Science.gov

Sample records for actual unit costs

  1. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Certificates of actual cost....

  2. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Certificates of actual cost....

  3. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Certificates of actual cost....

  4. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Certificates of actual cost....

  5. 24 CFR 200.96 - Certificates of actual cost.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Endorsement Generally Applicable to Multifamily and Health Care Facility Mortgage Insurance Programs; and Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Certificates of actual cost....

  6. 24 CFR 242.42 - Certificates of actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Endorsement for Insurance § 242.42 Certificates of actual cost. (a) The... cost, such certification shall be final and incontestable except for fraud or...

  7. 24 CFR 242.42 - Certificates of actual cost.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Endorsement for Insurance § 242.42 Certificates of actual cost. (a) The... cost, such certification shall be final and incontestable except for fraud or...

  8. An evaluation of contractor projected and actual costs

    NASA Technical Reports Server (NTRS)

    Kwiatkowski, K. A.; Buffalano, C.

    1974-01-01

    GSFC contractors with cost-plus contracts provide cost estimates for each of the next four quarters on a quarterly basis. Actual expenditures over a two-year period were compared to the estimates, and the data were sorted in different ways to answer several questions and give quantification to observations, such as how much does the accuracy of estimates degrade as they are made further into the future? Are estimates made for small dollar amounts more accurate than for large dollar estimates? Other government agencies and private companies with cost-plus contracts may be interested in this analysis as potential methods of contract management for their organizations. It provides them with the different methods one organization is beginning to use to control costs.

  9. 45 CFR 149.335 - Documentation of costs of actual claims involved.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... § 149.335 Documentation of costs of actual claims involved. (a) A submission of claims consists of a list of early retirees for whom claims are being submitted, and documentation of the actual costs of... 45 Public Welfare 1 2010-10-01 2010-10-01 false Documentation of costs of actual claims...

  10. A comparison of NEAR actual spacecraft costs with three parametric cost models

    NASA Astrophysics Data System (ADS)

    Mosher, Todd J.; Lao, Norman Y.; Davalos, Evelyn T.; Bearden, David A.

    1999-11-01

    Costs for modern (post-1990) U.S.-built small planetary spacecraft have been shown to exhibit significantly different trends from those of larger spacecraft. These differences cannot be accounted for simply by the change in size alone. Some have attributed this departure to NASA's "faster, better, cheaper" design approach embodied by the efficiency of smaller teams, reduced government oversight, increased focus on cost, and short development periods. With the Discovery, Mars Surveyor and New Millennium programs representing the new approach to planetary exploration, it is important to understand these current cost trends and to be able to estimate costs of future proposed missions. To address this issue, The Aerospace Corporation (hereafter referred to as Aerospace) performed a study to compare the actual costs of the Near Earth Asteroid Rendezvous (NEAR) spacecraft bus (instruments were not estimated) using three different cost models; the U.S. Air Force Unmanned Spacecraft Cost Model, Version 7 (USCM-7), the Science Applications International Corporation (SAIC) NASA/Air Force Cost Model 1996 (NAFCOM96) and The Aerospace Corporation's Small Satellite Cost Model 1998 (SSCM98). The NEAR spacecraft was chosen for comparison because it was the first Discovery mission launched, and recently recognized with a Laurel award by Aviation Week and Space Technology as a benchmark for NASA's Discovery program [North, 1997]. It was also selected because the cost data has been released into the public domain [Hemmings, 1996]which makes it easy to discuss in a public forum. This paper summarizes the NEAR program, provides a short synopsis of each of the three cost models, and demonstrates how they were applied for this study.

  11. 26 CFR 1.953-2 - Actual United States risks.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., of a husband for the acts of his spouse, and of a parent for the acts of his child. The term not only.... On May 1, 1963, R abandons his United States residence and establishes residence in foreign country...

  12. 26 CFR 1.953-2 - Actual United States risks.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., of a husband for the acts of his spouse, and of a parent for the acts of his child. The term not only.... On May 1, 1963, R abandons his United States residence and establishes residence in foreign country...

