a 5-year time horizon— 2010 to 2014— the time frame during which health systems are implementing CPOE to meet Meaningful Use criteria. We adopted the medical group’s perspective and utilized their costs, changes in efficiency, and actual number of medication errors and ADEs. One-way and probabilistic sensitivity analyses were conducted. Scenario analyses were explored. Results In the base case, CPOE dominated paper prescribing, that is, CPOE cost $18 million less than paper prescribing, and was associated with 1.5 million and 14,500 fewer medication errors and ADEs, respectively, over 5 years. In the scenario that reflected a practice group of five providers, CPOE cost $265,000 less than paper prescribing, was associated with 3875 and 39 fewer medication errors and ADEs, respectively, over 5 years, and was dominant in 80% of the simulations. Conclusions Our model suggests that the adoption of CPOE in the ambulatory setting provides excellent value for the investment, and is a cost-effective strategy to improve medication safety over a wide range of practice sizes. PMID:24968993

  18. Prevalence and cost of medication nonadherence in Parkinson's disease: evidence from administrative claims data.

    PubMed

    Davis, Keith L; Edin, Heather M; Allen, Jeffery K

    2010-03-15

    We estimated the prevalence of medication nonadherence in Parkinson's disease (PD) and the association between treatment nonadherence and healthcare costs. Insurance claims from over 30 US health plans were analyzed. Inclusion criteria were as follows: PD diagnosis, >or=1 PD-related prescription between 1/1/1997 and 12/31/2004, continuous health plan enrollment for >or=6 months before and >or=12 months after first PD prescription. Adherence, all-cause healthcare utilization, and all-cause costs were evaluated over 12 months post-treatment initiation. Adherence was measured using the medication possession ratio (MPR), with MPR < 0.8 defining nonadherence. Among patients identified for inclusion (N = 3,119), 58% were male and mean age was 69 years. Mean MPR was 0.58 and 61% of patients were nonadherent. Unadjusted mean medical costs were significantly higher (P < 0.01) among nonadherers ($15,826) compared with adherers ($9,228), although nonadherers had lower prescription drug costs ($2,684 vs. $3,854; P < 0.05). After controlling for confounders in multivariable analyses, a large positive relationship between nonadherence and both medical and total healthcare costs remained (+$3,451, P < 0.0001 and +$2,383, P = 0.0053, respectively). Medication adherence in PD is suboptimal and nonadherence may be associated with increased healthcare costs despite offsets from reduced drug intake. Efforts to promote medication adherence in PD may lead to cost savings for managed care systems. PMID:20131374

  19. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  20. Patient cost sharing and medical expenditures for the Elderly.

    PubMed

    Fukushima, Kazuya; Mizuoka, Sou; Yamamoto, Shunsuke; Iizuka, Toshiaki

    2016-01-01

    Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes. PMID:26603160

  1. How Are the Costs of Care for Medical Falls Distributed? The Costs of Medical Falls by Component of Cost, Timing, and Injury Severity

    ERIC Educational Resources Information Center

    Bohl, Alex A.; Phelan, Elizabeth A.; Fishman, Paul A.; Harris, Jeffrey R.

    2012-01-01

    Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…

  2. True costs of air medical vs. ground ambulance systems.

    PubMed

    Bruhn, J D; Williams, K A; Aghababian, R

    1993-08-01

    The economic model created in this paper replaces the existing University of Massachusetts Medical Center's New England Life Flight (NELF) helicopter ambulance service with a ground ambulance system to investigate comparative costs. The model is based on a less than 30-minute response time to the patient, similar medical team staffing and equal service area. The annual budgetary cost of the replacement ground network is $3,804,000 while the helicopter ambulance costs are $1,686,500 (based on 1991 dollars). The cost per patient transported is $4,475 for the ground system and $2,811 for the helicopter system. The comparison finds that the commonly held notion that condemns helicopters as an excessively expensive technology for patient transport is incorrect. Future research to address intermediate alternatives using similar analytical technology assessment techniques is recommended. PMID:10127870

  3. Direct Medical Cost of Type 2 Diabetes in Singapore

    PubMed Central

    Shuyu Ng, Charmaine; Toh, Matthias Paul Han Sim; Ko, Yu; Yu-Chia Lee, Joyce

    2015-01-01

    Due to the chronic nature of diabetes along with their complications, they have been recognised as a major health issue, which results in significant economic burden. This study aims to estimate the direct medical cost associated with type 2 diabetes mellitus (T2DM) in Singapore in 2010 and to examine both the relationship between demographic and clinical state variables with the total estimated expenditure. The National Healthcare Group (NHG) Chronic Disease Management System (CDMS) database was used to identify patients with T2DM in the year 2010. DM-attributable costs estimated included hospitalisations, accident and emergency (A&E) room visits, outpatient physician visits, medications, laboratory tests and allied health services. All charges and unit costs were provided by the NHG. A total of 500 patients with DM were identified for the analyses. The mean annual direct medical cost was found to be $2,034, of which 61% was accounted for by inpatient services, 35% by outpatient services, and 4% by A&E services. Independent determinants of total costs were DM treatments such as the use of insulin only (p<0.001) and the combination of both oral medications and insulin (p=0.047) as well as having complications such as cerebrovascular disease (p<0.001), cardiovascular disease (p=0.002), peripheral vascular disease (p=0.001), and nephropathy (p=0.041). In this study, the cost of DM treatments and DM-related complications were found to be strong determinants of costs. This finding suggests an imperative need to address the economic burden associated with diabetes with urgency and to reorganise resources required to improve healthcare costs. PMID:25816299

  4. Reducing medication errors in critical care: a multimodal approach

    PubMed Central

    Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad

    2014-01-01

    The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478

  5. Application of materials technology to reduce pipeline costs

    SciTech Connect

    Soentvedt, T.; Andersen, T.R.; Knagenhjelm, H.O.; Tystad, M.

    1995-12-01

    Solid pipes made in C-Mn steel, 13% Cr steel, or duplex stainless steels or flexible pipes are possible alternatives for pipelines. Failure modes for pipelines are discussed. Pipeline costs can be reduced by extending the application limits of C-Mn steel or by using new welding methods for stainless steel. A cost comparison between the pipeline alternatives are given.

  6. Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries

    PubMed Central

    Whaley, Christopher; Reed, Mary; Hsu, John; Fung, Vicki

    2015-01-01

    Objective Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support. Data Sources and Study Setting We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress. Study Design We used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics. Principal Findings Respondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2–8.5) and financial stress (OR = 2.4, 95% CI: 1.3–4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations. Conclusion The majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes. PMID:26642195

  7. With the advent of domestic 3-dimensional (3D) printers and their associated reduced cost, is it now time for every medical school to have their own 3D printer?

    PubMed

    Balestrini, Christopher; Campo-Celaya, Tatiana

    2016-01-01

    Anatomy is the backbone of medical education and new techniques to improve learning are frequently explored. With the introduction of 3D printers specifically for the home market, the price of this technology has reached affordable levels. Using patient scan data, accurate 3D models can be printed that represent real human variation in anatomy to provide an innovative, inexpensive and valuable adjunct to anatomical teaching. Is it now time for every medical school to have their own 3D printer? PMID:26383082

  8. Reducing biosolids disposal costs using land application in forested areas

    SciTech Connect

    Huffines, R.L.

    1995-11-01

    Switching biosolids land application from a reclamation site to a forested site significantly reduced the cost of biosolids disposal at the Savannah River Site. Previous beneficial reuse programs focused on reclamation of existing borrow pits. While extremely beneficial, this program became very costly due to the regulatory requirements for groundwater monitoring, soil monitoring and frequent biosolids analyses. A new program was developed to reuse biosolids in forested areas where the biosolids could be used as a soil conditioner and fertilizer to enhance timber yield. The forested land application site was designed so that groundwater monitoring and soil monitoring could be eliminated while biosolids monitoring and site maintenance were minimized. Monitoring costs alone were reduced by 80%. Capital costs for site preparation were also significantly reduced since there was no longer a need for expensive groundwater monitoring wells.

  9. Reducing Design Cycle Time and Cost Through Process Resequencing

    NASA Technical Reports Server (NTRS)

    Rogers, James L.

    2004-01-01

    In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

  10. Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs.

    PubMed

    Lo, Yuan-Ting C; Wahlqvist, Mark L; Huang, Yi-Chen; Lee, Meei-Shyuan

    2016-03-14

    A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65-79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30%) and total medical costs (19%), whereas those in the highest animal-derived group had a higher number of hospital days (28%) and costs (83%) as well as total medical costs (38%). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38,600) as well as the lowest total medical costs (NT$75,800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies. PMID:26786998

  11. Strategies Used by Adults to Reduce Their Prescription Drug Costs

    MedlinePlus

    ... Bookstore How to Order from the National Technical Information Service NCHS Strategies Used by Adults to Reduce Their Prescription Drug ... conducted over the telephone. The Family component collects information on ... Questions about strategies to reduce prescription drug cost are from the ...

  12. Potential impact of pharmacist interventions to reduce cost for Medicare Part D beneficiaries.

    PubMed

    Thatcher, Erin E; Vanwert, Elizabeth M; Erickson, Steven R

    2013-06-01

    The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients' therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients' pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program. PMID:23178417

  13. Prospects for reducing the processing cost of lithium ion batteries

    NASA Astrophysics Data System (ADS)

    Wood, David L.; Li, Jianlin; Daniel, Claus

    2015-02-01

    A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: 1) elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; 2) doubling the thicknesses of the anode and cathode to raise energy density; and 3) reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and a standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from 502.8 kW h-1-usable to 370.3 kW h-1-usable, a savings of 132.5/kWh (or 26.4%).

  14. Estimation of immunization providers' activities cost, medication cost, and immunization dose errors cost in Iraq.

    PubMed

    Al-lela, Omer Qutaiba B; Bahari, Mohd Baidi; Al-abbassi, Mustafa G; Salih, Muhannad R M; Basher, Amena Y

    2012-06-01

    The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors. PMID:22521848

  15. Children with medical complexity and Medicaid: spending and cost savings.

    PubMed

    Berry, Jay G; Hall, Matt; Neff, John; Goodman, Denise; Cohen, Eyal; Agrawal, Rishi; Kuo, Dennis; Feudtner, Chris

    2014-12-01

    A small but growing population of children with medical complexity, many of whom are covered by Medicaid, accounts for a high proportion of pediatric health care spending. We first describe the expenditures for children with medical complexity insured by Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for these children, relative to the small amount of primary care and home care spending. We then present a business case that estimates how cost savings might be achieved for children with medical complexity from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform. PMID:25489039

  16. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery...

  17. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery...

  18. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery...

  19. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery...

  20. 38 CFR 17.277 - Third-party liability/medical care cost recovery.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .../medical care cost recovery. 17.277 Section 17.277 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...)-Medical Care for Survivors and Dependents of Certain Veterans § 17.277 Third-party liability/medical care cost recovery. The Center will actively pursue third-party liability/medical care cost recovery...

  1. Adapting smartphones for low-cost optical medical imaging

    NASA Astrophysics Data System (ADS)

    Pratavieira, Sebastião.; Vollet-Filho, José D.; Carbinatto, Fernanda M.; Blanco, Kate; Inada, Natalia M.; Bagnato, Vanderlei S.; Kurachi, Cristina

    2015-06-01

    Optical images have been used in several medical situations to improve diagnosis of lesions or to monitor treatments. However, most systems employ expensive scientific (CCD or CMOS) cameras and need computers to display and save the images, usually resulting in a high final cost for the system. Additionally, this sort of apparatus operation usually becomes more complex, requiring more and more specialized technical knowledge from the operator. Currently, the number of people using smartphone-like devices with built-in high quality cameras is increasing, which might allow using such devices as an efficient, lower cost, portable imaging system for medical applications. Thus, we aim to develop methods of adaptation of those devices to optical medical imaging techniques, such as fluorescence. Particularly, smartphones covers were adapted to connect a smartphone-like device to widefield fluorescence imaging systems. These systems were used to detect lesions in different tissues, such as cervix and mouth/throat mucosa, and to monitor ALA-induced protoporphyrin-IX formation for photodynamic treatment of Cervical Intraepithelial Neoplasia. This approach may contribute significantly to low-cost, portable and simple clinical optical imaging collection.

  2. Reduced cost and improved figure of sapphire optical components

    NASA Astrophysics Data System (ADS)

    Walters, Mark; Bartlett, Kevin; Brophy, Matthew R.; DeGroote Nelson, Jessica; Medicus, Kate

    2015-10-01

    Sapphire presents many challenges to optical manufacturers due to its high hardness and anisotropic properties. Long lead times and high prices are the typical result of such challenges. The cost of even a simple 'grind and shine' process can be prohibitive. The high precision surfaces required by optical sensor applications further exacerbate the challenge of processing sapphire thereby increasing cost further. Optimax has demonstrated a production process for such windows that delivers over 50% time reduction as compared to traditional manufacturing processes for sapphire, while producing windows with less than 1/5 wave rms figure error. Optimax's sapphire production process achieves significant improvement in cost by implementation of a controlled grinding process to present the best possible surface to the polishing equipment. Following the grinding process is a polishing process taking advantage of chemical interactions between slurry and substrate to deliver excellent removal rates and surface finish. Through experiments, the mechanics of the polishing process were also optimized to produce excellent optical figure. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. Through specially developed polishing slurries, the peak-to-valley figure error of spherical sapphire parts is reduced by over 80%.

  3. Optimizing Ice Thermal Storage to Reduce Energy Cost

    NASA Astrophysics Data System (ADS)

    Hall, Christopher L.

    Energy cost for buildings is an issue of concern for owners across the U.S. The bigger the building, the greater the concern. A part of this is due to the energy required to cool the building and the way in which charges are set when paying for energy consumed during different times of the day. This study will prove that designing ice thermal storage properly will minimize energy cost in buildings. The effectiveness of ice thermal storage as a means to reduce energy costs lies within transferring the time of most energy consumption from on-peak to off-peak periods. Multiple variables go into the equation of finding the optimal use of ice thermal storage and they are all judged with the final objective of minimizing monthly energy costs. This research discusses the optimal design of ice thermal storage and its impact on energy consumption, energy demand, and the total energy cost. A tool for optimal design of ice thermal storage is developed, considering variables such as chiller and ice storage sizes and charging and discharge times. The simulations take place in a four-story building and investigate the potential of Ice Thermal Storage as a resource in reducing and minimizing energy cost for cooling. The simulations test the effectiveness of Ice Thermal Storage implemented into the four-story building in ten locations across the United States.

  4. Rightsizing HVAC Systems to Reduce Capital Costs and Save Energy

    ERIC Educational Resources Information Center

    Sebesta, James

    2010-01-01

    Nearly every institution is faced with the situation of having to reduce the cost of a construction project from time to time through a process generally referred to as "value engineering." Just the mention of those words, however, gives rise to all types of connotations, thoughts, and memories (usually negative) for those in the facilities…

  5. Chemical treatment costs reduced with in-pond raceway systems

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Production systems such as in-pond raceway systems (IPRS) and split ponds are providing an alternative to traditional pond culture for raising catfish in several southeastern states. One advantage noted by farmers utilizing these systems is the reduced cost associated with the chemical treatment of ...

  6. Computerized cathodic protection technology reduces pipeline reconditioning costs

    SciTech Connect

    Rizzo, M.E.; Wildman, T.A.

    1997-10-01

    New data collection technology and improved interpretation methods reducing excessive costs to recondition poorly coated pipelines without compromising safety. Application of alternative cathodic protection criteria will reward operators with additional resources for competitiveness. These technologies and the application of sound engineering principles ensure safe pipeline operation, and exceed the letter and the spirit of NACE and US Department of Transportation requirements.

  7. Square tubing reduces cost of telescoping bridge crane hoist

    NASA Technical Reports Server (NTRS)

    Bernstein, G.; Graae, J.; Schraidt, J.

    1967-01-01

    Using standard square tubing in a telescoping arrangement reduces the cost of a bridge crane hoist. Because surface tolerances of square tubing need not be as accurate as the tubing used previously and because no spline is necessary, the square tubing is significantly less expensive than splined telescoping tubes.

  8. Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

    PubMed Central

    Darbà, Josep; Kaskens, Lisette

    2015-01-01

    1,639.00), and €33,232.20 (€30,898.90), respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs. Conclusion The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs. PMID:26170703

  9. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    PubMed Central

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  10. US Dietary Supplement Labeling Rules and the Possibility of Medical Cost Reduction.

    PubMed

    Amagase, Harunobu

    2015-01-01

    US dietary supplements classified as foods are regulated under the Dietary Supplement Health and Education Act (DSHEA) and other rules. After the DSHEA established in 1994, the supplement market grew by about 4 times and reached $32 billion as of 2012. One of the major reasons for this market expansion is that consumers can recognize functions of the supplements by the structure/function (S/F) claims. S/F claims must not be false or misleading, and must be based upon reliable scientific evidence, especially clinical studies. At the same time, disclaimers must be shown on the package, which are "These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not intended to diagnose, treat, cure or prevent any disease." Both the FDA and Federal Trade Commission (FTC) are responsible for label claims and advertisement of dietary supplements. S/F claims are not medical claims, but these may have impact on people's mindset to be healthier. Recent research shows utilizing dietary supplements in 4 major areas with 10 popular ingredients could hypothetically reduce medical costs by over $50 billion in the US in the period of 2013-2020. Predicted fewer health problems and reduced medical cost information will further increase awareness of supplement usage and thus may raise quality of life. These may reduce the medical cost significantly, if the products are used appropriately with sufficient consumer education. PMID:26598828

  11. Kiovig for primary immunodeficiency: reduced infusion and decreased costs per infusion.

    PubMed

    Connolly, Mark; Simoens, Steven

    2011-09-01

    Kiovig is a ready-to-use 10% liquid immunoglobulin preparation that is medically indicated for the treatment of primary immunodeficiency. This study aims to conduct an economic evaluation which compares the intravenous immunoglobulin (IVIg) preparations Kiovig, Multigam, and Sandoglobulin from the Belgian societal perspective. As three prospective studies have observed no difference in outcomes, a cost-minimization analysis is considered appropriate to evaluate differences in treatment costs that can arise from IVIgs. A decision-analytic model simulated treatment costs attributed to one infusion. Resource use data were derived from a Dutch costing study. Cost items included immunoglobulin costs, pharmacy administration and nursing costs, mini-forfait for hospital infusion, costs of adverse events, and lost productivity with 2009 as base year. Cost data were identified from published sources and Belgian hospital administrators. A probabilistic sensitivity analysis explored the impact of parameter uncertainty on cost results. Costs per infusion cycle in adult primary immunodeficiency patients were €1,046 (95% confidence interval: €1,006-1,093) with Kiovig; €1,102 (€1,064-1,147) with Multigam; and €1,147 (€1,108-1,193) with Sandoglobulin. The average cost savings per infusion with Kiovig as compared to Multigam and Sandoglobulin amounted to €56 and €101 per infusion. In conclusion, treatment costs with Kiovig were shown to be lower as compared to other IVIgs in Belgium. Reduced costs per infusion were attributed to lower costs associated with treating adverse events and the opportunity cost of nursing time and time off work for working adults. PMID:21570491

  12. Reducing electricity generation costs by improving coal quality: Proceedings

    SciTech Connect

    Not Available

    1988-05-01

    The costs of generating electricity at a coal-fired power plant are significantly influenced by the characteristics of the coal that feeds the plant. Upgrading coal quality or assuring a consistent-quality coal can improve plant performance, increase boiler capacity, and raise plant availability. Sixteen papers presented at an EPRI seminar, ''Reducing Electricity Generation Costs by Improving Coal Quality,'' address how to determine which coal to burn to produce the lowest busbar costs. These papers include case histories of utilities that have switched to higher-quality coal. They also describe computer models to assess coal quality effects and estimate coal cleaning costs. In addition, they examine various methods to predict how a given coal will perform in a particular boiler, and how coal quality can reduce emission control costs. This unique gathering of coal quality information was presented by speakers from US utilities, the Electric Power Research Institute, and the electric power industry. The seminar, sponsored by EPRI's Coal Quality Development Center, formerly the Coal Cleaning Test Facility, was held in November 1986. It drew approximately 80 representatives from US utilities, coal companies, and engineering firms.

  13. Cost-Effectiveness of Pharmacotherapy to Reduce Obesity

    PubMed Central

    Veerman, J. Lennert; Barendregt, Jan J.; Forster, Megan; Vos, Theo

    2011-01-01

    Aims Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. Methods We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. Results The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000–180 000) for sibutramine and A$230 000/DALY (170 000–340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Conclusions Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden. PMID:22046255

  14. Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.

    PubMed

    Wagner, Todd H; Chen, Shuo; Barnett, Paul G

    2003-09-01

    The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems. PMID:15095543

  15. Small Habitat Commonality Reduces Cost for Human Mars Missions

    NASA Technical Reports Server (NTRS)

    Griffin, Brand N.; Lepsch, Roger; Martin, John; Howard, Robert; Rucker, Michelle; Zapata, Edgar; McCleskey, Carey; Howe, Scott; Mary, Natalie; Nerren, Philip (Inventor)

    2015-01-01

    Most view the Apollo Program as expensive. It was. But, a human mission to Mars will be orders of magnitude more difficult and costly. Recently, NASA's Evolvable Mars Campaign (EMC) mapped out a step-wise approach for exploring Mars and the Mars-moon system. It is early in the planning process but because approximately 80% of the total life cycle cost is committed during preliminary design, there is an effort to emphasize cost reduction methods up front. Amongst the options, commonality across small habitat elements shows promise for consolidating the high bow-wave costs of Design, Development, Test and Evaluation (DDT&E) while still accommodating each end-item's functionality. In addition to DDT&E, there are other cost and operations benefits to commonality such as reduced logistics, simplified infrastructure integration and with inter-operability, improved safety and simplified training. These benefits are not without a cost. Some habitats are sub-optimized giving up unique attributes for the benefit of the overall architecture and because the first item sets the course for those to follow, rapidly developing technology may be excluded. The small habitats within the EMC include the pressurized crew cabins for the ascent vehicle,

  16. Reduced Diabetic, Hypertensive, and Cholesterol Medication Use with Walking

    PubMed Central

    WILLIAMS, PAUL T.

    2010-01-01

    Purpose To assess the relationships of walking distance, frequency, and intensity to the prevalence of antidiabetic, antihypertensive, and LDL cholesterol–lowering medications use. Methods Cross-sectional analyses of 32,683 female and 8112 male participants of the National Walkers’ Health Study, of whom 2.8% and 7.4% reported antidiabetic, 14.3% and 29.0% reported antihypertensive, and 7.3% and 21.5% reported LDL cholesterol–lowering medication use, respectively. Results Weekly walking distance, longest walk, and walking intensity were inversely related to the prevalence of antidiabetic (males: P < 0.001, females: P < 0.0001), antihypertensive (males: P < 0.01, females: P < 0.0001), and LDL cholesterol–lowering medications (males: P < 0.01, females: P < 0.0001). Each medication remained significantly related to both walking intensity and longest weekly walk when adjusted for total weekly distance. Compared with men and women who walked at a speed of < 1.2 m/s, those who walked > 2.1 m/s had 48% and 52% lower odds for antihypertensive, 68% and 59% lower odds for antidiabetic, and 53% and 40% lower odds for LDL cholesterol–lowering medications, respectively, when adjusted for age, smoking, and diet. The longest usual weekly walk was a better discriminator of medication status than the total cumulative distance per week, particularly in men. Conclusion These results are consistent with the hypothesis that antidiabetic, antihypertensive, and LDL cholesterol–lowering medication use may be reduced substantially by walking more intensely and farther each week, and by including longer walks. PMID:18379204

  17. Leveraging metal matrix composites to reduce costs in space mechanisms

    NASA Technical Reports Server (NTRS)

    Nye, Ted; Claridge, Rex; Walker, Jim

    1994-01-01

    Advanced metal matrix composites may be one of the most promising technologies for reducing cost in structural components without compromise to strength or stiffness. A microlight 12.50 N (2.81 lb), two-axis, solar array drive assembly (SADA) was made for the Advanced Materials Applications to Space Structures (AMASS) Program flight experiment. The SADA had both its inner and outer axis housings fabricated from silicon carbide particulate reinforced alumimun. Two versions of the housings were made. The first was machined from a solid billet of material. The second was plaster cast to a near net shape that required minimal finish machining. Both manufacturing methods were compared upon completion. Results showed a cost savings with the cast housing was possible for quantities greater than one and probable for quantities greater than two. For quantities approaching ten, casting resulted in a reduction factor of almost three in the cost per part.

  18. Reduce gas utility costs with improved backfill stabilization

    SciTech Connect

    Kramer, S.R.; Baker, E.J.

    1983-12-01

    Backfilling and repaving over trenches and excavations for gas distribution piping leak repairs is a costly operation for gas utilities. The use of poor techniques or unsuitable material in the backfill operation may cause pavements to subside, resulting in hazardous potholes. In addition, some backfill materials may be corrosive to metal piping or hazardous for work crews to handle. There is a need to develop an improved material that can prevent excessive subsidence and reduce construction and maintenance costs. In 1981, the Gas Research Institute (GRI) initiated a project at Southwest Research Institute (SRI) to develop cost-effective methods for treating backfill in utility excavation operations. The results of the laboratory and field tests conducted during this project indicated that SRI has successfully developed a new soil stabilizer for use in backfilling excavations.

  19. Smoking among Vietnamese medical students: prevalence, costs, and predictors.

    PubMed

    Nguyen, Van Huy; Dao, Thi Minh An; Dao, Ngoc Phong

    2008-01-01

    This cross-sectional study investigated smoking patterns and predictors among Vietnamese medical students. In total, 4720 medical students from 3 universities, each located in South, Central, and North Vietnam, were interviewed using an adapted Global Youth Tobacco Survey Questionnaire. Ideas on smoking behavior and tobacco control derived from group discussions with students and from unstructured interviews with student managers and university directors. Overall, the current smoking rate was 25.0% and dominant in men at 43.7%. Most started smoking when just entering university (18 +/- 3.3 years). Male students from the central region had the highest smoking rate (35.1%), whereas their northern counterparts had the greatest smoking magnitude: age of smoking initiation (18.6 +/- 3.5), number of cigarettes per day (4.4 +/- 4.5), number of smoking days per month (16.5 +/- 11.6), and proportion of smoking cost among total expenses per month (10.9% +/- 11.9%). Smoking tended to increase across academic years, being highest in years 5 to 6 (35.0%). In contrast, the practice of ever quitting and the intention of quitting tended to decline from years 1-2 to years 5-6 (from 82.2% to 71.5%, P < .05, and from 70.8% to 51.5%, P < .001, respectively). Positive attitudes toward smoking (odds ratio = 1.4, P < .05), negative beliefs on hazards of smoking (odds ratio = 1.7), and daily exposure to family smokers (odds ratio = 2.0, P < .05) and to social smokers (odds ratio = 4.5, P < .05) were main predictors of smoking. Qualitative results suggest that nonsmoking university regulations played a critical role in tobacco control among medical students. Nonsmoking regulations and penalties for students who smoke need to be formulated at medical universities. The message that medical students must make a nonsmoking role model for community should be systematically promoted. PMID:19124295

  20. Medical Education and Research Costs (MERC). A Final Report to the Legislature.

    ERIC Educational Resources Information Center

    Minnesota State Dept. of Health, St. Paul.

    This final report discusses the activities of Minnesota's Medical Education and Research Costs (MERC) project, which was undertaken to gather data on the costs of medical education and health care research conducted by hospitals, medical centers, and health maintenance organizations and develop mechanisms to assess the costs across the health care…

  1. Medical Education and Research Costs (MERC). Study Recommendations and Progress Report to the Legislature.

    ERIC Educational Resources Information Center

    Minnesota State Dept. of Health, St. Paul.

    This report discusses the activities of Minnesota's Medical Education and Research Costs (MERC) project, which was undertaken to gather data on the costs of medical education and health care research conducted by hospitals, medical centers, and health maintenance organizations and to develop mechanisms to assess the costs across the health care…

  2. Copper-nickel piping reduces costs, biofouling/corrosion

    SciTech Connect

    Albaugh, E.K.

    1984-11-01

    Seawater piping systems for offshore drilling rigs and platforms are typically plagued by biofouling and/or corrosion, with piping failures occurring in only a few years. Discussed are alternate pipe materials with the emphasis on the testing of a copper-nickel alloy in the Gulf of Mexico. Results show that although initially more expensive, use of this alloy can extend system life to 20 years or more while improving productivity and reducing overall costs when compared to a comparable steel system.

  3. Advanced transfer chute reduces dust at lower cost

    SciTech Connect

    Blazek, C.

    2005-10-01

    Dominion Resources' Kincaid Generating Station in Illinois is recognized as a leader in handling and burning PRB coal. Since being named the Powder Plant of the Year in 2001 and 2004 by the PRB Coal Users' Group, Kincaid has improved its coal handling by installing an InteliFlo controlled-flow transfer chute from Benetech. The InteliFlo design eliminates the need for skirt boards, conveyor discharge hoods, and complex load bed designs, and reduces O & M costs. 4 figs.

  4. Did Statins Reduce the Health and Health Care Costs of Obesity?

    PubMed Central

    Gaudette, Étienne; Goldman, Dana P.; Messali, Andrew; Sood, Neeraj

    2015-01-01

    Context Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Due to the relationship between obesity and hypercholesterolemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Methods Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM) – an established dynamic microsimulation model of health of Americans aged over 50 – we estimate the changes in life expectancy, functional status and health care cost of obesity due to the introduction and widespread use of statins. Results Life expectancy gains of statins are estimated to be 5%–6% higher for obese than healthy-weight individuals, but most of this additional gain is associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (BMI larger or equal to 30 and 35 kg/m2), and increase the costs of class 3 obesity (BMI larger or equal to 40 kg/m2) by 1.2%. Conclusions Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity. PMID:25576147

  5. What have we learned about interventions to reduce medical errors?

    PubMed

    Woodward, Helen I; Mytton, Oliver T; Lemer, Claire; Yardley, Iain E; Ellis, Benjamin M; Rutter, Paul D; Greaves, Felix E C; Noble, Douglas J; Kelley, Edward; Wu, Albert W

    2010-01-01

    Medical errors and adverse events are now recognized as major threats to both individual and public health worldwide. This review provides a broad perspective on major effective, established, or promising strategies to reduce medical errors and harm. Initiatives to improve safety can be conceptualized as a "safety onion" with layers of protection, depending on their degree of remove from the patient. Interventions discussed include those applied at the levels of the patient (patient engagement and disclosure), the caregiver (education, teamwork, and checklists), the local workplace (culture and workplace changes), and the system (information technology and incident reporting systems). Promising interventions include forcing functions, computerized prescriber order entry with decision support, checklists, standardized handoffs and simulation training. Many of the interventions described still lack strong evidence of benefit, but this should not hold back implementation. Rather, it should spur innovation accompanied by evaluation and publication to share the results. PMID:20070203

  6. Reducing costs of marine monitoring: a case study

    NASA Astrophysics Data System (ADS)

    Garcia, Luz; van der Molen, Johan; Sivyer, Dave

    2016-04-01

    Monitoring programmes are suffering budget restrictions nowadays, a trend that is expected to continue in the future. However, the need of sustained reliable, high quality and comprehensive observations persists. Under these conditions, optimising existing or future monitoring programmes is becoming a priority. Here, we present first results of a study to use simple methods to optimise the UK OSPAR eutrophication monitoring programme. Since the results of the last UK OSPAR eutrophication assessment are known and the data are available, we have used this dataset as a case study to develop a generic system that allows i) to assess an observational network from a multi-variable point of view, ii) to get the most out of the data and iii) to reduce the cost of the monitoring programme. The method consists of tools to analyse, by means of simple statistical techniques, if any reduction of the available dataset would lead to similar results as the already known assessments, in combination with an estimate of the cost of the reduced programme. Data reduction must be done in a sensible way: either by calculating the relevant spatial and temporal scales (if enough data are available) or by trying ad hoc methods such as reducing a period of time, removing a complete dataset, a salinity group or some random reductions using Monte Carlo methods. Another way of reducing monitoring costs is using freely available third-party data (ferrybox data, satellite observations, etc). The developed method allows to combine all the available datasets and analyse if additional reductions in the monitoring programmes are possible by considering these additional datasets.

  7. Cost-effectiveness analysis of a hospital electronic medication management system

    PubMed Central

    Gospodarevskaya, Elena; Li, Ling; Richardson, Katrina L; Roffe, David; Heywood, Maureen; Day, Richard O; Graves, Nicholas

    2015-01-01

    Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS). Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors. PMID:25670756

  8. Adaptive function allocation reduces performance costs of static automation

    NASA Technical Reports Server (NTRS)

    Parasuraman, Raja; Mouloua, Mustapha; Molloy, Robert; Hilburn, Brian

    1993-01-01

    Adaptive automation offers the option of flexible function allocation between the pilot and on-board computer systems. One of the important claims for the superiority of adaptive over static automation is that such systems do not suffer from some of the drawbacks associated with conventional function allocation. Several experiments designed to test this claim are reported in this article. The efficacy of adaptive function allocation was examined using a laboratory flight-simulation task involving multiple functions of tracking, fuel-management, and systems monitoring. The results show that monitoring inefficiency represents one of the performance costs of static automation. Adaptive function allocation can reduce the performance cost associated with long-term static automation.

  9. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1989-02-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Co., acting as contractor for the City of Long Beach, operator of the Long Beach Unit. Thums Long Beach Co. currently operates 700 submersible pump installations located on four manmade islands and one landfill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100% pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and to lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump-performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from using more efficient pumps and a reduced frequency of pulling submersible equipment.

  10. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1986-01-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Company, acting as Contractor of the City of Long Beach, Operator of the Long Beach Unit. Thums Long Beach Company currently operates 700 submersible pump installations located on four man-made islands and one land fill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100 percent pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from utilizing higher efficiency pumps and a reduced frequency of pulling submersible equipment.

  11. Reducing Development and Operations Costs using NASA's "GMSEC" Systems Architecture

    NASA Technical Reports Server (NTRS)

    Smith, Dan; Bristow, John; Crouse, Patrick

    2007-01-01

    This viewgraph presentation reviews the role of Goddard Mission Services Evolution Center (GMSEC) in reducing development and operation costs in handling the massive data from NASA missions. The goals of GMSEC systems architecture development are to (1) Simplify integration and development, (2)Facilitate technology infusion over time, (3) Support evolving operational concepts, and (4) All for mix of heritage, COTS and new components. First 3 missions (i.e., Tropical Rainforest Measuring Mission (TRMM), Small Explorer (SMEX) missions - SWAS, TRACE, SAMPEX, and ST5 3-Satellite Constellation System) each selected a different telemetry and command system. These results show that GMSEC's message-bus component-based framework architecture is well proven and provides significant benefits over traditional flight and ground data system designs. The missions benefit through increased set of product options, enhanced automation, lower cost and new mission-enabling operations concept options .

  12. Reducing the Time and Cost of Testing Engines

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Producing a new aircraft engine currently costs approximately $1 billion, with 3 years of development time for a commercial engine and 10 years for a military engine. The high development time and cost make it extremely difficult to transition advanced technologies for cleaner, quieter, and more efficient new engines. To reduce this time and cost, NASA created a vision for the future where designers would use high-fidelity computer simulations early in the design process in order to resolve critical design issues before building the expensive engine hardware. To accomplish this vision, NASA's Glenn Research Center initiated a collaborative effort with the aerospace industry and academia to develop its Numerical Propulsion System Simulation (NPSS), an advanced engineering environment for the analysis and design of aerospace propulsion systems and components. Partners estimate that using NPSS has the potential to dramatically reduce the time, effort, and expense necessary to design and test jet engines by generating sophisticated computer simulations of an aerospace object or system. These simulations will permit an engineer to test various design options without having to conduct costly and time-consuming real-life tests. By accelerating and streamlining the engine system design analysis and test phases, NPSS facilitates bringing the final product to market faster. NASA's NPSS Version (V)1.X effort was a task within the Agency s Computational Aerospace Sciences project of the High Performance Computing and Communication program, which had a mission to accelerate the availability of high-performance computing hardware and software to the U.S. aerospace community for its use in design processes. The technology brings value back to NASA by improving methods of analyzing and testing space transportation components.

  13. Inpatient management protocols to reduce health care costs.

    PubMed

    Wachtel, T; Moulton, A W; Pezzullo, J; Hamolsky, M

    1986-01-01

    A group of 12 internists, members of a university-affiliated hospital, designed and implemented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, especially with the threat of more restrictive and less sympathetic modes of controlling costs. PMID:3084902

  14. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  15. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  16. Brand name versus generic drugs: the ethical quandary in caring for our sophisticated patients while trying to reduce health-care costs: facts and controversies.

    PubMed

    Payette, Michael; Grant-Kels, Jane M

    2013-01-01

    Medical ethics are the values and guidelines that govern decisions made in medical practice. Four prima facie moral principles can serve as a framework to help physicians analyze problems and make ethical decisions: (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice. With the cost of health care rising, all parties involved in the delivery of health care need to work to reduce costs, while continuing to provide quality care to our patients. One mechanism to reduce costs is to increase utilization of generic medications in daily practice, but there are many ethical issues inherent in utilizing brand name versus generic medications in dermatology. PMID:24160285

  17. A pivotal year for managing retiree medical benefit costs.

    PubMed

    Fontanetta, Ron

    2005-01-01

    With Medicare set to begin offering a prescription drug benefit in 2006, employers that provide medical coverage to retirees aged 65 and older have a unique opportunity to redefine their programs and financial commitments for the long term. The new Medicare Part D drug benefit poses a range of alternatives for employers to consider--from eliminating post-65 drug benefits altogether to maintaining or modifying their current programs to qualify for the 28% federal tax subsidy for eligible drug costs. In deciding on a course of action, companies need to consider a host of complex issues, including workforce needs and demographics, employee relations, plan design and administration--in addition to the long-term financial and accounting implications. This article reviews the alternatives available to employers with the advent of Medicare Part D and highlights some of the key factors employers should consider as part of this decision. PMID:16248227

  18. Reducing Mission Costs by Leveraging Previous Investments in Space

    NASA Technical Reports Server (NTRS)

    Miller, Ron; Adams, W. James

    1999-01-01

    The Rapid Spacecraft Development Office (RSDO) at NASA's Goddard Space Flight Center has been charged with the responsibility to reduce mission cost by allowing access to previous developments on government and commercial space missions. RSDO accomplishes this responsibility by implementing two revolutionary contract vehicles, the Rapid Spacecraft Acquisition (RSA) and Quick Ride. This paper will describe the concept behind these contracts, the current capabilities available to missions, analysis of pricing trends to date using the RSDO processes, and future plans to increase flexibility and capabilities available to mission planners.

  19. An Application of Six Sigma to Reduce Supplier Quality Cost

    NASA Astrophysics Data System (ADS)

    Gaikwad, Lokpriya Mohanrao; Teli, Shivagond Nagappa; Majali, Vijay Shashikant; Bhushi, Umesh Mahadevappa

    2016-01-01

    This article presents an application of Six Sigma to reduce supplier quality cost in manufacturing industry. Although there is a wider acceptance of Six Sigma in many organizations today, there is still a lack of in-depth case study of Six Sigma. For the present research the case study methodology was used. The company decided to reduce quality cost and improve selected processes using Six Sigma methodologies. Regarding the fact that there is a lack of case studies dealing with Six Sigma especially in individual manufacturing organization this article could be of great importance also for the practitioners. This paper discusses the quality and productivity improvement in a supplier enterprise through a case study. The paper deals with an application of Six Sigma define-measure-analyze-improve-control methodology in an industry which provides a framework to identify, quantify and eliminate sources of variation in an operational process in question, to optimize the operation variables, improve and sustain performance viz. process yield with well-executed control plans. Six Sigma improves the process performance (process yield) of the critical operational process, leading to better utilization of resources, decreases variations and maintains consistent quality of the process output.

  20. Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article

    PubMed Central

    French, Dustin D.; Dixon, Brian E.; Perkins, Susan M.; Myers, Laura J.; Weiner, Michael; Zillich, Allan J.; Haggstrom, David A.

    2016-01-01

    Abstract The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers. The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs. A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation. Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office. VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment. There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees. Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons. PMID:26765453

  1. A cost sensitive inpatient bed reservation approach to reduce emergency department boarding times.

    PubMed

    Qiu, Shanshan; Chinnam, Ratna Babu; Murat, Alper; Batarse, Bassam; Neemuchwala, Hakimuddin; Jordan, Will

    2015-03-01

    Emergency departments (ED) in hospitals are experiencing severe crowding and prolonged patient waiting times. A significant contributing factor is boarding delays where admitted patients are held in ED (occupying critical resources) until an inpatient bed is identified and readied in the admit wards. Recent research has suggested that if the hospital admissions of ED patients can be predicted during triage or soon after, then bed requests and preparations can be triggered early on to reduce patient boarding time. We propose a cost sensitive bed reservation policy that recommends optimal bed reservation times for patients. The policy relies on a classifier that estimates the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after. The policy is cost sensitive in that it accounts for costs associated with patient admission prediction misclassification as well as costs associated with incorrectly selecting the reservation time. Results from testing the proposed bed reservation policy using data from a VA Medical Center are very promising and suggest significant cost saving opportunities and reduced patient boarding times. PMID:24811547

  2. Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

    PubMed Central

    2013-01-01

    Background High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Methods Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. Results The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for

  3. Remotely operated guideposts reduce drilling time and costs

    SciTech Connect

    Watkins, S.S.; Beato, C.L. ); Vetter, V.H. )

    1990-03-01

    This paper reports remotely operated guideposts used to establish, release, and re-establish guidelines for a template installation in 1,758 ft (536 m) of water in the Gulf of Mexico. The guideposts were used to reduce the drilling-template weight, to improve accessibility of the remotely operated vehicle (ROV) around the well slots, and to reposition the blowout preventer (BOP) stack on a new well without tripping the stack to the surface. Before field installation, procedures were developed and the guideposts and running tools were function tested. Wet tests verified the reliability of the ROV and guidepost interface. This testing contributed to the successful use of guideposts. Drilling-template costs dropped significantly. The approach helped save about 36 days of drilling time. The guideposts were also used to tie back the tendons and production risers for the tension-leg well platform (TLWP).

  4. Global cost estimates of reducing carbon emissions through avoided deforestation

    PubMed Central

    Kindermann, Georg; Obersteiner, Michael; Sohngen, Brent; Sathaye, Jayant; Andrasko, Kenneth; Rametsteiner, Ewald; Schlamadinger, Bernhard; Wunder, Sven; Beach, Robert

    2008-01-01

    Tropical deforestation is estimated to cause about one-quarter of anthropogenic carbon emissions, loss of biodiversity, and other environmental services. United Nations Framework Convention for Climate Change talks are now considering mechanisms for avoiding deforestation (AD), but the economic potential of AD has yet to be addressed. We use three economic models of global land use and management to analyze the potential contribution of AD activities to reduced greenhouse gas emissions. AD activities are found to be a competitive, low-cost abatement option. A program providing a 10% reduction in deforestation from 2005 to 2030 could provide 0.3–0.6 Gt (1 Gt = 1 × 105 g) CO2·yr−1 in emission reductions and would require $0.4 billion to $1.7 billion·yr−1 for 30 years. A 50% reduction in deforestation from 2005 to 2030 could provide 1.5–2.7 Gt CO2·yr−1 in emission reductions and would require $17.2 billion to $28.0 billion·yr−1. Finally, some caveats to the analysis that could increase costs of AD programs are described. PMID:18650377

  5. Reducing medical errors through barcoding at the point of care.

    PubMed

    Nichols, James H; Bartholomew, Cathy; Brunton, Mary; Cintron, Carlos; Elliott, Sheila; McGirr, Joan; Morsi, Deborah; Scott, Sue; Seipel, Joseph; Sinha, Daisy

    2004-01-01

    Medical errors are a major concern in health care today. Errors in point-of-care testing (POCT) are particularly problematic because the test is conducted by clinical operators at the site of patient care and immediate medical action is taken on the results prior to review by the laboratory. The Performance Improvement Program at Baystate Health System, Springfield, Massachusetts, noted a number of identification errors occurring with glucose and blood gas POCT devices. Incorrect patient account numbers that were attached to POCT results prevented the results from being transmitted to the patient's medical record and appropriately billed. In the worst case, they could lead to results being transferred to the wrong patient's chart and inappropriate medical treatment. Our first action was to lock-out operators who repeatedly made identification errors (3-Strike Rule), requiring operators to be counseled and retrained after their third error. The 3-Strike Rule significantly decreased our glucose meter errors (p = 0.014) but did not have an impact on the rate of our blood gas errors (p = 0.378). Neither device approached our ultimate goal of zero tolerance. A Failure Mode and Effects Analysis (FMEA) was conducted to determine the various processes that could lead to an identification error. A primary source of system failure was the manual entry of 14 digits for each test, five numbers for operator and nine numbers for patient account identification. Patient barcoding was implemented to automate the data entry process, and after an initial familiarization period, resulted in significant improvements in error rates for both the glucose (p = 0.0007) and blood gas devices (p = 0.048). Despite the improvements, error rates with barcoding still did not achieve zero errors. Operators continued to utilize manual data entry when the barcode scan was unsuccessful or unavailable, and some patients were found to have incorrect patient account numbers due to hospital transfer

  6. Unique Tuft Test Facility Dramatically Reduces Brush Seal Development Costs

    NASA Technical Reports Server (NTRS)

    Fellenstein, James A.