  13. 26 CFR 1.953-2 - Actual United States risks.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., of a husband for the acts of his spouse, and of a parent for the acts of his child. The term not only.... On May 1, 1963, R abandons his United States residence and establishes residence in foreign country...

  14. 26 CFR 1.953-2 - Actual United States risks.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., of a husband for the acts of his spouse, and of a parent for the acts of his child. The term not only.... On May 1, 1963, R abandons his United States residence and establishes residence in foreign country...

  15. 26 CFR 1.953-2 - Actual United States risks.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., of a husband for the acts of his spouse, and of a parent for the acts of his child. The term not only.... On May 1, 1963, R abandons his United States residence and establishes residence in foreign country...

  16. 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.

  17. Rocky Flats Closure Unit Cost Data

    SciTech Connect

    Sanford, P.C.; Skokan, B.

    2007-07-01

    The Rocky Flats Closure Project has completed the process of stabilizing residual nuclear materials, decommissioning nuclear facilities, remediating environmental media and closing the Rocky Flats Site (Site). The project cost approximately $4.1 B and included the decommissioning of over 700 structures including 5 major plutonium facilities and 5 major uranium facilities, shipping over 14,600 cubic meters of transuranic and 565,000 cubic meters of low level radioactive waste, and remediating a 385-acre industrial area and the surrounding land. Actual costs were collected for a large variety of closure activities. These costs can be correlated with metrics associated with the facilities and environmental media to capture cost factors from the project that could be applicable to a variety of other closure projects both within and outside of the Department of Energy's weapons complex. The paper covers four general topics: the process to correlate the actual costs and metrics, an example of the correlated data for one large sub-project, a discussion of the results, and the additional activities that are planned to correlate and make this data available to the public. The process to collect and arrange the project control data of the Closure Project relied on the actual Closure Project cost information. It was used to correlate these actual costs with the metrics for the physical work, such as building area or waste generated, to support the development of parametric cost factors. The example provides cost factors for the Industrial Sites Project. The discussion addresses the strengths and weaknesses of the data, followed by a section identifying future activities to improve and extend the analyses and integrate it within the Department's Environmental Cost Analysis System. (authors)

  18. California Charter Oversight: Key Elements and Actual Costs. CRB 12-001

    ERIC Educational Resources Information Center

    Blanton, Rebecca E.

    2012-01-01

    This study was mandated by SB537 (Simitian, Chapter 650, Stats. of 2007, codified at Ed. Code Section 47613), which requires the California Research Bureau (CRB) to prepare and submit to the Legislature a report on the key elements and actual costs of charter school oversight. Charter schools are public schools that are operated by entities other…

  19. 45 CFR 149.335 - Documentation of costs of actual claims involved.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Documentation of costs of actual claims involved. 149.335 Section 149.335 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement...

  20. 45 CFR 149.335 - Documentation of costs of actual claims involved.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Documentation of costs of actual claims involved. 149.335 Section 149.335 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement...

  1. Urban rail transit projects: Forecast versus actual ridership and costs. Final report

    SciTech Connect

    Pickrell, D.H.

    1989-10-01

    Substantial errors in forecasting ridership and costs for the ten rail transit projects reviewed in the report put forth the possibility that more accurate forecasts would have led decision-makers to select projects other than those reviewed. The study examines the accuracy of forecasts prepared for ten major capital improvement projects in nine urban areas during 1971-1987. Each project includes construction of a fixed transit guideway: Rapid Rail or Metrorail (Washington DC, Atlanta, Baltimore, Miami); Light Rail Transit (Buffalo, Pittsburgh, Portland, Sacramento); and Downtown Peoplemover (Miami and Detroit). The study examines why actual costs and ridership differed so markedly from their forecast values. It focuses on the accuracy of projections made available to local decision-makers at the time when the choice among alternative projects was actually made. The study compares forecast and actual values for four types of measures: ridership, capital costs and financing, operating and maintenance costs, and cost-effectiveness. The report is organized into 6 chapters, numerous tables, and an appendix that documents the sources of all data appearing in the tables presented in the report.