    1997-01-01

    Brush seals have been incorporated in the latest turbine engines to reduce leakage and improve efficiency. However, the life of these seals is limited by wear. Studies have shown that optimal sealing characteristics for a brush seal occur before the interference fit between the brush and shaft is excessively worn. Research to develop improved tribopairs (brush and coating) with reduced wear and lower friction has been hindered by the lack of an accurate, low-cost, efficient test methodology. Estimated costs for evaluating a new material combination in an engine company seal test program are on the order of $100,000. To address this need, the NASA Lewis Research Center designed, built, and validated a unique, innovative brush seal tuft tester that slides a single tuft of brush seal wire against a rotating shaft under controlled loads, speeds, and temperatures comparable to those in turbine engines. As an initial screening tool, the brush seal tuft tester can tribologicaly evaluate candidate seal materials for 1/10th the cost of full-scale seal tests. Previous to the development of the brush seal tuft tester facility, most relevant tribological data had been obtained from full-scale seal tests conducted primarily to determine seal leakage characteristics. However, from a tribological point of view, these tests included the confounding effects of varying contact pressures, bristle flaring, high-temperature oxidation, and varying bristle contact angles. These confounding effects are overcome in tuft testing. The interface contact pressures can be either constant or varying depending on the tuft mounting device, and bristle wear can be measured optically with inscribed witness marks. In a recent cooperative program with a U.S. turbine engine manufacturer, five metallic wire candidates were tested against a plasma-sprayed Nichrome-bonded chrome carbide. The wire materials used during this collaboration were either nickel-chrome- or cobaltchrome-based superalloys. These

  7. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions. PMID:25534861

  8. Using clinically nuanced cost sharing to enhance consumer access to specialty medications.

    PubMed

    Buxbaum, Jason; de Souza, Jonas; Fendrick, A Mark

    2014-06-01

    With specialty pharmaceutical prices on the rise, patients are often expected to pay anywhere from 30% to 50% of the specialty-tier drug price through co-insurance-based cost sharing. As these prices continue to climb, patients may choose lower-value medications for their medical needs or become nonadherent for cost-related reasons. Value-based insurance design implementations for specialty medications connect cost sharing and clinical value by moving high-value medications into lower-priced tiers, adjusting cost-sharing based on patient-specific variables, applying the "reward the good soldier" strategy, and encouraging patients to seek high-performing providers. PMID:25180506

  9. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... the cost of inpatient medical services furnished by military treatment facilities through...

  10. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    PubMed

    Walsh, E K; Cussen, K

    2010-09-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction. PMID:21046863

  11. Financial costs and patients’ perceptions of medical tourism in bariatric surgery

    PubMed Central

    Kim, David H.; Sheppard, Caroline E.; de Gara, Christopher J.; Karmali, Shahzeer; Birch, Daniel W.

    2016-01-01

    Summary Many Canadians pursue surgical treatment for severe obesity outside of their province or country — so-called “medical tourism.” We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients’ motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources. PMID:26574702

  12. The costs of a suburban paramedic program in reducing deaths due to cardiac arrest.

    PubMed

    Urban, N; Bergner, L; Eisenberg, M S

    1981-04-01

    The marginal costs per averted death of a suburban paramedic program are estimated to be approximately $42,000, when program costs are attributed entirely to cardiac arrest cases due to underlying heart disease, and indirect costs attributable to episode-related hospitalization are included, It is suggested that at $42,000 per cardiac arrest death averted the program is cost-beneficial by two criteria. First, it compares favorably with an estimate obtained from the literature of the value to the average individual of saving the life of a myocardial infarction patient. Second, the people of King County passed a cost-commensurate Paramedic Program Property Tax Levy in 1979, revealing their willingness to support the program. Results of the study should be generalized in accordance with the facts that in King County 1) the population density averages approximately 1,300 per square mile; 2) a basic emergency medical system ensures a 4-minute average response time to initiation of cardiopulmonary resuscitation; 3) a citizen-training program in cardiopulmonary resuscitation further reduces average time to initiation of basic life support; and 4) the paramedic program is designed to ensure a 10-minute average time to definitive care. PMID:6785539

  13. Proceedings: Reducing Electricity Generation Costs by Improving Coal Quality

    SciTech Connect

    1988-05-01

    Determining the most economic coal to burn in a power plant requires balancing coal costs against the costs associated with plant performance and emissions control. These proceedings present utility case histories, research results, and industry experience in achieving the lowest busbar cost.

  14. Central vacuum system with programmable controller reduces energy costs 40%

    SciTech Connect

    De Silva, R.; Varnes, W.; Gaines, A.

    1985-11-01

    The B.F. Goodrich Company needed a more efficient vacuum source for the pilot plant facilities in Avon Lake, OH where new products and manufacturing procedures are developed and evaluated. Fourteen multi-stage steam jet ejector vacuum systems were installed in one building, since a number of vacuum users could be operating concurrently at different levels in the range of 15 to 150 Torr. Ejectors were normally turned on or off to provide the desired vacuum and to conserve steam. Steam is wasted, however, if all stages are on and the amount of vacuum is regulated by bleeding inert gas into the system. Water can also enter the system by kick back, if steam to the ejectors is abruptly shut off. The jet ejector vacuum systems required a steady supply of high pressure steam day and night, but fluctuating demands could create problems in the quality of vacuum obtained. Steam and maintenance costs were also significant. Goodrich decided to replace most of the steam-operated vacuum units because of the high energy requirements, and concurrently reduce hydrocarbon emissions. A major manufacturer or mechanical vacuum equipment was asked to design a vacuum system that could provide steady vacuum in the range of 10 to 250 Torr. The system had to have sufficient capacity for a number of concurrently operating processes, and handle a wide variety of hydrocarbons. The system, designed to meet these requirements and installed in June 1984, consists of a Roots-type vacuum booster with bypass valves, discharging into an intercondenser. The progammable-controlled vacuum system has reduced energy requirements by approximately 40%, and has helped in minimizing emissions. The projected pay-back for the entire system is 1 1/2 years.

  15. Retrospective comparison of costs between medical and surgical treatment of canine pyothorax

    PubMed Central

    Bach, Jonathan F.; Balakrishnan, Anusha

    2015-01-01

    This study compared costs of treating dogs with pyothorax medically versus surgically. Medical records from the University of Wisconsin School of Veterinary Medicine were searched for cases of pyothorax that underwent either medical or surgical treatment. Patients undergoing surgery were subdivided into early (ES; < 48 h) and late (LS; > 48 h) surgery groups. Costs and length of stay were compared between treatment groups. Treatment costs were adjusted for inflation. Nineteen dogs were included in analysis; 7 in the medical group (MG), 5 in the ES group, and 7 in the LS group. Total costs were significantly lower in the MG than in the LS group. Total costs were less for the MG than the ES group, and for ES than LS, but the differences did not achieve significance. Preoperative costs were higher in the LS than the ES group. We conclude that surgery for canine pyothorax is less costly if pursued earlier than later. PMID:26538667

  16. Use of Air Modeling to Reduce Facility Demolition Costs

    SciTech Connect

    Smith, Dennis; Sanford, Peter; Parsons, Duane A.

    2003-02-26

    DOE faces the problem of decommissioning facilities contaminated with plutonium, uranium, and beryllium. The standard process has been to remove the contaminated process equipment from a facility, and then decontaminate the residual radiological and hazardous contamination from the facility structure to an ''unconditional release'' level. The facility would then be taken down as a clean demolition. Several beryllium-contaminated facilities were identified that will be particularly difficult to decontaminate to these release levels. A number of alternative decommissioning approaches were investigated that would require less decontamination, and thus reduced cost and schedule. Initial alternative approaches proposed erection of barriers (i.e. building-size tent structures with ventilation controls) to minimize the release of contamination to the environment. More recently we have investigated methods to control contamination at the structure surfaces before and during demolition, and model the risk posed to the workers, public, and the environment by the small residual material actually dispersed. This approach promises to minimize decontamination by removing only the highest contamination levels, and eliminates the need for erecting large contamination control structures along with the attendant ventilation equipment and administrative controls. The modeling has demonstrated the regulatory acceptability of this approach, and the approach is ready to be discussed with the regulators and the public.

  17. Evolved plasmid-host interactions reduce plasmid interference cost.

    PubMed

    Yano, Hirokazu; Wegrzyn, Katarznya; Loftie-Eaton, Wesley; Johnson, Jenny; Deckert, Gail E; Rogers, Linda M; Konieczny, Igor; Top, Eva M

    2016-09-01

    Antibiotic selection drives adaptation of antibiotic resistance plasmids to new bacterial hosts, but the molecular mechanisms are still poorly understood. We previously showed that a broad-host-range plasmid was poorly maintained in Shewanella oneidensis, but rapidly adapted through mutations in the replication initiation gene trfA1. Here we examined if these mutations reduced the fitness cost of TrfA1, and whether this was due to changes in interaction with the host's DNA helicase DnaB. The strains expressing evolved TrfA1 variants showed a higher growth rate than those expressing ancestral TrfA1. The evolved TrfA1 variants showed a lower affinity to the helicase than ancestral TrfA1 and were no longer able to activate the helicase at the oriV without host DnaA. Moreover, persistence of the ancestral plasmid was increased upon overexpression of DnaB. Finally, the evolved TrfA1 variants generated higher plasmid copy numbers than ancestral TrfA1. The findings suggest that ancestral plasmid instability can at least partly be explained by titration of DnaB by TrfA1. Thus under antibiotic selection resistance plasmids can adapt to a novel bacterial host through partial loss of function mutations that simultaneously increase plasmid copy number and decrease unfavorably high affinity to one of the hosts' essential proteins. PMID:27121483

  18. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    ERIC Educational Resources Information Center

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  19. Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center

    PubMed Central

    Fargo, Kelly L.; Johnston, Jessica; Stevenson, Kurt B.; Deutscher, Meredith

    2015-01-01

    Background: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. Objective: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. Methods: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)–adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. Results: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. Conclusion: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated. PMID:26405341

  20. Reducing the Manufacturing Cost of Tubular SOFC Technology

    SciTech Connect

    George, R.A.; Bessette, N.F.

    1997-12-31

    In recent years, Westinghouse Electric Corporation has made great strides in advancing tubular solid oxide fuel cell (SOFC) technology towards commercialization by the year 2001. In 1993, Westinghouse initiated a program to develop a `MWe Class` (1-3 MWe) pressurized SOFC (PSOFC) gas turbine (GT) combined cycle power system for distributed power applications because of its: (1) ultra high efficiency (approx. 63% net AC/LHV CH{sub 4}), (2) its compatibility with a factory packaged, minimum site work philosophy, and (3) its cost effectiveness. Since then two cost studies on this market entry product performed by consultants to the U.S. Department of Energy have confirmed Westinghouse cost studies that fully installed costs of under $1300/kWe can be achieved in the early commercialization years for such small PSOFC/GT power systems. The paper will present the results of these cost studies in the areas of cell manufacturing cost, PSOFC generator manufacturing cost, balance-of-plant (BOP) cost, and system installation cost. In addition, cost of electricity calculations will be presented.

  1. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payments to MA organizations for graduate medical... Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time...

  2. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the...

  3. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the...

  4. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the...

  5. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments

    PubMed Central

    Manatakis, Dimitrios K.; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  6. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments.

    PubMed

    Manatakis, Dimitrios K; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  7. Reduce, reuse and recycle: a green solution to Canada's medical isotope shortage.

    PubMed

    Galea, R; Ross, C; Wells, R G

    2014-05-01

    Due to the unforeseen maintenance issues at the National Research Universal (NRU) reactor at Chalk River and coincidental shutdowns of other international reactors, a global shortage of medical isotopes (in particular technetium-99m, Tc-99m) occurred in 2009. The operation of these research reactors is expensive, their age creates concerns about their continued maintenance and the process results in a large amount of long-lived nuclear waste, whose storage cost has been subsidized by governments. While the NRU has since revived its operations, it is scheduled to cease isotope production in 2016. The Canadian government created the Non-reactor based medical Isotope Supply Program (NISP) to promote research into alternative methods for producing medical isotopes. The NRC was a member of a collaboration looking into the use of electron linear accelerators (LINAC) to produce molybdenum-99 (Mo-99), the parent isotope of Tc-99m. This paper outlines NRC's involvement in every step of this process, from the production, chemical processing, recycling and preliminary animal studies to demonstrate the equivalence of LINAC Tc-99m with the existing supply. This process stems from reusing an old idea, reduces the nuclear waste to virtually zero and recycles material to create a green solution to Canada's medical isotope shortage. PMID:24332878

  8. "Green Oncology": the Italian medical oncologists' challenge to reduce the ecological impact of their clinical activity.

    PubMed

    Bretti, Sergio; Porcile, Gianfranco; Romizi, Roberto; Palazzo, Salvatore; Oliani, Cristina; Crispino, Sergio; Labianca, Roberto

    2014-01-01

    For decades Western medicine has followed a biomedical model based on linear thinking and an individualized, disease-oriented doctor-patient relationship. Today this framework must be replaced by a biopsychosocial model based on complexity theory and a person-oriented medical team-patient relationship, taking into account the psychological and social determinants of health and disease. However, the new model is already proving no longer adequate or appropriate, and current events are urging us to develop an ecological model in which the medical team takes into account both individual illness and population health as a whole, since we are all part of the biosphere. In recent years, the rising costs of cancer treatment have raised a serious issue of economic sustainability. As the population of our planet, we now need to rapidly address this issue, and everyone of us must try to reduce their ecological footprint, measured as CO2 production. Medical oncologists need to reduce the ecological footprint of their professional activity by lowering the consumption of economic resources and avoiding environmental damage as much as possible. This new paradigm is endorsed by the Italian College of Hospital Medical Oncology Directors (CIPOMO). A working group of this organization has drafted the "Green Oncology Position Paper": a proposal of Italian medical oncology (in accordance with international guidelines) that oncologists, while aiming for the same end results, make a commitment toward the more appropriate management of health care and the careful use of resources in order to protect the environment and the ecosphere during the daily exercise of their professional activities. PMID:25076260

  9. Advanced Fuels Can Reduce the Cost of Getting Into Space

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    1998-01-01

    Rocket propellant and propulsion technology improvements can reduce the development time and operational costs of new space vehicle programs, and advanced propellant technologies can make space vehicles safer and easier to operate, and can improve their performance. Five major areas have been identified for fruitful research: monopropellants, alternative hydrocarbons, gelled hydrogen, metallized gelled propellants, and high-energy-density propellants. During the development of the NASA Advanced Space Transportation Plan, these technologies were identified as those most likely to be effective for new NASA vehicles. Several NASA research programs had fostered work in fuels under the topic Fuels and Space Propellants for Reusable Launch Vehicles in 1996 to 1997. One component of this topic was to promote the development and commercialization of monopropellant rocket fuels, hypersonic fuels, and high-energy-density propellants. This research resulted in the teaming of small business with large industries, universities, and Government laboratories. This work is ongoing with seven contractors. The commercial products from these contracts will bolster advanced propellant research. Work also is continuing under other programs, which were recently realigned under the "Three Pillars" of NASA: Global Civil Aviation, Revolutionary Technology Leaps, and Access to Space. One of the five areas is described below, and its applications and effect on future missions is discussed. This work is being conducted at the NASA Lewis Research Center with the assistance of the NASA Marshall Space Flight Center. The regenerative cooling of spacecraft engines and other components can improve overall vehicle performance. Endothermic fuels can absorb energy from an engine nozzle and chamber and help to vaporize high-density fuel before it enters the combustion chamber. For supersonic and hypersonic aircraft, endothermic fuels can absorb the high heat fluxes created on the wing leading edges and

  10. Strategies for reducing medication errors in the emergency department

    PubMed Central

    Weant, Kyle A; Bailey, Abby M; Baker, Stephanie N

    2014-01-01

    Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination. PMID:27147879

  11. Avoiding Medication Errors: Reducing Harm in Residents Using Oral Anticoagulants.

    PubMed

    Grissinger, Matthew; Gaunt, Michael J; Rich, Darryl S

    2016-01-01

    Medication errors involving oral anticoagulants have led to serious adverse events, including hemorrhage, treatment failures leading to thromboembolic events, and death. This article will highlight medication errors that may arise during the use of oral anticoagulants and provide risk-reduction strategies to address the potential for error and patient harm. PMID:27250070

  12. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

    PubMed Central

    Afulani, Patience; Coleman-Jensen, Alisha; Harrison, Gail G.

    2015-01-01

    Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households. PMID:26270308

  13. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis

    PubMed Central

    Kopp Kallner, Helena; Simeonova, Emilia; Madestam, Andreas; Gemzell-Danielsson, Kristina

    2016-01-01

    Objective The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. Study design A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. Results The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Conclusion Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women’s access to safe abortion. PMID:27362270

  14. Improving Learning and Reducing Costs: Fifteen Years of Course Description

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2015-01-01

    Recognizing that tuition increases can no longer be used as a safety valve to avoid dealing with the underlying issues of why costs increase so much, campuses have begun the hard work of cost containment. After sharpening priorities, sometimes making tough choices in light of those priorities, campuses are still groping for ways to wrestle costs…

  15. Reduce Operating Costs with an EnergySmart School Project

    ERIC Educational Resources Information Center

    US Department of Energy, 2008

    2008-01-01

    Energy costs are a school district's second highest expenditure after personnel. Public schools currently spend more than $8 billion per year for energy. School energy expenditures rose, on average, 20 percent per year between 2000 and 2002--and the costs continue to rise. Natural gas prices alone increased 14 percent annually between 2003 and…

  16. The Lifetime Medical Cost Savings from Preventing HIV in the United States

    PubMed Central

    Schackman, Bruce R.; Fleishman, John A.; Su, Amanda E.; Berkowitz, Bethany K.; Moore, Richard D.; Walensky, Rochelle P.; Becker, Jessica E.; Voss, Cindy; Paltiel, A. David; Weinstein, Milton C.; Freedberg, Kenneth A.; Gebo, Kelly A.; Losina, Elena

    2015-01-01

    Objective Enhanced HIV prevention interventions, such as pre-exposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting one HIV infection in the United States. Methods We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing one HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range $1,854–$4,545/month) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range $73–$628/month). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 US dollars). Results The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% non-drug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding one HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided. Conclusions The economic value of HIV prevention in the US is substantial given the high cost of HIV disease treatment. PMID:25710311

  17. Reducing annotation cost and uncertainty in computer-aided diagnosis through selective iterative classification

    NASA Astrophysics Data System (ADS)

    Riely, Amelia; Sablan, Kyle; Xiaotao, Thomas; Furst, Jacob; Raicu, Daniela

    2015-03-01

    Medical imaging technology has always provided radiologists with the opportunity to view and keep records of anatomy of the patient. With the development of machine learning and intelligent computing, these images can be used to create Computer-Aided Diagnosis (CAD) systems, which can assist radiologists in analyzing image data in various ways to provide better health care to patients. This paper looks at increasing accuracy and reducing cost in creating CAD systems, specifically in predicting the malignancy of lung nodules in the Lung Image Database Consortium (LIDC). Much of the cost in creating an accurate CAD system stems from the need for multiple radiologist diagnoses or annotations of each image, since there is rarely a ground truth diagnosis and even different radiologists' diagnoses of the same nodule often disagree. To resolve this issue, this paper outlines an method of selective iterative classification that predicts lung nodule malignancy by using multiple radiologist diagnoses only for cases that can benefit from them. Our method achieved 81% accuracy while costing only 46% of the method that indiscriminately used all annotations, which achieved a lower accuracy of 70%, while costing more.

  18. The Cost of Postgraduate Medical Education and Continuing Medical Education: Re-Examining the Status Fifty Years Back

    PubMed Central

    2015-01-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care. PMID:25802685

  19. The cost of postgraduate medical education and continuing medical education: re-examining the status fifty years back.

    PubMed

    Walsh, Kieran

    2015-03-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care. PMID:25802685

  20. Effect of Cost-Sharing on Use of Asthma Medication in Children

    PubMed Central

    Ungar, Wendy J.; Kozyrskyj, Anita; Paterson, Michael; Ahmad, Fida

    2016-01-01

    Objective To examine the effect of cost-sharing on the use of asthma medications in asthmatic children. According to asthma guidelines, children with asthma may require treatment with multiple medications, including controllers and relievers, to achieve optimal control. Although families may be enrolled in drug benefit plans, impediments to access persist in the form of cost-sharing. Design Population-based retrospective cohort study of children by analysis of administrative medication insurance claims data. Setting Ontario, Canada. Participants A cohort of 17 046 Ontario children with asthma enrolled in private drug plans. Main Exposure We used data on out-of-pocket expenses and reimbursement for medications to classify children as having zero, low (<20%), or high (≥20%) levels of cost-sharing. Main Outcome Measures We examined use of bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, and combination agents. Multiple linear and logistic regressions compared medication use between cost-sharing groups, controlling for age and sex. Results The annual number of asthma medication claims per child was significantly lower in the high cost-sharing group (6.6) compared with the zero (7.0) and low (7.2) cost-sharing groups (P<.001). Children in the high cost-sharing group were less likely to purchase bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists compared with the low cost-sharing group (odds ratio, 0.76; 95% confidence interval, 0.67–0.86) and were less likely to purchase dual agents compared with the low cost-sharing group (odds ratio, 0.70; 95% confidence interval, 0.66–0.75). Conclusion The cost-sharing level affected the use of asthma medication, with the highest cost-sharing group exhibiting significantly lower use of maintenance medications and newer dual agents. PMID:18250232

  1. Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

    PubMed

    Alenius, Malin; Graf, Peter

    2016-07-01

    Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process. PMID:27270628

  2. Improving Quality and Reducing Cost: Designs for Effective Learning.

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2003-01-01

    Discusses 30 institutions participating in a program exploring how large-enrollment introductory courses can be redesigned using technology to extend access to a new population of students without trading quality for cost savings. (EV)

  3. Guide for frozen food processors. Reducing energy costs means a better bottom line

    SciTech Connect

    Not Available

    1981-01-01

    Energy management questions in the food processing (freezing) industry are answered in this handbook. The handbook tells how to change equipment maintenance practices to save energy; what technology can help save energy costs; and how to make capital investments that provide significant returns on investment dollars. Specific energy-conserving measures discussed for the frozen foods industry are: reducing the cost of process energy; reducing lighting costs; and reducing heating costs. (MCW)

  4. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. PMID:25847647

  5. Value-based insurance design program in north Carolina increased medication adherence but was not cost neutral.

    PubMed

    Maciejewski, Matthew L; Wansink, Daryl; Lindquist, Jennifer H; Parker, John C; Farley, Joel F

    2014-02-01

    Value-based insurance design (VBID) has shown promise for improving medication adherence by lowering or eliminating patients' payments for some medications. Yet the business case for VBID remains unclear. VBID is based on the premise that higher medication and administrative expenses incurred by insurers will be offset by lower nonmedication expenditures that result from better disease control. This article examines Blue Cross Blue Shield of North Carolina's VBID program, which began in 2008. The program eliminated copayments for generic medications and reduced copays for brand-name medications. Patient adherence improved 2.7-3.4 percent during the two-year study period. Hospital admissions decreased modestly, but there were no significant changes in emergency department use or total health expenditures. The insurer incurred $6.4 million in higher medication expenditures; total nonmedication expenditures for the study population decreased $5.7 million. Our results provide limited support for the idea that VBID can be cost-neutral in specific subpopulations. The business case for VBID may be more compelling over the long term and in high risk subgroups for whose members cost is an important barrier to improved medication adherence. PMID:24493774

  6. Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China

    PubMed Central

    Wu, Jing; He, Xiaoning; Liu, Li; Ye, Wenyu; Montgomery, William; Xue, Haibo; McCombs, Jeffery S

    2015-01-01

    Objective Information concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China. Methods Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated. Results A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%). Conclusion The costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People’s Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential

  7. Centralized contracting an imperative for reducing health system costs.

    PubMed

    Baskel, Christopher

    2014-03-01

    As a health system expands, there is a concomitant need for its leaders to take steps to ensure that redundancies in purchasing processes do not drive up costs to unsustainable levels. Spectrum Health in Grand Rapids, Mich., tackled this challenge by instituting a revenue-driven, patient-care-focused value analysis process that centralized contracting processes in several areas of nonsalary expense. Spectrum went on to uncover opportunities for cutting costs in its decentralized, non-purchase order expenses, saving 24 percent in the first of four arenas. PMID:24701849

  8. Leasing strategies reduce the cost of financing healthcare equipment.

    PubMed

    Bayless, M E; Diltz, J D

    1985-10-01

    Prospective payment has increased the importance of controlling capital costs. One area where this may be possible is lease financing. Reasons commonly cited in favor of leasing may be of questionable validity, but, under an easily identified set of circumstances, lease financing can be cost effective. Recent developments in finance make it possible to not only evaluate the financial attractiveness of a given lease, but also to accurately predict bounds within which the terms of the lease must fall. Hospital administrators armed with this information should be able to negotiate more favorable lease terms under given tax and economic environments. PMID:10273774

  9. Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

    PubMed

    Goldfarb, Neil; Weston, Christine; Hartmann, Christine W; Sikirica, Mirko; Crawford, Albert; He, Hope; Howell, Jamie; Maio, Vittorio; Clarke, Janice; Nuthulaganti, Bhaskar; Cobb, Nicole

    2004-01-01

    This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health status and quality of life of individuals with chronic illnesses while reducing costs associated with utilization of emergency room, inpatient, and other medical services. A growing body of evidence also suggests that workers whose chronic conditions are effectively controlled with medications are more productive. For employers, the evidence translates into potential direct and indirect cost savings. The findings also confirm the importance of pharmaceutical management as a cornerstone of disease management. PMID:15035834

  10. Management Science/Industrial Engineering Techniques to Reduce Food Costs.

    ERIC Educational Resources Information Center

    Greenberg, Murray

    This paper examines the contributions of Industrial Engineering and Management Science toward reduction in the cost of production and distribution of food. Food processing firms were requested to respond to a questionnaire which asked for examples of their use of various operations research tools and information on the number of operations…

  11. 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Vedder, Richard; Gillen, Andrew; Bennett, Daniel; Denhart, Matthew; Robe, Jonathan; Holbrook, Todd; Neiger, Peter; Coleman, James; Templeton, Jordan; Leirer, Jonathan; Myers, Luke; Brady, Ryan; Malesick, Michael

    2010-01-01

    The Center for College Affordability and Productivity (CCAP) is an independent, nonprofit research center based in Washington, DC that is dedicated to researching public policy and economic issues relating to postsecondary education. CCAP aims to facilitate a broader dialogue that challenges conventional thinking about costs, efficiency and…

  12. Reducing High Absenteeism through Low-Cost Incentives.

    ERIC Educational Resources Information Center

    North Chaplik, Barbara D.; Engel, Ross A.

    1984-01-01

    Describes a study of the effects of a low-cost incentive program--including daily, weekly, and monthly reinforcements such as attention, approval, and inexpensive awards--on the absenteeism of high-absence employees in an urban school district's transportation department. A 20-percent reduction in absenteeism was achieved. (TE)

  13. Do Lower Prevailing Wages Reduce Public Construction Costs?

    ERIC Educational Resources Information Center

    Wial, Howard

    In 1997, the Pennsylvania Department of Labor and Industry implemented a change in its method of determining prevailing wage and benefit rates, resulting in a reduction in the legally required prevailing rates in many construction trades in much of the state. This report analyzes data to determine if this change in fact lowered the cost of public…

  14. EOS Operations Systems: EDOS Implemented Changes to Reduce Operations Costs

    NASA Technical Reports Server (NTRS)

    Cordier, Guy R.; Gomez-Rosa, Carlos; McLemore, Bruce D.

    2007-01-01

    The authors describe in this paper the progress achieved to-date with the reengineering of the Earth Observing System (EOS) Data and Operations System (EDOS), the experience gained in the process and the ensuing reduction of ground systems operations costs. The reengineering effort included a major methodology change, applying to an existing schedule driven system, a data-driven system approach.

  15. Target Context Specification Can Reduce Costs in Nonfocal Prospective Memory

    ERIC Educational Resources Information Center

    Lourenço, Joana S.; White, Katherine; Maylor, Elizabeth A.

    2013-01-01

    Performing a nonfocal prospective memory (PM) task results in a cost to ongoing task processing, but the precise nature of the monitoring processes involved remains unclear. We investigated whether target context specification (i.e., explicitly associating the PM target with a subset of ongoing stimuli) can trigger trial-by-trial changes in task…

  16. Reducing Building HVAC Costs with Site-Recovery Energy

    ERIC Educational Resources Information Center

    Pargeter, Stephen J.

    2012-01-01

    Building owners are caught between two powerful forces--the need to lower energy costs and the need to meet or exceed outdoor air ventilation regulations for occupant health and comfort. Large amounts of energy are wasted each day from commercial, institutional, and government building sites as heating, ventilation, and air conditioning (HVAC)…

  17. Direct medical cost of stroke: findings from a tertiary hospital in malaysia.

    PubMed

    Nor Azlin, M N; Syed Aljunid, S J; Noor Azahz, A; Amrizal, M N; Saperi, S

    2012-10-01

    This study aimed to estimate cost of in-patient medical care due to stroke in a tertiary hospital in Malaysia. A retrospective analysis of stroke patients admitted to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between January 2005 and December 2008 were conducted. Cost evaluation was undertaken from the health provider's perspective using a top-down costing approach. Mean length of stay (LOS) was 6.4 ± 3.1 days and mean cost of care per patient per admission was MYR 3,696.40 ± 1,842.17 or 16% of per capita GDP of the country. Human resources made up the highest cost component (MYR 1,343.90, SD: 669.8 or 36% of the total cost), followed by medications (MYR 867.30, SD:432.40) and laboratory services (MYR 337.90, SD:168.40). LOS and cost of care varied across different stroke severity levels (p<0.01). A regression analysis shown significant influence of stroke severity on cost of care, with the most severe stroke consumed MYR 1,598.10 higher cost than the mild stroke (p<0.001). Cost of medical care during hospital admission due to stroke is substantial. Health promotion and primary prevention activities need to take priority to minimise stroke admission in future. PMID:23770861

  18. Reducing costly zebra mussel infestations at power plants

    SciTech Connect

    Smythe, G.

    1994-10-01

    The fast-spreading-zebra mussel has significant potential to foul intakes and other water systems at North American hydro projects. Chemical controls can be effective in reducing infestations, but most have environmental and other drawbacks. Several non-chemical methods promise to help project operators reduce problems associated with the mussels.

  19. Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

    PubMed Central

    Alouki, Koffi; Delisle, Hélène; Besançon, Stéphane; Baldé, Naby; Sidibé-Traoré, Assa; Drabo, Joseph; Djrolo, François; Mbanya, Jean-Claude; Halimi, Serge

    2015-01-01

    AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularly patients with complications. METHODS: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin, Burkina Faso, Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines, published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications. RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes (in the public sector) would amount to 21%-34% of the country’s gross national income per capita, 26%-47% in the presence of retinopathy, and above 70% for nephropathy, the most expensive complication. CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction, it is innovative and of interest for several stakeholders. PMID:26617974

  20. Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Study objective We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Methods Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. Results There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Conclusion Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. PMID:20554078

  1. Excess Medical Care Costs Associated with Physical Inactivity among Korean Adults: Retrospective Cohort Study.

    PubMed

    Min, Jin-Young; Min, Kyoung-Bok

    2016-01-01

    Physical inactivity is a major risk factor for chronic diseases and premature death. The increased health risks associated with physical inactivity may also generate a heavier economic burden to society. We estimated the direct medical costs attributable to physical inactivity among adults using data from the 2002-2010 Korean National Health Insurance Service-National Sample Cohort. A total of 68,556 adults whose reported physical activity status did not change during the study period was included for this study. Propensity scores for inactive adults were used to match 23,645 inactive groups with 23,645 active groups who had similar propensity scores. We compared medical expenditures between the two groups using generalized linear models with a gamma distribution and a log link. Direct medical costs were based on the reimbursement records of all medical facilities from 2005 to 2010. The average total medical costs for inactive individuals were $1110.5, which was estimated to be 11.7% higher than the costs for physically active individuals. With respect to specific diseases, the medical costs of inactive people were significantly higher than those of active people, accounting for approximately 8.7% to 25.3% of the excess burden. Physical inactivity is associated with considerable medical care expenditures per capita among Korean adults. PMID:26797622

  2. Reducing Aversion to Side Effects in Preventive Medical Treatment Decisions

    ERIC Educational Resources Information Center

    Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen M.

    2007-01-01

    Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by…

  3. Direct medical cost of newly diagnosed stable coronary artery disease in Hong Kong

    PubMed Central

    Lee, Vivian W Y; Lam, Yat Yin; Yuen, Amy C M; Cheung, Shuk Yan; Yu, Cheuk-Man; Yan, Bryan P Y

    2013-01-01

    Background Stable coronary artery disease (CAD) affects approximately 7% of the population of Hong Kong and is associated with substantial healthcare costs. Objective We aimed to evaluate the first-year direct medical cost for a patient with newly diagnosed stable CAD at a tertiary care public hospital in Hong Kong and to identify CAD-related resource consumption pattern among different patient subgroups. Methods 89 consecutive patients with newly diagnosed stable CAD at our institution from January 2007 to December 2009 were retrospectively analysed. Direct medical costs including hospitalisation, clinic visits, diagnostic tests, laboratory tests, invasive procedures and medications were calculated for 1 year after diagnosis. Mann-Whitney tests were performed to compare median costs in patients with and without hypertension, diabetes mellitus and hyperlipidaemia, and in patients undergoing coronary intervention and those who were not. Results The mean first-year total direct medical cost of newly diagnosed stable CAD per patient was US$11 477. Hospitalisation was the dominant cost item accounting for 29.2% of the total cost. The total cost for patients who underwent invasive coronary procedure was higher than those treated medically alone (US$14 787 vs US$6121, p<0.001). Hyperlipidaemia was associated with higher incremental costs than hypertension and diabetes mellitus (p<0.001). (1US$=7.8HK$). Conclusions Huge healthcare expenses are incurred in the first year of stable CAD diagnosis from the perspective of the local public healthcare system. Healthcare costs are highest among patients with hyperlipidaemia and those undergoing invasive coronary procedures (even discounting costs for procedural consumables). Strategies for cost saving and preventive measures should be implemented to lower healthcare expenditure associated with CAD. PMID:27326062

  4. Utilization of UV Curing Technology to Significantly Reduce the Manufacturing Cost of LIB Electrodes

    SciTech Connect

    Voelker, Gary; Arnold, John

    2015-11-30

    Previously identified novel binders and associated UV curing technology have been shown to reduce the time required to apply and finish electrode coatings from tens of minutes to less than one second. This revolutionary approach can result in dramatic increases in process speeds, significantly reduced capital (a factor of 10 to 20) and operating costs, reduced energy requirements, and reduced environmental concerns and costs due to the virtual elimination of harmful volatile organic solvents and associated solvent dryers and recovery systems. The accumulated advantages of higher speed, lower capital and operating costs, reduced footprint, lack of VOC recovery, and reduced energy cost is a reduction of 90% in the manufacturing cost of cathodes. When commercialized, the resulting cost reduction in Lithium batteries will allow storage device manufacturers to expand their sales in the market and thereby accrue the energy savings of broader utilization of HEVs, PHEVs and EVs in the U.S., and a broad technology export market is also envisioned.

  5. Teaching Medical Students about Quality and Cost of Care at Case Western Reserve University.

    ERIC Educational Resources Information Center

    Headrick, Linda A.; And Others

    1992-01-01

    At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

  6. Residues recycling: Reducing costs and helping the environment

    NASA Astrophysics Data System (ADS)

    Venancio, Luis C. A.; Souza, José Antonio Silva; Macedo, Emanuel Negrão; Quaresma, João Nazareno N.; Paiva, Antonio Ernandes M.

    2010-09-01

    The aluminum production chain from bauxite to primary aluminum includes refining using the Bayer process, and smelting through electrolysis. This production chain produces two main solid residues, red mud at the refinery and spent pot lining at the smelter. The use of these residues as raw material for other industrial processes can save large amounts of energy, reduce the overall environmental impact, and even improve the emissions of other processes. This paper shows the results of ten years of co-processing of spent pot lining in the cement industry in Brazil and the efforts to develop technologies to reduce the reactivity and use the red mud as raw material for several different processes. This approach, although engineering intensive, can reduce C02 emissions and save huge amounts of wasted energy in transport and processing when compared with dedicated recycling or neutralizing processes.

  7. Laparoscopic gastric bypass results in decreased prescription medication costs within 6 months.

    PubMed

    Gould, Jon Charles; Garren, Michael Joseph; Starling, James Ralph

    2004-12-01

    The prevalence of obesity has reached epidemic proportions. The treatment of obesity-related health conditions is costly. Although laparoscopic gastric bypass is expensive, health care costs in obese patients should decrease with subsequent weight loss and overall improved health. Specifically, monthly prescription medication costs should decrease quickly after surgery. Fifty consecutive laparoscopic gastric bypass patients at a university-based bariatric surgery program were enrolled in the study. Medication consumption was prospectively recorded in a database. Patients' monthly prescription (not over-the-counter) medication costs before surgery and 6 months postoperatively were calculated. Retail costs were determined by a query to drugstore.com, an online pharmacy. Generic drugs were selected when appropriate. Costs for diabetic supplies and monitoring were not included in this analysis. Patients were mostly female (86%). Mean body mass index preoperatively was 51 kg/m2. Mean excess weight loss at 6 months was 52%. Patients took an average of 3.7 prescription medications before surgery compared with 1.7 after surgery (P < 0.05). All patients took nonprescription nutritional supplements, including multivitamins, oral vitamin B12, and calcium postoperatively. Laparoscopic gastric bypass resulted in a significant improvement in comorbid health conditions as early as 6 months after surgery. In an unselected group of patients, this led to a substantial overall mean monthly prescription medication cost savings, especially in those with gastroesophageal reflux disease, hypertension, diabetes, and hypercholesterolemia. PMID:15585385

  8. Interdisciplinary Coordination Reviews: A Process to Reduce Construction Costs.

    ERIC Educational Resources Information Center

    Fewell, Dennis A.

    1998-01-01

    Interdisciplinary Coordination design review is instrumental in detecting coordination errors and omissions in construction documents. Cleansing construction documents of interdisciplinary coordination errors reduces time extensions, the largest source of change orders, and limits exposure to liability claims. Improving the quality of design…

  9. The environmental cost of reducing agricultural fine particulate matter emissions

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The US Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) in 2006, reducing acceptable fine particulate (PM2.5) levels; state environmental protection agencies in states with non-attainment areas are required to draft State Implementation Plans (SIP) det...

  10. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D.

    PubMed

    Bradford, Ashley C; Bradford, W David

    2016-07-01

    Legalization of medical marijuana has been one of the most controversial areas of state policy change over the past twenty years. However, little is known about whether medical marijuana is being used clinically to any significant degree. Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D. PMID:27385238

  11. Constipation-related direct medical costs in 16 887 patients newly diagnosed with chronic constipation

    PubMed Central

    Dik, Vincent K.; Siersema, Peter D.; Joseph, Alain; Hodgkins, Paul; Smeets, Hugo M.

    2014-01-01

    Background Chronic constipation is a common condition, but the exact impact on healthcare budgets in Western Europe is poorly documented. Objectives The aim of this study was to (a) investigate chronic constipation-related direct medical costs in patients with newly diagnosed chronic constipation and (b) study differences in costs according to natural history. Patients and methods We identified 16 887 patients newly diagnosed with chronic constipation in a Dutch health insurance database (∼1.3 million patients) in 2006–2009. Individuals with chronic constipation were selected on the basis of chronic laxative use (≥90 days/year) and diagnostic related groups for chronic constipation. On the basis of the episodes of laxative use and diagnostic related groups, individuals were categorized as having persistent, episodic, and nonrecurrent disease. Unadjusted costs for laxatives and hospital care for chronic constipation and constipation-related comorbidities were assessed and compared between patients with nonrecurrent, episodic, and persistent disease. Factors associated with costs were identified using Cox regression analyses. Results The mean total chronic constipation-related direct medical costs in the first year after diagnosis were €310±845 and consisted of laxatives (45%) and hospital care for chronic constipation (26%) as well as constipation-related comorbidities (29%). Costs were highest in patients with persistent disease (€367±882) compared with patients with episodic (€292±808) and nonrecurrent (€263±613) disease (P<0.01). Male sex was associated with higher costs, whereas increasing age, diabetes, and use of opioids were associated with lower costs. Conclusion Pharmacy costs and hospital care costs for chronic constipation-related comorbidities were the largest cost drivers for total constipation-related direct medical costs in patients with newly diagnosed chronic constipation. Direct medical costs differed according to patient

  12. Activity cost analysis: a tool to cost medical services and improve quality of care.

    PubMed

    Udpa, S

    2001-01-01

    This paper suggests an activity-based cost (ABC) system as the appropriate cost accounting system to measure and control costs under the microstatistical episode of care (EOC) paradigm suggested by D. W. Emery (1999). ABC systems work well in such an environment because they focus on activities performed to provide services in the delivery of care. Thus, under an ABC system it is not only possible to accurately cost episodes of care but also to more effectively monitor and improve the quality of care. Under the ABC system, costs are first traced to activities and then traced from the activities to units of episodic care using cost drivers based on the consumption of activity resources. PMID:11556054

  13. Estimated Lifetime Medical and Work-Loss Costs of Fatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Simon, Thomas; Haegerich, Tamara; Luo, Feijun; Zhou, Chao

    2015-10-01

    Injury-associated deaths have substantial economic consequences. In 2013, unintentional injury was the fourth leading cause of death, suicide was the tenth, and homicide was the sixteenth; these three causes accounted for approximately 187,000 deaths in the United States. To assess the economic impact of fatal injuries, CDC analyzed death data from the National Vital Statistics System for 2013, along with cost of injury data using the Web-Based Injury Statistics Query and Reporting System. This report updates a previous study that analyzed death data from the year 2000, and employs recently revised methodology for determining the costs of injury outcomes, which uses the most current economic data and incorporates improvements for estimating medical costs associated with injury. Number of deaths, crude and age-specific death rates, and total lifetime work-loss costs and medical costs were calculated for fatal injuries by sex, age group, intent (intentional versus unintentional), and mechanism of injury. During 2013, the rate of fatal injury was 61.0 per 100,000 population, with combined medical and work-loss costs exceeding $214 billion. Costs from fatal injuries represent approximately one third of the total $671 billion medical and work-loss costs associated with all injuries in 2013. The magnitude of the economic burden associated with injury-associated deaths underscores the need for effective prevention. PMID:26421530

  14. Reducing The Operating Costs Of An Apartment Building

    NASA Astrophysics Data System (ADS)

    Takács, Ján; Rácz, Lukáš

    2015-09-01

    Circulation pumps are mechanical devices, which are used to create the overpressure required for the transportation of a heat-transfer medium in heating technology as well as in other related technologies. In a circulation pump the mechanical energy generated by the drive machine - an electric motor is transformed to hydraulic energy, which consists of kinetic and static energy. In the pipeline of a heating system circulation pumps represent a source of hydraulic energy (positive differential pressure), which is consumed to transport the heat-transfer medium. During the flow, the heat-transfer medium puts up resistance to the so-called passive resistors, which consist of pressure losses from friction in the pipes and pressure losses due to local resistance. In this article the authors analyze the effect of a circulation pump on the operating costs in an apartment building. Different types of circulating pumps, ranging from the most unfavorable to the optimal, were selected.

  15. Streamlining: Reducing costs and increasing STS operations effectiveness

    NASA Technical Reports Server (NTRS)

    Petersburg, R. K.

    1985-01-01

    The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

  16. Aircraft Geared Architecture Reduces Fuel Cost and Noise

    NASA Technical Reports Server (NTRS)

    2015-01-01

    In an effort to increase fuel efficiency and reduce noise in commercial airplanes, NASA aeronautics teamed up with East Hartford, Connecticut-based Pratt & Whitney through a Space Act Agreement to help the company increase the efficiency of its turbofan engine. The company's new PurePower line of engines is 15 percent more fuel-efficient and up to 75 percent quieter than its competitors.

  17. Placebo effect of medication cost in Parkinson disease

    PubMed Central

    Norris, Matthew M.; Eliassen, James C.; Dwivedi, Alok; Smith, Matthew S.; Banks, Christi; Allendorfer, Jane B.; Lang, Anthony E.; Fleck, David E.; Linke, Michael J.; Szaflarski, Jerzy P.

    2015-01-01

    Objective: To examine the effect of cost, a traditionally “inactive” trait of intervention, as contributor to the response to therapeutic interventions. Methods: We conducted a prospective double-blind study in 12 patients with moderate to severe Parkinson disease and motor fluctuations (mean age 62.4 ± 7.9 years; mean disease duration 11 ± 6 years) who were randomized to a “cheap” or “expensive” subcutaneous “novel injectable dopamine agonist” placebo (normal saline). Patients were crossed over to the alternate arm approximately 4 hours later. Blinded motor assessments in the “practically defined off” state, before and after each intervention, included the Unified Parkinson's Disease Rating Scale motor subscale, the Purdue Pegboard Test, and a tapping task. Measurements of brain activity were performed using a feedback-based visual-motor associative learning functional MRI task. Order effect was examined using stratified analysis. Results: Although both placebos improved motor function, benefit was greater when patients were randomized first to expensive placebo, with a magnitude halfway between that of cheap placebo and levodopa. Brain activation was greater upon first-given cheap but not upon first-given expensive placebo or by levodopa. Regardless of order of administration, only cheap placebo increased activation in the left lateral sensorimotor cortex and other regions. Conclusion: Expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa. Perceptions of cost are capable of altering the placebo response in clinical studies. Classification of evidence: This study provides Class III evidence that perception of cost is capable of influencing motor function and brain activation in Parkinson disease. PMID:25632091

  18. Cost outcomes of supplemental nurse staffing in a large medical center.

    PubMed

    Xue, Ying; Chappel, Andre R; Freund, Deborah A; Aiken, Linda H; Noyes, Katia

    2015-01-01

    Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses. PMID:25479239

  19. The Medical Cost Attributable to Obesity and Overweight in China: Estimation Based on Longitudinal Surveys.

    PubMed

    Qin, Xuezheng; Pan, Jay

    2016-10-01

    With its rapid economic growth and fast changing lifestyle, China witnessed expansionary prevalence of obesity and overweight during the recent decades. This paper provides the first nationally representative estimate of the medical cost attributable to obesity and overweight in China. We improve upon the traditional estimation methodology (two-part model) by jointly adopting the instrumental variable approach and the panel data methods in order to correct for the potential endogeneity of body size and the individual heterogeneity in medical expenditure. Using longitudinal data from 2000-2009 China Health and Nutrition Surveys, we find that body size has a significant impact on the individual expected medical expenditure and the per capita medical cost attributable to obesity and overweight in a single medical event is estimated to be 6.18 Yuan, or 5.29% of the total personal medical expenditure. This translates to 24.35 billion Yuan annual cost on the national scale, accounting for 2.46% of China's national health care expenditure. The subsample analyses also show that such cost is higher for the urban, women, and better educated people and increases over time. Our results contribute to the literature on the economic impact of obesity in developing countries and bear policy implications on controlling the rising health care costs in China. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26223895

  20. Nisin Production Utilizing Skimmed Milk Aiming to Reduce Process Cost

    NASA Astrophysics Data System (ADS)

    Jozala, Angela Faustino; de Andrade, Maura Sayuri; de Arauz, Luciana Juncioni; Pessoa, Adalberto; Penna, Thereza Christina Vessoni

    Nisin is a natural additive for conservation of food, pharmaceutical, and dental products and can be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. This study was performed to optimize large-scale nisin production in skimmed milk and subproducts aiming at low-costs process and stimulating its utilization. Lactococcus lactis American Type Culture Collection (ATCC) 11454 was developed in a rotary shaker (30°C/36 h/100 rpm) in diluted skimmed milk and nisin activity, growth parameters, and media components were also studied. Nisin activity in growth media was expressed in arbitrary units (AU/mL) and converted to standard nisin concentration (Nisaplin®, 25 mg of pure nisin is 1.0×106 AU/mL). Nisin activity in skimmed milk 2.27 gtotal solids was up to threefold higher than transfers in skimmed milk 4.54 gtotal solids and was up to 85-fold higher than transfers in skimmed milk 1.14 gtotal solids. L. lactis was assayed in a New Brunswick fermentor with 1.5 L of diluted skimmed milk (2.27 gtotal solids) and airflow of 1.5 mL/min (30°C/36/200 rpm), without pH control. In this condition nisin activity was observed after 4 h (45.07 AU/mL) and in the end of 36 h process (3312.07 AU/mL). This work shows the utilization of a low-cost growth medium (diluted skimmed milk) to nisin production with wide applications. Furthermore, milk subproducts (milk whey) can be exploited in nisin production, because in Brazil 50% of milk whey is disposed with no treatment in rivers and because of high organic matter concentrations it is considered an important pollutant. In this particular case an optimized production of an antimicrobial would be lined up with industrial disposal recycling.

  1. Fiber Optic Sensing Monitors Strain and Reduces Costs

    NASA Technical Reports Server (NTRS)

    2008-01-01

    In applications where stress on a structure may vary widely and have an unknown impact on integrity, a common engineering strategy has been overbuilding to ensure a sufficiently robust design. While this may be appropriate in applications where weight concerns are not paramount, space applications demand a bare minimum of mass, given astronomical per-pound launch costs. For decades, the preferred solution was the tactic of disassembly and investigation between flights. Knowing there must be a better way, Dr. Mark Froggatt, of Langley Research Center, explored alternate means of monitoring stresses and damage to the space shuttle. While a tear-it-apart-and-have-a-look strategy was effective, it was also a costly and time consuming process that risked further stresses through the very act of disassembly and reassembly. An alternate way of monitoring the condition of parts under the enormous stresses of space flight was needed. Froggatt and his colleagues at Langley built an early-warning device to provide detailed information about even minuscule cracks and deformations by etching a group of tiny lines, or grating, on a fiber optic cable five-thousandths of an inch thick with ultraviolet light. By then gluing the fiber to the side of a part, such as a fuel tank, and shining a laser beam down its length, reflected light indicated which gratings were under stress. Inferring this data from measurements in light rather than in bonded gauges saved additional weight. Various shuttle components now employ the ultrasonic dynamic vector stress sensor (UDVSS), allowing stress detection by measuring light beamed from a built-in mini-laser. By measuring changes in dynamic directional stress occurring in a material or structure, and including phase-locked loop, synchronous amplifier, and contact probe, the UDVSS proved especially useful among manufacturers of aerospace and automotive structures for stress testing and design evaluation. Engineers could ensure safety in airplanes

  2. Soil Segregation Methods for Reducing Transportation and Disposal Costs - 13544

    SciTech Connect

    Frothingham, David; Andrews, Shawn; Barker, Michelle; Boyle, James; Buechi, Stephen; Graham, Marc; Houston, Linda; Polek, Michael; Simmington, Robert; Spector, Harold; Elliott, Robert 'Dan'; Durham, Lisa

    2013-07-01

    At Formerly Utilized Sites Remedial Action Program (FUSRAP) sites where the selected alternative for contaminated soil is excavation and off-site disposal, the most significant budget items of the remedial action are the costs for transportation and disposal of soil at an off-site facility. At these sites, the objective is to excavate and dispose of only those soils that exceed derived concentration guideline levels. In situ soil segregation using gross gamma detectors to guide the excavation is often challenging at sites where the soil contamination is overlain by clean soil or where the contaminated soil is located in isolated, subsurface pockets. In addition, data gaps are often identified during the alternative evaluation and selection process, resulting in increased uncertainty in the extent of subsurface contamination. In response, the U.S. Army Corps of Engineers, Buffalo District is implementing ex situ soil segregation methods. At the remediated Painesville Site, soils were excavated and fed through a conveyor-belt system, which automatically segregated them into above- and below-cleanup criteria discharge piles utilizing gamma spectroscopy. At the Linde Site and the Shallow Land Disposal Area (SLDA) Site, which are both in the remediation phase, soils are initially segregated during the excavation process using gross gamma detectors and then transported to a pad for confirmatory manual surveying and sampling. At the Linde Site, the ex situ soils are analyzed on the basis of a site-specific method, to establish compliance with beneficial reuse criteria that were developed for the Linde remediation. At the SLDA Site, the ex situ soils are surveyed and sampled based on Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) final status survey guidance to demonstrate compliance with the derived concentration guideline levels. At all three sites, the ex situ soils that meet the site- specific DCGLs are retained on-site and used as backfill

  3. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    SciTech Connect

    Weinstein, Marvin; Auerbach, Assa; Chandra, V.Ravi; /Technion

    2011-11-04

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. The lattice of size N is partitioned into two subclusters. At each iteration the Lanczos vector is projected into a set of n{sub svd} smaller subcluster vectors using singular value decomposition. For low entanglement entropy S{sub ee}, (satisfied by short range Hamiltonians), we expect the truncation error to vanish as exp(-n{sup 1/S{sub ee}}{sub svd}). Convergence is tested for the Heisenberg model on Kagome clusters of up to 36 sites, with no symmetries exploited, using less than 15GB of memory. Generalization to multiple partitioning is discussed.

  4. A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Patients at Private Hospital in Western India

    PubMed Central

    Kumbar, Shivaprasad Kalakappa

    2015-01-01

    Background Pharmacoeconomics is analytical tool to know cost of hospitalization and its effect on health care system and society. In India, apart from the government health services, private sector also play big role to provide health care services. Objective To study the direct medical cost and cost of drug therapy in hospitalized patients at private hospital. Materials and Methods A retrospective study was conducted at private hospital in a metro city of Western India. Total 400 patients’ billing records were selected randomly for a period from 01/01/2013 to 31/12/2014. Data were collected from medical record of hospital with permission of medical director of hospital. Patients’ demographic profile age, sex, diagnosis and various costs like ICU charge, ventilator charge, diagnostic charge, etc. were noted in previously formed case record form. Data were analysed by Z, x2 and unpaired t-test. Result Patients were divided into less than 45 years and more than 45 year age group. They were divided into medical and surgical patients according to their admission in medical or surgical ward. Mortality, Intensive Care Unit (ICU) admission, patients on ventilator were significantly (p<0.05) higher in medical patients. Direct medical cost, ward bed charge, ICU bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients while operation theatre and procedural charge were significantly (p<0.05) higher in surgical patients. Cost of fibrinolytics, anticoagulants, cardiovascular drugs were significantly (p<0.05) higher in medical patients. Cost of antimicrobials, proton pump inhibitors (PPIs), antiemetics, analgesics, were significantly (p<0.05) higher in surgical patients. Conclusion Ward bed charge, ICU bed charge, ventilator charge accounted more than one third cost of direct medical cost in all the patients. Cost of drug therapy was one fourth of direct medical cost. Antimicrobials cost accounted 33% of cost

  5. Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

    PubMed Central

    Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

    2014-01-01

    Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

  6. Medical cost analysis: application to colorectal cancer data from the SEER Medicare database.

    PubMed

    Bang, Heejung

    2005-10-01

    Incompleteness is a key feature of most survival data. Numerous well established statistical methodologies and algorithms exist for analyzing life or failure time data. However, induced censorship invalidates the use of those standard analytic tools for some survival-type data such as medical costs. In this paper, some valid methods currently available for analyzing censored medical cost data are reviewed. Some cautionary findings under different assumptions are envisioned through application to medical costs from colorectal cancer patients. Cost analysis should be suitably planned and carefully interpreted under various meaningful scenarios even with judiciously selected statistical methods. This approach would be greatly helpful to policy makers who seek to prioritize health care expenditures and to assess the elements of resource use. PMID:16084777

  7. [The evaluation of costs: standards of medical care and clinical statistic groups].

    PubMed

    Semenov, V Iu; Samorodskaia, I V

    2014-01-01

    The article presents the comparative analysis of techniques of evaluation of costs of hospital treatment using medical economic standards of medical care and clinical statistical groups. The technique of evaluation of costs on the basis of clinical statistical groups was developed almost fifty years ago and is largely applied in a number of countries. Nowadays, in Russia the payment for completed case of treatment on the basis of medical economic standards is the main mode of payment for medical care in hospital. It is very conditionally a Russian analogue of world-wide prevalent system of diagnostic related groups. The tariffs for these cases of treatment as opposed to clinical statistical groups are counted on basis of standards of provision of medical care approved by Minzdrav of Russia. The information derived from generalization of cases of treatment of real patients is not applied. PMID:25799750

  8. A Summary of: 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Center for College Affordability and Productivity (NJ1), 2010

    2010-01-01

    Almost everyone agrees that colleges have become costly to attend and are a growing burden on society to finance. Rising tuition costs threaten the ability and desire of students to attend college. Are there things that can be done to significantly reduce the cost of college? The answer is an emphatic "yes." The Center for College Affordability…

  9. Sound Stabilizes Locomotor-Respiratory Coupling and Reduces Energy Cost

    PubMed Central

    Hoffmann, Charles P.; Torregrosa, Gérald; Bardy, Benoît G.

    2012-01-01

    A natural synchronization between locomotor and respiratory systems is known to exist for various species and various forms of locomotion. This Locomotor-Respiratory Coupling (LRC) is fundamental for the energy transfer between the two subsystems during long duration exercise and originates from mechanical and neurological interactions. Different methodologies have been used to compute LRC, giving rise to various and often diverging results in terms of synchronization, (de-)stabilization via information, and associated energy cost. In this article, the theory of nonlinear-coupled oscillators was adopted to characterize LRC, through the model of the sine circle map, and tested it in the context of cycling. Our specific focus was the sound-induced stabilization of LRC and its associated change in energy consumption. In our experimental study, participants were instructed during a cycling exercise to synchronize either their respiration or their pedaling rate with an external auditory stimulus whose rhythm corresponded to their individual preferential breathing or cycling frequencies. Results showed a significant reduction in energy expenditure with auditory stimulation, accompanied by a stabilization of LRC. The sound-induced effect was asymmetrical, with a better stabilizing influence of the metronome on the locomotor system than on the respiratory system. A modification of the respiratory frequency was indeed observed when participants cycled in synchrony with the tone, leading to a transition toward more stable frequency ratios as predicted by the sine circle map. In addition to the classical mechanical and neurological origins of LRC, here we demonstrated using the sine circle map model that information plays an important modulatory role of the synchronization, and has global energetic consequences. PMID:23028849

  10. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    NASA Astrophysics Data System (ADS)

    Weinstein, Marvin; Chandra, Ravi; Auerbach, Assa

    2012-02-01

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. In contrast to variational approaches and most implementations of DMRG, Lanczos rotations towards the ground state do not involve incremental minimizations, (e.g. sweeping procedures) which may get stuck in false local minima. The lattice of size N is partitioned into two subclusters. At each iteration the rotating Lanczos vector is compressed into two sets of nsvd small subcluster vectors using singular value decomposition. For low entanglement entropy See, (satisfied by short range Hamiltonians), the truncation error is bounded by (-nsvd^1/See). Convergence is tested for the Heisenberg model on Kagom'e clusters of 24, 30 and 36 sites, with no lattice symmetries exploited, using less than 15GB of dynamical memory. Generalization of the Lanczos-SVD algorithm to multiple partitioning is discussed, and comparisons to other techniques are given. Reference: arXiv:1105.0007

  11. Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital

    PubMed Central

    Choi, Jong Soo; Lee, Woo Baik

    2013-01-01

    Objectives Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric. PMID:24175119

  12. 43 CFR 429.26 - When may Reclamation reduce or waive costs or fees?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false When may Reclamation reduce or waive costs or fees? 429.26 Section 429.26 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF... reduce or waive costs or fees? (a) As determined appropriate and approved and documented by...

  13. 43 CFR 429.26 - When may Reclamation reduce or waive costs or fees?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false When may Reclamation reduce or waive costs or fees? 429.26 Section 429.26 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF... reduce or waive costs or fees? (a) As determined appropriate and approved and documented by...

  14. New molecular strategies for reducing implantable medical devices associated infections.

    PubMed

    Holban, Alina Maria; Gestal, Monica Cartelle; Grumezescu, Alexandru Mihai

    2014-01-01

    Due to the great prevalence of persistent and recurrent implanted device associated-infections novel and alternative therapeutic approaches are intensely investigated. For reducing complications and antibiotic resistance development, one major strategy is using natural or synthetic modulators for targeting microbial molecular pathways which are not related with cell multiplication and death, as Quorum Sensing, virulence and biofilm formation. The purpose of this review paper is to discuss the most recent in vitro approaches, investigating the efficiency of some novel antimicrobial products and the nano-technologic progress performed in order to increase their effect and stability. PMID:24606502

  15. Chronotherapy with conventional blood pressure medications improves management of hypertension and reduces cardiovascular and stroke risks.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Smolensky, Michael H; Fernández, José R; Mojón, Artemio; Portaluppi, Francesco

    2016-05-01

    Correlation between blood pressure (BP) and target organ damage, vascular risk and long-term patient prognosis is greater for measurements derived from around-the-clock ambulatory BP monitoring than in-clinic daytime ones. Numerous studies consistently substantiate the asleep BP mean is both an independent and a much better predictor of cardiovascular disease (CVD) risk than either the awake or 24 h means. Sleep-time hypertension is much more prevalent than suspected, not only in patients with sleep disorders, but also among those who are elderly or have type 2 diabetes, chronic kidney disease or resistant hypertension. Hence, cost-effective adequate control of sleep-time BP is of marked clinical relevance. Ingestion time, according to circadian rhythms, of hypertension medications of six different classes and their combinations significantly affects BP control, particularly sleep-time BP, and adverse effects. For example, because the high-amplitude circadian rhythm of the renin-angiotensin-aldosterone system activates during nighttime sleep, bedtime vs. morning ingestion of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers better reduces the asleep BP mean, with additional benefit, independent of medication terminal half-life, of converting the 24 h BP profile into more normal dipper patterning. The MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) study, first prospective randomized treatment-time investigation designed to test the worthiness of bedtime chronotherapy with ⩾1 conventional hypertension medications so as to specifically target attenuation of asleep BP, demonstrated, relative to conventional morning therapy, 61% reduction of total CVD events and 67% decrease of major CVD events, that is, CVD death, myocardial infarction, and ischemic and hemorrhagic stroke. The MAPEC study, along with other earlier conducted less refined trials, documents the asleep BP mean is the most significant

  16. Effects of reduced cost-sharing on children's health: Evidence from Japan.

    PubMed

    Takaku, Reo

    2016-02-01

    Although childhood health status is widely recognized as an important determinant for future achievement and health, there are few studies on the impact of patient cost-sharing on children's health. This paper investigates whether reduced cost-sharing leads to an improvement of health status among preschool and school-age children in Japan, exploiting regional disparities in expansions of municipality-level subsidy programs for out-of-pocket expenditure. With the eligibility for this subsidy program, known as the Medical Subsidy for Children and Infants (MSCI), the coinsurance rate generally decreases from 30% or 20% to zero for outpatient health care services and drug prescriptions. In order to uncover the impact of this program, I conducted an original survey of all municipalities in Japan to understand the time-series evolution of the eligible age for the MSCI in October 2013 (weighted response rate = 75%), and the probability of being eligible for the MSCI was then calculated by the age, prefecture of residence, and year. These probabilities were matched to children's health data from the Comprehensive Survey of Living Conditions from 1995 to 2010. The results show that eligibility for the MSCI improves subjective measures of health status among preschool children (n = 115,019). However, I find no such improvement among school-age children (n = 133,855). In addition, MSCI eligibility does not reduce hospitalization among either preschool or school-age children. Taken together, this study finds no discernible effects on health among school-age children, suggesting recent rapid expansions of the MSCI for this age group have not been associated with the improvement of health status. PMID:26773292

  17. Do family physicians know the costs of medical care? Survey in British Columbia.

    PubMed Central

    Allan, G. Michael; Innes, Grant D.

    2004-01-01

    OBJECTIVE: To determine the cost of 46 commonly used investigations and therapies and to assess British Columbia family doctors' awareness of these costs. DESIGN: Mailed survey asking about costs of 23 investigations and 23 therapies relevant to family practice. A random sample of 600 doctors was asked to report their awareness of costs and to estimate costs of the 46 items. SETTING: British Columbia. PARTICIPANTS: Six hundred family physicians. MAIN OUTCOME MEASURES: Estimates within 25% of actual cost were considered correct. Associations between cost awareness and respondents'characteristics (eg, sex, practice location) were sought. Degree of error in estimates was also assessed. RESULTS: Overall, 283 (47.2%) surveys were returned and 259 analyzed. Few respondents estimated costs within 25% of true cost, and estimates were highly variable. Physicians underestimated costs of expensive drugs and laboratory investigations and overestimated costs of inexpensive drugs. Cost awareness did not correlate with sex, practice location, College certification, faculty appointment, or years in practice. CONCLUSION: Family doctors in British Columbia have little awareness of the costs of medical care. PMID:15000338

  18. Cost-related Nonadherence by Medication Type among Medicare Part D Beneficiaries with Diabetes

    PubMed Central

    Williams, Jessica; Steers, W. Neil; Ettner, Susan L.; Mangione, Carol M.; Duru, O. Kenrik

    2013-01-01

    Background Despite the rollout of Medicare Part D, cost-related non-adherence (CRN) among older adults remains a problem. Objectives To examine the rate and correlates of self-reported CRN among a population of older persons with diabetes. Research Design Cross-sectional. Subjects 1,264 Part D patients with diabetes, who entered the coverage gap in 2006. Measures Initial administrative medication lists were verified in computer-assisted telephone interviews, in which participants brought their medication bottles to the phone. Medications were classified into cardiometabolic (diabetes, hypertension, cholesterol-lowering), symptom relief, and “other.” Participants were asked if they had any cost-related non-adherence during 2006, and if so to which medication/s. We used the person-medication dyad as the unit of analysis, and tested a multivariate random effects logistic regression model to analyze the correlates of CRN. Results Approximately 16% of participants reported any CRN. CRN was more frequent for cholesterol-lowering medications [Relative risk 1.54, 95%CI 1.01-2.32] compared to medications taken for symptom relief. CRN was reported less frequently with increasing age above 75 years, compared to patients between 65 and 69. In addition, compared to those with incomes >$40,000, CRN risk for those with incomes <$25,000 was markedly higher [RR 3.05, 95%CI 1.99-4.65]. Conclusions In summary, we found high rates of CRN among Medicare beneficiaries with diabetes, particularly those with lower incomes. We observed more frequent CRN for cholesterol-lowering medications as compared to medications for symptom relief. Efforts to ensure medication affordability for this population will be important in boosting adherence to key medications. PMID:23032359

  19. 76 FR 72003 - Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... BUDGET Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental, and cosmetic surgery services furnished by military treatment... outpatient medical, dental, and cosmetic surgery services rates referenced are effective upon publication...

  20. 78 FR 62709 - Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... BUDGET Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental and cosmetic surgery services furnished by military treatment... Outpatient Medical, Dental, and Cosmetic Surgery rates referenced are effective upon publication of...

  1. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in... reasonable cost basis for the direct medical and surgical services of its physicians in lieu of fee...

  2. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in... reasonable cost basis for the direct medical and surgical services of its physicians in lieu of fee...

  3. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... Election of reasonable cost payment for direct medical and surgical services of physicians in teaching... cost basis for the direct medical and surgical services of its physicians in lieu of fee...

  4. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in... reasonable cost basis for the direct medical and surgical services of its physicians in lieu of fee...

  5. Medical costs of treatment and survival of patients with acute myeloid leukemia in Belgium.

    PubMed

    Van de Velde, A L; Beutels, P; Smits, E L; Van Tendeloo, V F; Nijs, G; Anguille, S; Verlinden, A; Gadisseur, A P; Schroyens, W A; Dom, S; Cornille, I; Goossens, H; Berneman, Z N

    2016-07-01

    The advent of new cell-based immunotherapies for leukemia offers treatment possibilities for certain leukemia subgroups. The wider acceptability of these new technologies in clinical practice will depend on its impact on survival and costs. Due to the small patient groups who have received it, these aspects have remained understudied. This non-randomized single-center study evaluated medical costs and survival for acute myeloid leukemia between 2005 and 2010 in 50 patients: patients treated with induction and consolidation chemotherapy (ICT) alone; patients treated with ICT plus allogeneic hematopoietic stem cell transplantation (HCT), which is the current preferred post-remission therapy in patients with intermediate- and poor-risk AML with few co-morbidities, and patients treated with ICT plus immunotherapy using autologous dendritic cells (DC) engineered to express the Wilms' tumor protein (WT1). Total costs including post- consolidation costs on medical care at the hematology ward and outpatient clinic, pharmaceutical prescriptions, intensive care ward, laboratory tests and medical imaging were analyzed. Survival was markedly better in HCT and DC. HCT and DC were more costly than ICT. The median total costs for HCT and DC were similar. These results need to be confirmed to enable more thorough cost-effectiveness analyses, based on observations from multicenter, randomized clinical trials and preferably using quality-adjusted life-years as an outcome measure. PMID:27111858

  6. The process and costs of publishing medical journals in Sri Lanka: an economic evaluation

    PubMed Central

    Perera, Y S; Abeygunasekara, A M

    2011-01-01

    Objectives Medical journals have contributed to the advancement of medicine by helping to disseminate scientific knowledge and providing a forum for medical communities to debate issues in depth. To the authors' knowledge, there are no studies examining the process of medical journal publication in developing Asian countries. The authors analysed the process and costs of publishing medical journals in Sri Lanka, a developing country in South Asia. Methods Data were collected by interviewing the editors and perusing the records at the editorial offices of the respective medical journals. Articles published in 2009 (or 2008 for journals not published in 2009) were analysed by perusing the respective journals. Results A total of 44 medical journals were published in Sri Lanka's history, of which only 28 journals remained in publication after 2007. A majority (54%) of the journals published after 2007 were published once per year. Seventeen journals in publication after 2007 were published in paper version only, and 11 journals were also available online. The mean cost of printing one issue was Sri Lankan Rupees (LKR) 97 720 (US$888) (range LKR 28 000–270 000). The cost of distribution ranged from LKR 2000 to 140 000 (US$18–1273). The mean cost of publishing one article was LKR 6646 (US$60). A total of 456 articles were published in 2009 (/2008). The total number of pages published was 1723. Conclusion The infrastructure for medical journal publishing in Sri Lanka has many good qualities such as free access, minimum charges for authors and potential for online availability. The journals are solely academic (non-profit), but the costs remain high. PMID:22021741

  7. Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe

    PubMed Central

    Hatzold, Karin; Reed, Jason; Edgil, Dianna; Jaramillo, Juan; Castor, Delivette; Forsythe, Steven; Xaba, Sinokuthemba; Mugurungi, Owen

    2014-01-01

    Background Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. Methods and Findings We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. Conclusions VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established. PMID:24801515

  8. Imaging choices hold key for reduced cost and improved quality of care.

    PubMed

    Goodwin, Kevin; Hochman, Rodney

    2013-10-01

    Finance leaders should understand the drivers of cost and quality in their organizations, including how best to make cost-effective use of technologies. Ultrasound, in particular, can provide a means to improve quality of care and reduce costs because it can help a hospital avoid costly mistakes, can sometimes serve as a substitute for more expensive scans, and can help reduce the risk of extra days in the hospital. Optimum use of ultrasound can help to improve performance on measures that determine a hospital's eligibility to receive valued-based incentive payments. PMID:24244991

  9. Development of a fixed abrasive slicing technique (FAST) for reducing the cost of photovoltaic wafers

    SciTech Connect

    Schmid, F. )

    1991-12-01

    This report examines a wafer slicing technique developed by Crystal Systems, Inc. that reduces the cost of photovoltaic wafers. This fixed, abrasive slicing technique (FAST) uses a multiwire bladepack and a diamond-plated wirepack; water is the coolant. FAST is in the prototype production stage and reduces expendable material costs while retaining the advantages of a multiwire slurry technique. The cost analysis revealed that costs can be decreased by making more cuts per bladepack and slicing more wafers per linear inch. Researchers studied the degradation of bladepacks and increased wirepack life. 21 refs.

  10. An evaluation of welding processes to reduce hexavalent chromium exposures and reduce costs by using better welding techniques.

    PubMed

    Keane, Michael J

    2014-01-01

    A group of stainless steel arc welding processes was compared for emission rates of fume and hexavalent chromium, and costs per meter length of weld. The objective was to identify those with minimal emissions and also compare relative labor and consumables costs. The selection included flux-cored arc welding (FCAW), shielded-metal arc welding (SMAW), and multiple gas metal arc welding (GMAW) processes. Using a conical chamber, fumes were collected, and fume generation rates and hexavalent chromium (Cr(6+)) were measured. GMAW processes used were short-circuit (SC) and pulsed-spray modes. Flux-cored welding used gas shielding. Costs were estimated per meter of a 6.3-mm thick horizontal butt weld. Emission rates of Cr(6+) were lowest for GMAW processes and highest for SMAW; several GMAW processes had less than 2% of the SMAW generation rate. Labor and consumable costs for the processes studied were again highest for SMAW, with those of several GMAW types about half that cost. The results show that use of any of the GMAW processes (and flux-cored welding) could substantially reduce fume and Cr(6+) emissions, and greatly reduce costs relative to SMAW. PMID:25574138

  11. An Evaluation of Welding Processes to Reduce Hexavalent Chromium Exposures and Reduce Costs by Using Better Welding Techniques

    PubMed Central

    Keane, Michael J

    2014-01-01

    A group of stainless steel arc welding processes was compared for emission rates of fume and hexavalent chromium, and costs per meter length of weld. The objective was to identify those with minimal emissions and also compare relative labor and consumables costs. The selection included flux-cored arc welding (FCAW), shielded-metal arc welding (SMAW), and multiple gas metal arc welding (GMAW) processes. Using a conical chamber, fumes were collected, and fume generation rates and hexavalent chromium (Cr6+) were measured. GMAW processes used were short-circuit (SC) and pulsed-spray modes. Flux-cored welding used gas shielding. Costs were estimated per meter of a 6.3-mm thick horizontal butt weld. Emission rates of Cr6+ were lowest for GMAW processes and highest for SMAW; several GMAW processes had less than 2% of the SMAW generation rate. Labor and consumable costs for the processes studied were again highest for SMAW, with those of several GMAW types about half that cost. The results show that use of any of the GMAW processes (and flux-cored welding) could substantially reduce fume and Cr6+ emissions, and greatly reduce costs relative to SMAW. PMID:25574138

  12. The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States

    PubMed Central

    Magill, Michael K.; Ehrenberger, David; Scammon, Debra L.; Day, Julie; Allen, Tatiana; Reall, Andreu J.; Sides, Rhonda W.; Kim, Jaewhan

    2015-01-01

    PURPOSE As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. PMID:26371263

  13. Should We Offer Medication to Reduce Breast Cancer Risk?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    PubMed

    Burns, Risa B; Schonberg, Mara A; Tung, Nadine M; Libman, Howard

    2016-08-01

    In November 2013, the U.S. Preventive Services Task Force issued a guideline on medications for risk reduction of primary breast cancer in women. Although mammography can detect early cases, it cannot prevent development of breast cancer. Tamoxifen and raloxifene are selective estrogen receptor modulators that have been shown to reduce the risk for estrogen receptor-positive breast cancer and are approved by the U.S. Food and Drug Administration (FDA) for this indication. However, neither medication reduces the risk for estrogen receptor-negative breast cancer or all-cause mortality. The Task Force concluded that postmenopausal women with an estimated 5-year risk for breast cancer of 3% or greater will probably have more net benefit than harm and recommends that clinicians engage in shared, informed decision making about these medications. The American Society of Clinical Oncology issued a practice guideline on use of pharmacologic interventions for breast cancer in 2013. It recommends that women aged 35 years or older at increased risk, defined as a 5-year absolute risk for breast cancer of 1.66% or greater, discuss breast cancer prevention medications with their primary care practitioner. The Society includes the aromatase inhibitor exemestane in addition to tamoxifen and raloxifene as a breast cancer prevention medication, although exemestane is not FDA approved for this indication. Here, an oncologist and an internist discuss how they would balance these recommendations and what they would suggest for an individual patient. PMID:27479221

  14. Long-acting medications for the hyperkinetic disorders. A note on cost-effectiveness.

    PubMed

    Schlander, Michael

    2007-10-01

    New long-acting medications for attention-deficit/ hyperactivity disorder (ADHD) have become available, which combine certain advantages over conventional short-acting drugs with higher acquisition costs. Choices between these drugs should thus be driven by their clinical profiles and by an acceptable balance of increased costs and additional benefits. Accordingly, the notion of relative cost-effectiveness should be central to recommendations about the use of these drugs in practice. A recent technology assessment on behalf of the National Institute for Health and Clinical Excellence (NICE) did not identify differences between compounds in terms of clinical efficacy and described drug cost as the major driver of cost-effectiveness. The underlying economic model was restricted to a cost-utility analysis that used only a fraction of the available clinical evidence base and did not address the distinction between efficacy and effectiveness. Cost-effectiveness evaluations including the potential impact of improved treatment compliance indicate a relatively more attractive cost-effectiveness of long-acting medications than suggested by the NICE assessment. These evaluations provide health economic support to treatment recommendations recently published by the European Network for Hyperkinetic Disorders. Limitations of currently available economic evaluations include their short time horizon, and future research should assess treatment effects on long-term sequelae associated with ADHD. PMID:17401606

  15. The cost to successfully apply for level 3 medical home recognition

    PubMed Central

    Mottus, Kathleen; Reiter, Kristin; Mitchell, C. Madeline; Donahue, Katrina E.; Gabbard, Wilson M.; Gush, Kimberly

    2016-01-01

    BACKGROUND The NCQA Patient Centered Medical Home (PCMH) recognition program provides practices an opportunity to implement Medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. METHODS Practice coaches identified 5 exemplar practices that received level 3 recognition (3 pediatric and 2 family medicine practices). This analysis focuses on 4 that received 2011 recognition. Clinical, informatics and administrative staff participated in 2–3 hour interviews. We collected the time required to develop, implement and maintain required activities. We categorized costs as: 1) non-personnel, 2) developmental 3) those to implement activities 4) those to maintain activities, 5) those to document the work and 6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent provider (pFTE) RESULTS Practice size ranged from 2.5 – 10.5 pFTE’s, payer mixes from 7–43 % Medicaid. There was variation in the distribution of costs by activity by practice; but the costs to apply were remarkably similar ($11,453–$15,977 pFTE). CONCLUSION The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low value activities could benefit practices. PMID:26769879

  16. Application of the structured history taking of medication use tool to optimise prescribing for older patients and reduce adverse events.

    PubMed

    Cullinan, Shane; O'Mahony, Denis; Byrne, Stephen

    2016-04-01

    Background Older patients, due to polypharmacy, co-morbidities and often multiple prescribing doctors are particularly susceptible to medication history errors, leading to adverse drug events, patient harm and increased costs. Medication reconciliation at the point of admission to hospital can reduce medication discrepancies and adverse events. The Structured HIstory taking of Medication use (SHiM) tool was developed to provide a structure to the medication reconciliation process. There has been very little research with regards to SHiM, it's application to older patients and it's potential to reduce adverse events. Objective To determine whether application of SHiM could optimise older patients' prescriptions on admission to hospital, and in-turn reduce adverse events, compared to standard care. Setting A sub-study of a large clinical trial involving hospital inpatients over the age of 65 in five hospitals across Europe. Method A modified version of SHiM was used to obtain accurate drug histories for patients after the attending physician had obtained a medication list via standard methods. Discrepancies between the two lists were recorded and classified, and the clinical relevance of the discrepancies was determined. Whether discrepancies in patients' medication histories, as revealed by SHiM, resulted in actual clinical consequences was then investigated. As this study was carried out during the observation phase of the clinical trial, results were not communicated to the medical teams. Main outcome measure Discrepancies between medication lists and whether these resulted in clinical consequences. Results SHiM was applied to 123 patients. The mean age of the participants was 78 (±6). 200 discrepancies were identified. 90 patients (73 %) had at least one discrepancy with a median of 1.0 discrepancies per patient (IQR 0.00-2.25). 53 (26.5 %) were classified as 'unlikely to cause patient discomfort or clinical deterioration', 145 (72.5 %) as 'having potential

  17. Implementable strategies and exploratory considerations to reduce costs associated with anti-TNF therapy in inflammatory bowel disease.

    PubMed

    Park, K T; Crandall, Wallace V; Fridge, Jacqueline; Leibowitz, Ian H; Tsou, Marc; Dykes, Dana M H; Hoffenberg, Edward J; Kappelman, Michael D; Colletti, Richard B

    2014-05-01

    A health care system is needed where care is based on the best available evidence and is delivered reliably, efficiently, and less expensively (best care at lower cost). In gastroenterology, anti-tumor necrosis factor agents represent the most effective medical therapeutic option for patients with moderate-to-severe inflammatory bowel disease (IBD), but are very expensive and account for nearly a quarter of the cost of IBD care, representing a major area of present and future impact in direct health care costs. The ImproveCareNow Network, consisting of over 55 pediatric IBD centers, seeks ways to improve the value of care in IBD, curtailing unnecessary costs and promoting better health outcomes through systematic and incremental quality improvement initiatives. This report summarizes the key evidence to facilitate the cost-effective use of anti-tumor necrosis factor agents for patients with IBD. Our review outlines the scientific rationale for initiating cost-reducing measures in anti-tumor necrosis factor use and focuses on 3 implementable strategies and 4 exploratory considerations through practical clinical guidelines, as supported by existing evidence. Implementable strategies can be readily integrated into today's daily practice, whereas exploratory considerations can guide research to support future implementation. PMID:24451222

  18. Upgrade of Compressed Air Control System Reduces Energy Costs at Michelin Tire Plant

    SciTech Connect

    2002-01-01

    This case study highlights the upgraded compressed air system at a Michelin tire manufacturing plant in Spartanburg, South Carolina. The controls upgrade project enabled multiple compressor operation without blow-off, and significantly reduced energy costs.

  19. Steel: Reducing BOF Hood Scrubber Energy Costs at a Steel Mill (Technical Case Study)

    SciTech Connect

    Ericksen, E.

    1999-01-27

    This OIT Technical Case Study reveals how Bethlehem Steel Corporation, by installing a variable-frequency drive and making associated equipment modifications, was able to save energy, reduce operational costs, and decrease system maintenance.

  20. Integrated crop/livestock systems reduce late-fall livestock feeding costs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Feed costs during the late-fall and winter periods represent the greatest cost to cow-calf production in the northern Great Plains. Integration of crop and livestock enterprises may improve sustainability through synergisms among enterprises reducing waste and improving productivity, and providing b...

  1. Reducing Energy Cost and Greenhouse Gas Emission in the Corporate Sector, a Delphi Study

    ERIC Educational Resources Information Center

    Kramer, Maxim L.

    2013-01-01

    The study is titled "Reducing energy cost and GreenHouse Gas emission in the corporate sector, A Delphi Study". The study applied the Delphi methodology and focused on the Green IT solutions that can help the modern corporate organizations with less than 1000 employees to decrease their energy costs and GHG emissions. The study presents…

  2. Reducing Enzyme Costs Increases the Market Potential of Biofuels (Fact Sheet)

    SciTech Connect

    Not Available

    2013-08-01

    Cellulosic ethanol prices depend heavily on the cost of the cellulase enzymes used to break down the biomass into fermentable sugars. To reduce these costs, NREL partnered with two leading enzyme companies, Novozymes and Genencor, to engineer new cellulase enzymes that are exceptionally good at breaking down cellulose. Genencor is now part of DuPont Industrial Biosciences.

  3. Mixed-Mode Surveys: A Strategy to Reduce Costs and Enhance Response Rates

    ERIC Educational Resources Information Center

    Tobin, Daniel; Thomson, Joan; Radhakrishna, Rama; LaBorde, Luke

    2012-01-01

    Mixed-mode surveys present one opportunity for Extension to determine program outcomes at lower costs. In order to conduct a follow-up evaluation, we implemented a mixed-mode survey that relied on communication using the Web, postal mailings, and telephone calls. Using multiple modes conserved costs by reducing the number of postal mailings yet…

  4. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    ERIC Educational Resources Information Center

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  5. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payments to MA organizations for graduate medical education costs. 422.324 Section 422.324 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations §...

  6. The Impact of Living in Rural and Urban Areas: Vitamin D and Medical Costs in Veterans

    ERIC Educational Resources Information Center

    Bailey, Beth A.; Manning, Todd; Peiris, Alan N.

    2012-01-01

    Purpose: Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and…

  7. Opportunities for Reducing Total Maximum Daily Load (TMDL) compliance costs: lessons from the Chesapeake Bay.

    PubMed

    Wainger, Lisa A

    2012-09-01

    The Chesapeake Bay Total Maximum Daily Load (TMDL) program is an unprecedented opportunity to restore the Chesapeake Bay, yet program costs threaten to undermine its complete implementation. Analyses of Bay TMDL program design and implementation were used to relate program cost-effectiveness to choices in (1) compliance definitions, (2) geographic load allocations, and (3) approaches to engaging unregulated sources. A key finding was that many design choices require choosing an acceptable level of risk of achieving water quality outcomes, and a lack of data can lead to precautionary choices, which increase compliance costs. Furthermore, although some choices managed costs, others decisions may have reduced the potential for cost savings from water quality trading and payment programs. In particular, the choice by some states to distribute the portion of load reductions that improve water quality in the Bay mainstem to many small basins is likely to diminish the potential for market development or reduce funding for the most cost-effective nutrient and sediment reduction practices. Strategies for reducing costs of future TMDLs include considering diminishing marginal returns early in the TMDL design to balance costs and risks in regulatory goal setting and to design rules and incentives that promote innovation and cost-effective compliance strategies. PMID:22891870

  8. Production cost of a real microalgae production plant and strategies to reduce it.

    PubMed

    Acién, F G; Fernández, J M; Magán, J J; Molina, E

    2012-01-01

    The cost analysis of a real facility for the production of high value microalgae biomass is presented. The facility is based on ten 3 m3 tubular photobioreactors operated in continuous mode for 2 years, data of Scenedesmus almeriensis productivity but also of nutrients and power consumption from this facility being used. The yield of the facility was close to maximum expected for the location of Almería, the annual production capacity being 3.8 t/year (90 t/ha·year) and the photosynthetic efficiency being 3.6%. The production cost was 69 €/kg. Economic analysis shows that labor and depreciation are the major factors contributing to this cost. Simplification of the technology and scale-up to a production capacity of 200 t/year allows to reduce the production cost up to 12.6 €/kg. Moreover, to reduce the microalgae production cost to approaches the energy or commodities markets it is necessary to reduce the photobioreactor cost (by simplifying its design or materials used), use waste water and flue gases, and reduce the power consumption and labor required for the production step. It can be concluded that although it has been reported that production of biofuels from microalgae is relatively close to being economically feasible, data here reported demonstrated that to achieve it by using the current production technologies, it is necessary to substantially reduce their costs and to operate them near their optimum values. PMID:22361647

  9. Data Mining to Improve Management and Reduce Costs Associated With Environmental Remediation

    NASA Astrophysics Data System (ADS)

    Minsker, B. S.; Farrell, D. M.

    2004-12-01

    In this study, data from 105 soil and groundwater remediation projects at BP gas stations were mined for lessons to reduce cost and improve management of remediation sites. A data mining tool called D2K was used to train decision tree, stepwise linear regression and instance based weighting models that relate hydrogeologic, sociopolitical, temporal and remedial factors in the site closure reports to remediation cost. The most important factors influencing cost were found to be the amount of soil excavated and the number of wells installed, suggesting that better management of excavation and well placement could result in significant cost savings. The best model for predicting cost classes (low, medium, and high cost) was the decision tree which had a prediction accuracy of approximately 73%. The misclassification of approximately 27% of the sites in even the best model suggests that remediation costs at service stations are influenced by other site-specific factors that may be difficult to accurately predict in advance.

  10. Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs.

    PubMed

    Bhatt, Nikhilesh; Turakhia, Mintu; Fogarty, Thomas J

    2016-01-01

    In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year. Individuals with AF are three times more likely to be hospitalized over the span of a year when compared to medically matched control groups. The considerably large clinical population of individuals with AF mandates that the cost-effectiveness and efficacy of current treatment regimens for AF have egregious implications for health care spending and public health. Unfortunately, catheter ablation for AF treatment has been shown to make only modest gains in quality-adjusted life years, has yet to demonstrate cost-utility advantages over conventional therapies for AF, and has a reported rate of recurrence for AF that is notably high. Thus, there is a major unmet clinical need for a therapeutic option to treat AF that produces more consistent and efficacious results that are cost-effective. Cardiac radiosurgery as a therapy for AF has the potential to be remarkably cost-effective and produce robust patient outcomes. CyberHeart Inc. has developed the world's first-ever cardiac radiosurgery (CRS) system designed to ablate the heart non-invasively. Procedures that ablate the heart utilizing the Cyberheart CRS system are anticipated to allow higher efficacy and more consistent results than current techniques such as catheter ablation. The aim of this study is to present the current healthcare utilization and expenditures in AF treatment, report the cost-effectiveness of catheter ablation for AF, and project the potential cost-effectiveness of cardiac radiosurgery for the treatment of AF. PMID:27625906

  11. Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs

    PubMed Central

    Turakhia, Mintu; Fogarty, Thomas J.

    2016-01-01

    In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year. Individuals with AF are three times more likely to be hospitalized over the span of a year when compared to medically matched control groups. The considerably large clinical population of individuals with AF mandates that the cost-effectiveness and efficacy of current treatment regimens for AF have egregious implications for health care spending and public health. Unfortunately, catheter ablation for AF treatment has been shown to make only modest gains in quality-adjusted life years, has yet to demonstrate cost-utility advantages over conventional therapies for AF, and has a reported rate of recurrence for AF that is notably high. Thus, there is a major unmet clinical need for a therapeutic option to treat AF that produces more consistent and efficacious results that are cost-effective. Cardiac radiosurgery as a therapy for AF has the potential to be remarkably cost-effective and produce robust patient outcomes. CyberHeart Inc. has developed the world’s first-ever cardiac radiosurgery (CRS) system designed to ablate the heart non-invasively. Procedures that ablate the heart utilizing the Cyberheart CRS system are anticipated to allow higher efficacy and more consistent results than current techniques such as catheter ablation. The aim of this study is to present the current healthcare utilization and expenditures in AF treatment, report the cost-effectiveness of catheter ablation for AF, and project the potential cost-effectiveness of cardiac radiosurgery for the treatment of AF. PMID:27625906

  12. Methodological issues in assessing changes in costs pre- and post-medication switch: a schizophrenia study example

    PubMed Central

    Faries, Douglas E; Nyhuis, Allen W; Ascher-Svanum, Haya

    2009-01-01

    Background Schizophrenia is a severe, chronic, and costly illness that adversely impacts patients' lives and health care payer budgets. Cost comparisons of treatment regimens are, therefore, important to health care payers and researchers. Pre-Post analyses ("mirror-image"), where outcomes prior to a medication switch are compared to outcomes post-switch, are commonly used in such research. However, medication changes often occur during a costly crisis event. Patients may relapse, be hospitalized, have a medication change, and then spend a period of time with intense use of costly resources (post-medication switch). While many advantages and disadvantages of Pre-Post methodology have been discussed, issues regarding the attributability of costs incurred around the time of medication switching have not been fully investigated. Methods Medical resource use data, including medications and acute-care services (hospitalizations, partial hospitalizations, emergency department) were collected for patients with schizophrenia who switched antipsychotics (n = 105) during a 1-year randomized, naturalistic, antipsychotic cost-effectiveness schizophrenia trial. Within-patient changes in total costs per day were computed during the pre- and post-medication change periods. In addition to the standard Pre-Post analysis comparing costs pre- and post-medication change, we investigated the sensitivity of results to varying assumptions regarding the attributability of acute care service costs occurring just after a medication switch that were likely due to initial medication failure. Results Fifty-six percent of all costs incurred during the first week on the newly initiated antipsychotic were likely due to treatment failure with the previous antipsychotic. Standard analyses suggested an average increase in cost-per-day for each patient of $2.40 after switching medications. However, sensitivity analyses removing costs incurred post-switch that were potentially due to the failure of

  13. Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

    PubMed Central

    Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

    2014-01-01

    Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

  14. At what cost do we reduce pollution Shadow prices of SO[sub 2] emissions

    SciTech Connect

    Swinton, J.R. )

    1998-01-01

    The US EPA's infant market for SO[sub 2] emissions has the potential for improving the cost effectiveness of reducing acid rain pollutants. If the market works as planned, over time one should see the cost of reducing additional amounts of sulfur dioxide converge across plants. The results of the study described here demonstrate that before the market opened marginal abatement costs varied wildly across plants. This work provides estimates of the shadow price of SO[sub 2] abatement using the output distance function approach for Illinois, Minnesota and Wisconsin coal-burning electric plants. The results demonstrate that the coal-burning electric plants with the highest emissions rates are also the plants with the lowest marginal abatement costs, a fact that may explain lower-than-expected prices in the new market for allowances. The data include information about plants with installed scrubber capital allowing for an investigation of the effect of scrubber capital on marginal abatement costs.

  15. Making the case to improve quality and reduce costs in pediatric health care.

    PubMed

    Sachdeva, Ramesh C; Jain, Shabnam

    2009-08-01

    This article makes a case for the urgent need to improve health care quality and reduce costs. It provides an overview of the importance of the quality movement and the definition of quality, including the concept of clinical and operational quality. Some national drivers for quality improvement as well as drivers of escalating health care costs are discussed, along with the urgency of reducing health care costs. The link between quality and cost is reviewed using the concept of value in health care, which combines quality and cost in the same equation. The article ends with a discussion of future directions of the quality movement, including emerging concepts, such as risk-adjustment, shared responsibility for quality, measuring quality at the individual provider level, and evolving legal implications of the quality movement, as well as the concept of a shared savings model. PMID:19660624

  16. Assessing long-term health and cost outcomes of patient-centered medical homes serving adults with poor diabetes control.

    PubMed

    Pagán, José A; Carlson, Erin K

    2013-10-01

    The patient-centered medical home (PCMH) is an integrated primary care delivery model particularly suited for patients with poor diabetes control. Although PCMH models targeting adults with diabetes have shown some early success, little is known about the long-term benefits of medical homes in terms of health and cost outcomes. The performance of a PCMH model in adults with poor diabetes control was assessed using simulated controlled trial data obtained from the Archimedes model of disease progression and health care utilization. Using the Cardio-Metabolic Risk data set, we compared health and cost outcomes over a 20-year period between adults with poor diabetes control (HbA1c >9%) receiving standard care and these same adults receiving care under a PCMH model with a 49% HbA1c intervention improvement rate at a per-beneficiary per-month care management cost of $20 per month. The results suggest that the PCMH model has the potential to not only reduce the proportion of the population with bilateral blindness, foot amputations, and myocardial infarctions-and the mortality rate-but it can also do so in a cost-effective manner ($7898 per quality-adjusted life year). The PCMH model is cost saving for the population 50 to 64 years old and it is particularly cost-effective for men ($883 per quality-adjusted life year). Moreover, these effects are relatively large for adults 30 to 49 years old (lower bilateral blindness and death rates), women (lower foot amputation and death rates), and men (lower bilateral blindness and myocardial infarction rates). The PCMH model has potential long-term benefits to both patients with poor diabetes control as well as health care systems and providers willing to invest in this health care delivery approach. PMID:23799676

  17. A Flexible Two-Part Random Effects Model for Correlated Medical Costs

    PubMed Central

    Liu, Lei; Cowen, Mark E.; Strawderman, Robert L.; Shih, Ya-Chen T.

    2009-01-01

    In this paper, we propose a flexible “two-part” random Effects model (Olsen and Schafer 2001; Tooze, Grunwald, and Jones 2002) for correlated medical cost data. Typically, medical cost data are right-skewed, involve a substantial proportion of zero values, and may exhibit heteroscedasticity. In many cases, such data is also obtained in hierarchical form, e.g., on patients served by the same physician. The proposed model specification therefore consists of two generalized linear mixed models (GLMM), linked together by correlated random Effects. Respectively, and conditionally on the random Effects and covariates, we model the odds of cost being positive (Part I) using a GLMM with a logistic link and the mean cost (Part II) given that costs were actually incurred using a generalized gamma regression model with random Effects and a scale parameter that is allowed to depend on covariates (c.f. Manning, Basu, and Mullahy 2005). The class of generalized gamma distributions is very flexible and includes the lognormal, gamma, inverse gamma and Weibull distributions as special cases. We demonstrate how to carry out estimation using the Gaussian quadrature techniques conveniently implemented in SAS Proc NLMIXED. The proposed model is used to analyze pharmacy cost data on 56,245 adult patients clustered within 239 physicians in a mid-western U.S. managed care organization. PMID:20015560

  18. Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

    PubMed Central

    Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Aborigo, Raymond; Awine, Timothy; Azongo, Daniel Kweku; Asaana, Prosper; Atuguba, Frank; Oduro, Abraham

    2014-01-01

    Introduction The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households. Objective To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. Methods We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Results Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330). Conclusion Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost

  19. Measuring Time Costs in Interventions Designed to Reduce Behavior Problems Among Children and Youth

    PubMed Central

    Foster, E. Michael; Johnson‐Shelton, Deborah; Taylor, Ted K.

    2007-01-01

    The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist’s understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. We consider the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a prominent intervention in the field, the Incredible Years Program. We find that the time costs are potentially rather large and consider the implications for public policy of ignoring them. PMID:17592769

  20. Reducing the oxygen concentration of gases delivered from anaesthetic machines unadapted for medical air

    PubMed Central

    Clutton, R. E.; Schoeffmann, G.; Chesnil, M.; Gregson, R.; Reed, F.; Lawson, H.; Eddleston, M.

    2014-01-01

    High fractional concentrations of inspired oxygen (FiO2) delivered over prolonged periods produce characteristic histological changes in the lungs and airway of exposed animals. Modern medical anaesthetic machines are adapted to deliver medical air (FiO2=0.21) for the purpose of reducing FiO2; anaesthetic machines designed for the veterinary market have not been so adapted. Two inexpensive modifications that allow medical air to be added to the gas flow from veterinary anaesthetic machines are described. The advantages and disadvantages of each modification are discussed. PMID:21862470

  1. Updated forecasts of the costs of medical care for persons with AIDS, 1989-93.

    PubMed Central

    Hellinger, F J

    1990-01-01

    Data on the number of AIDS cases reported to the Centers for Disease Control (CDC) from January 1984 to June 1989 are used to predict the number of AIDS cases that will be diagnosed during the years 1989 through 1993. Using quadratic and linear models with the most recent data, it is projected that about 44,000 cases will be diagnosed in 1989, 56,000 in 1990, 70,000 in 1991, 87,000 in 1992, and 104,000 in 1993. These projections are lower than estimates derived using data from January 1984 to June 1988, and they are similar to estimates derived by the CDC. The lifetime medical care cost of treating a person with AIDS is estimated to be about $75,000 (all estimates are in 1988 dollars) assuming that the average length of survival is 15 months and that the intensity of care (that is, the cost of medical care per month) does not fall as longevity rises. This total, $75,000, reflects recent increases in the length of survival and the diffusion of costly drug therapies (for example, AZT and aerosol pentamidine). This study forecasts that the cumulative lifetime medical care costs of treating all people diagnosed with AIDS during a given year to be about $3.3 billion in 1989, $4.3 billion in 1990, $5.3 billion in 1991, $6.5 billion in 1992, and $7.8 billion in 1993. PMID:2106697

  2. Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations.

    PubMed

    van Boven, Job F M; Ryan, Dermot; Eakin, Michelle N; Canonica, Giorgio W; Barot, Aji; Foster, Juliet M

    2016-01-01

    Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits. PMID:27587317

  3. 3D-printing and the effect on medical costs: a new era?

    PubMed

    Choonara, Yahya E; du Toit, Lisa C; Kumar, Pradeep; Kondiah, Pierre P D; Pillay, Viness

    2016-01-01

    3D-printing (3DP) is the art and science of printing in a new dimension using 3D printers to transform 3D computer aided designs (CAD) into life-changing products. This includes the design of more effective and patient-friendly pharmaceutical products as well as bio-inspired medical devices. It is poised as the next technology revolution for the pharmaceutical and medical-device industries. After decorous implementation scientists in collaboration with CAD designers have produced innovative medical devices ranging from pharmaceutical tablets to surgical transplants of the human face and skull, spinal implants, prosthetics, human organs and other biomaterials. While 3DP may be cost-efficient, a limitation exists in the availability of 3D printable biomaterials for most applications. In addition, the loss of skilled labor in producing medical devices such as prosthetics and other devices may affect developing economies. This review objectively explores the potential growth and impact of 3DP costs in the medical industry. PMID:26817398

  4. Review of cost estimates for reducing CO2 emissions. Final report, Task 9

    SciTech Connect

    Not Available

    1990-10-01

    Since the ground breaking work of William Nordhaus in 1977, cost estimates for reducing CO{sub 2} emissions have been developed by numerous groups. The various studies have reported sometimes widely divergent cost estimates for reducing CO{sub 2} emissions. Some recent analyses have indicated that large reductions in CO{sub 2} emissions could be achieved at zero or negative costs (e.g. Rocky Mountain Institute 1989). In contrast, a recent study by Alan Manne of Stanford and Richard Richels of the Electric Power Research Institute (Manne-Richels 1989) concluded that in the US the total discounted costs of reducing CO{sub 2} emissions by 20 percent below the 1990 level could be as much as 3.6 trillion dollars over the period from 1990 to 2100. Costs of this order of magnitude would represent about 5 percent of US GNP. The purpose of this briefing paper is to summarize the different cost estimates for CO{sub 2} emission reduction and to identify the key issues and assumptions that underlie these cost estimates.

  5. Cost-effectiveness of reducing glycaemic episodes through community pharmacy management of patients with type 2 diabetes mellitus.

    PubMed

    Hendrie, Delia; Miller, Ted R; Woodman, Richard J; Hoti, Kreshnik; Hughes, Jeff

    2014-12-01

    Accessibility, availability and frequent public contact place community pharmacists in an ideal position to provide medically necessary, intensive health education and preventive health services to diabetes patients, thus reducing physician burden. We assessed the cost-effectiveness of reducing glycaemic episodes in patients with type 2 diabetes mellitus through a pharmacist-led Diabetes Management Education Program (DMEP) compared to standard care. We recruited eight metropolitan community pharmacies in Perth, Western Australia for the study. We paired them based on geographical location and the socioeconomic status of the population served, and then randomly selected one pharmacy in each pair to be in the intervention group, with the other assigned to the control group. We conducted an incremental cost-effectiveness analysis to compare the costs and effectiveness of DMEP with standard pharmacy care. Cost per patient of implementing DMEP was AU$394 (US$356) for the 6-month intervention period. Significantly greater reductions in number of hyperglycaemic and hypoglycaemic episodes occurred in the intervention relative to the control group [OR 0.34 (95 % CI 0.22, 0.52), p = 0.001; OR 0.54 (95 % CI 0.34, 0.86), p = 0.009], respectively, with a net reduction of 1.86 days with glycaemic episodes per patient per month. The cost-effectiveness of DMEP relative to standard pharmacy care was AU$43 (US$39) per day of glycaemic symptoms avoided. Patients with type 2 diabetes in three surveys were willing to pay an average of 1.9 times that amount to avoid a hypoglycaemic day. We conclude that DMEP decreased days with glycaemic symptoms at a reasonable cost. If a larger-scale replication study confirms these findings, widespread adoption of this approach would improve diabetes health without burdening general practitioners. PMID:25257687

  6. 76 FR 15349 - Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental and cosmetic surgery services furnished by military...

  7. Residential therapy. Hospitals take on finding housing for homeless patients, hoping to reduce readmissions, lower costs.

    PubMed

    Evans, Melanie

    2012-09-24

    As they grapple with containing the cost of caring for patients who frequently return to the ER or hospital for care, some hospitals are trying a new route: housing. In San Francisco, plans are under way to house 50 homeless patients. "Hospitalization is a failure of the medical system. It means that the condition has gotten so out of control that someone is at risk of life or limb," says Dr. Kelly Pfeifer, left, of the San Francisco Health Plan. PMID:23163192

  8. The relationship of antipsychotic medication class and adherence with treatment outcomes and costs for Florida Medicaid beneficiaries with schizophrenia.

    PubMed

    Becker, Marion A; Young, M Scott; Ochshorn, Ezra; Diamond, Ronald J

    2007-05-01

    While some studies show a significant advantage in adherence rates with use of atypical versus typical antipsychotic medication, others show no advantage or mixed results (Jones et al. (2006). Archives of General Psychiatry, 63, 1079-1087; Rosenheck, (2006). Archives of General Psychiatry, 63, 1074-1076). This study examined treatment outcomes and costs associated with adherence rates by antipsychotic medication class for adult Medicaid beneficiaries in Florida diagnosed with schizophrenia. Outcomes examined include arrests, involuntary commitments, and physical and behavioral healthcare costs. Study findings demonstrate that medication adherence for persons with schizophrenia may be as important to treatment costs and benefits as the class of medication used. PMID:17211716

  9. A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study

    PubMed Central

    Kandola, Manjinder Singh; Saldana, Fidencio; Kvedar, Joseph C

    2016-01-01

    Background Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. Objective The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Methods Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Results Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants

  10. Double robust estimator of average causal treatment effect for censored medical cost data.

    PubMed

    Wang, Xuan; Beste, Lauren A; Maier, Marissa M; Zhou, Xiao-Hua

    2016-08-15

    In observational studies, estimation of average causal treatment effect on a patient's response should adjust for confounders that are associated with both treatment exposure and response. In addition, the response, such as medical cost, may have incomplete follow-up. In this article, a double robust estimator is proposed for average causal treatment effect for right censored medical cost data. The estimator is double robust in the sense that it remains consistent when either the model for the treatment assignment or the regression model for the response is correctly specified. Double robust estimators increase the likelihood the results will represent a valid inference. Asymptotic normality is obtained for the proposed estimator, and an estimator for the asymptotic variance is also derived. Simulation studies show good finite sample performance of the proposed estimator and a real data analysis using the proposed method is provided as illustration. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26818601

  11. How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?

    PubMed Central

    Larson, Bruce; Tindikahwa, Allan; Mwidu, George; Kibuuka, Hannah; Magala, Fred

    2015-01-01

    Background The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015). Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites). The difference between such costs is the cost of improving access to VMMC. Methods A micro-costing approach was used to estimate costs from the service provider’s perspective of a circumcision. Supply chain and higher-level program support costs are not included. Results The average cost (US$2012) of resources used per circumcision was $61 in the mobile program ($72 for more remote locations) compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time. Conclusion The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment. PMID:25774677

  12. AB026. Excess medical cost in patients with asthma and the role of comorbidity

    PubMed Central

    Chen, Wenjia; Lynd, Larry D.; FitzGerald, J. Mark; Marra, Carlo A.; Balshaw, Robert; To, Teresa; Tavakoli, Hamid; Sadatsafavi, Mohsen

    2016-01-01

    Background Comorbid conditions are prevalent in asthma patients but its impact on the economic burden of asthma is not well understood. To estimate the excess direct medical costs in patients with asthma, accounting for both the costs attributable to asthma and to comorbidities. Methods We created a propensity-score matched cohort of individuals aged 5 to 55 years between 1997 and 2012 with incident asthma and a comparison group of individuals without asthma from the health administrative data of British Columbia (BC), Canada. Sixteen major disease categories were identified using the International Classification of Diseases (ICD) codes. Excess costs [in 2013 Canadian dollars, ($)] were defined as the adjusted difference in total costs between the two groups. Results There were 145,742 individuals in both asthma and comparison groups. Average excess costs were $1,186.5/person-year (95% CI: 1,130.4–1,242.6) overall, of which $145.2 (143.0–147.4) were attributable to asthma and $787.7 (95% CI: 743.7, 831.7) to major comorbidity classes. Psychological disorders were the largest component of excess comorbidity costs, followed by other respiratory diseases, digestive disorders and diseases of nervous system. Comorbidity-attributable excess costs greatly increased with age but did not increase over the 10-year course of asthma. Conclusions In the asthma group, the excess costs attributable to comorbidity are five-times higher than costs attributable to asthma, which aggregated over age. In evaluating options for asthma management, consideration of asthma-related costs alone may result in sub-optimal policies and clinical decisions.

  13. Notion of "virtual library" developing as medical schools cope with rising journal costs.

    PubMed Central

    Birenbaum, R

    1996-01-01

    The skyrocketing cost of medical and scientific journals has caused most Canadian universities to cut their subscription lists by an average of 20% over the last 3 years. Researchers say this causes delays in getting pertinent articles and journals and is an impediment to their work, but on the positive side the continuing decline in library holdings is stimulating libraries and researchers alike to use alternative strategies when seeking information, including computer databases, e-mail and the Internet. PMID:8612263

  14. Reducing the Cost of Energy from Parabolic Trough Solar Power Plants: Preprint

    SciTech Connect

    Price, H.; Kearney, D.

    2003-01-01

    Parabolic trough solar technology is the most proven and lowest cost large-scale solar power technology available today, primarily because of the nine large commercial-scale solar power plants that are operating in the California Mojave Desert. However, no new plants have been built during the past ten years because the cost of power from these plants is more expensive than power from conventional fossil fuel power plants. This paper reviews the current cost of energy and the potential for reducing the cost of energy from parabolic trough solar power plant technology based on the latest technological advancements and projected improvements from industry and sponsored R&D. The paper also looks at the impact of project financing and incentives on the cost of energy.

  15. Technology Needs for Reduced Design and Manufacturing Cost of Commercial Transport Engines

    NASA Technical Reports Server (NTRS)

    Rohn, Douglas A.

    1997-01-01

    The objective of the study was to assess the needs in the design and manufacturing processes and identify areas where technology could impact in cost and cycle-time reduction. At the highest level, the team first identified the goals that were in line with long-range needs of the aeropropulsion industry, and to which technology and process improvements would be required to contribute. These goals are to reduce the time and costs in the development cycle of aircraft engines by a factor of two, reduce production cycle time by a factor of four, and to reduce production costs by 25%. Also, it was the intent of the team to identify the highest impact technologies that could be developed and demonstrated in five years.

  16. Implementation of a Low-Cost Mobile Devices to Support Medical Diagnosis

    PubMed Central

    García Sánchez, Carlos; Botella Juan, Guillermo; Ayuso Márquez, Fermín; González Rodríguez, Diego; Prieto-Matías, Manuel; Tirado Fernández, Francisco

    2013-01-01

    Medical imaging has become an absolutely essential diagnostic tool for clinical practices; at present, pathologies can be detected with an earliness never before known. Its use has not only been relegated to the field of radiology but also, increasingly, to computer-based imaging processes prior to surgery. Motion analysis, in particular, plays an important role in analyzing activities or behaviors of live objects in medicine. This short paper presents several low-cost hardware implementation approaches for the new generation of tablets and/or smartphones for estimating motion compensation and segmentation in medical images. These systems have been optimized for breast cancer diagnosis using magnetic resonance imaging technology with several advantages over traditional X-ray mammography, for example, obtaining patient information during a short period. This paper also addresses the challenge of offering a medical tool that runs on widespread portable devices, both on tablets and/or smartphones to aid in patient diagnostics. PMID:24489600

  17. Diagnostics-while drilling: Reducing the cost of geothermal-produced electricity

    SciTech Connect

    PRAIRIE,MICHAEL R.; GLOWKA,DAVID A.

    2000-01-26

    The goal of this document is to estimate the potential impact of proposed new Diagnostics-While-Drilling technology on the cost of electricity (COE) produced with geothermal energy. A cost model that predicts the COE was developed and exercised over the range of conditions found for geothermal plants in flashed-steam, binary, and enhanced-reservoir (e.g., Hot Dry Rock) applications. The calculations were repeated assuming that DWD technology is available to reduce well costs and improve well productivity. The results indicate that DWD technology would reduce the geothermal COE by 2--31%, depending on well depth, well productivity, and the type of geothermal reservoir. For instance, for a typical 50-MW, flashed-steam geothermal power plant employing 3-MW wells, 6,000-ft deep, the model predicts an electricity cost of 4.9 cents/kwh. With the DWD technology envisioned, the electricity cost could be reduced by nearly 20%, to less than 4 cents/kwh. Such a reduction in the cost of electricity would give geothermal power a competitive edge over other types of power at many locations across the US and around the world. It is thus believed that DWD technology could significantly expand the role of geothermal energy in providing efficient, environment-friendly electric generating capacity.

  18. A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking

    PubMed Central

    Malcolm, Philippe; Derave, Wim; Galle, Samuel; De Clercq, Dirk

    2013-01-01

    Background Even though walking can be sustained for great distances, considerable energy is required for plantarflexion around the instant of opposite leg heel contact. Different groups attempted to reduce metabolic cost with exoskeletons but none could achieve a reduction beyond the level of walking without exoskeleton, possibly because there is no consensus on the optimal actuation timing. The main research question of our study was whether it is possible to obtain a higher reduction in metabolic cost by tuning the actuation timing. Methodology/Principal Findings We measured metabolic cost by means of respiratory gas analysis. Test subjects walked with a simple pneumatic exoskeleton that assists plantarflexion with different actuation timings. We found that the exoskeleton can reduce metabolic cost by 0.18±0.06 W kg−1 or 6±2% (standard error of the mean) (p = 0.019) below the cost of walking without exoskeleton if actuation starts just before opposite leg heel contact. Conclusions/Significance The optimum timing that we found concurs with the prediction from a mathematical model of walking. While the present exoskeleton was not ambulant, measurements of joint kinetics reveal that the required power could be recycled from knee extension deceleration work that occurs naturally during walking. This demonstrates that it is theoretically possible to build future ambulant exoskeletons that reduce metabolic cost, without power supply restrictions. PMID:23418524

  19. A medical cost estimation with fuzzy neural network of acute hepatitis patients in emergency room.

    PubMed

    Kuo, R J; Cheng, W C; Lien, W C; Yang, T J

    2015-10-01

    Taiwan is an area where chronic hepatitis is endemic. Liver cancer is so common that it has been ranked first among cancer mortality rates since the early 1980s in Taiwan. Besides, liver cirrhosis and chronic liver diseases are the sixth or seventh in the causes of death. Therefore, as shown by the active research on hepatitis, it is not only a health threat, but also a huge medical cost for the government. The estimated total number of hepatitis B carriers in the general population aged more than 20 years old is 3,067,307. Thus, a case record review was conducted from all patients with diagnosis of acute hepatitis admitted to the Emergency Department (ED) of a well-known teaching-oriented hospital in Taipei. The cost of medical resource utilization is defined as the total medical fee. In this study, a fuzzy neural network is employed to develop the cost forecasting model. A total of 110 patients met the inclusion criteria. The computational results indicate that the FNN model can provide more accurate forecasts than the support vector regression (SVR) or artificial neural network (ANN). In addition, unlike SVR and ANN, FNN can also provide fuzzy IF-THEN rules for interpretation. PMID:26153643

  20. Medical decision making for patients with Parkinson disease under Average Cost Criterion.

    PubMed

    Goulionis, John E; Vozikis, Athanassios

    2009-01-01

    Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels. PMID:19549341

  1. Reducing the energy penalty costs of postcombustion CCS systems with amine-storage.

    PubMed

    Patiño-Echeverri, Dalia; Hoppock, David C

    2012-01-17

    Carbon capture and storage (CCS) can significantly reduce the amount of CO(2) emitted from coal-fired power plants but its operation significantly reduces the plant's net electrical output and decreases profits, especially during times of high electricity prices. An amine-based CCS system can be modified adding amine-storage to allow postponing 92% of all its energy consumption to times of lower electricity prices, and in this way has the potential to effectively reduce the cost of CO(2) capture by reducing the costs of the forgone electricity sales. However adding amine-storage to a CCS system implies a significant capital cost that will be outweighed by the price-arbitrage revenue only if the difference between low and high electricity prices is substantial. In this paper we find a threshold for the variability in electricity prices that make the benefits from electricity price arbitrage outweigh the capital costs of amine-storage. We then look at wholesale electricity markets in the Eastern Interconnect of the United States to determine profitability of amine-storage systems in this region. Using hourly electricity price data from years 2007 and 2008 we find that amine storage may be cost-effective in areas with high price variability. PMID:22214538

  2. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013.

    PubMed

    Xie, Zhao; Burge, Russel; Yang, Yicheng; Du, Fen; Lu, Tie; Huang, Qiang; Ye, Wenyu; Xu, Weihua

    2015-01-01

    Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture. PMID:26221563

  3. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

    PubMed Central

    Xie, Zhao; Burge, Russel; Yang, Yicheng; Du, Fen; Lu, Tie; Huang, Qiang; Ye, Wenyu; Xu, Weihua

    2015-01-01

    Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture. PMID:26221563

  4. Micro-costing studies in the health and medical literature: protocol for a systematic review

    PubMed Central

    2014-01-01

    Background Micro-costing is a cost estimation method that allows for precise assessment of the economic costs of health interventions. It has been demonstrated to be particularly useful for estimating the costs of new interventions, for interventions with large variability across providers, and for estimating the true costs to the health system and to society. However, existing guidelines for economic evaluations do not provide sufficient detail of the methods and techniques to use when conducting micro-costing analyses. Therefore, the purpose of this study is to review the current literature on micro-costing studies of health and medical interventions, strategies, and programs to assess the variation in micro-costing methodology and the quality of existing studies. This will inform current practice in conducting and reporting micro-costing studies and lead to greater standardization in methodology in the future. Methods/Design We will perform a systematic review of the current literature on micro-costing studies of health and medical interventions, strategies, and programs. Using rigorously designed search strategies, we will search Ovid MEDLINE, EconLit, BIOSIS Previews, Embase, Scopus, and the National Health Service Economic Evaluation Database (NHS EED) to identify relevant English-language articles. These searches will be supplemented by a review of the references of relevant articles identified. Two members of the review team will independently extract detailed information on the design and characteristics of each included article using a standardized data collection form. A third reviewer will be consulted to resolve discrepancies. We will use checklists that have been developed for critical appraisal of health economics studies to evaluate the quality and potential risk of bias of included studies. Discussion This systematic review will provide useful information to help standardize the methods and techniques for conducting and reporting micro-costing

  5. Quality and Safety in Health Care, Part X: Other Technology to Reduce Medication Errors.

    PubMed

    Harolds, Jay A; Harolds, Laura B

    2016-05-01

    There are many devices, as well as computer programs, that have the potential to reduce medication errors. In the prior article, computer provider order entry linked to electronic clinical decision support was discussed. The current article discusses bar coding, automated dispensing cabinets, and smart intravenous infusion pumps. PMID:26914567

  6. 75 FR 18514 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-12

    ...The Food and Drug Administration (FDA) is announcing a public workshop entitled ``Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors.'' The purpose of the public workshop is to initiate constructive dialogue and information sharing among regulators, researchers, the pharmaceutical industry, health care organizations, health care professionals, and......

  7. Medical costs and lost productivity from health conditions at volatile organic compound-contaminated Superfund sites

    SciTech Connect

    Lybarger, J.A.; Spengler, R.F.; Brown, D.R.; Lee, R.; Vogt, D.P. |; Perhac, R.M. Jr. |

    1998-10-01

    This paper estimates the health costs at Superfund sites for conditions associated with volatile organic compounds (VOCs) in drinking water. Health conditions were identified from published literature and registry information as occurring at excess rates in VOC-exposed populations. These health conditions were: (1) some categories of birth defects, (2) urinary tract disorders, (3) diabetes, (4) eczema and skin conditions, (5) anemia, (6) speech and hearing impairments in children under 10 years of age, and (7) stroke. Excess rates were used to estimate the excess number of cases occurring among the total population living within one-half mile of 258 Superfund sites. These sites had evidence of completed human exposure pathways for VOCs in drinking water. For each type of medical condition, an individual`s expected medical costs, long-term care costs, and lost work time due to illness or premature mortality were estimated. Costs were calculated to be approximately $330 million per year, in the absence of any remediation or public health intervention programs. The results indicate the general magnitude of the economic burden associated with a limited number of contaminants at a portion of all Superfund sites, thus suggesting that the burden would be greater than that estimated in this study if all contaminants at all Superfund sites could be taken into account.

  8. Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa

    PubMed Central

    Bollinger, Lori; Adesina, Adebiyi; Forsythe, Steven; Godbole, Ramona; Reuben, Elan; Njeuhmeli, Emmanuel

    2014-01-01

    Background As voluntary medical male circumcision (VMMC) programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model. Methods and Findings We examined the main cost drivers (i.e., personnel and consumables) associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS) is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile. Conclusions The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease. PMID:24802593

  9. Baby Budgeting: Oocyte Cryopreservation in Women Delaying Reproduction Can Reduce Cost per Live Birth

    PubMed Central

    Devine, Kate; Mumford, Sunni L.; Goldman, Kara N.; Hodes-Wertz, Brooke; Druckenmiller, Sarah; Propst, Anthony M.; Noyes, Nicole

    2015-01-01

    Objective To determine whether oocyte cryopreservation (OC) for deferred reproduction is cost-effective per live birth using a model constructed from observed clinical practice. Design Decision-tree mathematical model with sensitivity analyses. Setting Not applicable. Patients A simulated cohort of women wishing to delay childbearing until age 40 years. Interventions Not applicable. Main Outcome Measure Cost per live birth. Results Our primary model predicted that OC at age 35 years by women planning to defer pregnancy attempts until age 40 would decrease cost per live birth to $39,946 (and increase odds of live birth to 62% by the end of the model),indicating OC to be a cost-effective strategy relative to forgoing OC, which was associated with a predicted cost per live birth of $55,060 (and 42% chance of live birth). If fresh autologous ART was added at age 40 prior to thawing oocytes, 74% obtained a live birth, though at an increased cost of $61,887. Separate sensitivity analyses demonstrated that OC remained cost-effective so long as patients underwent OC prior to age 38, more than 49% of those not obtaining a spontaneously conceived live birth returned to thaw oocytes, and likelihood of obtaining a spontaneously conceived live birth after six months’ attempts at age 40 was less than 35%. Conclusions In women who plan to delay childbearing until age 40, oocyte cryopreservation before 38 years of age reduces the cost to obtain a live birth. PMID:25813281

  10. Implementation and opportunity costs of reducing deforestation and forest degradation in Tanzania

    NASA Astrophysics Data System (ADS)

    Fisher, Brendan; Lewis, Simon L.; Burgess, Neil D.; Malimbwi, Rogers E.; Munishi, Panteleo K.; Swetnam, Ruth D.; Kerry Turner, R.; Willcock, Simon; Balmford, Andrew

    2011-06-01

    The Cancún Agreements provide strong backing for a REDD+ (Reducing Emissions from Deforestation and Forest Degradation) mechanism whereby developed countries pay developing ones for forest conservation. REDD+ has potential to simultaneously deliver cost-effective climate change mitigation and human development. However, most REDD+ analysis has used coarse-scale data, overlooked important opportunity costs to tropical forest users and failed to consider how to best invest funds to limit leakage, that is, merely displacing deforestation. Here we examine these issues for Tanzania, a REDD+ country, by comparing district-scale carbon losses from deforestation with the opportunity costs of carbon conservation. Opportunity costs are estimated as rents from both agriculture and charcoal production (the most important proximate causes of regional forest conversion). As an alternative we also calculate the implementation costs of alleviating the demand for forest conversion--thereby addressing the problem of leakage--by raising agricultural yields on existing cropland and increasing charcoal fuel-use efficiency. The implementation costs exceed the opportunity costs of carbon conservation (medians of US$6.50 versus US$3.90 per Mg CO2), so effective REDD+ policies may cost more than simpler estimates suggest. However, even if agricultural yields are doubled, implementation is possible at the competitive price of ~US$12 per Mg CO2.

  11. Improving viable low cost generic medication prescription rate in primary care pediatric practice

    PubMed Central

    Sudhanthar, Sathyanarayan; Turner, Jane; Thakur, Kripa; Sigal, Yakov

    2015-01-01

    The pediatric clinics of the Michigan State University College of Human Medicine (MSU-CHM) consist of academic pediatricians serving two clinics with a patient population of 5200. The internal quality measures published by the MSU health team had consistently indicated our generic medications prescription rate to be very low, with an average of about 21% for the years 2009, 2010, and 2011. There was an earnest need to increase our generic medication prescription rates, which is considered an indicator of good practice. The stakeholders identified were physicians, nurses, care managers, and the health information technology (HIT) team. The purpose of the project was to increase the prescribing rate of viable low cost and approved generic medications for the patients of the MSU-CHM general pediatric clinics. The stakeholders regularly met every few months to work on increasing the generic medication prescription rates based on the PDSA cycle. Help was sought from HIT to identify and acquire the top 10 brand names the group was prescribing along with individual provider data. The team reviewed the brand names most prescribed, and made a recommendation that the best group to target were the stimulant medications, allergy and asthma medications, and other psychotropics. The HIT team was then requested to add the available generics for all stimulant medications, asthma medications, and others in the electronic medical record (EMR). They were also clearly marked for ease of use, for example: amphetamine-dextroamphetamine extended release “generic for Adderall XR." It was decided that providers would prescribe all stimulants as a generic, unless not available, and nurses would change each brand name of stimulants to a generic every time they refilled a medicine, based on a protocol outlining the appropriate generic medications corresponding to the respective brand names. The physicians and nurses were also urged to discuss with the patients the substitution process and

  12. The Direct Medical Costs of Outpatient Cares of Type 2 Diabetes in Iran: A Retrospective Study

    PubMed Central

    Davari, Majid; Boroumand, Zahra; Amini, Masoud; Aslani, Abolfazl; Hosseini, Mohsen

    2016-01-01

    Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC) by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients’ profiles manually. The incidence of major diabetes complications were also examined from the subjects’ profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients’ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country. PMID:27217937

  13. Cost-effective means of reducing ammonia emissions from UK agriculture using the NARSES model

    NASA Astrophysics Data System (ADS)

    Webb, J.; Ryan, M.; Anthony, S. G.; Brewer, A.; Laws, J.; Aller, M. F.; Misselbrook, T. H.

    To comply with International agreements to improve air quality, signatory states need to reduce emissions of ammonia (NH 3). Since the majority of NH 3 emissions come from agriculture, measures may need to be implemented by the farming industry. Member states of the EU will, by 2010, require large pig and poultry production units to reduce NH 3 emissions to comply with the integrated pollution prevention and control directive (IPPC). The NARSES model uses a mass-flow method to estimate NH 3 emission from UK agriculture and to identify the most cost-effective means of reducing NH 3 emissions. Model runs were carried out to assess the likely impact of the IPPC Directive on UK NH 3 emissions and the sensitivity of model output to input data on the costs and abatement efficiencies of proposed abatement measures. The impact of the IPPC Directive is likely to be small, offering a reduction of c. 8700 t, 3.5% of total UK agricultural NH 3 emissions. Even large (30%) changes in our estimates of cost or changes of 10% in our estimates of abatement efficiency will make little difference to the ranking of abatement techniques according to cost-effectiveness. The most cost-effective reductions may be achieved by replacing urea fertilizer with ammonium nitrate, immediate incorporation of manures and slurries to tillage land by discs, storing all FYM and poultry manures before spreading to land and applying slurries to grassland by trailing shoe.

  14. Costs and efficacy of public health interventions to reduce aflatoxin–induced human disease

    PubMed Central

    Khlangwiset, Pornsri; Wu, Felicia

    2010-01-01

    This study reviews available information on the economics and efficacy of aflatoxin risk-reduction interventions, and provides an approach for analysis of the cost-effectiveness of public health interventions to reduce aflatoxin-induced human disease. Many strategies have been developed to reduce aflatoxin or its adverse effects in the body. However, a question that has been under-addressed is how likely these strategies will be adopted in the countries that need them most to improve public health. This study evaluates two aspects crucial to adoption of new technologies and methods: the costs and the efficacy of different strategies. First, we describe and categorize different aflatoxin risk-reduction strategies into preharvest, postharvest, dietary, and clinical settings. Then we compile and discuss relevant data on the costs and efficacy of each strategy, in reducing either aflatoxin in food or its metabolites in the body. In addition, we describe which crops are affected by each intervention, who is likely to pay for the control strategy, and who is likely to benefit. A framework is described for how to evaluate cost-effectiveness of strategies according to World Health Organization standards. Finally, we discuss which strategies are likely to be cost-effective and helpful under different conditions worldwide of regulations, local produce and soil ecology, and potential health emergencies. PMID:20419532

  15. Balancing the cost and value of medications: the dilemma facing clinicians.

    PubMed

    Avorn, Jerry

    2002-01-01

    In the current complex healthcare environment, considerations of medication efficacy, risk, cost, reimbursement, and regulation compete to influence the physician's clinical decision making in an atmosphere marked by curtailed physician autonomy, adversarial doctor-patient relationships, and conflict between clinical and managerial goals. Often, pharmaceutical expenditures are managed as if they exist in a universe separate from that occupied by all other aspects of patient care, even when a societally based cost-effectiveness analysis might favour more aggressive use of drug therapy for the long-term benefits it can generate. One response to these conflicting pressures is the creation of institutional resources to help reconcile the inevitable conflicts between such forces. At the author's institution, the Brigham and Women's Hospital, a new clinical Division of Pharmacoepidemiology and Pharmacoeconomics seeks to develop a reservoir of expertise to address the issue of appropriate medication use in a proactive way. Its goal is to help the hospital remain on the cutting edge of therapeutics while containing its drug budget within reasonable bounds. The programme consists of a system of ongoing formulary review, surveillance of current prescribing patterns, the production of educational monographs, a computer-based order entry system, a curriculum on cost effectiveness for interns, residents and medical students, and deployment of hospital-based 'detailers' to discuss problematical prescribing decisions with practitioners. The dissemination of such an approach in multiple sectors of the healthcare system could lead to greater sophistication by payers, prescribers, patients, and policy makers concerning how best to balance benefits, risks, and costs in pharmacotherapy. PMID:12457426

  16. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    SciTech Connect

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; Sanyal, Jibonananda; Starke, Michael R.

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype, we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.

  17. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    DOE PAGESBeta

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; Sanyal, Jibonananda; Starke, Michael R.

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype,more » we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.« less

  18. Coal flow aids reduce coke plant operating costs and improve production rates

    SciTech Connect

    Bedard, R.A.; Bradacs, D.J.; Kluck, R.W.; Roe, D.C.; Ventresca, B.P.

    2005-06-01

    Chemical coal flow aids can provide many benefits to coke plants, including improved production rates, reduced maintenance and lower cleaning costs. This article discusses the mechanisms by which coal flow aids function and analyzes several successful case histories. 2 refs., 10 figs., 1 tab.

  19. [Reduce Energy Costs While Maintaining Healthy IAQ.] "Indoor Air Quality Tools for Schools" Update #17

    ERIC Educational Resources Information Center

    US Environmental Protection Agency, 2009

    2009-01-01

    This issue of "Indoor Air Quality Tools for Schools" Update ("IAQ TfS" Update) contains the following items: (1) News and Events; (2) Feature Article: Reduce Energy Costs while Maintaining Healthy IAQ; (3) Insight into Excellence: North East Independent School District ; (4) School Building Week 2009; and (5) Have Your Questions Answered!

  20. Development of Advanced Technologies to Reduce Design, Fabrication and Construction Costs for Future Nuclear Power Plants

    SciTech Connect

    DiNunzio, Camillo A.; Gupta, Abhinav; Golay, Michael; Luk, Vincent; Turk, Rich; Morrow, Charles; Jin, Geum-Taek

    2002-11-30

    This report presents a summation of the third and final year of a three-year investigation into methods and technologies for substantially reducing the capital costs and total schedule for future nuclear plants. In addition, this is the final technical report for the three-year period of studies.

  1. Opportunity Analysis and Selection: 50 or More Ways To Reduce Costs. Mendip Papers.

    ERIC Educational Resources Information Center

    Kedney, Bob; Davies, Trefor

    This paper discusses activity analysis and the identification of options as the first two stages of a structured approach to achieving budget savings at postsecondary institutions, focusing on schools and practices in the United Kingdom. It presents five checklists of opportunities for reducing spending and controlling costs. The checklists cover:…

  2. Medical students' knowledge of indications for imaging modalities and cost analysis of incorrect requests, shiraz, iran 2011-2012.

    PubMed

    Islami Parkoohi, Parisa; Jalli, Reza; Danaei, Mina; Khajavian, Shiva; Askarian, Mehrdad

    2014-05-01

    Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion (fail to excellent) using Iranian academic grading (0 to 20). In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 (74%). The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled $104303 (public tariff) and $205581 (private tariff). Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns. PMID:24850988

  3. The role of technology in reducing health care costs. Phase II and phase III.

    SciTech Connect

    Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray; Tebo, Michael A.; Murphy, Martin D.; Hightower, Marion Michael; Gallagher, Linda K.; Craft, Richard Layne, II; Garcia, Rudy John

    2004-04-01

    In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care delivery costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.

  4. Merchant plant capital cost trades that can reduce the initial capital investment needed for APFBC repowering

    SciTech Connect

    Weinstein, R.E.; Freier, M.D.; Buchanan, T.L.; Goldstein, H.N.

    1999-07-01

    Earlier evaluations provided concept evaluation estimates of the performance and cost for repowering two power stations with advanced circulating pressurized fluidized bed combustion combined cycles (APFBC). Each APFBC repowering evaluation used a Foster Wheeler APFBC island supplying a single APFBC-modified Siemens Westinghouse Power Corporation W501F gas turbine, retaining the use of the existing station's steam turbine/generator. These evaluations found that there are significant opportunities from repowering these units. Unit energy efficiency improves dramatically, output from the site is increased, and very significant environmental emission improvements occur. The low production cost of such plants is excellent, and both power companies found their projected use of this type of plant would make these aging units flagships in baseload dispatch, among the first coal-fired units in the dispatch order. Since then, two additional repowering concept evaluations are underway, adding to the base of information on PPFBC repowering costs, and cost trades involved in the initial design of these units. This paper discusses completed work, and work in progress that evaluates merchant plant cost reduction opportunities compared to baseline regulated utility APFBC repowering designs. It shows how plant design might be changed to reduce capital cost with only slight losses in reliability and flexibility, but at no compromise in environmental quality. The paper gives estimates of the levels of cost reduction possible with these design changes, and discusses the design and economic implications to the plant owner of these initial design decisions.

  5. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

    PubMed Central

    Morton, A.; Anderson, G.; Van Der Meer, R. B.; Rymaszewski, L. A.

    2016-01-01

    Objectives “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings. Cite this article: P. J. Jenkins. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33–36. DOI: 10.1302/2046-3758.52.2000506 PMID:26851287

  6. An assessment of monitoring requirements and costs of 'Reduced Emissions from Deforestation and Degradation'

    PubMed Central

    Böttcher, Hannes; Eisbrenner, Katja; Fritz, Steffen; Kindermann, Georg; Kraxner, Florian; McCallum, Ian; Obersteiner, Michael

    2009-01-01

    Background Negotiations on a future climate policy framework addressing Reduced Emissions from Deforestation and Degradation (REDD) are ongoing. Regardless of how such a framework will be designed, many technical solutions of estimating forest cover and forest carbon stock change exist to support policy in monitoring and accounting. These technologies typically combine remotely sensed data with ground-based inventories. In this article we assess the costs of monitoring REDD based on available technologies and requirements associated with key elements of REDD policy. Results We find that the design of a REDD policy framework (and specifically its rules) can have a significant impact on monitoring costs. Costs may vary from 0.5 to 550 US$ per square kilometre depending on the required precision of carbon stock and area change detection. Moreover, they follow economies of scale, i.e. single country or project solutions will face relatively higher monitoring costs. Conclusion Although monitoring costs are relatively small compared to other cost items within a REDD system, they should be shared not only among countries but also among sectors, because an integrated monitoring system would have multiple benefits for non-REDD management. Overcoming initialization costs and unequal access to monitoring technologies is crucial for implementation of an integrated monitoring system, and demands for international cooperation. PMID:19709413

  7. SunShot solar power reduces costs and uncertainty in future low-carbon electricity systems.

    PubMed

    Mileva, Ana; Nelson, James H; Johnston, Josiah; Kammen, Daniel M

    2013-08-20

    The United States Department of Energy's SunShot Initiative has set cost-reduction targets of $1/watt for central-station solar technologies. We use SWITCH, a high-resolution electricity system planning model, to study the implications of achieving these targets for technology deployment and electricity costs in western North America, focusing on scenarios limiting carbon emissions to 80% below 1990 levels by 2050. We find that achieving the SunShot target for solar photovoltaics would allow this technology to provide more than a third of electric power in the region, displacing natural gas in the medium term and reducing the need for nuclear and carbon capture and sequestration (CCS) technologies, which face technological and cost uncertainties, by 2050. We demonstrate that a diverse portfolio of technological options can help integrate high levels of solar generation successfully and cost-effectively. The deployment of GW-scale storage plays a central role in facilitating solar deployment and the availability of flexible loads could increase the solar penetration level further. In the scenarios investigated, achieving the SunShot target can substantially mitigate the cost of implementing a carbon cap, decreasing power costs by up to 14% and saving up to $20 billion ($2010) annually by 2050 relative to scenarios with Reference solar costs. PMID:23865424

  8. Reduction of Medical Cost through Pharmaceutical Inquiries by Community Pharmacists and Relation with Iyaku Bungyo Rates: A Nationwide Survey on Prescription Inquiries.

    PubMed

    Shikamura, Yoshiaki; Mano, Yasunari; Komoda, Masayo; Negishi, Kenichi; Sato, Tsugumichi; Miyazaki, Satoru

    2016-01-01

    This nationwide survey aimed to evaluate reduction of drug and medical costs due to prevention of serious adverse drug reactions through pharmaceutical inquires by community pharmacist, and investigate relation with iyaku bungyo (separation of dispensing from medical practice) rates. Using the national list of pharmacies, 10% of pharmacies were randomly selected by prefecture and asked to participate in an Internet-based survey. The survey period was 7 days, from July 21 to July 27, 2015. Of the 5575 pharmacies queried, 818 responded to the survey (response rate: 14.7%). The proportion of inquiries to total prescriptions was 2.6%. Among these, the proportion of prescriptions changed in response to inquiry was 74.9%. An estimated 103 million yen was saved by reducing drug costs, and 133 million yen was saved by reducing medical costs due to prevention of serious adverse drug reactions. Comparison of prescription change rates between pharmacies with high and low iyaku bungyo rates indicated that the proportion of prescriptions changed was significantly higher in pharmacies with high iyaku bungyo rates than in those with low iyaku bungyo rates (78.2% vs. 69.9%, p<0.01). The findings suggest that inquiries about prescriptions are useful in ensuring the safety of pharmacotherapy and reducing the cost of healthcare. They also suggest that iyaku bungyo promotes prescription changes through inquiries, leading to proper use of pharmaceutical products. PMID:27592829

  9. Economic organization of medicine and the Committee on the Costs of Medical Care.

    PubMed Central

    Perkins, B B

    1998-01-01

    Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. PMID:9807547

  10. Application of the Discrimination Inference to Reduce Expected Cost Technique (DIRECT) to a Contaminant Transport Problem.

    NASA Astrophysics Data System (ADS)

    Bayley, T. W.; Ferré, T. P. A.

    2014-12-01

    There is growing recognition in the hydrologic community that deterministic hydrologic models are imperfect tools for decision support. Despite this insight, the state of practice for a hydrologic investigation follows this sequence: data collection, conceptual model development, numerical model development, and finally decision making based on model projections. This approach, based on relatively unconsidered design of data collection, may result in uninformative data. As a result, it is commonly repeated several times to resolve critical uncertainties. We present a novel two step multi-model approach to optimizing data collection to aid decision making, risk analysis. Here, we describe the application this approach (Discrimination Inference to Reduce Expected Cost Technique - DIRECT) for a contaminant transport problem. DIRECT has 7 steps. First, outcomes of concern were defined explicitly. Next a probabilistic analysis of the outcomes was conducted that incorporated multiple conceptual and parametric realizations. The likelihood of each model was assessed based on goodness of fit to existing data. A cost function was developed and used to define the projected costs based on the model-predicted outcomes of concern. Data collection was then optimized to identify the data that could test the models of greatest concern (cost) against the other models in the ensemble. Finally a field program was conducted that included gathering lithologic, hydrologic, and chemical data from 22 new wells that were drilled in projected high value locations. The additional data reduced the expected cost of model projections to an acceptable level for defining new site compliance conditions.

  11. Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement.

    PubMed

    Gortmaker, Steven L; Wang, Y Claire; Long, Michael W; Giles, Catherine M; Ward, Zachary J; Barrett, Jessica L; Kenney, Erica L; Sonneville, Kendrin R; Afzal, Amna Sadaf; Resch, Stephen C; Cradock, Angie L

    2015-11-01

    Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity. PMID:26526252

  12. Analysis of Potential Alternatives to Reduce NASA's Cost of Human Access to Space

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The purpose of this report is to analyze NASA's potential options for significantly reducing the cost of human access to space. The opinions expressed in this report are based on Hawthorne, Krauss & Associates' ("HKA") interaction with NASA and several of its key contractors over the past nine months. This report is not intended to be an exhaustive quantitative analysis of the various options available to NASA. Instead, its purpose is to outline key decision-related issues that the agency should consider prior to making a decision as to which option to pursue. This report attempts to bring a private-sector perspective to bear on the issue of reducing the cost of human access to space. HKA believes that the key to the NASA's success in reducing those costs over the long-term is the involvement of the private-sector incentives and disciplines--which is achieved only through the assumption of risk by the private sector, not through a traditional contractor relationship--is essential to achieve significant long-term cost reductions.

  13. The Effectiveness of Insurer-Supported Safety and Health Engineering Controls in Reducing Workers’ Compensation Claims and Costs

    PubMed Central

    Wurzelbacher, Steven J.; Bertke, Stephen J.; Lampl, Michael P.; Bushnell, P. Timothy; Meyers, Alysha R.; Robins, David C.; Al-Tarawneh, Ibraheem S.

    2015-01-01

    Background This study evaluated the effectiveness of a program in which a workers’ compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Methods Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. Results For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. Conclusions The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. PMID:25223846

  14. Cost benefit analysis of the radiological shielding of medical cyclotrons using a genetic algorithm

    NASA Astrophysics Data System (ADS)

    Mukherjee, Bhaskar

    2001-12-01

    Adequate radiation shielding is vital to the safe operation of modern commercial medical cyclotrons producing large yields of short-lived radioisotopes. The radiological shielding constitutes a significant capital investment for any new cyclotron-based radioisotope production facility; hence, the shielding design requires an accurate cost-benefit analysis often based on a complex multi-variant optimization technique. This paper demonstrates the application of a Genetic Algorithm (GA) for the optimum design of the high yield target cave of a Medical Cyclotron radioisotope production facility based in Sydney, Australia. The GA is a novel optimization technique that mimics the Darwinian Evolution paradigm and is ideally suited to search for global optima in a large multi-dimensional solution space.

  15. Installation, Operation, and Maintenance Strategies to Reduce the Cost of Offshore Wind Energy

    SciTech Connect

    Maples, B.; Saur, G.; Hand, M.; van de Pieterman, R.; Obdam, T.

    2013-07-01

    Currently, installation, operation, and maintenance (IO&M) costs contribute approximately 30% to the LCOE of offshore wind plants. To reduce LCOE while ensuring safety, this paper identifies principal cost drivers associated with IO&M and quantifies their impacts on LCOE. The paper identifies technology improvement opportunities and provides a basis for evaluating innovative engineering and scientific concepts developed subsequently to the study. Through the completion of a case study, an optimum IO&M strategy for a hypothetical offshore wind project is identified.

  16. Two ideas to increase innovation and reduce pharmaceutical costs and prices.

    PubMed

    Jayadev, Arjun; Stiglitz, Joseph

    2009-01-01

    The pharmaceutical industry is undergoing a period of uncertainty. Profits are being squeezed by increasing costs and competitive pressures, and new drug production is slowing down. This Perspective reviews two policies that could assist in realigning incentives toward genuine innovation while also keeping drug spending growth under check. Value-based pricing can incentivize genuinely new discoveries and align research and development with social welfare. Public funding of clinical trials likewise can reduce both pharmaceutical costs and prices and direct research effort in a manner that is more socially productive than the current state of affairs. PMID:19088104

  17. Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study

    PubMed Central

    Bonafede, Machaon; Chandran, Arthi; DiMario, Stefan; Saltiel-Berzin, Rita; Saliu, Drilon

    2016-01-01

    Objective The goal of this study was to describe medication usage patterns in patients with type 2 diabetes mellitus (T2DM) initiating treatment with non-insulin antidiabetic drugs (NIADs), basal insulin, or prandial/mixed insulin using real-world data. Research design and methods A retrospective analysis using the Truven Health MarketScan Research Databases was conducted to identify adults (≥18 years) with T2DM from 2006 to 2012. Patients were categorized into four cohorts based on diabetes treatment. Cohort 1 (n=597 664) consisted of newly diagnosed patients who did not receive any treatment, cohort 2 (n=342 511) included NIAD initiators, cohort 3 (n=99 578) included basal insulin initiators, and cohort 4 (n=62 876) included prandial/mixed insulin initiators. Patients transitioned out of a cohort once they met the criteria for the next one. Results Patients in cohort 2 were younger (56.2 years, SD±12.1) than patients in cohorts 1, 3, and 4 (58 years, SD±0.75). Metformin was the most commonly prescribed drug in cohort 2 patients. Basal insulin usage decreased from 71% in year 1 to 47% in year 4, in cohort 3 patients. Approximately one-third of these patients switched to prandial/mixed insulin each year. In cohort 4, the usage of prandial/mixed insulin decreased to 61% by year 4. Use of basal insulin and NIAD remained common in this group. Mean glycosylated hemoglobin (HbA1c) values decreased by ∼1% for each of the treatment cohorts following treatment initiation and remained stable during follow-up. All-cause and diabetes-related medical costs were highest for patients in cohorts 3 and 4. Conclusions Overall, our findings demonstrate that treatment intensification was low in all study cohorts despite elevated HbA1c levels during preindex and follow-up period. PMID:27547410

  18. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment.

    PubMed

    Bode, Nikolai W F; Miller, Jordan; O'Gorman, Rick; Codling, Edward A

    2015-01-01

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations. PMID:26541505

  19. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment

    NASA Astrophysics Data System (ADS)

    Bode, Nikolai W. F.; Miller, Jordan; O'Gorman, Rick; Codling, Edward A.

    2015-11-01

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations.

  20. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment

    PubMed Central

    Bode, Nikolai W. F.; Miller, Jordan; O’Gorman, Rick; Codling, Edward A.

    2015-01-01

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations. PMID:26541505

  1. Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs

    NASA Technical Reports Server (NTRS)

    Pettit, R. G.; Wang, J. J.; Toh, C.

    2000-01-01

    The continual need to reduce airframe cost and the emergence of high speed machining and other manufacturing technologies has brought about a renewed interest in large-scale integral structures for aircraft applications. Applications have been inhibited, however, because of the need to demonstrate damage tolerance, and by cost and manufacturing risks associated with the size and complexity of the parts. The Integral Airframe Structures (IAS) Program identified a feasible integrally stiffened fuselage concept and evaluated performance and manufacturing cost compared to conventional designs. An integral skin/stiffener concept was produced both by plate hog-out and near-net extrusion. Alloys evaluated included 7050-T7451 plate, 7050-T74511 extrusion, 6013-T6511 extrusion, and 7475-T7351 plate. Mechanical properties, structural details, and joint performance were evaluated as well as repair, static compression, and two-bay crack residual strength panels. Crack turning behavior was characterized through panel tests and improved methods for predicting crack turning were developed. Manufacturing cost was evaluated using COSTRAN. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current technology baseline.

  2. Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding?

    PubMed Central

    Breijer, M. C.; van Hanegem, N.; Visser, N. C. M.; Verheijen, R. H. M.; Mol, B. W. J.; Pijnenborg, J. M. A.; Opmeer, B. C.; Timmermans, A.

    2015-01-01

    Objective. To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Design, Setting, and Population. Model based cost-minimization analysis. Methods. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Main Outcome Measures. Costs for the different strategies. Results. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved. Conclusions. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up. PMID:25785283

  3. Changing the Graduate Medical Education Funding Path to Reduce the Price of Health Care Services.

    PubMed

    Martin, Ralph A

    2015-01-01

    An analysis of the current Graduate Medical Education (GME) funding stream reveals undesired aspects that limit the number of graduates and may tend to raise the price of health care services. The author shows that a different model of GME funding changes the economic dynamics and takes advantage of economic forces to increase the supply of graduates, while potentially reducing the price of health care services. PMID:26731880

  4. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care

    PubMed Central

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-01-01

    Abstract Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205) PMID:26348492

  5. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care.

    PubMed

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Mohlman, Mary Kate; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-06-01

    Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by -$482 relative to the comparison (95% CI, -$573 to -$391; P < .001). The lower costs were driven primarily by inpatient (-$218; P < .001) and outpatient hospital expenditures (-$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196-205). PMID:26348492

  6. The cost-effectiveness of shopping to a predetermined grocery list to reduce overweight and obesity

    PubMed Central

    Au, N; Marsden, G; Mortimer, D; Lorgelly, P K

    2013-01-01

    Background: Pre-commitment strategies can encourage participants to commit to a healthy food plan and have been suggested as a potential strategy for weight loss. However, it is unclear whether such strategies are cost-effective. Objective: To analyse whether pre-commitment interventions that facilitate healthier diets are a cost-effective approach to tackle obesity. Methods: Effectiveness evidence was obtained from a systematic review of the literature. For interventions demonstrating a clinically significant change in weight, a Markov model was employed to simulate the long-term health and economic consequences. The review supported modelling just one intervention: grocery shopping to a predetermined list combined with standard behavioural therapy (SBT). SBT alone and do nothing were used as comparators. The target population was overweight or obese adult women. A lifetime horizon for health effects (expressed as quality-adjusted life years (QALYs)) and costs from the perspective of the UK health sector were used to calculate incremental cost-effectiveness ratios (ICERs). Results: In the base case analysis, the pre-commitment strategy of shopping to a list was found to be more effective and cost saving when compared against SBT, and cost-effective when compared against ‘do nothing' (ICER=£166 per QALY gained). A sensitivity analysis indicated that shopping to a list remained dominant or cost-effective under various scenarios. Conclusion: Our findings suggest grocery shopping to a predetermined list combined with SBT is a cost-effective means for reducing obesity and its related health conditions. PMID:23797384

  7. Medical costs and adherence in patients receiving aqueous versus pressurized aerosol formulations of intranasal corticosteroids.

    PubMed

    Hankin, Cheryl S; Cox, Linda; Lang, David; Bronstone, Amy; Wang, Zhaohui; Lepore, Mark S; Buck, Philip O

    2012-01-01

    Intranasal corticosteroid (INS) formulations have different sensory attributes that influence patient preferences, and thereby possibly adherence and health outcomes. This study compares health care use and costs and medication adherence in matched cohorts of patients with allergic rhinitis (AR) using a chlorofluorocarbon-propelled pressurized metered-dose inhaler (pMDI) or aqueous intranasal corticosteroid (A-INS). Florida Medicaid retrospective claims analysis was performed of enrollees aged ≥12 years with at least 1 year of continuous enrollment before their initial AR diagnosis, 1 year for continuous enrollment before their index INS claim, and 18 months of continuous enrollment after their index INS claim during which they received either pMDI or A-INS. pMDI and A-INS patients were matched 1:2 using propensity scores. Nonparametric analyses compared outcomes between matched cohorts at 6, 12, and 18 months of follow-up. A total of 585 patients were matched (pMDI = 195, A-INS = 390). pMDI patients were more adherent to INS, as reflected in their higher median medication possession ratio (53.2% versus 32.7%; p < 0.0001) and fewer median days between fills (73 days versus 111 days; p = 0.0003). Significantly lower median per patient pharmacy fills (34.0 versus 50.5; p < 0.05) and costs ($1282 versus $2178; p < 0.01) were observed among pMDI patients versus A-INS patients 18 months after INS initiation and were maintained when analyses excluded INS fills. Adherence to INS and health care utilization and costs following INS initiation for AR differed by type of formulation received. Our findings suggest patient preferences for INS sensory attributes can drive adherence and affect disease control, and ultimately impact health care costs. PMID:22737709

  8. Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples

    PubMed Central

    Gao, Lan; Hu, Hao; Zhao, Fei-Li; Li, Shu-Chuen

    2016-01-01

    Objectives To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries. Methods A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted). Results In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP. Conclusions Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data. PMID:26814959

  9. Teleconferencing: Cost optimization of satellite and ground systems for continuing progressional education and medical services

    NASA Technical Reports Server (NTRS)

    Dunn, D.; Lusignan, B.

    1972-01-01

    A set of analytical capabilities that are needed to assess the role satellite communications technology will play in public and other services was developed. It is user oriented in that it starts from descriptions of user demand and develops the ability to estimate the cost of satisfying that demand with the lowest cost communications system. To ensure that the analysis could cope with the complexities of the real users, two services were chosen as examples, continuing professional education and medical services. Telecommunications costs are effected greatly by demographic factors, involving distribution of users in urban areas and distances between towns in rural regions. For this reason the analytical tools were exercised on sample locations. San Jose, California and Denver, Colorado were used to represent an urban area and the Rocky Mountain states were used to represent a rural region. In assessing the range of satellite system costs, two example coverage areas were considered, one appropriate to cover the contiguous forty-eight states, a second appropriate to cover about one-third that area.

  10. Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

    NASA Astrophysics Data System (ADS)

    Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

    Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

  11. [Medications and financing of health systems in Third World countries. Cost recovery: a concept to review].

    PubMed

    Velasquez, G

    1989-01-01

    During the 1960s most African countries declared that health care would be free in their newly independent countries. Unfortunately, the health care systems inherited from colonial days were hospital based and emphasized curative rather than preventive care, and were too expensive for most countries to maintain. As the quality and availability of health services have deteriorated, the concept of free care has been questioned. At the same time, the number of countries involved in programs of structural adjustment imposed by the International Monetary Fund has grown steadily since the early 1980s, and some countries have drastically restricted public expenditures for health care. IN the search for new sources of financing, the concept of recovery of costs has become prominent. Various attempts have been made to "recover costs" even before the costs have been assessed. Financing of health care by governments, besides being insufficient, has impeded analysis of health care costs in most African countries. The World Bank proposes that the price of each medical product or service should be equal to the cost of providing it. UNICEF proposals stress the need to rationalize expenses and to defend vulnerable population groups during application of adjustment measures. The World Health Organization approach is geared toward attaining the objective of health for all by the year 2000. The basic question is still how to finance quality health care with reasonable participation of users without impeding access of the population to needed health services. An objective of 100% cost recovery will seriously compromise access for the large number of persons without purchasing power to pay the real price of health care. The term "recovery of costs" is inappropriate; the problem is to achieve a balance between participation of the population and government resources for the health system. Health services are not completely self-financing in any developed country and it appears

  12. 75 FR 24754 - Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... BUDGET Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third Persons AGENCY: Office... inpatient medical services furnished by military treatment facilities through the Department of Defense...

  13. 76 FR 15349 - Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... BUDGET Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... furnished by military treatment facilities through the Department of Defense (DoD). The rates have...

  14. Cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system

    NASA Technical Reports Server (NTRS)

    Kraus, E. F.; Vanabkoude, J. C.

    1976-01-01

    The fuel saving potential and cost effectiveness of numerous operational and technical options proposed for reducing the fuel consumption of the U.S. commercial airline fleet was examined and compared. The impact of the most promising fuel conserving options on fuel consumption, passenger demand, operating costs and airline profits when implemented in the U.S. domestic and international airline fleets was determined. A forecast estimate was made of the potential fuel savings achievable in the U.S. scheduled air transportation system. Specifically, the means for reducing the jet fuel consumption of the U.S. scheduled airlines in domestic and international passenger operations were investigated. A design analysis was made of two turboprop aircraft as possible fuel conserving derivatives of the DC-9-30.

  15. Waste water treatment costs reduced by 50% with rotary vacuum precoat filter

    SciTech Connect

    Mrozinski, W.; Short, A.J.

    1983-01-01

    This article describes a rotary vacuum precoat filter which reduces waste treatment costs by 50%. This filter was used to solve Union Carbide Corporation's Linde Division's plant problem of high operating costs at the facility due to frequent cleaning, repair, and replacement of electric filters.The solids separation system at Linde's waste water treatment facility also had high operating, maintenance and sludge disposal costs. Installation of the rotary vacuum precoat filter with diatomite precoat performs the same functions as were previously accomplished with the high pressure filter and a centrifuge, and does these with less total horsepower, fewer water treatment chemicals, reduced maintenance, and lower water content in the sludge. All of these improvements have added up to a 50% reduction in the total cost of waste water treatment. On a trial-basis, the small rotary vacuum precoat flter satisfactorily handled all the waste water treatment required at present plant production rates. Based on full plant operating rates and the installation of an appropriate sized filter, total savings from using this system are estimated at $92,000/yr.

  16. Less is more: a project to reduce the number of PIMs (potentially inappropriate medications) on an elderly care ward

    PubMed Central

    Aung, Tin Htun; Judith Beck, Adèle; Siese, Thomas; Berrisford, Richard

    2016-01-01

    Potentially inappropriate prescribing in healthcare of the elderly (HCE) is associated with avoidable adverse drug events (ADEs).1,2 A recent set of prescribing criteria has been designed and validated, called “Screening Tool of Older Persons' Prescriptions” (STOPP), to rationalise prescribing in hospitalised patients on HCE wards.1,3 The aim of this quality improvement project was to identify how many potentially inappropriate medications (PIMs) were prescribed on these wards, and remove them. This was executed by implementing a ward round checklist, which incorporated STOPP criteria, for the twice weekly, consultant led ward rounds. This quality improvement project was carried out over four months. In a pilot study, we identified eight inappropriate medical prescriptions among 148 medications (5.4% ) prescribed on one ward. After applying a checklist for a structured ward round, we reviewed the medications prescribed on that ward, and found 10 PIMs out of 192 (5.2% ). Utilising the increasingly recognised “plan, do, study, act” (PDSA) cycle,4 we implemented departmental teaching and meetings with other members of the multidisciplinary team, which raised awareness of PIMs among junior doctors, as well as involving our pharmacists in drug chart screening. During this process we continued with a further six cycles on a bi-weekly basis, and saw a gradual decrease in PIM to 1.5%. In conclusion, a structured ward round, facilitated by a checklist that included review of drug charts based on STOPP criteria, demonstrated a considerable reduction of PIMs. It would be interesting to apply this quality improvement project to non-HCE wards, including general surgical wards or adult psychiatry wards, as a means of not only reducing the effects of ADEs, but also the expenditure associated with unnecessary drug prescriptions, and the costs associated with additional care arising from associated ADEs. PMID:27096089

  17. Innovative, High-Pressure, Cryogenic Control Valve: Short Face-to-Face, Reduced Cost

    NASA Technical Reports Server (NTRS)

    Wilkes, Karlin; Larsen, Ed; McCourt, Jackson

    2003-01-01

    A control valve that can throttle high-pressure cryogenic fluid embodies several design features that distinguish it over conventional valves designed for similar applications. Field and design engineers worked together to create a valve that would simplify installation, trim changes, and maintenance, thus reducing overall cost. The seals and plug stem packing were designed to perform optimally in cryogenic temperature ranges. Unlike conventional high-pressure cryogenic valves, the trim size can be changed independent of the body.

  18. STAAR: improving the reliability of care coordination and reducing hospital readmissions in an academic medical centre

    PubMed Central

    Carter, Jocelyn Alexandria; Carr, Laura S; Collins, Jacqueline; Doyle Petrongolo, Joanne; Hall, Kathryn; Murray, Jane; Smith, Jessica; Tata, Lee Ann

    2015-01-01

    Setting Massachusetts General Hospital embarked on a 4-year project to reduce readmissions in a high volume general medicine unit (November 2009 to September 2013). Objective To reduce 30-day readmissions to 10% through improved care coordination. Design As a before–after study, a total of 7586 patients admitted to the medicine unit during the intervention period included 2620 inpatients meeting high risk for readmission criteria. Of those, 2620 patients received nursing interventions and 539 patients received pharmacy interventions. Intervention The introduction of a Discharge Nurse (D/C RN) for patient/family coaching and a Transitional Care Pharmacist (TC PharmD) for predischarge medication reconciliation and postdischarge patient phone calls. Other interventions included modifications to multidisciplinary care rounds and electronic medication reconciliation. Main outcome measure All-cause 30-day readmission rates. Results Readmission rates decreased by 30% (21% preintervention to 14.5% postintervention) (p<0.05). From July 2010 to December 2011, rates of readmission among high-risk patients who received the D/C RN intervention with or without the TC PharmD medication reconciliation/education intervention decreased to 15.9% (p=0.59). From January to June 2010, rates of readmission among high-risk patients who received the TC PharmD postdischarge calls decreased to 12.9% (p=0.55). From June 2010 to December 2011, readmission rates for patients on the medical unit that did not receive the designated D/C RN or TC PharmD interventions decreased to 15.8% (p=0.61) and 16.2% (0.31), respectively. Conclusions A multidisciplinary approach to improving care coordination reduced avoidable readmissions both among those who received interventions and those who did not. This further demonstrated the importance of multidisciplinary collaboration. PMID:26246901

  19. Effects of medication adherence on hospitalizations and healthcare costs in patients with schizophrenia in Thailand

    PubMed Central

    Dilokthornsakul, Piyameth; Thoopputra, Thitaporn; Patanaprateep, Oraluck; Kongsakon, Ronnachai; Chaiyakunapruk, Nathorn

    2016-01-01

    Background: This study was conducted to determine the impacts of medication adherence on hospitalization and direct healthcare cost in patients with schizophrenia in Thailand. Methods: A retrospective study was undertaken. Patients with schizophrenia aged 18–65 years who visited a University hospital and received antipsychotics from April 2011 to October 2011 were included. Propensity score–adjusted logistic regression was used to determine the impacts of medication adherence on schizophrenia-related and all-cause hospitalizations. Results: A total of 582 patients were included. Three out of 224 patients (1.3%) were hospitalized with schizophrenia in optimal adherence group, while 10 of 140 (7.1%) were hospitalized in under-adherence group, and 7 of 218 (3.2%) were hospitalized in over-adherence group. Based on propensity score–adjusted multivariate logistic regression, the adjusted odds ratio was 5.86 (95% confidence interval = 1.53–22.50) for schizophrenia-related hospitalization and 8.04 (95% confidence interval = 2.20–29.40) for all-cause hospitalization. The average annual direct healthcare costs in patients with optimal adherence, under-adherence, and over-adherence were US$371 ± US$836, US$386 ± US$734, and US$508 ± US$2168, respectively. Conclusion: An initiation of interventions to maintain optimal adherence in patients with schizophrenia would significantly impact the healthcare system. PMID:27026801

  20. Marketplace Subsidies: Changing The 'Family Glitch' Reduces Family Health Spending But Increases Government Costs.

    PubMed

    Buettgens, Matthew; Dubay, Lisa; Kenney, Genevieve M

    2016-07-01

    Under the Affordable Care Act, if one family member has an employer offer of single coverage deemed to be affordable-that is, costing less than 9.66 percent of family income in 2016-then all family members are ineligible for tax credits for Marketplace coverage, even if the cost of providing coverage to the whole family is greater than 9.66 percent of income. More than six million people live in such families and as a result are ineligible for premium tax credits. These families face premiums that can amount to 15.8 percent of income, or 12.0 percent after the tax advantages of employer-sponsored health coverage are factored in. We modeled the potential impact of changing the affordability test to take into account the cost of family coverage. Doing so would reduce spending on premiums from 12.0 percent to 6.3 percent of income, significantly alleviating financial burdens, but would generate little additional coverage. We estimated the additional costs to the federal government for premium tax credits and cost-sharing reductions to be between $3.7 billion and $6.5 billion in 2016. PMID:27385230

  1. A female-biased sex ratio reduces the twofold cost of sex.

    PubMed

    Kobayashi, Kazuya; Hasegawa, Eisuke

    2016-01-01

    The evolution of sexual reproduction remains a fascinating enigma in biology. Theoretically, populations of sexual organisms investing half of their resources into producing male offspring that don't contribute to reproduction should grow at only half the rate of their asexual counterparts. This demographic disadvantage due to male production is known as the twofold cost of sex. However, the question of whether this cost is truly twofold for sexual females remains unanswered. The cost of producing males should decrease when the number of male offspring is reduced. Here, we report a case where the cost of males is actually less than twofold. By measuring the numbers of sexual strain coexisting with asexual strain among thrips, our survey revealed that the sexual strain showed female-biased sex ratios and that the relative frequency of sexual strain is negatively correlated with the proportion of males in the sexual strain. Using computer simulations, we confirmed that a female-biased sex ratio evolves in sexual individuals due to the coexistence of asexual individuals. Our results demonstrate that there is a cost of producing males that depends on the number of males. We therefore conclude that sexual reproduction can evolve with far fewer benefits than previously assumed. PMID:27035400

  2. A female-biased sex ratio reduces the twofold cost of sex

    PubMed Central

    Kobayashi, Kazuya; Hasegawa, Eisuke

    2016-01-01

    The evolution of sexual reproduction remains a fascinating enigma in biology. Theoretically, populations of sexual organisms investing half of their resources into producing male offspring that don’t contribute to reproduction should grow at only half the rate of their asexual counterparts. This demographic disadvantage due to male production is known as the twofold cost of sex. However, the question of whether this cost is truly twofold for sexual females remains unanswered. The cost of producing males should decrease when the number of male offspring is reduced. Here, we report a case where the cost of males is actually less than twofold. By measuring the numbers of sexual strain coexisting with asexual strain among thrips, our survey revealed that the sexual strain showed female-biased sex ratios and that the relative frequency of sexual strain is negatively correlated with the proportion of males in the sexual strain. Using computer simulations, we confirmed that a female-biased sex ratio evolves in sexual individuals due to the coexistence of asexual individuals. Our results demonstrate that there is a cost of producing males that depends on the number of males. We therefore conclude that sexual reproduction can evolve with far fewer benefits than previously assumed. PMID:27035400

  3. Root phenes that reduce the metabolic costs of soil exploration: opportunities for 21st century agriculture.

    PubMed

    Lynch, Jonathan P

    2015-09-01

    Crop genotypes with reduced metabolic costs of soil exploration would have improved water and nutrient acquisition. Three strategies to achieve this goal are (1) production of the optimum number of axial roots; (2) greater biomass allocation to root classes that are less metabolically demanding; and (3) reduction of the respiratory requirement of root tissue. An example of strategy 1 is the case of reduced crown root number in maize, which is associated with greater rooting depth, N capture and yield in low N soil. An example of strategy 2 is the case of increased hypocotyl-borne rooting in bean, which decreases root cost and increases P capture from low P soil. Examples of strategy 3 are the cases of increased formation of root cortical aerenchyma, decreased cortical cell file number and increased cortical cell size in maize, which decrease specific root respiration, increase rooting depth and increase water capture and yield under water stress. Root cortical aerenchyma also increases N capture and yield under N stress. Root phenes that reduce the metabolic cost of soil exploration are promising, underexploited avenues to the climate-resilient, resource-efficient crops that are urgently needed in global agriculture. PMID:25255708

  4. Reducing metal alloy powder costs for use in powder bed fusion additive manufacturing: Improving the economics for production

    NASA Astrophysics Data System (ADS)

    Medina, Fransisco

    Titanium and its associated alloys have been used in industry for over 50 years and have become more popular in the recent decades. Titanium has been most successful in areas where the high strength to weight ratio provides an advantage over aluminum and steels. Other advantages of titanium include biocompatibility and corrosion resistance. Electron Beam Melting (EBM) is an additive manufacturing (AM) technology that has been successfully applied in the manufacturing of titanium components for the aerospace and medical industry with equivalent or better mechanical properties as parts fabricated via more traditional casting and machining methods. As the demand for titanium powder continues to increase, the price also increases. Titanium spheroidized powder from different vendors has a price range from 260/kg-450/kg, other spheroidized alloys such as Niobium can cost as high as $1,200/kg. Alternative titanium powders produced from methods such as the Titanium Hydride-Dehydride (HDH) process and the Armstrong Commercially Pure Titanium (CPTi) process can be fabricated at a fraction of the cost of powders fabricated via gas atomization. The alternative powders can be spheroidized and blended. Current sectors in additive manufacturing such as the medical industry are concerned that there will not be enough spherical powder for production and are seeking other powder options. It is believed the EBM technology can use a blend of spherical and angular powder to build fully dense parts with equal mechanical properties to those produced using traditional powders. Some of the challenges with angular and irregular powders are overcoming the poor flow characteristics and the attainment of the same or better packing densities as spherical powders. The goal of this research is to demonstrate the feasibility of utilizing alternative and lower cost powders in the EBM process. As a result, reducing the cost of the raw material to reduce the overall cost of the product produced with

  5. Enforcing Quality Metrics over Equipment Utilization Rates as Means to Reduce Centers for Medicare and Medicaid Services Imaging Costs and Improve Quality of Care

    PubMed Central

    Sura, Amit; Ho, Alexander

    2011-01-01

    Radiology has been the focus of efforts to reduce inefficiencies while attempting to lower medical costs. The 2010 Medicare Physician Fee Schedule has reduced Centers for Medicare and Medicaid Services’ (CMS) reimbursements related to the technical component of imaging services. By increasing the utilization rate, the cost of equipment spreads over more studies, thus lowering the payments per procedure. Is it beneficial for CMS to focus on equipment utilization as a cost-cutting measure? Can greater financial and quality of care rewards be made by improving metrics like appropriateness criteria and pre-authorization? On examining quality metrics, such as appropriateness criteria and pre-authorization, promising results have ensued. The development and enforcement of appropriateness criteria lowers overutilization of studies without requiring unattainable fixed rates. Pre-authorization educates ordering physicians as to when imaging is indicated. PMID:21966625

  6. Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

    PubMed

    da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

    2005-01-01

    This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment. PMID:17281912

  7. Cost-effective targeting of conservation investments to reduce the northern Gulf of Mexico hypoxic zone.

    PubMed

    Rabotyagov, Sergey S; Campbell, Todd D; White, Michael; Arnold, Jeffrey G; Atwood, Jay; Norfleet, M Lee; Kling, Catherine L; Gassman, Philip W; Valcu, Adriana; Richardson, Jeffrey; Turner, R Eugene; Rabalais, Nancy N

    2014-12-30

    A seasonally occurring summer hypoxic (low oxygen) zone in the northern Gulf of Mexico is the second largest in the world. Reductions in nutrients from agricultural cropland in its watershed are needed to reduce the hypoxic zone size to the national policy goal of 5,000 km(2) (as a 5-y running average) set by the national Gulf of Mexico Task Force's Action Plan. We develop an integrated assessment model linking the water quality effects of cropland conservation investment decisions on the more than 550 agricultural subwatersheds that deliver nutrients into the Gulf with a hypoxic zone model. We use this integrated assessment model to identify the most cost-effective subwatersheds to target for cropland conservation investments. We consider targeting of the location (which subwatersheds to treat) and the extent of conservation investment to undertake (how much cropland within a subwatershed to treat). We use process models to simulate the dynamics of the effects of cropland conservation investments on nutrient delivery to the Gulf and use an evolutionary algorithm to solve the optimization problem. Model results suggest that by targeting cropland conservation investments to the most cost-effective location and extent of coverage, the Action Plan goal of 5,000 km(2) can be achieved at a cost of $2.7 billion annually. A large set of cost-hypoxia tradeoffs is developed, ranging from the baseline to the nontargeted adoption of the most aggressive cropland conservation investments in all subwatersheds (estimated to reduce the hypoxic zone to less than 3,000 km(2) at a cost of $5.6 billion annually). PMID:25512489

  8. Cost-effective targeting of conservation investments to reduce the northern Gulf of Mexico hypoxic zone

    PubMed Central

    Rabotyagov, Sergey S.; Campbell, Todd D.; White, Michael; Arnold, Jeffrey G.; Atwood, Jay; Norfleet, M. Lee; Kling, Catherine L.; Gassman, Philip W.; Valcu, Adriana; Richardson, Jeffrey; Turner, R. Eugene; Rabalais, Nancy N.

    2014-01-01

    A seasonally occurring summer hypoxic (low oxygen) zone in the northern Gulf of Mexico is the second largest in the world. Reductions in nutrients from agricultural cropland in its watershed are needed to reduce the hypoxic zone size to the national policy goal of 5,000 km2 (as a 5-y running average) set by the national Gulf of Mexico Task Force’s Action Plan. We develop an integrated assessment model linking the water quality effects of cropland conservation investment decisions on the more than 550 agricultural subwatersheds that deliver nutrients into the Gulf with a hypoxic zone model. We use this integrated assessment model to identify the most cost-effective subwatersheds to target for cropland conservation investments. We consider targeting of the location (which subwatersheds to treat) and the extent of conservation investment to undertake (how much cropland within a subwatershed to treat). We use process models to simulate the dynamics of the effects of cropland conservation investments on nutrient delivery to the Gulf and use an evolutionary algorithm to solve the optimization problem. Model results suggest that by targeting cropland conservation investments to the most cost-effective location and extent of coverage, the Action Plan goal of 5,000 km2 can be achieved at a cost of $2.7 billion annually. A large set of cost-hypoxia tradeoffs is developed, ranging from the baseline to the nontargeted adoption of the most aggressive cropland conservation investments in all subwatersheds (estimated to reduce the hypoxic zone to less than 3,000 km2 at a cost of $5.6 billion annually). PMID:25512489

  9. Low-cost/high-efficiency lasers for medical applications in the 14XX-nm regime

    NASA Astrophysics Data System (ADS)

    Callahan, J. J.; McIntyre, E.; Rafferty, C.; Yanushefski, L.; Bean, D. M.

    2011-03-01

    Laser therapy is becoming an increasingly popular method of treating numerous dermatological conditions. The widespread use of these devices is often limited by the cost and size. Low cost, portable lasers would expand the laser market further into homes, general practitioners, dermatologists, plastic surgeons, and 3rd world countries. There are numerous light devices currently on the market for hair removal and growth, acne reduction, and wrinkles. These devices are varied, from LEDs to intense pulsed light (IPL) to lasers. One particular disease is leishmaniasis, caused by a parasite carried by sand flies, most often occurring in third world countries. While there are drug therapies available, they sometimes require hospitalization for several days and are very expensive. An RF device has been FDA approved for treatment of leishmaniasis, but costs about $20,000 which is too expensive for widespread use. Since the method is heating the lesion, the same affect could be achieved using an infrared laser. Diode lasers have the capability to be produced in mass quantity for low costs, as shown by the ubiquity of diode lasers in the telecom industry and household appliances. Unfortunately, many diode lasers suffer from poor efficiency, particularly in wavelengths for dermatology. Advances are being made to improve wall plug efficiency of lasers to reduce waste heat and increase output power. In this paper, those efforts being made to develop manufacturing partners to lower the cost while increasing the production volume of long wavelength lasers will be discussed along with performance data and clinical results.

  10. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology.

    PubMed

    Benjamin, David M

    2003-07-01

    Today, reducing medication errors and improving patient safety have become common topics of discussion for the president of the United States, federal and state legislators, the insurance industry, pharmaceutical companies, health care professionals, and patients. But this is not news to clinical pharmacologists. Improving the judicious use of medications and minimizing adverse drug reactions have always been key areas of research and study for those working in clinical pharmacology. However, added to the older terms of adverse drug reactions and rational therapeutics, the now politically correct expression of medication error has emerged. Focusing on the word error has drawn attention to "prevention" and what can be done to minimize mistakes and improve patient safety. Webster's New Collegiate Dictionary has several definitions of error, but the one that seems to be most appropriate in the context of medication errors is "an act that through ingnorance, deficiency, or accident departs from or fails to achieve what should be done." What should be done is generally known as "the five rights": the right drug, right dose, right route, right time, and right patient. One can make an error of omission (failure to act correctly) or an error of commission (acted incorrectly). This article now summarizes what is currently known about medication errors and translates the information into case studies illustrating common scenarios leading to medication errors. Each case is analyzed to provide insight into how the medication error could have been prevented. "System errors" are described, and the application of failure mode effect analysis (FMEA) is presented to determine the part of the "safety net" that failed. Examples of reengineering the system to make it more "error proof" are presented. An error can be prevented. However, the practice of medicine, pharmacy, and nursing in the hospital setting is very complicated, and so many steps occur from "pen to patient" that there

  11. Relation of Elevated Heart Rate in Patients With Heart Failure With Reduced Ejection Fraction to One-Year Outcomes and Costs.

    PubMed

    DeVore, Adam D; Schulte, Phillip J; Mentz, Robert J; Hardy, N Chantelle; Kelly, Jacob P; Velazquez, Eric J; Maya, Juan F; Kielhorn, Adrian; Patel, Harshali K; Reed, Shelby D; Hernandez, Adrian F

    2016-03-15

    There are limited data describing outcomes associated with an elevated heart rate in patients with heart failure with reduced ejection fraction (HFrEF) in routine clinical practice. We identified patients with HFrEF at Duke University Hospital undergoing echocardiograms and heart rate assessments without paced rhythms or atrial fibrillation. Outcomes (all-cause mortality or hospitalization and medical costs per day alive) were assessed using electronic medical records, hospital cost accounting data, and national death records. Patients were stratified by heart rate (<70 and ≥70 beats/min) and compared using generalized linear models specified with gamma error distributions and log links for costs and proportional hazard models for mortality/hospitalization. Of 722 eligible patients, 582 patients (81%) were treated with β blockers. The median heart rate was 81 beats/min (25th and 75th percentiles 69 to 96) and 527 patients (73%) had a heart rate ≥70 beats/min. After multivariate adjustment, a heart rate ≥70 beats/min was associated with increased 1-year all-cause mortality or hospitalization, hazard ratio 1.37 (95% CI 1.07 to 1.75) and increased medical costs per day alive, cost ratio 2.03 (95% CI 1.53 to 2.69). In conclusion, at a large tertiary care center, despite broad use of β blockers, a heart rate ≥70 beats/min was observed in 73% of patients with HFrEF and associated with worse 1-year outcomes and increased direct medical costs per day alive. PMID:26805662

  12. Building Commissioning: A Golden Opportunity for Reducing Energy Costs and Greenhouse-gas Emissions

    SciTech Connect

    Mills, Evan

    2009-07-16

    available revealed over 10,000 energy-related problems, resulting in 16% median whole-building energy savings in existing buildings and 13% in new construction, with payback time of 1.1 years and 4.2 years, respectively. In terms of other cost-benefit indicators, median benefit-cost ratios of 4.5 and 1.1, and cash-on-cash returns of 91% and 23% were attained for existing and new buildings, respectively. High-tech buildings were particularly cost-effective, and saved higher amounts of energy due to their energy-intensiveness. Projects with a comprehensive approach to commissioning attained nearly twice the overall median level of savings and five-times the savings of the least-thorough projects. It is noteworthy that virtually all existing building projects were cost-effective by each metric (0.4 years for the upper quartile and 2.4 years for the lower quartile), as were the majority of new-construction projects (1.5 years and 10.8 years, respectively). We also found high cost-effectiveness for each specific measure for which we have data. Contrary to a common perception, cost-effectiveness is often achieved even in smaller buildings. Thanks to energy savings valued more than the cost of the commissioning process, associated reductions in greenhouse gas emissions come at 'negative' cost. In fact, the median cost of conserved carbon is negative - -$110 per tonne for existing buildings and -$25/tonne for new construction - as compared with market prices for carbon trading and offsets in the +$10 to +$30/tonne range. Further enhancing the value of commissioning, its non-energy benefits surpass those of most other energy-management practices. Significant first-cost savings (e.g., through right-sizing of heating and cooling equipment) routinely offset at least a portion of commissioning costs - fully in some cases. When accounting for these benefits, the net median commissioning project cost was reduced by 49% on average, while in many cases they exceeded the direct value of the

  13. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

    PubMed

    Piette, John D; Rosland, Ann Marie; Silveira, Maria J; Hayward, Rodney; McHorney, Colleen A

    2011-01-01

    A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN) and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40-64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40-64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness. PMID:21573050

  14. Medical and Indirect Costs Associated with a Rocky Mountain Spotted Fever Epidemic in Arizona, 2002–2011

    PubMed Central

    Drexler, Naomi A.; Traeger, Marc S.; McQuiston, Jennifer H.; Williams, Velda; Hamilton, Charlene; Regan, Joanna J.

    2015-01-01

    Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002–2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study. PMID:26033020

  15. Medical and Indirect Costs Associated with a Rocky Mountain Spotted Fever Epidemic in Arizona, 2002-2011.

    PubMed

    Drexler, Naomi A; Traeger, Marc S; McQuiston, Jennifer H; Williams, Velda; Hamilton, Charlene; Regan, Joanna J

    2015-09-01

    Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002-2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study. PMID:26033020

  16. Medical care costs of patients with rheumatoid arthritis during the prebiologics period in Japan: a large prospective observational cohort study.

    PubMed

    Tanaka, Eiichi; Inoue, Eisuke; Mannalithara, Ajitha; Bennett, Mihoko; Kamitsuji, Shigeo; Taniguchi, Atsuo; Momohara, Shigeki; Hara, Masako; Singh, Gurkirpal; Yamanaka, Hisashi

    2010-02-01

    Our objective was to describe outpatient medical care costs of patients with rheumatoid arthritis (RA) in the prebiologics period in Japan. The outpatient costs of 6,771 RA patients (17,666 patient years) who were enrolled in an observational cohort study at the Institute of Rheumatology, Rheumatoid Arthritis (IORRA), in Tokyo, Japan, were calculated from the billing records dated from 2000 to 2004. Associations between outpatient costs and variables such as age, RA duration, RA disease activities, and disability levels were assessed. The average outpatient cost gradually increased (+7.7% in 4 years) from 271,498 JPY per year in 2000 to 292,417 JPY per year in 2004. Medications accounted for approximately 50% of total outpatient costs, which increased 29.6% during the 4 years. The outpatient costs increased in association with aging, longer RA duration, higher Disease Activity Score of 28 Joints (DAS28), and higher Japanese version of Health Assessment Questionnaire (J-HAQ) score. Generalized linear regression analysis revealed that both DAS28 and J-HAQ scores were the most significant factors associated with outpatient costs (p < 0.001). Outpatient costs for patients with RA increased year after year over the 4-year period under observation in Japan. Medical costs were higher with increasing RA disease activity and disability levels. PMID:19821162

  17. Improving end of life care: an information systems approach to reducing medical errors.

    PubMed

    Tamang, S; Kopec, D; Shagas, G; Levy, K

    2005-01-01

    Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide "error-reducing" reforms to vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in health informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS) to transform the delivery of care, streamline processes and improve the efficiency and appropriateness of medical treatment. As a result, medical error(s) that occur with patients dealing with severe, chronic illness and the frail elderly can be reduced.The palliative model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend this convention, but there is no widely accepted definition. This research will discuss the development life cycle of two palliative information systems: the CONFER QOLP management information system (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN case-based reasoning prototype. CONFER is a web platform based on the idea of "eCare". CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark up to define systems data. The second system, CAREN, is a CBR prototype designed for palliative care patients in the cancer trajectory. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best

  18. Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes

    PubMed Central

    van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G; Smith, Kevin W

    2015-01-01

    Objective To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Data Sources Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. Study Design This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008–June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Data Collection Methods Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Principal Findings Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. Conclusions This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. PMID:25077375

  19. Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost

    PubMed Central

    Tawara, Yuichi; Senjyu, Hideaki; Tanaka, Kenichiro; Tanaka, Takako; Asai, Masaharu; Kozu, Ryo; Tabusadani, Mitsuru; Honda, Sumihisa; Sawai, Terumitsu

    2015-01-01

    Objective We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs. Method We distributed a questionnaire to all 8,878 inhabitants aged 50–89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change. Results As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time. Conclusion The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The success of this program suggests that a similar program could reduce the economic and human costs of COPD morbidity throughout Japan. PMID:26347397

  20. [Reducing non-communicable diseases and health care costs: building a prevention alliance].

    PubMed

    Piccinelli, Cristiano; Pagano, Eva; Segnan, Nereo

    2015-01-01

    In Italy, as well as in most European Countries, the loss of almost 70% of the years of life is attributable to cerebro-cardiovascular diseases and cancers. Whereas the Italian population is expected to grow older, with a significant increase in the burden of chronic non-communicable diseases, the reduction in incidence of chronic diseases and the compression of morbidity are priorities. This is the reason why in Italy the implementation of the National Plan for Prevention and related regional plans becomes necessary, as it can promote the co-operation of multidisciplinary skills in several areas: political, health, economic, legal, sociological. In Piedmont (Northern Italy), it seems useful the creation of a regional Laboratory of prevention,which provides support for the development and implementation of the regional prevention plan, through actions and programmes based on cost-effectiveness analyses. The use of resources in prevention should not be exclusively interpreted as a cost, but as an investment, which, in some cases, can become an avoided cost. Using prevention policies makes it possible to gain years of healthy life and to potentially reduce the cost of healthcare system. The creation of the Laboratory of prevention is a multidisciplinary context, so it is an opportunity to involve the stakeholders in order to achieve the regional health objectives. PMID:26668919

  1. Reduced Metabolic Cost of Locomotion in Svalbard Rock Ptarmigan (Lagopus muta hyperborea) during Winter

    PubMed Central

    Lees, John; Nudds, Robert; Stokkan, Karl-Arne; Folkow, Lars; Codd, Jonathan

    2010-01-01

    The Svalbard rock ptarmigan, Lagopus muta hyperborea experiences extreme photoperiodic and climatic conditions on the Arctic archipelago of Svalbard. This species, however, is highly adapted to live in this harsh environment. One of the most striking adaptations found in these birds is the deposition, prior to onset of winter, of fat stores which may comprise up to 32% of body mass and are located primarily around the sternum and abdominal region. This fat, while crucial to the birds' survival, also presents a challenge in that the bird must maintain normal physiological function with this additional mass. In particular these stores are likely to constrain the respiratory system, as the sternum and pelvic region must be moved during ventilation and carrying this extra load may also impact upon the energetic cost of locomotion. Here we demonstrate that winter birds have a reduced cost of locomotion when compared to summer birds. A remarkable finding given that during winter these birds have almost twice the body mass of those in summer. These results suggest that Svalbard ptarmigan are able to carry the additional winter fat without incurring any energetic cost. As energy conservation is paramount to these birds, minimising the costs of moving around when resources are limited would appear to be a key adaptation crucial for their survival in the barren Arctic environment. PMID:21125015

  2. Reduced cost alternatives to premise wiring using ATM and microcellular technologies

    NASA Technical Reports Server (NTRS)

    Gejji, Raghvendra R.

    1993-01-01

    The cost of premises wiring keeps increasing due to personnel moves, new equipment, capacity upgrades etc. It would be desirable to have a wireless interface from the workstations to the fixed network, so as to minimize the wiring changes needed. New technologies such as microcellular personal communication systems are promising to bring down the cost of wireless communication. Another promising technology is Code Division Multiple Access (CDMA), which could dramatically increase the bandwidth available for wireless connections. In addition, Asynchronous Transfer Mode (ATM) technology is emerging as a technique for integrated management of voice, data, and video traffic on a single network. The focus of this investigation will be to assess the future utility of these new technologies for reducing the premise wiring cost at KSC. One of the issues to be studied is the cost comparison of 'old' versus 'new,' especially as time and technology progress. An additional issue for closer study is a feasible time-line for progress in technological capability.

  3. Cost-effectiveness of feeding strategies to reduce greenhouse gas emissions from dairy farming.

    PubMed

    Van Middelaar, C E; Dijkstra, J; Berentsen, P B M; De Boer, I J M

    2014-01-01

    The objective of this paper was to evaluate the cost-effectiveness of 3 feeding strategies to reduce enteric CH4 production in dairy cows by calculating the effect on labor income at the farm level and on greenhouse gas (GHG) emissions at the chain level (i.e., from production of farm inputs to the farm gate). Strategies included were (1) dietary supplementation of an extruded linseed product (56% linseed; 1kg/cow per day in summer and 2kg/cow per day in winter), (2) dietary supplementation of a nitrate source (75% nitrate; 1% of dry matter intake), and (3) reducing the maturity stage of grass and grass silage (grazing at 1,400 instead of 1,700kg of dry matter/ha and harvesting at 3,000 instead of 3,500kg of dry matter/ha). A dairy farm linear programing model was used to define an average Dutch dairy farm on sandy soil without a predefined feeding strategy (reference situation). Subsequently, 1 of the 3 feeding strategies was implemented and the model was optimized again to determine the new economically optimal farm situation. Enteric CH4 production in the reference situation and after implementing the strategies was calculated based on a mechanistic model for enteric CH4 and empirical formulas explaining the effect of fat and nitrate supplementation on enteric CH4 production. Other GHG emissions along the chain were calculated using life cycle assessment. Total GHG emissions in the reference situation added up to 840kg of CO2 equivalents (CO2e) per t of fat- and protein-corrected milk (FPCM) and yearly labor income of €42,605. Supplementation of the extruded linseed product reduced emissions by 9kg of CO2e/t of FPCM and labor income by €16,041; supplementation of the dietary nitrate source reduced emissions by 32kg of CO2e/t of FPCM and labor income by €5,463; reducing the maturity stage of grass and grass silage reduced emissions by 11kg of CO2e/t of FPCM and labor income by €463. Of the 3 strategies, reducing grass maturity was the most cost

  4. Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

    PubMed Central

    Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

    2002-01-01

    Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction

  5. Reducing risk and enhancing education: U.S. medical students on global health electives.

    PubMed

    Reid, Michael J A; Biller, Nancy; Lyon, Sarah M; Reilly, John P; Merlin, Jessica; Dacso, Matthew; Friedman, Harvey M

    2014-12-01

    This study assessed the impact of several interventions, including predeparture simulation training and procedure logs, on incidence needlestick injuries (NSIs) among U.S. medical students on global health (GH) elective in Botswana. Review of NSI incident reports before and after introduction of these interventions demonstrated a reduction in the number of splash and body fluid exposures (n = 5 [6%] vs n = 21 [23%]; P < .001), respectively. Simple predeparture training is highly effective in reducing NSIs among students participating in GH electives. PMID:25465263

  6. Cost of reducing carbon emissions in developing countries: Evidence from Columbia. Staff working paper No. 9

    SciTech Connect

    Linden, G.

    1993-06-01

    The author discusses the issue of the cost of reducing CO2 emissions related to the energy sector and the implications for the structure of the energy sector in Colombia. While there have been a number of attempts to estimate the costs of CO2 reduction in various developed countries such as the United States, there appears to be a lack of similar studies for developing countries. The analysis is based on optimizations using a comprehensive mathematical programming model of Colombia's energy sector in conjunction with an econometric model of the sector. Section one outlines the empirical methods used to analyze the energy/environmental linkages in Colombia. Section two summarizes the simulated results.

  7. Great hammerhead sharks swim on their side to reduce transport costs.

    PubMed

    Payne, Nicholas L; Iosilevskii, Gil; Barnett, Adam; Fischer, Chris; Graham, Rachel T; Gleiss, Adrian C; Watanabe, Yuuki Y

    2016-01-01

    Animals exhibit various physiological and behavioural strategies for minimizing travel costs. Fins of aquatic animals play key roles in efficient travel and, for sharks, the functions of dorsal and pectoral fins are considered well divided: the former assists propulsion and generates lateral hydrodynamic forces during turns and the latter generates vertical forces that offset sharks' negative buoyancy. Here we show that great hammerhead sharks drastically reconfigure the function of these structures, using an exaggerated dorsal fin to generate lift by swimming rolled on their side. Tagged wild sharks spend up to 90% of time swimming at roll angles between 50° and 75°, and hydrodynamic modelling shows that doing so reduces drag-and in turn, the cost of transport-by around 10% compared with traditional upright swimming. Employment of such a strongly selected feature for such a unique purpose raises interesting questions about evolutionary pathways to hydrodynamic adaptations, and our perception of form and function. PMID:27457414

  8. Great hammerhead sharks swim on their side to reduce transport costs

    PubMed Central

    Payne, Nicholas L.; Iosilevskii, Gil; Barnett, Adam; Fischer, Chris; Graham, Rachel T.; Gleiss, Adrian C.; Watanabe, Yuuki Y.

    2016-01-01

    Animals exhibit various physiological and behavioural strategies for minimizing travel costs. Fins of aquatic animals play key roles in efficient travel and, for sharks, the functions of dorsal and pectoral fins are considered well divided: the former assists propulsion and generates lateral hydrodynamic forces during turns and the latter generates vertical forces that offset sharks' negative buoyancy. Here we show that great hammerhead sharks drastically reconfigure the function of these structures, using an exaggerated dorsal fin to generate lift by swimming rolled on their side. Tagged wild sharks spend up to 90% of time swimming at roll angles between 50° and 75°, and hydrodynamic modelling shows that doing so reduces drag—and in turn, the cost of transport—by around 10% compared with traditional upright swimming. Employment of such a strongly selected feature for such a unique purpose raises interesting questions about evolutionary pathways to hydrodynamic adaptations, and our perception of form and function. PMID:27457414

  9. The role of technology in reducing health care costs. Final project report

    SciTech Connect

    Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

    1997-08-01

    Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

  10. Reducing the cost of maintaining valve-regulated lead/acid batteries in telecommunications applications

    NASA Astrophysics Data System (ADS)

    Kniveton, M. W.

    British Telecommunications has utilized valve-regulated lead/acid (VRLA) technology for 10 years and has considerable experience of varying product performance. A discussion is given of battery applications in telecommunications and includes experiences of typical failure modes such as group-bar corrosion and premature capacity loss, together with the detrimental effects of high temperature on service life. Specific maintenance requirements are also reviewed with particular attention to costs and reliability. Data are presented on the effectiveness of new methods of testing large numbers of VRLA batteries and, in particular, the reliability of conductance testing. An explanation is given of the role of conductance measurements, discharge testing and manufacturers' laboratory analysis in contributing to an effective maintenance programme. Specific requirements for the management of a battery-replacement programme are also included. Finally, BT user experience is described and solutions are provided to reduce the cost of VRLA maintenance while improving reliability.

  11. The relative cost of bent-hip bent-knee walking is reduced in water.

    PubMed

    Kuliukas, Algis V; Milne, Nick; Fournier, Paul

    2009-01-01

    The debate about how early hominids walked may be characterised as two competing hypotheses: They moved with a fully upright (FU) gait, like modern humans, or with a bent-hip, bent-knee (BK) gait, like apes. Both have assumed that this bipedalism was almost exclusively on land, in trees or a combination of the two. Recent findings favoured the FU hypothesis by showing that the BK gait is 50-60% more energetically costly than a FU human gait on land. We confirm these findings but show that in water this cost differential is markedly reduced, especially in deeper water, at slower speeds and with greater knee flexion. These data suggest that the controversy about australopithecine locomotion may be eased if it is assumed that wading was a component of their locomotor repertoire and supports the idea that shallow water might have been an environment favourable to the evolution of early forms of "non-optimal" hominid bipedalism. PMID:19853850

  12. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.

    PubMed

    Hover, Alexander R; Sistrunk, William W; Cavagnol, Robert M; Scarrow, Alan; Finley, Phillip J; Kroencke, Audrey D; Walker, Judith L

    2014-01-01

    Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective. PMID:24101683

  13. Reducing the cost of Ca-based direct air capture of CO2.

    PubMed

    Zeman, Frank

    2014-10-01

    Direct air capture, the chemical removal of CO2 directly from the atmosphere, may play a role in mitigating future climate risk or form the basis of a sustainable transportation infrastructure. The current discussion is centered on the estimated cost of the technology and its link to "overshoot" trajectories, where atmospheric CO2 levels are actively reduced later in the century. The American Physical Society (APS) published a report, later updated, estimating the cost of a one million tonne CO2 per year air capture facility constructed today that highlights several fundamental concepts of chemical air capture. These fundamentals are viewed through the lens of a chemical process that cycles between removing CO2 from the air and releasing the absorbed CO2 in concentrated form. This work builds on the APS report to investigate the effect of modifications to the air capture system based on suggestions in the report and subsequent publications. The work shows that reduced carbon electricity and plastic packing materials (for the contactor) may have significant effects on the overall price, reducing the APS estimate from $610 to $309/tCO2 avoided. Such a reduction does not challenge postcombustion capture from point sources, estimated at $80/tCO2, but does make air capture a feasible alternative for the transportation sector and a potential negative emissions technology. Furthermore, air capture represents atmospheric reductions rather than simply avoided emissions. PMID:25207956

  14. Methods for evaluation of medical care other than credentialing. Cost, experience, and results.

    PubMed

    Ebert, P A

    1990-08-01

    Unfortunately, the majority of studies proposed to evaluate a physician's capabilities, such as effectiveness programs, outcome research, and hospital evaluation, do not focus directly on the individual practitioner. The certifying process, although imperfect, still offers the best method of evaluation. The other evaluation methods will need additional refinement to be able to individually analyze a specific physician's performance and determine whether he or she is truly providing the highest quality care. Physicians are being asked to document the effectiveness of their clinical decision making. On the surface this seems so simple, and in some areas where the outcome is either life or death or a specific yes or no type of answer, many have the capability to come forth with some realistic documentation. However, today's society is focused on health and the perfect outcome, and many nonlife-threatening therapies are evaluated by a patient's unrealistic expectation. Thus, the same result may be interpreted differently in one geographic area or by patients with different expectations. The biggest mistake would be to believe that outcome studies can be used to reduce cost. There may be some initial reduction or delays in treatment that suggest an immediate reduction of cost, the so-called sentinel effect, but no information or evidence indicates that these effects can be expanded without actually reducing needed health care services. In fact, the delays or obstruction to entering the health-care system experienced by many individuals often lead to more costly and less effective care with suboptimal results. PMID:2116255

  15. The Effects of Health Information Technology on the Costs and Quality of Medical Care

    PubMed Central

    Agha, Leila

    2015-01-01

    Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998-2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3 percent increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates. PMID:24463141

  16. Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

    SciTech Connect

    Larsson, Arne; Lidar, Per; Bergh, Niklas; Hedin, Gunnar

    2013-07-01

    -necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)

  17. Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs: Cost Assessment of Manufacturing/Design Concepts

    NASA Technical Reports Server (NTRS)

    Metschan, S.

    2000-01-01

    The objective of the Integral Airframe Structures (IAS) program was to demonstrate, for an integrally stiffened structural concept, performance and weight equal to "built-up" structure with lower manufacturing cost. This report presents results of the cost assessment for several design configuration/manufacturing method combinations. The attributes of various cost analysis models were evaluated and COSTRAN selected for this study. A process/design cost evaluation matrix was developed based on material, forming, machining, and assembly of structural sub-elements and assembled structure. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current built-up technology baseline. This would correspond to a total cost reduction of $1.7 million per ship set for a 777-sized airplane. However, there are important outstanding issues with regard to the cost of capacity of high technology machinery, and the ability to cost-effectively provide surface finish acceptable to the commercial aircraft industry. The projected high raw material cost of large extrusions also played an important role in the trade-off between plate and extruded concepts.

  18. A decentralized approach to reducing the social costs of cascading failures

    NASA Astrophysics Data System (ADS)

    Hines, Paul

    Large cascading failures in electrical power networks come with enormous social costs. These can be direct financial costs, such as the loss of refrigerated foods in grocery stores, or more indirect social costs, such as the traffic congestion that results from the failure of traffic signals. While engineers and policy makers have made numerous technical and organizational changes to reduce the frequency and impact of large cascading failures, the existing data, as described in Chapter 2 of this work, indicate that the overall frequency and impact of large electrical blackouts in the United States are not decreasing. Motivated by the cascading failure problem, this thesis describes a new method for Distributed Model Predictive Control and a power systems application. The central goal of the method, when applied to power systems, is to reduce the social costs of cascading failures by making small, targeted reductions in load and generation and changes to generator voltage set points. Unlike some existing schemes that operate from centrally located control centers, the method is operated by software agents located at substations distributed throughout the power network. The resulting multi-agent control system is a new approach to decentralized control, combining Distributed Model Predictive Control and Reciprocal Altruism. Experimental results indicate that this scheme can in fact decrease the average size, and thus social costs, of cascading failures. Over 100 randomly generated disturbances to a model of the IEEE 300 bus test network, the method resulted in nearly an order of magnitude decrease in average event size (measured in cost) relative to cascading failure simulations without remedial control actions. Additionally, the communication requirements for the method are measured, and found to be within the bandwidth capabilities of current communications technology (on the order of 100kB/second). Experiments on several resistor networks with varying structures

  19. The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

  20. Proven Innovations and New Initiatives in Ground System Development: Reducing Costs in the Ground System

    NASA Technical Reports Server (NTRS)

    Gunn, Jody M.

    2006-01-01

    The state-of-the-practice for engineering and development of Ground Systems has evolved significantly over the past half decade. Missions that challenge ground system developers with significantly reduced budgets in spite of requirements for greater and previously unimagined functionality are now the norm. Making the right trades early in the mission lifecycle is one of the key factors to minimizing ground system costs. The Mission Operations Strategic Leadership Team at the Jet Propulsion Laboratory has spent the last year collecting and working through successes and failures in ground systems for application to future missions.

  1. Integrating MEA Regeneration with CO2 Compression and Peaking to Reduce CO2 Capture Costs

    SciTech Connect

    Kevin S. Fisher; Carrie Beitler; Curtis Rueter; Katherine Searcy; Dr. Gary Rochelle; Dr. Majeed Jassim

    2005-06-09

    Capturing CO{sub 2} from coal-fired power plants is a necessary component of any large-scale effort to reduce anthropogenic CO{sub 2} emissions. Conventional absorption/stripping with monoethanolamine (MEA) or similar solvents is the most likely current process for capturing CO{sub 2} from the flue gas at these facilities. However, one of the largest problems with MEA absorption/stripping is that conventional process configurations have energy requirements that result in large reductions in the net power plant output. Several alternative process configurations for reducing these parasitic energy requirements were investigated in this research with the assistance of the Platte River Power Authority, based on recovering energy from the CO{sub 2} compression train and using that energy in the MEA regeneration step. In addition, the feasibility of selective operation of the amine system at a higher CO{sub 2} removal efficiency during non-peak electricity demand periods was also evaluated. Four process configurations were evaluated: A generic base case MEA system with no compression heat recovery, CO{sub 2} vapor recompression heat recovery, and multipressure stripping with and without vapor recompression heat recovery. These configurations were simulated using a rigorous rate-based model, and the results were used to prepare capital and operating cost estimates. CO{sub 2} capture economics are presented, and the cost of CO{sub 2} capture (cost per tonne avoided) is compared among the base case and the alternative process configurations. Cost savings per tonne of CO{sub 2} avoided ranged from 4.3 to 9.8 percent. Energy savings of the improved configurations (8-10%, freeing up 13 to 17 MW of power for sale to the grid based on 500 MW unit ) clearly outweighed the modest increases in capital cost to implement them; it is therefore likely that one of these improved configurations would be used whenever MEA-based (or similar) scrubbing technologies are implemented. In fact

  2. Reducing legal fees in medical group practices. The role of health care alternative dispute resolution.

    PubMed

    Joseph, D M

    1995-01-01

    Conflict is a growth industry, particularly in an increasingly complex health care system. Litigation is the most common, and most costly, method of settling health care disputes. Highly adversarial, the process of litigation often generates as much, if not more, hostility than the original dispute. In addition, satisfaction with the outcome is very low. The challenge that has arisen is to manage the conflicts so that the underlying needs and interests of all the parties can best be met. Often the techniques and processes of alternative dispute resolution (ADR) can be successfully used in resolving these sorts of conflicts quickly, cheaply and with greater satisfaction for all parties. Various applications of ADR are currently being used or tested in a variety of health care disputes in the United States and Canada. Tremendous success has been achieved in mediating medical malpractice claims, medical staff disputes, economic credentialing conflicts, insurer relations issues and denial of coverage disputes. Professional relations and departmental staff disputes, partnership and employee conflicts, and organizational disputes within clinics, HMOs and large group practices have all been found particularly amenable to ADR. These are all situations in which everyone benefits from quick, non-hostile resolutions and on-going relationships can continue. PMID:10144247

  3. A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre's syndrome and peritonsillar abscesses.

    PubMed

    Bank, S; Christensen, K; Kristensen, L H; Prag, J

    2013-01-01

    The main purpose of this paper was to estimate the cost per quality-adjusted life year (QALY) saved by identifying Fusobacterium necrophorum in throat swabs followed by proper antibiotic treatment, to reduce the incidence of Lemierre's syndrome and peritonsillar abscesses (PTA) originating from a pharyngitis. The second purpose was to estimate the population size required to indicate that antibiotic treatment has an effect. Data from publications and our laboratory were collected. Monte Carlo simulation and one-way sensitivity analysis were used to analyse cost-effectiveness. The cost-effectiveness analysis shows that examining throat swabs from 15- to 24-year-olds for F. necrophorum followed by antibiotic treatment will probably be less costly than most other life-saving medical interventions, with a median cost of US$8,795 per QALY saved. To indicate a reduced incidence of Lemierre's syndrome and PTA in Denmark, the intervention probably has to be followed for up to 5 years. Identifying F. necrophorum in throat swabs from 15- to 24-year-olds followed by proper antibiotic treatment only requires a reduction of 20-25 % in the incidence of Lemierre's syndrome and PTA to be cost-effective. This study warrants further examination of the effect of antibiotic treatment on the outcome of F. necrophorum acute and recurrent pharyngitis, as well as the effect on Lemierre's syndrome and PTA. PMID:22886057

  4. Lessons for Teaching Cost Containment.

    ERIC Educational Resources Information Center

    McPhee, Stephen J.; And Others

    1984-01-01

    An educational program for medical and surgical house staffs and for medical students designed to reduce unneeded orders for low cost, high volume ancillary and nursing services is discussed. The program components include lectures, medical record audits and reviews, and group feedback in the form of cost summaries. (Author/MLW)

  5. Costs and Cost-Effectiveness of Training Traditional Birth Attendants to Reduce Neonatal Mortality in the Lufwanyama Neonatal Survival Study (LUNESP)

    PubMed Central

    Sabin, Lora L.; Knapp, Anna B.; MacLeod, William B.; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H.; Gill, Christopher J.

    2012-01-01

    Background The Lufwanyama Neonatal Survival Project (“LUNESP”) was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. Methods and Findings We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011–2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as ‘conservative’ and ‘optimistic’ scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Conclusions Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was ‘highly cost effective’. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care. PMID:22545117

  6. Re-Engineering of the Hubble Space Telescope (HST) to Reduce Operational Costs

    NASA Technical Reports Server (NTRS)

    Garvis, Michael; Dougherty, Andrew; Whittier, Wallace

    1996-01-01

    Satellite telemetry processing onboard the Hubble Space Telescope (HST) is carried out using dedicated software and hardware. The current ground system is expensive to operate and maintain. The mandate to reduce satellite ground system operations and maintenance costs by the year 2000 led NASA to upgrade the command and control systems in order to improve the data processing capabilities, reduce operator experience levels and increase system standardization. As a result, a command and control system product development team was formed to redesign and develop the HST ground system. The command and control system ground system development consists of six elements. The results of the prototyping phase carried out for the following of these elements are presented: the front end processor; middleware, and the graphical user interface.

  7. Metal and Glass Manufactures Reduce Costs by Increasing Energy Efficiency in Process Heating Systems

    SciTech Connect

    2004-05-01

    Process heating plays a key role in producing steel, aluminum, and glass and in manufacturing products made from these materials. Faced with regulatory and competitive pressures to control emissions and reduce operating costs, metal and glass manufacturers are considering a variety of options for reducing overall energy consumption. As 38% of the energy used in U.S. industrial plants is consumed for process heating applications, metal and glass manufacturers are discovering that process heating technologies provide significant opportunities for improving industrial productivity, energy efficiency, and global competitiveness. This fact sheet is the first in a series to describe such opportunities that can be realized in industrial systems by conducting plant-wide assessments (PWA).

  8. How positive affect modulates cognitive control: the costs and benefits of reduced maintenance capability.

    PubMed

    Dreisbach, Gesine

    2006-02-01

    Adaptive action in a constantly changing environment requires the ability to maintain intentions and goals over time and to flexibly switch between these goals in response to significant changes. argued that positive affect modulates these antagonistic control demands in favor of a more flexible but also more distractible behavior. In the present paper, the author will present further evidence for the affective modulation of cognitive control: mild positive affect reduced maintenance capability in a simple cuing paradigm (the AX Continuous Performance Task) as compared to negative and neutral affect. This reduced maintenance capability results in costs when a to be maintained goal has to be executed and conversely results in benefits when a to be maintained goal unexpectedly changes. The data will be discussed with respect to existing theories on positive affect, cognitive control, and dopamine. PMID:16216400

  9. Use of Biostratigraphy to Increase Production, Reduce Operating Costs and Risks and Reduce Environmental Concerns in Oil Well Drilling

    SciTech Connect

    Edward Marks

    2005-09-09

    out at the top of the late Miocene, early Mohnian: Bolivina aff hughesi, Rotalia becki, Suggrunda californica, Virgulina grandis, Virgulina ticensis, Bulimina ecuadorana, Denticula lauta and Nonion medio-costatum. Please see Appendix B, Fig. 1, Neogene Zones, p. 91 and Appendix C, chart 5, p. 99 By the use of Stratigraphy, employing both Paleontology and Lithology, we can increase hydrocarbon production, reduce operating costs and risks by the identification of the productive sections, and reduce environmental concerns by drilling less dry holes needlessly.

  10. Impact of Alternative Medical Device Approval Processes on Costs and Health

    PubMed Central

    George, Benjamin P.; Venkataraman, Vinayak; Dorsey, E. Ray; Johnston, S. Claiborne

    2014-01-01

    Background Medical devices are often introduced prior to randomized-trial evidence of efficacy and this slows completion of trials. Alternative regulatory approaches include restricting device use outside of trials prior to trial evidence of efficacy (like the drug approval process) or restricting out-of-trial use but permitting coverage within trials such as Medicare’s Coverage with Study Participation (CSP). Methods We compared the financial impact to manufacturers and insurers of three regulatory alternatives: (1) limited regulation (current approach), (2) CSP, and (3) restrictive regulation (like the current drug approval process). Using data for patent foramen ovale closure devices, we modeled key parameters including recruitment time, probability of device efficacy, market adoption, and device cost/price to calculate profits to manufacturers, costs to insurers, and overall societal impact on health. Results For manufacturers, profits were greatest under CSP—driven by faster market adoption of effective devices—followed by restrictive regulation. Societal health benefit in total quality-adjusted life years was greatest under CSP. Insurers’ expenditures for ineffective devices were greatest with limited regulation. Findings were robust over a reasonable range of probabilities of trial success. Conclusions Regulation restricting out-of-trial device use and extending limited insurance coverage to clinical trial participants may balance manufacturer and societal interests. PMID:25185975

  11. Direct Medical Cost of Influenza-Related Hospitalizations among Severe Acute Respiratory Infections Cases in Three Provinces in China

    PubMed Central

    Zhu, Xiaoping; Gao, Lidong; Li, Zhong; Feng, Ao; Jin, Hui; Wang, Shiyuan; Su, Qiru; Xu, Zhen; Feng, Zijian

    2013-01-01

    Background Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. Methods Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI) sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital’s Hospital Information System (HIS) and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range) and median (interquartile range [IQR]) costs were calculated and compared among children (≤15 years), adults (16–64 years) and elderly (≥65 years) groups. Factors influencing cost were analyzed. Results A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range) direct medical cost was $1,797 ($80–$27,545) for all hospitalizations, and the median (IQR) direct medical cost was $231 ($164), $854 ($890), and $2,263 ($7,803) for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. Conclusion Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies. PMID:23717485

  12. On Reducing Test Power, Volume and Routing Cost by Chain Reordering and Test Compression Techniques

    NASA Astrophysics Data System (ADS)

    Lin, Chia-Yi; Hsu, Li-Chung; Chen, Hung-Ming

    With the advancement of VLSI manufacturing technology, entire electronic systems can be implemented in a single integrated circuit. Due to the complexity in SoC design, circuit testability becomes one of the most challenging works. Without careful planning in Design For Testability (DFT) design, circuits consume more power in test mode operation than that in normal functional mode. This elevated testing power may cause problems including overall yield lost and instant circuit damage. In this paper, we present two approaches to minimize scan based DFT power dissipation. First methodology includes routing cost consideration in scan chain reordering after cell placement, while second methodology provides test pattern compression for lower power. We formulate the first problem as a Traveling Salesman Problem (TSP), with different cost evaluation from [18], [19], and apply an efficient heuristic to solve it. In the second problem, we provide a selective scan chain architecture and perform a simple yet effective encoding scheme for lower scan testing power dissipation. The experimental results of ISCAS'89 benchmarks show that the first methodology obtains up to 10% average power saving under the same low routing cost compared with a recent result in [19]. The second methodology reduces over 17% of test power compared with filling all don't care (X) bit with 0 in one of ISCAS'89 benchmarks. We also provide the integration flow of these two approaches in this paper.

  13. Costs for switching partners reduce network dynamics but not cooperative behaviour.

    PubMed

    Bednarik, Peter; Fehl, Katrin; Semmann, Dirk

    2014-10-01

    Social networks represent the structuring of interactions between group members. Above all, many interactions are profoundly cooperative in humans and other animals. In accordance with this natural observation, theoretical work demonstrates that certain network structures favour the evolution of cooperation. Yet, recent experimental evidence suggests that static networks do not enhance cooperative behaviour in humans. By contrast, dynamic networks do foster cooperation. However, costs associated with dynamism such as time or resource investments in finding and establishing new partnerships have been neglected so far. Here, we show that human participants are much less likely to break links when costs arise for building new links. Especially, when costs were high, the network was nearly static. Surprisingly, cooperation levels in Prisoner's Dilemma games were not affected by reduced dynamism in social networks. We conclude that the mere potential to quit collaborations is sufficient in humans to reach high levels of cooperative behaviour. Effects of self-structuring processes or assortment on the network played a minor role: participants simply adjusted their cooperative behaviour in response to the threats of losing a partner or of being expelled. PMID:25122233

  14. Do female Nicrophorus vespilloides reduce direct costs by choosing males that mate less frequently?

    PubMed

    Hopwood, P E; Mazué, G P F; Carter, M J; Head, M L; Moore, A J; Royle, N J

    2016-03-01

    Sexual conflict occurs when selection to maximize fitness in one sex does so at the expense of the other sex. In the burying beetle Nicrophorus vespilloides, repeated mating provides assurance of paternity at a direct cost to female reproductive productivity. To reduce this cost, females could choose males with low repeated mating rates or smaller, servile males. We tested this by offering females a dichotomous choice between males from lines selected for high or low mating rate. Each female was then allocated her preferred or non-preferred male to breed. Females showed no preference for males based on whether they came from lines selected for high or low mating rates. Pairs containing males from high mating rate lines copulated more often than those with low line males but there was a negative relationship between female size and number of times she mated with a non-preferred male. When females bred with their preferred male the number of offspring reared increased with female size but there was no such increase when breeding with non-preferred males. Females thus benefited from being choosy, but this was not directly attributable to avoidance of costly male repeated mating. PMID:26979560

  15. Do female Nicrophorus vespilloides reduce direct costs by choosing males that mate less frequently?

    PubMed Central

    Mazué, G. P. F.; Carter, M. J.; Head, M. L.; Moore, A. J.; Royle, N. J.

    2016-01-01

    Sexual conflict occurs when selection to maximize fitness in one sex does so at the expense of the other sex. In the burying beetle Nicrophorus vespilloides, repeated mating provides assurance of paternity at a direct cost to female reproductive productivity. To reduce this cost, females could choose males with low repeated mating rates or smaller, servile males. We tested this by offering females a dichotomous choice between males from lines selected for high or low mating rate. Each female was then allocated her preferred or non-preferred male to breed. Females showed no preference for males based on whether they came from lines selected for high or low mating rates. Pairs containing males from high mating rate lines copulated more often than those with low line males but there was a negative relationship between female size and number of times she mated with a non-preferred male. When females bred with their preferred male the number of offspring reared increased with female size but there was no such increase when breeding with non-preferred males. Females thus benefited from being choosy, but this was not directly attributable to avoidance of costly male repeated mating. PMID:26979560

  16. Reducing the cost of evaluating the committor by a fitting procedure

    NASA Astrophysics Data System (ADS)

    Li, Wenjin; Ma, Ao

    2015-11-01

    Correct identification of reaction coordinates in complex systems is essential for understanding the mechanisms of their reaction dynamics. Existing methods for identifying reaction coordinates typically require knowledge of the committor—the probability of a given configuration to reach the product basin. The high computational cost of evaluating committors has limited applications of methods for identifying reaction coordinates. We proposed a fitting procedure that can reduce the cost of evaluating committors by an order of magnitude or more. The method only requires evaluating the committors of a few configurations in a transition path by the standard and costly shooting procedure. The committors of the other configurations are then estimated with great accuracy by a sigmoid function derived from fitting the few numerically evaluated committors. The method has been systematically tested on a model system of a Brownian particle moving in a one-dimensional double-well potential, and a small biomolecular system—the isomerization of alanine dipeptide in vacuum and in explicit water.

  17. Costs for switching partners reduce network dynamics but not cooperative behaviour

    PubMed Central

    Bednarik, Peter; Fehl, Katrin; Semmann, Dirk

    2014-01-01

    Social networks represent the structuring of interactions between group members. Above all, many interactions are profoundly cooperative in humans and other animals. In accordance with this natural observation, theoretical work demonstrates that certain network structures favour the evolution of cooperation. Yet, recent experimental evidence suggests that static networks do not enhance cooperative behaviour in humans. By contrast, dynamic networks do foster cooperation. However, costs associated with dynamism such as time or resource investments in finding and establishing new partnerships have been neglected so far. Here, we show that human participants are much less likely to break links when costs arise for building new links. Especially, when costs were high, the network was nearly static. Surprisingly, cooperation levels in Prisoner's Dilemma games were not affected by reduced dynamism in social networks. We conclude that the mere potential to quit collaborations is sufficient in humans to reach high levels of cooperative behaviour. Effects of self-structuring processes or assortment on the network played a minor role: participants simply adjusted their cooperative behaviour in response to the threats of losing a partner or of being expelled. PMID:25122233

  18. Effective information channels for reducing costs of environmentally- friendly technologies: evidence from residential PV markets

    NASA Astrophysics Data System (ADS)

    Rai, Varun; Robinson, Scott A.

    2013-03-01

    Realizing the environmental benefits of solar photovoltaics (PV) will require reducing costs associated with perception, informational gaps and technological uncertainties. To identify opportunities to decrease costs associated with residential PV adoption, in this letter we use multivariate regression models to analyze a unique, household-level dataset of PV adopters in Texas (USA) to systematically quantify the effect of different information channels on aspiring PV adopters’ decision-making. We find that the length of the decision period depends on the business model, such as whether the system was bought or leased, and on special opportunities to learn, such as the influence of other PV owners in the neighborhood. This influence accrues passively through merely witnessing PV systems in the neighborhood, increasing confidence and motivation, as well as actively through peer-to-peer communications. Using these insights we propose a new framework to provide public information on PV that could drastically reduce barriers to PV adoption, thereby accelerating its market penetration and environmental benefits. This framework could also serve as a model for other distributed generation technologies.

  19. Cost-benefit analysis of the Swiss national policy on reducing micropollutants in treated wastewater.

    PubMed

    Logar, Ivana; Brouwer, Roy; Maurer, Max; Ort, Christoph

    2014-11-01

    Contamination of freshwater with micropollutants (MPs) is a growing concern worldwide. Even at very low concentrations, MPs can have adverse effects on aquatic ecosystems and possibly also on human health. Switzerland is one of the first countries to start implementing a national policy to reduce MPs in the effluents of municipal sewage treatment plants (STPs). This paper estimates the benefits of upgrading STPs based on public's stated preferences. To assess public demand for the reduction of the environmental and health risks of MPs, we conducted a choice experiment in a national online survey. The results indicate that the average willingness to pay per household is CHF 100 (US$ 73) annually for reducing the potential environmental risk of MPs to a low level. These benefits, aggregated over households in the catchment of the STPs to be upgraded, generate a total annual economic value of CHF 155 million (US$ 113 million). This compares with estimated annual costs for upgrading 123 STPs of CHF 133 million (US$ 97 million) or CHF 86 (US$ 63) per household connected to these STPs. Hence, a cost-benefit analysis justifies the investment decision from an economic point of view and supports the implementation of the national policy in the ongoing political discussion. PMID:25251946

  20. The Manuscript that We Finished: Structural Separation Reduces the Cost of Complement Coercion

    PubMed Central

    Lowder, Matthew W.; Gordon, Peter C.

    2014-01-01

    Two eye-tracking experiments examined the effects of sentence structure on the processing of complement coercion, in which an event-selecting verb combines with a complement that represents an entity (e.g., began the memo). Previous work has demonstrated that these expressions impose a processing cost, which has been attributed to the need to type-shift the entity into an event in order for the sentence to be interpretable (e.g., began writing the memo). Both experiments showed that the magnitude of the coercion cost was reduced when the verb and complement appeared in separate clauses (e.g., The memo that was begun by the secretary; What the secretary began was the memo) compared to when the constituents appeared together in the same clause. The moderating effect of sentence structure on coercion is similar to effects that have been reported for the processing of two other types of semantically complex expressions (inanimate subject-verb integration and metonymy). We propose that sentence structure influences the depth at which complex semantic relationships are computed. When the constituents that create the need for a complex semantic interpretation appear in a single clause, readers experience processing difficulty stemming from the need to detect and/or resolve the semantic mismatch. In contrast, the need to engage in additional processing is reduced when the expression is established across a clause boundary or other structure that deemphasizes the complex relationship. PMID:24999707

  1. The manuscript that we finished: structural separation reduces the cost of complement coercion.

    PubMed

    Lowder, Matthew W; Gordon, Peter C

    2015-03-01

    Two eye-tracking experiments examined the effects of sentence structure on the processing of complement coercion, in which an event-selecting verb combines with a complement that represents an entity (e.g., began the memo). Previous work has demonstrated that these expressions impose a processing cost, which has been attributed to the need to type-shift the entity into an event in order for the sentence to be interpretable (e.g., began writing the memo). Both experiments showed that the magnitude of the coercion cost was reduced when the verb and complement appeared in separate clauses (e.g., The memo that was begun by the secretary; What the secretary began was the memo) compared with when the constituents appeared together in the same clause. The moderating effect of sentence structure on coercion is similar to effects that have been reported for the processing of 2 other types of semantically complex expressions (inanimate subject-verb integration and metonymy). We propose that sentence structure influences the depth at which complex semantic relationships are computed. When the constituents that create the need for a complex semantic interpretation appear in a single clause, readers experience processing difficulty stemming from the need to detect or resolve the semantic mismatch. In contrast, the need to engage in additional processing is reduced when the expression is established across a clause boundary or other structure that deemphasizes the complex relationship. PMID:24999707

  2. Report: landfill alternative daily cover: conserving air space and reducing landfill operating cost.

    PubMed

    Haughey, R D

    2001-02-01

    Title 40, Part 258 of the Code of Federal Regulations, Solid Waste Disposal Facility Criteria, commonly referred to as Subtitle D, became effective on October 9, 1993. It establishes minimum criteria for solid waste disposal facility siting, design, operations, groundwater monitoring and corrective action, and closure and postclosure maintenance, while providing EPA-approved state solid waste regulatory programs flexibility in implementing the criteria. Section 258.21(a) [40 CFR 258.21(a)] requires owners or operators of municipal solid waste landfill (MSWLF) units to cover disposed solid waste with 30cm of earthen material at the end of the operating day, or at more frequent intervals, if necessary, to control disease vectors, fires, odours, blowing litter, and scavenging. This requirement is consistent with already existing solid waste facility regulations in many states. For many MSWLFs, applying daily cover requires the importation of soil which increases landfill operating costs. Daily cover also uses valuable landfill air space, reducing potential operating revenue and the landfill's operating life. 40 CFR 258.21 (b) allows the director of an approved state to approve alternative materials of an alternative thickness if the owner or operator demonstrates that the alternative material and thickness will control disease vectors, fires, odours, blowing litter, and scavenging without presenting a threat to human health and the environment. Many different types of alternative daily cover (ADC) are currently being used, including geosynthetic tarps, foams, garden waste, and auto shredder fluff. These materials use less air space than soil and can reduce operating costs. This paper discusses the variety of ADCs currently being used around the country and their applicability to different climates and operating conditions, highlighting the more unusual types of ADC, the types of demonstrations necessary to obtain approval of ADC, and the impact on landfill air space

  3. Origin of how steam rockets can reduce space transport cost by orders of magnitude

    SciTech Connect

    Zuppero, A.; Larson, T.K.; Schnitzler, B.G.; Rice, J.W.; Hill, T.J.; Richins, W.D.; Parlier, L.; Werner, J.E.

    1999-01-01

    A brief sketch shows the origin of why and how thermal rocket propulsion has the unique potential to dramatically reduce the cost of space transportation for most inner solar system missions of interest. Orders of magnitude reduction in cost are apparently possible when compared to all processes requiring electrolysis for the production of rocket fuels or propellants and to all electric propulsion systems. An order of magnitude advantage can be attributed to rocket propellant tank factors associated with storing water propellant, compared to cryogenic liquids. An order of magnitude can also be attributed to the simplicity of the extraction and processing of ice on the lunar surface, into an easily stored, non-cryogenic rocket propellant (water). A nuclear heated thermal rocket can deliver thousands of times its mass to Low Earth Orbit from the Lunar surface, providing the equivalent to orders of magnitude drop in launch cost for mass in Earth orbit. Mass includes water ice. These cost reductions depend (exponentially) on the mission delta-v requirements being less than about 6 km/s, or about 3 times the specific velocity of steam rockets (2 km/s, from Isp 200 sec). Such missions include: from the lunar surface to Low Lunar Orbit, (LLO), from LLO to lunar escape, from Low Earth Orbit (LEO) to Geosynchronous Orbit (GEO), from LEO to Earth Escape, from LEO to Mars Transfer Orbit, from LLO to GEO, missions returning payloads from about 10{percent} of the periodic comets using propulsive capture to orbits around Earth itself, and fast, 100 day missions from Lunar Escape to Mars. All the assertions depend entirely and completely on the existence of abundant, nearly pure ice at the permanently dark North and South Poles of the Moon. {copyright} {ital 1999 American Institute of Physics.}

  4. Trade in the US and Mexico helps reduce environmental costs of agriculture

    NASA Astrophysics Data System (ADS)

    Martinez-Melendez, Luz A.; Bennett, Elena M.

    2016-05-01

    Increasing international crop trade has enlarged global shares of cropland, water and fertilizers used to grow crops for export. Crop trade can reduce the environmental burden on importing countries, which benefit from embedded environmental resources in imported crops, and from avoided environmental impacts of production in their territory. International trade can also reduce the universal environmental impact of food production if crops are grown where they are produced in the most environmentally efficient way. We compared production efficiencies for the same crops in the US and Mexico to determine whether current crop trade between these two countries provides an overall benefit to the environment. Our economic and environmental accounting for the key traded crops from 2010 to 2014 shows that exports to Mexico are just 3% (∼16 thousand Gg) of the total production of these crops in the US, and exports to US represent roughly 0.13% (∼46 Gg) of Mexican total production of the same crops. Yields were higher in US than Mexico for all crops except wheat. Use of nitrogen fertilizer was higher in US than in Mexico for all crops except corn. Current trade reduces some, but not all, environmental costs of agriculture. A counterfactual trade scenario showed that an overall annual reduction in cultivated land (∼371 thousand ha), water use (∼923 million m3), fertilizer use (∼122 Gg; ∼68 Gg nitrogen) and pollution (∼681 tonnes of N2O emissions to the atmosphere and ∼511 tonnes of leached nitrogen) can be achieved by changing the composition of food products traded. In this case, corn, soybeans and rice should be grown in the US, while wheat, sorghum and barley should be grown in Mexico. Assigning greater economic weight to the environmental costs of agriculture might improve the balance of trade to be more universally beneficial, environmentally.

  5. A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

    PubMed Central

    Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

    2014-01-01

    Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

  6. A conceptual framework for the evaluation of cost-effectiveness of projects to reduce GHG emissions and sequester carbon

    SciTech Connect

    Sathaye, J.; Norgaard, R.; Makundi, W.

    1993-07-01

    This paper proposes a conceptual framework for evaluating the cost of projects to reduce atmospheric greenhouse gases (GHGs). The evaluation of cost-effectiveness should account for both the timing of carbon emissions and the damage caused by the atmospheric stock of carbon. We develop a conceptual basis to estimate the cost-effectiveness of projects in terms of the cost of reducing atmospheric carbon (CRAC) and other GHGs. CRAC accounts for the economic discount rate, alternative functional forms of the shadow price, the residence period of carbon in the atmosphere, and the multiple monetary benefits of projects. The last item is of particular importance to the developing countries.

  7. SOAP-V: Introducing a method to empower medical students to be change agents in bending the cost curve.

    PubMed

    Moser, Eileen M; Huang, Grace C; Packer, Clifford D; Glod, Susan; Smith, Cynthia D; Alguire, Patrick C; Fazio, Sara B

    2016-03-01

    Medical students must learn how to practice high-value, cost-conscious care. By modifying the traditional SOAP (Subjective-Objective-Assessment-Plan) presentation to include a discussion of value (SOAP-V), we developed a cognitive forcing function designed to promote discussion of high-value, cost-conscious care during patient delivery. The SOAP-V model prompts the student to consider (1) the evidence that supports a test or treatment, (2) the patient's preferences and values, and (3) the financial cost of a test or treatment compared to alternatives. Students report their findings to their teams during patient care rounds. This tool has been successfully used at 3 medical schools. Preliminary results find that students who have been trained in SOAP-V feel more empowered to address the economic healthcare crisis, are more comfortable in initiating discussions about value, and are more likely to consider potential costs to the healthcare system. PMID:26416013

  8. Medication reviews.

    PubMed

    Blenkinsopp, Alison; Bond, Christine; Raynor, David K

    2012-10-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195

  9. Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials

    PubMed Central

    Hallsworth, Michael; Berry, Dan; Sanders, Michael; Sallis, Anna; King, Dominic; Vlaev, Ivo; Darzi, Ara

    2015-01-01

    Background Missed hospital appointments are a major cause of inefficiency worldwide. Healthcare providers are increasingly using Short Message Service reminders to reduce ‘Did Not Attend’ (DNA) rates. Systematic reviews show that sending such reminders is effective, but there is no evidence on whether their impact is affected by their content. Accordingly, we undertook two randomised controlled trials that tested the impact of rephrasing appointment reminders on DNA rates in the United Kingdom. Trial Methods Participants were outpatients with a valid mobile telephone number and an outpatient appointment between November 2013 and January 2014 (Trial One, 10,111 participants) or March and May 2014 (Trial Two, 9,848 participants). Appointments were randomly allocated to one of four reminder messages, which were issued five days in advance. Message assignment was then compared against appointment outcomes (appointment attendance, DNA, cancellation by patient). Results In Trial One, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4%, compared to 11.1% for the existing message (OR 0.74, 95% CI 0.61–0.89, P<0.01). Trial Two replicated this effect (DNA rate 8.2%), but also found that expressing the same concept in general terms was significantly less effective (DNA rate 9.9%, OR 1.22, 95% CI 1.00–1.48, P<0.05). Moving from the existing reminder to the more effective costs message would result in 5,800 fewer missed appointments per year in the National Health Service Trust in question, at no additional cost. The study’s main limitations are that it took place in a single location in England, and that it required accurate phone records, which were only obtained for 20% of eligible patients. We conclude that missed appointments can be reduced, for no additional cost, by introducing persuasive messages to appointment reminders. Future studies could examine the impact of varying reminder messages in other health

  10. Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients

    PubMed Central

    Cubro, Hajrunisa; Somun-Kapetanovic, Rabija; Thiery, Guillaume; Talmor, Daniel; Gajic, Ognjen

    2016-01-01

    AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed. RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria. CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services. PMID:27152258

  11. Thermal energy storage for space cooling. Technology for reducing on-peak electricity demand and cost

    SciTech Connect

    2000-12-01

    Cool storage technology can be used to significantly reduce energy costs by allowing energy intensive, electrically driven cooling equipment to be predominantly operated during off-peak hours when electricity rates are lower. In addition, some system configurations may result in lower first costs and/or lower operating costs. Cool storage systems of one type or another could potentially be cost-effectively applied in most buildings with a space cooling system. A survey of approximately 25 manufacturers providing cool storage systems or components identified several thousand current installations, but less than 1% of these were at Federal facilities. With the Federal sector representing nearly 4% of commercial building floor space and 5% of commercial building energy use, Federal utilization would appear to be lagging. Although current applications are relatively few, the estimated potential annual savings from using cool storage in the Federal sector is $50 million. There are many different types of cool storage systems representing different combinations of storage media, charging mechanisms, and discharging mechanisms. The basic media options are water, ice, and eutectic salts. Ice systems can be further broken down into ice harvesting, ice-on-coil, ice slurry, and encapsulated ice options. Ice-on-coil systems may be internal melt or external melt and may be charged and discharged with refrigerant or a single-phase coolant (typically a water/glycol mixture). Independent of the technology choice, cool storage systems can be designed to provide full storage or partial storage, with load-leveling and demand-limiting options for partial storage. Finally, storage systems can be operated on a chiller-priority or storage priority basis whenever the cooling load is less than the design conditions. The first section describes the basic types of cool storage technologies and cooling system integration options. The next three sections define the savings potential in the

  12. Do HMOs reduce health care costs? A multivariate analysis of two Medicare HMO demonstration projects.

    PubMed Central

    McCombs, J S; Kasper, J D; Riley, G F

    1990-01-01

    Charge data from two Medicare HMO demonstration projects were analyzed to determine if prepaid plans achieved cost savings for enrolled beneficiaries. Fallon Community Health Plan of Massachusetts did not reduce total charges significantly for survivors in their first year postenrollment. However, the plan enjoyed reductions in total charges per month after the first year of nearly 38 percent (41 percent for Part A; 31 percent for Part B). Savings for decedents were more modest, reducing total charges per month by around 27 percent (19 percent, Part A; 68 percent, Part B). Greater Marshfield Community Health Plan of Wisconsin was not successful in controlling charges during the demonstration period. Marshfield incurred losses in the first postenrollment year for survivors due to a 38 percent increase in total charges per month (18 percent, Part A; 73 percent, Part B). In the second year postenrollment, the Marshfield plan was able to reduce losses for survivors to roughly 11 percent (-6 percent, Part A; 44 percent, Part B). For decedents, Marshfield experienced an increase in total charges per month of approximately 21 percent relative to fee-for-service comparisons, with Part B charges again much higher than those of the comparison group (47 percent). PMID:2211129

  13. Reducing Emergency Medical Service response time via the reallocation of ambulance bases.

    PubMed

    Nogueira, L C; Pinto, L R; Silva, P M S

    2016-03-01

    The demand for highly efficient and effective services and consumer goods is an essential prerequisite for modern organizations. In healthcare, efficiency and effectiveness mean reducing disabilities and maintaining human life. One challenge is guaranteeing rapid Emergency Medical Service (EMS) response. This study analyzes the EMS of Belo Horizonte, Brazil, using two modeling techniques: optimization and simulation. The optimization model locates ambulance bases and allocates ambulances to those bases. A simulation of this proposed configuration is run to analyze the dynamic behavior of the system. The main assumption is that optimizing the ambulance base locations can improve the system response time. Feasible solutions were found and the current system may be improved while considering economic and operational changes. PMID:24744263

  14. A reconstruction of a medical history from administrative data: with an application to the cost of skin cancer.

    PubMed

    Rowell, David; Gordon, Louisa G; Olsen, Catherine M; Whiteman, David C

    2015-01-01

    The medical record is a repository of clinical data, which can greatly enhance the quality of health and healthcare analysis. Administrative data are collected for the purpose of billing and reimbursement, and are valued by health researchers because the data are routinely audited to maintain accurate financial records. However, the quantity of incorporated clinical data can be variable. In this paper we reconstruct the medical record from health service invoices to estimate the cost of treating keratinocytic cancer (KC). The data from an epidemiological survey were linked to an administrative data set supplied by the national health insurer. A matched sampling technique with multivariable analysis was used to estimate cost. A KC treatment was identified with 42 service codes which explicitly nominated treatment of a KC. Algorithms identifying comorbities potentially correlated with KC were constructed from the service codes. The annual cost of a KC treatment was estimated to be AU$667 per individual. The average cost of explicit KC treatments was AU$231, while the cost of generic procedures used to treat KC was AU$436. Our ability to accurately control for the medical history enabled our analysis to quantify and describe the constituent costs of KC treatment. PMID:25853002

  15. Reducing emissions from the electricity sector: the costs and benefits nationwide and for the Empire State

    SciTech Connect

    Karen Palmer; Dallas Butraw; Jhih-Shyang Shih

    2005-06-15

    Using four models, this study looks at EPA's Clean Air Interstate Rule (CAIR) as originally proposed, which differs in only small ways from the final rule issued in March 2005, coupled with several approaches to reducing emissions of mercury including one that differs in only small ways from the final rule also issued in March 2005. This study analyzes what costs and benefits each would incur to New York State and to the nation at large. Benefits to the nation and to New York State significantly outweigh the costs associated with reductions in SO{sub 2}, NOx and mercury, and all policies show dramatic net benefits. The manner in which mercury emissions are regulated will have important implications for the cost of the regulation and for emission levels for SO{sub 2} and NOx and where those emissions are located. Contrary to EPA's findings, CAIR as originally proposed by itself would not keep summer emissions of NOx from electricity generators in the SIP region below the current SIP seasonal NOx cap. In the final CAIR, EPA added a seasonal NOx cap to address seasonal ozone problems. The CAIR with the seasonal NOx cap produces higher net benefits. The effect of the different policies on the mix of fuels used to supply electricity is fairly modest under scenarios similar to the EPA's final rules. A maximum achievable control technology (MACT) approach, compared to a trading approach as the way to achieve tighter mercury targets (beyond EPA's proposal), would preserve the role of coal in electricity generation. The evaluation of scenarios with tighter mercury emission controls shows that the net benefits of a maximum achievable control technology (MACT) approach exceed the net benefits of a cap and trade approach. 39 refs., 10 figs., 30 figs., 5 apps.

  16. Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan

    PubMed Central

    Salahuddin, Naseem; Gohar, M. Aftab; Baig-Ansari, Naila

    2016-01-01

    Background Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP). Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG), assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED) health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV) per patient, whereas Thai Red Cross intradermal (TRC-id) regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen. Methodology/Principal Findings This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded. Conclusions/Significance Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique. PMID:26919606

  17. The use of the ARP© system to reduce the costs of soil survey for precision viticulture

    NASA Astrophysics Data System (ADS)

    Andrenelli, M. C.; Magini, S.; Pellegrini, S.; Perria, R.; Vignozzi, N.; Costantini, E. A. C.

    2013-12-01

    The goal of this research was to develop a procedure to minimize the cost of soil survey optimizing ARP© (Automatic Resistivity Profiling) deployment and selecting the best placement of the sampling sites to employ for soil profile description and analysis. In this respect, devoted tests were conducted in a 3.5 ha vineyard located in Tuscany (central Italy). ARP© produced close-spaced measurements (2335 points) of geo-referenced values of apparent electrical resistivity (ERa) related approximately to 0.5 m depth. A fast soil surface sampling (0.1-0.3 m depth) was contemporarily carried out for analyzing moisture, particle size distribution and electrical conductivity. Relationships between soil properties, elevation and ERa data were analyzed along with a comparative investigation about the cost for soil description, analysis and ARP survey. The best correlated soil property (clay) to ERa was then employed for evaluating its predictability starting from different combinations of reduced ARP measurements and sampling sites chosen by regression-driven method and the ESAP (ECe Sampling, Assessment and Prediction) software. It was noticed that the reduction of the soil sample number affects clay map predictability less than the decrease of ARP survey intensity. The regression approach provided higher clay predictability than ESAP for the densest ARP survey and loosest soil sampling. Such a procedure can be applied to fields once the geoelectrical calibration phase is performed. Given that the study case can be considered representative of many Mediterranean viticulture districts, we are confident that the methodology can be widely used. These findings indicate that ARP on-the-go sensor can fruitfully support traditional soil investigation, allowing the cost reduction for sampling and laboratory analyses.

  18. Efficient and cost-reduced glucoamylase fed-batch production with alternative carbon sources.

    PubMed

    Luo, Hongzhen; Liu, Han; He, Zhenni; Zhou, Cong; Shi, Zhongping

    2015-02-01

    Glucoamylase is an important industrial enzyme. Glucoamylase production by industrial Aspergillus niger strain featured with two major problems: (i) empirical substrate feeding methods deteriorating the fermentation performance; and (ii) the high raw materials cost limiting the economics of the glucoamylase product with delegated specification. In this study, we first proposed a novel three-stage varied-rate substrate feeding strategy for efficient glucoamylase production in a 5 L bioreactor using the standard feeding medium, by comparing the changing patterns of the important physiological parameters such as DO, OUR, RQ, etc., when using different substrate feeding strategies. With this strategy, the glucoamylase activity and productivity reached higher levels of 11,000 U/ml and 84.6 U/ml/h, respectively. The performance enhancement in this case was beneficial from the following results: DO and OUR could be controlled at the higher levels (30%, 43.83 mmol/l/h), while RQ was maintained at a stable/lower level of 0.60 simultaneously throughout the fed-batch phase. Based on this three-stage varied-rate substrate feeding strategy, we further evaluated the economics of using alternative carbon sources, attempting to reduce the raw materials cost. The results revealed that cornstarch hydrolysate could be considered as the best carbon source to replace the standard and expensive feeding medium. In this case, the production cost of the glucoamylase with delegated specification (5,000 U/ml) could be saved by more than 61% while the product quality be ensured simultaneously. The proposed strategy showed application potential in improving the economics of industrial glucoamylase production. PMID:25262682

  19. Recycling Flight Hardware Components and Systems to Reduce Next Generation Research Costs

    NASA Technical Reports Server (NTRS)

    Turner, Wlat

    2011-01-01

    With the recent 'new direction' put forth by President Obama identifying NASA's new focus in research rather than continuing on a path to return to the Moon and Mars, the focus of work at Kennedy Space Center (KSC) may be changing dramatically. Research opportunities within the micro-gravity community potentially stands at the threshold of resurgence when the new direction of the agency takes hold for the next generation of experimenters. This presentation defines a strategy for recycling flight experiment components or part numbers, in order to reduce research project costs, not just in component selection and fabrication, but in expediting qualification of hardware for flight. A key component of the strategy is effective communication of relevant flight hardware information and available flight hardware components to researchers, with the goal of 'short circuiting' the design process for flight experiments

  20. Reducing the cost of energy delivery disruptions: The role of advanced technology

    SciTech Connect

    Brown, M.L.

    1997-03-01

    In July and August 1996, the electric grid in the western Unite States experienced widespread power outages from southern California to western Canada. These large disruptions reminded us of the vulnerability of our energy delivery systems. While these disruptions may have been isolated events, there are a growing number of threats to the security, stability, reliability and safety of our national energy delivery systems. For a fraction of the billions of dollars a year these outages cost our economy, technologies could be developed that would reduce the threats and consequences of such disturbances. Many of these same developments also would better enable our energy delivery systems to accommodate the demands of pending competition in the energy marketplace. 10 refs.

  1. Innovative, High-Pressure, Cryogenic Control Valve: Short Face-to-Face, Reduced Cost

    NASA Technical Reports Server (NTRS)

    Wilkes, Karlin; Larsen, Ed; McCourt, Jackson

    2004-01-01

    A control valve that can throttle high pressure cryogenic fluid embodies several design features that distinguish it over conventional valves designed for similar applications. Field and design engineers worked together to create a valve that would simplify installation, trim changes, and maintenance, thus reducing overall cost. The seals and plug stem packing were designed to perform optimally in cryogenic temperature ranges. Unlike conventional high-pressure cryogenic valves, the trim size can be changed independent of the body. The design feature that provides flexibility for changing the trim is a split body. The body is divided into an upper and a lower section with the seat ring sandwiched in between. In order to maintain the plug stem packing at an acceptable sealing temperature during cryogenic service, heat-exchanging fins were added to the upper body section (see figure). The body is made of stainless steel.

  2. Synthesis of medicinally relevant terpenes: reducing the cost and time of drug discovery

    PubMed Central

    Jansen, Daniel J; Shenvi, Ryan A

    2014-01-01

    Terpenoids constitute a significant fraction of molecules produced by living organisms that have found use in medicine and other industries. Problems associated with their procurement and adaptation for human use can be solved using chemical synthesis, which is an increasingly economical option in the modern era of chemistry. This article documents, by way of individual case studies, strategies for reducing the time and cost of terpene synthesis for drug discovery. A major trend evident in recent syntheses is that complex terpenes are increasingly realistic starting points for both medicinal chemistry campaigns and large-scale syntheses, at least in the context of the academic laboratory, and this trend will likely penetrate the commercial sector in the near future. PMID:25078134

  3. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    SciTech Connect

    Sullivan, Kevin; Anasti, William; Fang, Yichuan; Subramanyan, Karthik; Leininger, Tom; Zemsky, Christine

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

  4. Domain Analysis of Integrated Data to Reduce Cost Associated with Liver Disease

    PubMed Central

    Motiwala, Tasneem; Kite, Bobbie; Regan, Kelly; Gascon, Gregg M.; Payne, Philip R.O.

    2016-01-01

    Liver cancer, the fifth most common cancer and second leading cause of cancer-related death among men worldwide, is plagued by not only lack of clinical research, but informatics tools for early detection. Consequently, it presents a major health and cost burden. Among the different types of liver cancer, hepatocellular carcinoma (HCC) is the most common and deadly form, arising from underlying liver disease. Current models for predicting risk of HCC and liver disease are limited to clinical data. A domain analysis of existing research related to screening for HCC and liver disease suggests that metabolic syndrome (MetS) may present oppportunites to detect early signs of liver disease. The purpose of this paper is to (i) provide a domain analysis of the relationship between HCC, liver disease, and metabolic syndrome, (ii) a review of the current disparate sources of data available for MetS diagnosis, and (iii) recommend informatics solutions for the diagnosis of MetS from available administrative (Biometrics, PHA, claims) and laboratory data, towards early prediction of liver disease. Our domain analysis and recommendations incorporate best practices to make meaningful use of available data with the goal of reducing cost associated with liver disease. PMID:26262083

  5. Complementarity in the provision of ecosystem services reduces the cost of mitigating amplified natural disturbance events

    PubMed Central

    Sims, Charles; Aadland, David; Powell, James; Finnoff, David C.; Crabb, Ben

    2014-01-01

    Climate change has been implicated as a root cause of the recent surge in natural disturbance events such as storms, wildfires, and insect outbreaks. This climate-based surge has led to a greater focus on disturbance-mitigating benefits of ecosystem management. Quantifying these benefits requires knowledge of the relationship between natural and anthropogenic disturbances, which is lacking at the temporal and spatial scales needed to inform ecosystem-based management. This study investigates a specific relationship between timber harvesting and climate-amplified outbreaks of mountain pine beetle. If harvesting is located to mitigate long-distance insect dispersal, there is potential for a win–win outcome in which both timber production and forest conservation can be increased. This spatially targeted harvesting strategy lowers the cost of providing disturbance-mitigating ecosystem services, because valuable timber products are also produced. Mitigating long-distance dispersal also produces net gains in forest conservation across various stakeholder groups. These results speak to ongoing federal efforts to encourage forest vegetation removal on public forestlands to improve forest health. These efforts will lower the cost of responding to climate-amplified natural disturbance events but only if vegetation removal efforts are spatially located to reduce disturbance risk. Otherwise, efforts to improve forest health may be converting forest conservation services to timber services. PMID:25385604

  6. A New User-Friendly Model to Reduce Cost for Headwater Benefits Assessment

    SciTech Connect

    Bao, Y.S.; Cover, C.K.; Perlack, R.D.; Sale, M.J.; Sarma, V.

    1999-07-07

    Headwater benefits at a downstream hydropower project are energy gains that are derived from the installation of upstream reservoirs. The Federal Energy Regulatory Commission is required by law to assess charges of such energy gains to downstream owners of non-federal hydropower projects. The high costs of determining headwater benefits prohibit the use of a complicated model in basins where the magnitude of the benefits is expected to be small. This paper presents a new user-friendly computer model, EFDAM (Enhanced Flow Duration Analysis Method), that not only improves the accuracy of the standard flow duration method but also reduces costs for determining headwater benefits. The EFDAM model includes a MS Windows-based interface module to provide tools for automating input data file preparation, linking and executing of a generic program, editing/viewing of input/output files, and application guidance. The EDFAM was applied to various river basins. An example was given to illustrate the main features of EFDAM application for creating input files and assessing headwater benefits at the Tulloch Hydropower Plant on the Stanislaus River Basin, California.

  7. Assessing diagnostic complexity: An image feature-based strategy to reduce annotation costs.

    PubMed

    Zamacona, Jose R; Niehaus, Ronald; Rasin, Alexander; Furst, Jacob D; Raicu, Daniela S

    2015-07-01

    Computer-aided diagnosis systems can play an important role in lowering the workload of clinical radiologists and reducing costs by automatically analyzing vast amounts of image data and providing meaningful and timely insights during the decision making process. In this paper, we present strategies on how to better manage the limited time of clinical radiologists in conjunction with predictive model diagnosis. We first introduce a metric for discriminating between the different categories of diagnostic complexity (such as easy versus hard) encountered when interpreting CT scans. Second, we propose to learn the diagnostic complexity using a classification approach based on low-level image features automatically extracted from pixel data. We then show how this classification can be used to decide how to best allocate additional radiologists to interpret a case based on its diagnosis category. Using a lung nodule image dataset, we determined that, by a simple division of cases into hard and easy to diagnose, the number of interpretations can be distributed to significantly lower the cost with limited loss in prediction accuracy. Furthermore, we show that with just a few low-level image features (18% of the original set) we are able to determine the easy from hard cases for a significant subset (66%) of the lung nodule image data. PMID:25712071

  8. Use of clinical pharmacists to reduce cefamandole, cefoxitin, and ticarcillin costs.

    PubMed

    Abramowitz, P W; Nold, E G; Hatfield, S M

    1982-07-01

    The financial impact of using cefamandole and cefoxitin rather than cefazolin and of using ticarcillin rather than carbenicillin in one institution was assessed; the effectiveness of clinical pharmacists in reducing the costs associated with these drugs also was determined. During Phase 1 (July 1, 1980-March 31, 1981), the numbers of intravenous piggyback cefazolin, cephalothin, cefamandole, cefoxitin, carbenicillin, and ticarcillin doses prepared were recorded. Quarterly purchase data for each drug were determined from invoice records. During Phase 2 (April 1, 1981-September 30, 1981), eight clinical pharmacists reviewed all patient charts for cefamandole, cefoxitin, and ticarcillin orders. If the indication for these orders was missing or considered inappropriate, the pharmacist contacted the prescriber and recommended substituting appropriate doses of cefazolin for cefamandole and cefoxitin and of carbenicillin for ticarcillin. The number of doses prepared and quarterly purchase data were collected as in Phase 1. The projected savings resulting from clinical pharmacist input relating to these drugs was calculated. Based on Phase 1 data, the total theoretical expense resulting from cefamandole and cefoxitin use instead of cefazolin and from ticarcillin use in place of carbenicillin was projected to be $233,448 annually. Cefamandole and cefoxitin accounted for 59.8 and 39.7% of total cephalosporin use in Phases 1 and 2, respectively. Ticarcillin accounted for 77.1% of the total ticarcillin and carbenicillin doses in Phase 1, and 16.6% in Phase 2. A projected annual savings of $156,756 was achieved because of clinical pharmacist input at a cost of $16,000 for time devoted to the effort. Clinical pharmacists were effective in reducing the use of cefamandole, cefoxitin, and ticarcillin in situations where cefazolin or carbenicillin could be substituted. PMID:7114059

  9. Reducing Nitrogen Pollution while Decreasing Farmers' Costs and Increasing Fertilizer Industry Profits.

    PubMed

    Kanter, David R; Zhang, Xin; Mauzerall, Denise L

    2015-03-01

    Nitrogen (N) pollution is emerging as one of the most important environmental issues of the 21st Century, contributing to air and water pollution, climate change, and stratospheric ozone depletion. With agriculture being the dominant source, we tested whether it is possible to reduce agricultural N pollution in a way that benefits the environment, reduces farmers' costs, and increases fertilizer industry profitability, thereby creating a "sweet spot" for decision-makers that could significantly increase the viability of improved N management initiatives. Although studies of the economic impacts of improved N management have begun to take into account farmers and the environment, this is the first study to consider the fertilizer industry. Our "sweet spot" hypothesis is evaluated via a cost-benefit analysis of moderate and ambitious N use efficiency targets in U.S. and China corn sectors over the period 2015-2035. We use a blend of publicly available crop and energy price projections, original time-series modeling, and expert elicitation. The results present a mixed picture: although the potential for a "sweet spot" exists in both countries, it is more likely that one occurs in China due to the currently extensive overapplication of fertilizer, which creates a greater potential for farmers and the fertilizer industry to gain economically from improved N management. Nevertheless, the environmental benefits of improving N management consistently dwarf the economic impacts on farmers and the fertilizer industry in both countries, suggesting that viable policy options could include incentives to farmers and the fertilizer industry to increase their support for N management policies. PMID:26023952

  10. Autonomous exoskeleton reduces metabolic cost of human walking during load carriage

    PubMed Central

    2014-01-01

    Background Many soldiers are expected to carry heavy loads over extended distances, often resulting in physical and mental fatigue. In this study, the design and testing of an autonomous leg exoskeleton is presented. The aim of the device is to reduce the energetic cost of loaded walking. In addition, we present the Augmentation Factor, a general framework of exoskeletal performance that unifies our results with the varying abilities of previously developed exoskeletons. Methods We developed an autonomous battery powered exoskeleton that is capable of providing substantial levels of positive mechanical power to the ankle during the push-off region of stance phase. We measured the metabolic energy consumption of seven subjects walking on a level treadmill at 1.5 m/s, while wearing a 23 kg vest. Results During the push-off portion of the stance phase, the exoskeleton applied positive mechanical power with an average across the gait cycle equal to 23 ± 2 W (11.5 W per ankle). Use of the autonomous leg exoskeleton significantly reduced the metabolic cost of walking by 36 ± 12 W, which was an improvement of 8 ± 3% (p = 0.025) relative to the control condition of not wearing the exoskeleton. Conclusions In the design of leg exoskeletons, the results of this study highlight the importance of minimizing exoskeletal power dissipation and added limb mass, while providing substantial positive power during the walking gait cycle. PMID:24885527

  11. A hypothetical profile of ordinary steam turbines with reduced cost and enhanced reliability for contemporary conditions

    SciTech Connect

    Leyzerovich, A.S.

    1998-12-31

    Power steam turbines should be characterized with the reduced cost and enhanced reliability and designed on the basis of experience in steam turbine design and operation accumulated in the world`s practice for the latest years. Currently, such turbines have to be particularly matched with requirements of operation for deregulated power systems; so they should be capable of operating in both base-load and cycling modes. It seems reasonable to have such turbines with the single capacity about 250--400 MW, supercritical main steam pressure, and single steam reheat. This makes it possible to design such turbines with the minimum specific metal amount and length, with the integrated HP-IP and one two-flow LP cylinders. With existing ferritic and martensitic-class steels, the main and reheat steam temperatures can be chosen at the level of 565--580 C (1050--1075 F) without remarkable supplemental expenditures and a sacrifice of reliability. To reduce the capital cost and simplify operation and maintenance, the turbine`s regenerative system can be designed deaeratorless with motor-driven boiler-feed pumps. Such turbines could be used to replace existing old turbines with minimum expenditures. They can also be combined with large high-temperature gas-turbine sets to shape highly efficient combined-cycle units. There exist various design and technological decisions to enhance the turbine reliability and efficiency; they are well worked up and verified in long-term operation practice of different countries. For reliable and efficient operation, the turbine should be furnished with advanced automatic and automated control, diagnostic monitoring, and informative support for the operational personnel.

  12. Basking hamsters reduce resting metabolism, body temperature and energy costs during rewarming from torpor.

    PubMed

    Geiser, Fritz; Gasch, Kristina; Bieber, Claudia; Stalder, Gabrielle L; Gerritsmann, Hanno; Ruf, Thomas

    2016-07-15

    Basking can substantially reduce thermoregulatory energy expenditure of mammals. We tested the hypothesis that the largely white winter fur of hamsters (Phodopus sungorus), originating from Asian steppes, may be related to camouflage to permit sun basking on or near snow. Winter-acclimated hamsters in our study were largely white and had a high proclivity to bask when resting and torpid. Resting hamsters reduced metabolic rate (MR) significantly (>30%) when basking at ambient temperatures (Ta) of ∼15 and 0°C. Interestingly, body temperature (Tb) also was significantly reduced from 34.7±0.6°C (Ta 15°C, not basking) to 30.4±2.0°C (Ta 0°C, basking), which resulted in an extremely low (<50% of predicted) apparent thermal conductance. Induced torpor (food withheld) during respirometry at Ta 15°C occurred on 83.3±36.0% of days and the minimum torpor MR was 36% of basal MR at an average Tb of 22.0±2.6°C; movement to the basking lamp occurred at Tb<20.0°C. Energy expenditure for rewarming was significantly reduced (by >50%) during radiant heat-assisted rewarming; however, radiant heat per se without an endogenous contribution by animals did not strongly affect metabolism and Tb during torpor. Our data show that basking substantially modifies thermal energetics in hamsters, with a drop of resting Tb and MR not previously observed and a reduction of rewarming costs. The energy savings afforded by basking in hamsters suggest that this behaviour is of energetic significance not only for mammals living in deserts, where basking is common, but also for P. sungorus and probably other cold-climate mammals. PMID:27207637

  13. Reducing the energy cost of human walking using an unpowered exoskeleton.

    PubMed

    Collins, Steven H; Wiggin, M Bruce; Sawicki, Gregory S

    2015-06-11

    With efficiencies derived from evolution, growth and learning, humans are very well-tuned for locomotion. Metabolic energy used during walking can be partly replaced by power input from an exoskeleton, but is it possible to reduce metabolic rate without providing an additional energy source? This would require an improvement in the efficiency of the human-machine system as a whole, and would be remarkable given the apparent optimality of human gait. Here we show that the metabolic rate of human walking can be reduced by an unpowered ankle exoskeleton. We built a lightweight elastic device that acts in parallel with the user's calf muscles, off-loading muscle force and thereby reducing the metabolic energy consumed in contractions. The device uses a mechanical clutch to hold a spring as it is stretched and relaxed by ankle movements when the foot is on the ground, helping to fulfil one function of the calf muscles and Achilles tendon. Unlike muscles, however, the clutch sustains force passively. The exoskeleton consumes no chemical or electrical energy and delivers no net positive mechanical work, yet reduces the metabolic cost of walking by 7.2 ± 2.6% for healthy human users under natural conditions, comparable to savings with powered devices. Improving upon walking economy in this way is analogous to altering the structure of the body such that it is more energy-effective at walking. While strong natural pressures have already shaped human locomotion, improvements in efficiency are still possible. Much remains to be learned about this seemingly simple behaviour. PMID:25830889

  14. Cutting costs of multiple mini-interviews – changes in reliability and efficiency of the Hamburg medical school admission test between two applications

    PubMed Central

    2014-01-01

    Background Multiple mini-interviews (MMIs) are a valuable tool in medical school selection due to their broad acceptance and promising psychometric properties. With respect to the high expenses associated with this procedure, the discussion about its feasibility should be extended to cost-effectiveness issues. Methods Following a pilot test of MMIs for medical school admission at Hamburg University in 2009 (HAM-Int), we took several actions to improve reliability and to reduce costs of the subsequent procedure in 2010. For both years, we assessed overall and inter-rater reliabilities based on multilevel analyses. Moreover, we provide a detailed specification of costs, as well as an extrapolation of the interrelation of costs, reliability, and the setup of the procedure. Results The overall reliability of the initial 2009 HAM-Int procedure with twelve stations and an average of 2.33 raters per station was ICC=0.75. Following the improvement actions, in 2010 the ICC remained stable at 0.76, despite the reduction of the process to nine stations and 2.17 raters per station. Moreover, costs were cut down from $915 to $495 per candidate. With the 2010 modalities, we could have reached an ICC of 0.80 with 16 single rater stations ($570 per candidate). Conclusions With respect to reliability and cost-efficiency, it is generally worthwhile to invest in scoring, rater training and scenario development. Moreover, it is more beneficial to increase the number of stations instead of raters within stations. However, if we want to achieve more than 80 % reliability, a minor improvement is paid with skyrocketing costs. PMID:24645665

  15. Lower Restrictions for Sheet Metal Trimming Processes can Reduce Die Costs in The Automotive Industry

    NASA Astrophysics Data System (ADS)

    Hogg, Markus; Rohleder, Martin; Roll, Karl

    2011-05-01

    To reduce costs of trimming dies influencing parameters of the shearing process were identified, new technical approaches for a more cost efficient die design were developed, and comprehensive investigations on a sample tool were done. These approaches will be verified on a trimming die in series production. If this pilot application is successful, many sheet metal forming parts can be trimmed by less die investment in the future. In the automotive industry complex sheet metal forming parts are often trimmed by shearing. Ideally this shearing is done with a 90° angle between the cutting edge and the part surface. Because of complex part geometry different angles always occur. Often shearing angles and the effective sheet thickness increases so much that trimming in the working direction of the press machine is not possible anymore. In these cases sliding cams have to be used. That makes trimming dies expensive and maintenance intensive. For reliable trimming a good understanding of the process and its limitations is necessary. By not considering these limitations the tool can fail after a few operations or/and the resulting edge of the sheet metal part is no longer acceptable. In worst case a new tool has to be built or at least must be reworked. In operational practice so far only empirical values about limitations are known. The stability limit for trimming is not known for all shearing angles and for new high-strength materials. Therefore detailed investigations were done on a sample tool to determine these stability limits for different materials and shearing angles. The basis for starting these principle investigations was empirical values from operational practise. By using a high-quality material and a completely new shape for the trimming die elements both the reliable processable effective sheet thickness respectively the shearing angle as well as the acting forces could be optimized. In the basic investigations trimming in one direction was often still

  16. Reducing BOF Hood Scrubber Energy Costs at a Steel Mill (Bethlehem Steel Corporation Basic Oxygen Furnace No. 3)

    SciTech Connect

    1999-01-01

    This Office of Industrial Technologies Technical Case Study reveals how Bethlehem Steel Corporation was able to save energy, reduce operational costs, and decrease system maintenance by installing a variable-frequency drive and making associated equipment modifications.

  17. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Election of reasonable cost payment for direct medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415.160 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES...

  18. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Executive Summary.

    ERIC Educational Resources Information Center

    Musgrave, Gerald L.

    A study that forecast the consequences of the projected growth in the number of practicing U.S. physicians during the 1980s and beyond is summarized. Attention was directed to the potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services. Econometric modeling and analysis of…

  19. 77 FR 69504 - Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-19

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF MANAGEMENT AND BUDGET Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of... Persons AGENCY: Office of Management and Budget, Executive Office of the President. ACTION:...

  20. Indian Health: Budgetary Effects of Indigent Indians' Medical Costs on Two Montana Counties. Fact Sheet for Congressional Requesters.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    A fact sheet reported medical care costs incurred and funding sources received by county and local governments in Blaine and Hill Counties, Montana, to provide care for indigent Indians. Data obtained from county clerk and recorder offices and welfare departments showed that Blaine County spent about 1% of its operating revenue on indigent medical…

  1. The Relationship between National Heart, Lung, and Blood Institute Weight Guidelines and Concurrent Medical Costs in a Manufacturing Population.

    ERIC Educational Resources Information Center

    Wang, Feifei; Schultz, Alyssa B.; Musich, Shirley; McDonald, Tim; Hirschland, David; Edington, Dee W.

    2003-01-01

    Explored the relationship between the 1998 National Heart, Lung, and Blood Institute (NHLBI) weight guidelines and concurrent medical costs among 177,971 employees, retirees, and adult dependents from a nationwide manufacturing corporation. Results indicated that the six weight groups defined by the NHLBI guidelines were consistent with concurrent…

  2. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Final Report.

    ERIC Educational Resources Information Center

    Musgrave, Gerald L.

    The potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services is addressed in detail in this final research report. Econometric modeling and analyses of economic activity within the health sector were undertaken. An eight equation model of the hospital and physician sectors…

  3. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ... purposes of the reporting requirement of 5 U.S.C. 801. List of Subjects in 28 CFR Part 43 Claims, Health... Department of Justice. * * * * * Dated: February 23, 2010. Eric H. Holder, Jr., Attorney General. BILLING... Part 43 Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United...

  4. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation? 404.32 Section 404.32 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Cost-Sharing § 404.32...

  5. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model

    PubMed Central

    2014-01-01

    Background Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Methods Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. Results The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. Conclusions Increasing dietary fiber

  6. Synchronized ovulation for first insemination improves reproductive performance and reduces cost per pregnancy in dairy heifers.

    PubMed

    Silva, T V; Lima, F S; Thatcher, W W; Santos, J E P

    2015-11-01

    .2% in TAI heifers. In fact, the hazard of pregnancy was 60% greater for TAI than CON. The increased pregnancy rate in TAI reduced the median days to pregnancy by 12 d (CON=2.0 vs. TAI=14.0) and increased the proportion of pregnant heifers by 6.3 percentage points by study d 84 (CON=85.2 vs. TAI=91.5%). The cost per pregnancy was $17.00 less for TAI than CON. The sensitivity analysis indicated that TAI was economically more advantageous to produce a pregnancy compared with CON. Only when insemination rate after the first 21 d of breeding was very high and P/AI was relatively low did the cost per pregnancy become similar for the 2 treatments. Collectively, inseminating all heifers within 2 d of breeding with the 5-d timed AI protocol maintains P/AI, improves pregnancy rate, and reduces cost per pregnancy compared with insemination after detected estrus. PMID:26298767

  7. Medical alert management: a real-time adaptive decision support tool to reduce alert fatigue.

    PubMed

    Lee, Eva K; Wu, Tsung-Lin; Senior, Tal; Jose, James

    2014-01-01

    With the adoption of electronic medical records (EMRs), drug safety alerts are increasingly recognized as valuable tools for reducing adverse drug events and improving patient safety. However, even with proper tuning of the EMR alert parameters, the volume of unfiltered alerts can be overwhelming to users. In this paper, we design an adaptive decision support tool in which past cognitive overriding decisions of users are learned, adapted and used for filtering actions to be performed on current alerts. The filters are designed and learned based on a moving time window, number of alerts, overriding rates, and monthly overriding fluctuations. Using alerts from two separate years to derive filters and test performance, predictive accuracy rates of 91.3%-100% are achieved. The moving time window works better than a static training approach. It allows continuous learning and capturing of the most recent decision characteristics and seasonal variations in drug usage. The decision support system facilitates filtering of non-essential alerts and adaptively learns critical alerts and highlights them prominently to catch providers' attention. The tool can be plugged into an existing EMR system as an add-on, allowing real-time decision support to users without interfering with existing EMR functionalities. By automatically filtering the alerts, the decision support tool mitigates alert fatigue and allows users to focus resources on potentially vital alerts, thus reducing the occurrence of adverse drug events. PMID:25954391

  8. Report on audit of fire and emergency medical services cost sharing between the Department of Energy and Los Alamos County

    SciTech Connect

    1995-10-02

    Los Alamos County was created in 1964 as a response to a Congressional mandate, promulgated in the Atomic Energy Act of 1954. Because the county came into existence via the Atomic Energy Act, the Department provided fire and emergency medical services. In the intervening years, however, the Department and the county have worked toward making the county self-sufficient. The contract for fire and emergency medical services represented a step in the direction of self-sufficiency by requiring the county to begin paying for its share of the related costs. The purpose of the audit was to determine if the costs for fire and emergency medical services were shared appropriately commensurate with the use of the services.

  9. Medication Management in Schools: A Systems Approach to Reducing Risk and Strengthening Quality in School Medication Management

    ERIC Educational Resources Information Center

    Center for Health and Health Care in Schools, 2004

    2004-01-01

    This paper and the invitational meeting for which it has been prepared make certain assumptions about the challenge of strengthening the quality of medication management in school. The participants believe that recent research on improving the safety and quality of patient care has relevance for health services in school, particularly the safety…

  10. Pointed Wings, Low Wingloading and Calm Air Reduce Migratory Flight Costs in Songbirds

    PubMed Central

    Bowlin, Melissa S.; Wikelski, Martin

    2008-01-01

    Migratory bird, bat and insect species tend to have more pointed wings than non-migrants. Pointed wings and low wingloading, or body mass divided by wing area, are thought to reduce energy consumption during long-distance flight, but these hypotheses have never been directly tested. Furthermore, it is not clear how the atmospheric conditions migrants encounter while aloft affect their energy use; without such information, we cannot accurately predict migratory species' response(s) to climate change. Here, we measured the heart rates of 15 free-flying Swainson's Thrushes (Catharus ustulatus) during migratory flight. Heart rate, and therefore rate of energy expenditure, was positively associated with individual variation in wingtip roundedness and wingloading throughout the flights. During the cruise phase of the flights, heart rate was also positively associated with wind speed but not wind direction, and negatively but not significantly associated with large-scale atmospheric stability. High winds and low atmospheric stability are both indicative of the presence of turbulent eddies, suggesting that birds may be using more energy when atmospheric turbulence is high. We therefore suggest that pointed wingtips, low wingloading and avoidance of high winds and turbulence reduce flight costs for small birds during migration, and that climate change may have the strongest effects on migrants' in-flight energy use if it affects the frequency and/or severity of high winds and atmospheric instability. PMID:18478072

  11. Incremental Cost-effectiveness of Combined Therapy vs Medication Only for Youth With Selective Serotonin Reuptake Inhibitor–Resistant Depression

    PubMed Central

    Lynch, Frances L.; Dickerson, John F.; Clarke, Greg; Vitiello, Benedetto; Porta, Giovanna; Wagner, Karen D.; Emslie, Graham; Asarnow, Joan Rosenbaum; Keller, Martin B.; Birmaher, Boris; Ryan, Neal D.; Kennard, Betsy; Mayes, Taryn; DeBar, Lynn; McCracken, James T.; Strober, Michael; Suddath, Robert L.; Spirito, Anthony; Onorato, Matthew; Zelazny, Jamie; Iyengar, Satish; Brent, David

    2013-01-01

    Context Many youth with depression do not respond to initial treatment with selective serotonin reuptake inhibitors (SSRIs), and this is associated with higher costs. More effective treatment for these youth may be cost-effective. Objective To evaluate the incremental cost-effectiveness over 24 weeks of combined cognitive behavior therapy plus switch to a different antidepressant medication vs medication switch only in adolescents who continued to have depression despite adequate initial treatment with an SSRI. Design Randomized controlled trial. Setting Six US academic and community clinics. Patients Three hundred thirty-four patients aged 12 to 18 years with SSRI-resistant depression. Intervention Participants were randomly assigned to (1) switch to a different medication only or (2) switch to a different medication plus cognitive behavior therapy. Main Outcome Measures Clinical outcomes were depression-free days (DFDs), depression-improvement days (DIDs), and quality-adjusted life-years based on DFDs (DFD-QALYs). Costs of intervention, nonprotocol services, and families were included. Results Combined treatment achieved 8.3 additional DFDs (P=.03), 0.020 more DFD-QALYs (P=.03), and 11.0 more DIDs (P=.04). Combined therapy cost $1633 more (P=.01). Cost per DFD was $188 (incremental cost-effectiveness ratio [ICER]=$188; 95% confidence interval [CI], −$22 to $1613), $142 per DID (ICER=$142; 95% CI, −$14 to $2529), and $78 948 per DFD-QALY (ICER=$78 948; 95% CI, −$9261 to $677 448). Cost-effectiveness acceptability curve analyses suggest a 61% probability that combined treatment is more cost-effective at a willingness to pay $100 000 per QALY. Combined treatment had a higher net benefit for subgroups of youth without a history of abuse, with lower levels of hopelessness, and with comorbid conditions. Conclusions For youth with SSRI-resistant depression, combined treatment decreases the number of days with depression and is more costly. Depending on a decision

  12. A 10-year analysis of "revenues," costs, staffing, and workload in an academic medical center clinical chemistry laboratory.

    PubMed

    Benge, H; Csako, G; Parl, F F

    1993-09-01

    From 1980 to 1990 we found progressive increases in workload (number of billable tests; 12.1% per year), staffing [number of full-time equivalents (FTEs); 5.6% per year], "revenues" (gross billings; 25.8% per year), and direct cost (12.9% per year) in the clinical chemistry laboratory of a large tertiary-care university medical center. The increase in direct cost was mainly attributable to an increase in salary cost (23.7% per year), whereas the impact of increasing "consumable" cost was relatively small (5.3% per year). In fact, after adjustment for inflation, the consumable cost was virtually unchanged or decreased during the 10-year study period. Initially, consumables represented about 60% of the direct cost, and the remaining 40% was for salaries. After 1982/83, however, the relative contribution of consumables and salaries to direct cost gradually reversed. Because the workload grew at a higher rate than staffing, the workload per FTE increased from 1980 to 1990. This was paralleled by gradual increases in both "revenue" per FTE and salary per FTE in actual dollars, but by lesser increases to no increases in inflation-corrected dollars. After adjusting for inflation with different indices, the direct cost per test, the consumable cost per test, and the salary cost per test either remained unchanged or decreased in the 1980s. The findings are discussed in the context of technical advancements in laboratory testing, nationwide shortages of medical technologists, and implementation of prospective fixed-fee reimbursement practices during the study period. PMID:8375047

  13. A Comparison of Live Counseling with a Web-Based Lifestyle and Medication Intervention to Reduce Coronary Risk A Randomized Clinical Trial

    PubMed Central

    Keyserling, Thomas C.; Sheridan, Stacey L.; Draeger, Lindy B.; Finkelstein, Eric A.; Gizlice, Ziya; Kruger, Eliza; Johnston, Larry F.; Sloane, Philip D.; Samuel-Hodge, Carmen; Evenson, Kelly R.; Gross, Myron D.; Donahue, Katrina E.; Pignone, Michael P.; Vu, Maihan B.; Steinbacher, Erika A.; Weiner, Bryan J.; Bangdiwala, Shrikant I.; Ammerman, Alice S.

    2014-01-01

    Importance Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings. Objective To assess the effectiveness, acceptability, and cost-effectiveness of a combined lifestyle and medication intervention to reduce CHD risk offered in counselor-delivered and web-based formats. Design Comparative effectiveness trial. Setting Five diverse family medicine practices in North Carolina. Participants Established patients, age 35–79, with no known cardiovascular disease, and at moderate to high risk for CHD -- 10 year Framingham Risk Score (FRS) ≥ 10%. Intervention Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats utilized a web-based decision aid showing potential CHD risk reduction associated with lifestyle and medication risk reducing strategies. Participants chose the risk reducing strategies they wished to follow. Main Outcome and Measures Outcomes were assessed at 4 and 12 months; the primary outcome was within group change in FRS at 4 month follow-up. Other measures included standardized assessments of blood pressure, blood lipids, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Results Of 2,274 screened patients, 385 were randomized (192 counselor; 193 web): mean age 62 years, 24% African American, and mean FRS 16.9%. Follow-up at 4 and 12 months was 91% and 87%, respectively. There was a sustained reduction in FRS at both 4 (primary outcome) and 12 month follow-up: for counselor, −2.3% (95% CI: −3.0% to −1.6%) and −1.9% (−2.8% to −1.1%) and for web, −1.5% (−2.2% to −0.9%) and −1.7%, (−2.6% to −0.8%) respectively. At 4 month follow-up, the adjusted difference in FRS between groups was

  14. The Potential of Medical Abortion to Reduce Maternal Mortality in Africa: What Benefits for Tanzania and Ethiopia?

    PubMed Central

    Baggaley, Rebecca F.; Burgin, Joanna; Campbell, Oona M. R.

    2010-01-01

    Background Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. Methods By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios) and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. Results Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia). Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. Conclusions This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention. PMID:20948995

  15. Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

    PubMed Central

    Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

    2015-01-01

    Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID

  16. Reduced neophobia: a potential mechanism explaining the emergence of self-medicative behavior in sheep.

    PubMed

    Egea, A Vanina; Hall, Jeffery O; Miller, James; Spackman, Casey; Villalba, Juan J

    2014-08-01

    Gastrointestinal helminths challenge ruminants in ways that reduce their fitness. In turn, ruminants have evolved physiological and behavioral adaptations that counteract this challenge. For instance, emerging behavioral evidence suggests that ruminants self-select medicinal compounds and foods that reduce parasitic burdens. However, the mechanism/s leading to self-medicative behaviors in sick animals is still unknown. We hypothesized that when homeostasis is disturbed by a parasitic infection, consumers should respond by increasing the acceptability of novel foods relative to healthy individuals. Three groups of lambs (N=10) were dosed with 0 (Control-C), 5000 (Medium-M) and 15000 (High-H) L3 stage larvae of Haemonchus contortus. When parasites had reached the adult stage, all animals were offered novel foods and flavors in pens and then novel forages at pasture. Ingestive responses by parasitized lambs were different from non-parasitized Control animals and they varied with the type of food and flavor on offer. Parasitized lambs consumed initially more novel beet pulp and less novel beet pulp mixed with tannins than Control lambs, but the pattern reversed after 9d of exposure to these foods. Parasitized lambs ingested more novel umami-flavored food and less novel bitter-flavored food than Control lambs. When offered choices of novel unflavored and bitter-flavored foods or different forage species to graze, parasitized lambs selected a more diverse array of foods than Control lambs. Reductions in food neophobia or selection of a more diverse diet may enhance the likelihood of sick herbivores encountering novel medicinal plants and nutritious forages that contribute to restore health. PMID:24955494

  17. Reduced knee joint moment in ACL deficient patients at a cost of dynamic stability during landing.

    PubMed

    Oberländer, Kai Daniel; Brüggemann, Gert-Peter; Höher, Jürgen; Karamanidis, Kiros

    2012-05-11

    The current study aimed to examine the effect of anterior cruciate ligament deficiency (ACLd) on joint kinetics and dynamic stability control after a single leg hop test (SLHT). Twelve unilateral ACLd patients and a control subject group (n=13) performed a SLHT over a given distance with both legs. The calculation of joint kinetics was done by means of a soft-tissue artifact optimized rigid full-body model. Margin of stability (MoS) was quantified by the difference between the base of support and the extrapolated center of mass. During landing, the ACLd leg showed lower external knee flexion moments but demonstrated higher moments at the ankle and hip compared to controls (p<0.05). The main reason for the joint moment redistribution in the ACLd leg was a more anterior position of the ground reaction force (GRF) vector, which affected the moment arms of the GRF acting about the joints (p<0.05). For the ACLd leg, trunk angle was more flexed over the entire landing phase compared to controls (p<0.05) and we found a significant correlation between moment arms at the knee joint and trunk angle (r² = 0.48;p<0.01). The consequence of this altered landing strategy in ACLd legs was a more anterior position of the center of mass reducing the MoS (p<0.05). The results illustrate the interaction between trunk angle, joint kinetics and dynamic stability during landing maneuvers and provide evidence of a feedforward adaptive adjustment in ACLd patients (i.e. more flexed trunk angle) aimed at reducing knee joint moments at the cost of dynamic stability control. PMID:22440611

  18. Capsiate Supplementation Reduces Oxidative Cost of Contraction in Exercising Mouse Skeletal Muscle In Vivo

    PubMed Central

    Yashiro, Kazuya; Tonson, Anne; Pecchi, Émilie; Vilmen, Christophe; Le Fur, Yann; Bernard, Monique; Bendahan, David; Giannesini, Benoît

    2015-01-01

    Chronic administration of capsiate is known to accelerate whole-body basal energy metabolism, but the consequences in exercising skeletal muscle remain very poorly documented. In order to clarify this issue, the effect of 2-week daily administration of either vehicle (control) or purified capsiate (at 10- or 100-mg/kg body weight) on skeletal muscle function and energetics were investigated throughout a multidisciplinary approach combining in vivo and in vitro measurements in mice. Mechanical performance and energy metabolism were assessed strictly non-invasively in contracting gastrocnemius muscle using magnetic resonance (MR) imaging and 31-phosphorus MR spectroscopy (31P-MRS). Regardless of the dose, capsiate treatments markedly disturbed basal bioenergetics in vivo including intracellular pH alkalosis and decreased phosphocreatine content. Besides, capsiate administration did affect neither mitochondrial uncoupling protein-3 gene expression nor both basal and maximal oxygen consumption in isolated saponin-permeabilized fibers, but decreased by about twofold the Km of mitochondrial respiration for ADP. During a standardized in vivo fatiguing protocol (6-min of repeated maximal isometric contractions electrically induced at a frequency of 1.7 Hz), both capsiate treatments reduced oxidative cost of contraction by 30-40%, whereas force-generating capacity and fatigability were not changed. Moreover, the rate of phosphocreatine resynthesis during the post-electrostimulation recovery period remained unaffected by capsiate. Both capsiate treatments further promoted muscle mass gain, and the higher dose also reduced body weight gain and abdominal fat content. These findings demonstrate that, in addition to its anti-obesity effect, capsiate supplementation improves oxidative metabolism in exercising muscle, which strengthen this compound as a natural compound for improving health. PMID:26030806

  19. Capsiate supplementation reduces oxidative cost of contraction in exercising mouse skeletal muscle in vivo.

    PubMed

    Yashiro, Kazuya; Tonson, Anne; Pecchi, Émilie; Vilmen, Christophe; Le Fur, Yann; Bernard, Monique; Bendahan, David; Giannesini, Benoît

    2015-01-01

    Chronic administration of capsiate is known to accelerate whole-body basal energy metabolism, but the consequences in exercising skeletal muscle remain very poorly documented. In order to clarify this issue, the effect of 2-week daily administration of either vehicle (control) or purified capsiate (at 10- or 100-mg/kg body weight) on skeletal muscle function and energetics were investigated throughout a multidisciplinary approach combining in vivo and in vitro measurements in mice. Mechanical performance and energy metabolism were assessed strictly non-invasively in contracting gastrocnemius muscle using magnetic resonance (MR) imaging and 31-phosphorus MR spectroscopy (31P-MRS). Regardless of the dose, capsiate treatments markedly disturbed basal bioenergetics in vivo including intracellular pH alkalosis and decreased phosphocreatine content. Besides, capsiate administration did affect neither mitochondrial uncoupling protein-3 gene expression nor both basal and maximal oxygen consumption in isolated saponin-permeabilized fibers, but decreased by about twofold the Km of mitochondrial respiration for ADP. During a standardized in vivo fatiguing protocol (6-min of repeated maximal isometric contractions electrically induced at a frequency of 1.7 Hz), both capsiate treatments reduced oxidative cost of contraction by 30-40%, whereas force-generating capacity and fatigability were not changed. Moreover, the rate of phosphocreatine resynthesis during the post-electrostimulation recovery period remained unaffected by capsiate. Both capsiate treatments further promoted muscle mass gain, and the higher dose also reduced body weight gain and abdominal fat content. These findings demonstrate that, in addition to its anti-obesity effect, capsiate supplementation improves oxidative metabolism in exercising muscle, which strengthen this compound as a natural compound for improving health. PMID:26030806

  20. Policy change to improve pathology turnaround time and reduce costs – possible to do both?

    PubMed Central

    Dimeski, Goce; Silvester, Breeann; Ungerer, Jacobus; Johnson, Leslie; Martin, Jennifer H.

    2013-01-01

    Background: Overcrowding and prolonged length of stay in emergency departments (ED) are increasing problems in hospitals. Rapid availability of all laboratory results has an impact on clinical decision-making, admissions or discharge decisions and resource utilisation. Increasing number of our urinary drugs of abuse (DOA) screens had a turnaround time (TAT) of up to 33 days after the discharge of the patient. Materials and methods: Following an audit and a consultation period with clinicians using the service, a policy change was implemented to reduce the use of gas chromatography mass spectroscopy (GCMS): all requests would have a standard immunoassay (IA) test panel undertaken unless specifically they requested GCMS (including medico-legal) analysis. Results: Almost all of the clinicians interviewed had no understanding of the DOA screening or the difference in the information generated between a confirmatory GCMS urine toxicology screen and IA DOA panel. It appeared none of the patients surveyed in the audit would have had a different clinical decision made if a GCMS had not been undertaken. Post change audit showed only 4.3% of drug requests for IA also received a confirmatory GCMS testing. The estimated saving post change implementation was $127,000 (AU $) in test costs alone over a two year period. The TAT of GCMS results was reduced to 3–4 days. Conclusion: A laboratory-led behavioural change in test requesting is possible and sustainable provided the reason is clinically sound and accompanied by consultation and availability of advice by phone when requested on test requesting or interpretation. PMID:24266298

  1. Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty

    PubMed Central

    Seabury, Seth A.; Helland, Eric; Jena, Anupam B.

    2014-01-01

    The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of 220,653 malpractice claims from 1985–2010 merged with information on state liability reforms. We estimated the impact of state noneconomic damage caps on average malpractice payment size for physicians overall and for 10 different specialties, and compared how the effects differed according to the restrictiveness of the cap ($250,000 vs. $500,000 cap). We found noneconomic damage caps reduced payments by $42,980 (15%; p<0.001), with a $250,000 cap reducuing average payments by $59,331 (20%; p<0.001), while a $500,000 cap had no significant effect. Effects varied according to specialty and were largest in specialties with high average payments, such as pediatrics. This suggests that the effect of noneconomic damage caps differs by specialty, and only more restrictive caps result in lower average payments. PMID:25339633

  2. Laser surface modification of medical grade alloys for reduced heating in a magnetic resonance imaging environment

    SciTech Connect

    Benafan, O. E-mail: raj@ucf.edu; Vaidyanathan, R. E-mail: raj@ucf.edu; Chen, S.-Y.; Kar, A.

    2015-12-15

    Nanoscale surface modification of medical grade metallic alloys was conducted using a neodymium-doped yttrium aluminum garnet laser-based dopant diffusion technique. The objective of this approach was to minimize the induction heating by reducing the absorbed radio frequency field. Such an approach is advantageous in that the dopant is diffused into the alloy and is not susceptible to detachment or spallation as would an externally applied coating, and is expected to not deteriorate the mechanical and electrical properties of the base alloy or device. Experiments were conducted using a controlled environment laser system with the ability to control laser properties (i.e., laser power, spot size, and irradiation time) and dopant characteristics (i.e., temperature, concentration, and pressure). The reflective and transmissive properties of both the doped and untreated samples were measured in a radio frequency (63.86 MHz) magnetic field using a system comprising a high power signal generator, a localized magnetic field source and sensor, and a signal analyzer. The results indicate an increase in the reflectivity of the laser-treated samples compared to untreated samples. The effect of reflectivity on the heating of the alloys is investigated through a mathematical model incorporating Maxwell’s equations and heat conduction.

  3. Laser surface modification of medical grade alloys for reduced heating in a magnetic resonance imaging environment.

    PubMed

    Benafan, O; Chen, S-Y; Kar, A; Vaidyanathan, R

    2015-12-01

    Nanoscale surface modification of medical grade metallic alloys was conducted using a neodymium-doped yttrium aluminum garnet laser-based dopant diffusion technique. The objective of this approach was to minimize the induction heating by reducing the absorbed radio frequency field. Such an approach is advantageous in that the dopant is diffused into the alloy and is not susceptible to detachment or spallation as would an externally applied coating, and is expected to not deteriorate the mechanical and electrical properties of the base alloy or device. Experiments were conducted using a controlled environment laser system with the ability to control laser properties (i.e., laser power, spot size, and irradiation time) and dopant characteristics (i.e., temperature, concentration, and pressure). The reflective and transmissive properties of both the doped and untreated samples were measured in a radio frequency (63.86 MHz) magnetic field using a system comprising a high power signal generator, a localized magnetic field source and sensor, and a signal analyzer. The results indicate an increase in the reflectivity of the laser-treated samples compared to untreated samples. The effect of reflectivity on the heating of the alloys is investigated through a mathematical model incorporating Maxwell's equations and heat conduction. PMID:26724043

  4. Laser surface modification of medical grade alloys for reduced heating in a magnetic resonance imaging environment

    NASA Astrophysics Data System (ADS)

    Benafan, O.; Chen, S.-Y.; Kar, A.; Vaidyanathan, R.

    2015-12-01

    Nanoscale surface modification of medical grade metallic alloys was conducted using a neodymium-doped yttrium aluminum garnet laser-based dopant diffusion technique. The objective of this approach was to minimize the induction heating by reducing the absorbed radio frequency field. Such an approach is advantageous in that the dopant is diffused into the alloy and is not susceptible to detachment or spallation as would an externally applied coating, and is expected to not deteriorate the mechanical and electrical properties of the base alloy or device. Experiments were conducted using a controlled environment laser system with the ability to control laser properties (i.e., laser power, spot size, and irradiation time) and dopant characteristics (i.e., temperature, concentration, and pressure). The reflective and transmissive properties of both the doped and untreated samples were measured in a radio frequency (63.86 MHz) magnetic field using a system comprising a high power signal generator, a localized magnetic field source and sensor, and a signal analyzer. The results indicate an increase in the reflectivity of the laser-treated samples compared to untreated samples. The effect of reflectivity on the heating of the alloys is investigated through a mathematical model incorporating Maxwell's equations and heat conduction.

  5. Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence

    PubMed Central

    Chen, Mingsheng; Si, Lei; Winzenberg, Tania M; Gu, Jieruo; Jiang, Qicheng; Palmer, Andrew J

    2016-01-01

    Aims Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods We used a previously developed and validated osteoporosis state-transition microsimulation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medication persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness-to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost-effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost-effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion Given the willingness-to-pay threshold

  6. Assessment of xylanase activity in dry storage as a potential method of reducing feedstock cost.

    PubMed

    Smith, William A; Thompson, David N; Thompson, Vicki S; Radtke, Corey W; Carter, Brady

    2009-05-01

    Enzymatic preprocessing of lignocellulosic biomass in dry storage systems has the potential to improve feedstock characteristics and lower ethanol production costs. To assess the potential for endoxylanase activity at low water contents, endoxylanase activity was tested using a refined wheat arabinoxylan substrate and three commercial endoxylanases over the water activity range 0.21-1.0, corresponding to water contents of 5% to >60% (dry basis). Homogeneously mixed dry samples were prepared at a fixed enzyme to substrate ratio and incubated in chambers at a variety of fixed water activities. Replicates were sacrificed periodically, and endoxylanase activity was quantified as an increase in reducing sugar relative to desiccant-stored controls. Endoxylanase activity was observed at water activities over 0.91 in all enzyme preparations in less than 4 days and at a water activity of 0.59 in less than 1 week in two preparations. Endoxylanase activity after storage was confirmed for selected desiccant-stored controls by incubation at 100% relative humidity. Water content to water activity relationships were determined for three lignocellulosic substrates, and results indicate that two endoxylanase preparations retained limited activity as low as 7% to 13% water content (dry basis), which is well within the range of water contents representative of dry biomass storage. Future work will examine the effects of endoxylanase activity toward substrates such as corn stover, wheat straw, and switchgrass in low water content environments. PMID:19096939

  7. The role of photoperiods on photobioreactors - A potential strategy to reduce costs.

    PubMed

    Maroneze, Mariana Manzoni; Siqueira, Stefania Fortes; Vendruscolo, Raquel Guidetti; Wagner, Roger; de Menezes, Cristiano Ragagnin; Zepka, Leila Queiroz; Jacob-Lopes, Eduardo

    2016-11-01

    The aim of this work was evaluate the role of photoperiods (long-term, frequencies and short) on the growth and lipid content of microalgae Scenedesmus obliquus CPCC05. The results showed that Scenedesmus obliquus can store sufficient energy to sustain cell growth for continuous periods of up to 2h in the dark, without affecting the photosynthetic rate. The values for maximum biomass (9.58mg/Lh) and lipid productivities (2.56mg/Lh) were obtained at photoperiod of 0.91:0.09s (light:dark) and 48 t/d, respectively. Moreover, the best trade-offs between biomass productivity and light energy economy occurred in photoperiods of 0.5:0.5s and 0.91:0.09s (light:dark), and those between lipid productivity and light energy economy occurred in the frequency photoperiod of 24 and 48 t/d. Thus, the use of the photoperiods are an effective strategy for reducing costs of microalgal biomass production. PMID:27521786

  8. Selection for reduced translation costs at the intronic 5′ end in fungi

    PubMed Central

    Zafrir, Zohar; Zur, Hadas; Tuller, Tamir

    2016-01-01

    It is generally believed that introns are not translated; therefore, the potential intronic features that may be related to the translation step (occurring after splicing) have yet to be thoroughly studied. Here, focusing on four fungi, we performed for the first time a comprehensive study aimed at characterizing how translation efficiency is encoded in introns and affects their evolution. By analysing their intronome we provide evidence of selection for STOP codons close to the intronic 5′ end, and show that the beginning of introns are selected for significantly high translation, presumably to reduce translation and metabolic costs in cases of non-spliced introns. Ribosomal profiling data analysis in Saccharomyces cerevisiae supports the conjecture that in this organism intron retention frequently occurs, introns are partially translated, and their translation efficiency affects organismal fitness. We show that the reported results are more significant in highly translated and highly spliced genes, but are not associated only with genes with a specific function. We also discuss the potential relation of the reported signals to efficient nonsense-mediated decay due to splicing errors. These new discoveries are supported by population-genetics considerations. In addition, they are contributory steps towards a broader understanding of intron evolution and the effect of silent mutations on gene expression and organismal fitness. PMID:27260512

  9. Can remotely sensed meteorological data significantly contribute to reduce costs of tsetse surveys?

    PubMed

    Hendrickx, G; Napala, A; Rogers, D; Bastiaensen, P; Slingenbergh, J

    1999-01-01

    A 0.125 degree raster or grid-based Geographic Information System with data on tsetse, trypanosomiasis animal production, agriculturerkina> and land use has recently been developed in Togo. This paper addresses the problem of generating tsetse distribution and abundance maps from remotely sensed data, using a restricted amount of field data. A discriminant analysis model is tested using contemporary tsetse data and remotely sensed, low resolution data acquired from the National Oceanographic and Atmospheric Administration and Meteosat platforms. A split sample technique is adopted where a randomly selected part of the field measured data (training set) serves to predict the other part (predicted set). The obtained results are then compared with field measured data per corresponding grid-square. Depending on the size of the training set the percentage of concording predictions varies from 80 to 95 for distribution figures and from 63 to 74 for abundance. These results confirm the potential of satellite data application and multivariate analysis for the prediction, not only of the tsetse distribution, but more importantly of their abundance. This opens up new avenues because satellite predictions and field data may be combined to strengthen or substitute one another and thus reduce costs of field surveys. PMID:10224542

  10. Cost Effective Measures to Reduce CO2 Emissions in the Air Freight Sector

    NASA Technical Reports Server (NTRS)

    Blinge, Magnus

    2003-01-01

    This paper presents cost effective measures to reduce CO2 emissions in the air freight sector. One door-to-door transport chain is studied in detail from a Scandinavian city to a city in southern Europe. The transport chain was selected by a group of representatives from the air freight sector in order to encompass general characteristics within the sector. Three different ways of shipping air cargo are studied, i.e., by air freighter, as belly freight (in passenger aircrafts) and trucking. CO2 emissions are calculated for each part of the transport chain and its relative importance towards the total amount CO2 emitted during the whole transport chain is shown. It is confirmed that the most CO2 emitting part of the transport chain is the actual flight and that it is in the take-off and climbing phases that most fuel are burned. It is also known that the technical development of aircraft implies a reduction in fuel consumption for each new generation of aircraft. Thus, the aircraft manufacturers have an important role in this development. Having confirmed these observations, this paper focuses on other factors that significantly affects the fuel consumption. Analyzed factors are, e.g., optimization of speed and altitude, traffic management, congestion on and around the airfields, tankering, "latest acceptance time" for goods and improving the load factor. The different factors relative contribution to the total emission levels for the transport chain has been estimated.

  11. Animals prefer leg stiffness values that may reduce the energetic cost of locomotion.

    PubMed

    Shen, ZhuoHua; Seipel, Justin

    2015-01-01

    Despite the neuromechanical complexity and wide diversity of running animals, most run with a center-of-mass motion that is similar to a simple mass bouncing on a spring. Further, when animals׳ effective leg stiffness is measured and normalized for size and weight, the resulting relative leg stiffness that most animals prefer lies in a narrow range between 7 and 27. Understanding why this nearly universal preference exists could shed light on how whole animal behaviors are organized. Here we show that the biologically preferred values of relative leg stiffness coincide with a theoretical minimal energetic cost of locomotion. This result strongly implies that animals select and regulate leg stiffness in order to reduce the energy required to move, thus providing animals an energetic advantage. This result also helps explain how high level control targets such as energy efficiency might influence overall physiological parameters and the underlying neuromechanics that produce it. Overall, the theory presented here provides an explanation for the existence of a nearly universal preferred leg stiffness. Also, the results of this work are beneficial for understanding the principles underlying human and animal locomotion, as well as for the development of prosthetic, orthotic and robotic devices. PMID:25234232

  12. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    PubMed Central

    Maeng, Daniel Dukjae; Sciandra, Joann P; Tomcavage, Janet F

    2016-01-01

    The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan’s claims data from 2008 through 2013 among its commercially insured members were obtained and analyzed. Over the 6-year period, the PCMH implementation beyond the first 6 months of exposure was associated with a lower total cost of care of ∼9% (P<0.05). The largest reduction was observed in outpatient costs (12%; P<0.05). This study suggests that PCMH implementation among the non-elderly adult population can potentially lead to cost savings. Future studies are necessary to identify the drivers of the cost savings and examine if similar results can be replicated elsewhere by other health care delivery systems. PMID:27307773

  13. Clinical Recommendations in Medical Practice: A Proposed Framework to Reduce Bias and Improve the Quality of Medical Decisions.

    PubMed

    Alfandre, David

    2016-01-01

    Patients rely on, benefit from, and are strongly influenced by physicians' recommendations. In spite of the centrality and importance of physicians' recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of those processes or how patients' preferences ought to be considered and how much weight they should hold. Moreover, physicians' bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients' trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions-that is, clinical decisions when patients' values and preferences are relevant-the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients' values and preferences. When patients' preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. PMID:27045301

  14. A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia

    PubMed Central

    Rowell, David; Gordon, Louisa G; Olsen, Catherine M; Whiteman, David C

    2016-01-01

    Objectives: The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers. Methods: We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers. Results: Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis. Conclusion: Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference. PMID:27231550

  15. The green operating room: simple changes to reduce cost and our carbon footprint.

    PubMed

    Wormer, Blair A; Augenstein, Vedra A; Carpenter, Christin L; Burton, Patrick V; Yokeley, William T; Prabhu, Ajita S; Harris, Beth; Norton, Sujatha; Klima, David A; Lincourt, Amy E; Heniford, B Todd

    2013-07-01

    Generating over four billion pounds of waste each year, the healthcare system in the United States is the second largest contributor of trash with one-third produced by operating rooms. Our objective is to assess improvement in waste reduction and recycling after implementation of a Green Operating Room Committee (GORC) at our institution. A surgeon and nurse-initiated GORC was formed with members from corporate leadership, nursing, anesthesia, and OR staff. Initiatives for recycling opportunities, reduction of energy and water use as well as solid waste were implemented and the results were recorded. Since formation of GORC in 2008, our OR has diverted 6.5 tons of medical waste. An effort to recycle all single-use devices was implemented with annual solid waste reduction of approximately 12,860 lbs. Disposable OR foam padding was replaced with reusable gel pads at greater than $50,000 per year savings. Over 500 lbs of previously discarded batteries were salvaged from the OR and donated to charity or redistributed in the hospital ($9,000 annual savings). A "Power Down" initiative to turn off all anesthesia and OR lights and equipment not in use resulted in saving $33,000 and 234.3 metric tons of CO2 emissions reduced per year. Converting from soap to alcohol-based waterless scrub demonstrated a potential saving of 2.7 million liters of water annually. Formation of an OR committee dedicated to ecological initiatives can provide a significant opportunity to improve health care's impact on the environment and save money. PMID:23815997

  16. [It is not only about cost ... when it comes to generic medication].

    PubMed

    Piguet, Valérie; D'Incau, Stéphanie; Besson, Marie; Desmeules, Jules; Cedraschi, Christine

    2016-06-22

    The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Patients' representations suggest that they might be confident in taking a generic medication: when the generic medication is prescribed by the physician and each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Economic arguments are not sufficient to accept substitution. Negative representations require attention and need be considered. PMID:27506067

  17. Branching angles reflect a trade-off between reducing trail maintenance costs or travel distances in leaf-cutting ants.

    PubMed

    Farji-Brener, Alejandro Gustavo; Chinchilla, Federico; Umaña, María Natalia; Ocasio-Torres, Maríia Elena; Chauta-Mellizo, Alexander; Acosta-Rojas, Diana; Marinaro, Sofía; Curth, Mónica de Torres; Amador-Vargas, Sabrina

    2015-02-01

    The design of transport paths in consuming entities that use routes to access food should be under strong selective pressures to reduce costs and increase benefits. We studied the adaptive nature of branching angles in foraging trail networks of the two most abundant tropical leaf-cutting ant species. We mathematically assessed how these angles should reflect the relative weight of the pressure for reducing either trail maintenance effort or traveling distances. Bifurcation angles of ant foraging trails strongly differed depending on the location of the nests. Ant colonies in open areas showed more acute branching angles, which best shorten travel distances but create longer new trail sections to maintain than a perpendicular branch, suggesting that trail maintenance costs are smaller compared to the benefit of reduced traveling distance. Conversely, ant colonies in forest showed less acute branching angles, indicating that maintenance costs are of larger importance relative to the benefits of shortening travel distances. The trail pattern evident in forests may be attributable to huge amounts of litterfall that .increase trail maintenance costs, and the abundant canopy cover that reduces traveling costs by mitigating direct sunlight and rain. These results suggest that branching angles represent a trade-off between reducing maintenance work and shortening travel distances, illustrating how animal constructions can adjust to diverse environmental conditions. This idea may help to understand diverse networks systems, including urban travel networks. PMID:26240872

  18. An initial assessment of the cost and utilization of the Integrated Academic Information System (IAIMS) at Columbia Presbyterian Medical Center.

    PubMed Central

    Clayton, P. D.; Anderson, R. K.; Hill, C.; McCormack, M.

    1991-01-01

    The concept of "one stop information shopping" is becoming a reality at Columbia Presbyterian Medical Center (CPMC). The goal of our effort is to provide access to university and hospital administrative systems as well as clinical and library applications from a single workstation, which also provides utility functions such as word processing and mail. Since June 1987, CPMC has invested the equivalent of $23 million dollars to install a digital communications network that encompasses 18 buildings at seven geographically separate sites and to develop clinical and library applications that are integrated with the existing hospital and university administrative and research computing facilities. During June 1991, 2425 different individuals used the clinical information system, 425 different individuals used the library applications, and 900 different individuals used the hospital administrative applications via network access. If we were to freeze the system in its current state, amortize the development and network installation costs, and add projected maintenance costs for the clinical and library applications, our integrated information system would cost $2.8 million on an annual basis. This cost is 0.3% of the medical center's annual budget. These expenditures could be justified by very small improvements in time savings for personnel and/or decreased length of hospital stay and/or more efficient use of resources. In addition to the direct benefits which we detail, a major benefit is the ease with which additional computer-based applications can be added incrementally at an extremely modest cost. PMID:1666966

  19. Low-cost flexible thin-film detector for medical dosimetry applications.

    PubMed

    Zygmanski, P; Abkai, C; Han, Z; Shulevich, Y; Menichelli, D; Hesser, J

    2014-01-01

    The purpose of this study is to characterize dosimetric properties of thin film photovoltaic sensors as a platform for development of prototype dose verification equipment in radiotherapy. Towards this goal, flexible thin-film sensors of dose with embedded data acquisition electronics and wireless data transmission are prototyped and tested in kV and MV photon beams. Fundamental dosimetric properties are determined in view of a specific application to dose verification in multiple planes or curved surfaces inside a phantom. Uniqueness of the new thin-film sensors consists in their mechanical properties, low-power operation, and low-cost. They are thinner and more flexible than dosimetric films. In principle, each thin-film sensor can be fabricated in any size (mm² - cm² areas) and shape. Individual sensors can be put together in an array of sensors spreading over large areas and yet being light. Photovoltaic mode of charge collection (of electrons and holes) does not require external electric field applied to the sensor, and this implies simplicity of data acquisition electronics and low power operation. The prototype device used for testing consists of several thin film dose sensors, each of about 1.5 cm × 5 cm area, connected to simple readout electronics. Sensitivity of the sensors is determined per unit area and compared to EPID sensitivity, as well as other standard photodiodes. Each sensor independently measures dose and is based on commercially available flexible thin-film aSi photodiodes. Readout electronics consists of an ultra low-power microcontroller, radio frequency transmitter, and a low-noise amplification circuit implemented on a flexible printed circuit board. Detector output is digitized and transmitted wirelessly to an external host computer where it is integrated and processed. A megavoltage medical linear accelerator (Varian Tx) equipped with kilovoltage online imaging system and a Cobalt source are used to irradiate different thin

  20. Barefoot Running Reduces the Submaximal Oxygen Cost in Female Distance Runners.

    PubMed

    Berrones, Adam J; Kurti, Stephanie P; Kilsdonk, Korey M; Cortez, Delonyx J; Melo, Flavia F; Whitehurst, Michael

    2016-08-01

    Berrones, AJ, Kurti, SP, Kilsdonk, KM, Cortez, DJ, Melo, FF, and Whitehurst, M. Barefoot running reduces the submaximal oxygen cost in female distance runners. J Strength Cond Res 30(8): 2348-2353, 2016-Being a competitive distance runner is, in part, attributable to a high V[Combining Dot Above]O2max. However, running economy (RE) is a more robust indicator of distance running performance among endurance athletes of similar V[Combining Dot Above]O2max levels. The purpose of this study was to examine the influence of unshod (barefoot) vs. shod (wearing shoes) running on RE (expressed as ml·kg·min) during three 5-minute submaximal running trials representing 65, 75, and 85% of V[Combining Dot Above]O2max. Other physiologic and perceptual variables such as respiratory exchange ratio, lactate, heart rate, and ratings of perceived exertion were also chosen as dependent variables. We measured V[Combining Dot Above]O2max in 14 recreationally active trained distance female runners (age = 27.6 ± 1.6 years; height = 163.3 ± 1.7 cm; weight = 57.8 ± 1.9 kg) who were completely inexperienced with unshod running. After initial testing, each subject was randomized to either unshod or shod for days 2 and 3. We analyzed the data with a 2-way (condition by intensity) repeated-measures analysis of variance. Submaximal oxygen consumption was significantly reduced at 85% of V[Combining Dot Above]O2max (p = 0.018), indicating an improvement in RE, but not during the 65% or 75% trials (p > 0.05, both). No other dependent measure was different between unshod and shod conditions. Our results indicate that the immediate improvement to RE while barefoot occurs at a relatively high fraction of maximal oxygen consumption. For the recreational or competitive distance runner, training or competing while barefoot may be a useful strategy to improve endurance performance. PMID:26808847