  2. Low-cost inertial measurement unit.

    SciTech Connect

    Deyle, Travis Jay

    2005-03-01

    Sandia National Laboratories performs many expensive tests using inertial measurement units (IMUs)--systems that use accelerometers, gyroscopes, and other sensors to measure flight dynamics in three dimensions. For the purpose of this report, the metrics used to evaluate an IMU are cost, size, performance, resolution, upgradeability and testing. The cost of a precision IMU is very high and can cost hundreds of thousands of dollars. Thus the goals and results of this project are as follows: (1) Examine the data flow in an IMU and determine a generic IMU design. (2) Discuss a high cost IMU implementation and its theoretically achievable results. (3) Discuss design modifications that would save money for suited applications. (4) Design and implement a low cost IMU and discuss its theoretically achievable results. (5) Test the low cost IMU and compare theoretical results with empirical results. (6) Construct a more streamlined printed circuit board design reducing noise, increasing capabilities, and constructing a self-contained unit. Using these results, we can compare a high cost IMU versus a low cost IMU using the metrics from above. Further, we can examine and suggest situations where a low cost IMU could be used instead of a high cost IMU for saving cost, size, or both.

  3. Wind farm production cost: Optimum turbine size and farm capacity in the actual market

    SciTech Connect

    Laali, A.R.; Meyer, J.L.; Bellot, C.; Louche, A.

    1996-12-31

    Several studies are undertaken in R&D Division of EDF in collaboration with ERASME association in order to have a good knowledge of the wind energy production costs. These studies are performed in the framework of a wind energy monitoring project and concern the influence of a few parameters like wind farm capacity, turbine size and wind speed on production costs, through an analysis of the actual market trend. Some 50 manufacturers and 140 different kind of wind turbines are considered for this study. The minimum production cost is situated at 800/900 kW wind turbine rated power. This point will probably move to more important powers in the future. This study is valid only for average conditions and some special parameters like particular climate conditions or lack of infrastructure for a special site the could modify the results shown on the curves. The variety of wind turbines (rated power as a function of rotor diameter, height and specific rated power) in the actual market is analyzed. A brief analysis of the market trend is also performed. 7 refs., 7 figs.

  4. Unit Costs for Lunar-Derived Propellants

    NASA Astrophysics Data System (ADS)

    Blair, Brad R.

    2004-02-01

    The estimated propellant production cost per metric ton will be derived and presented for solar system transportation waypoints. Background on recent and ongoing space resource propellant supply models will be presented, with a review of architectural assumptions, costs and expected markets. Integrated economic and engineering models (Duke et al., 2003; Duke, Blair and Diaz, 2002; Lamassoure et al. 2003; and Blair et al., 2002) estimate production costs, expected productivity of the mining and processing system, reusable transportation element behavior, fuel depot activity and revenues based on projected market conditions. Results of these economic models are used to derive total and marginal unit costs for propellant at fuel depot facilities for the purpose of facilitating the commercial development of space and to aid program and logistic planning for human space exploration missions.

  5. Estimating the costs of landslide damage in the United States

    USGS Publications Warehouse

    Fleming, Robert W.; Taylor, Fred A.

    1980-01-01

    Landslide damages are one of the most costly natural disasters in the United States. A recent estimate of the total annual cost of landslide damage is in excess of $1 billion {Schuster, 1978}. The damages can be significantly reduced, however, through the combined action of technical experts, government, and the public. Before they can be expected to take action, local governments need to have an appreciation of costs of damage in their areas of responsibility and of the reductions in losses that can be achieved. Where studies of cost of landslide damages have been conducted, it is apparent that {1} costs to the public and private sectors of our economy due to landslide damage are much larger than anticipated; {2} taxpayers and public officials generally are unaware of the magnitude of the cost, owing perhaps to the lack of any centralization of data; and {3} incomplete records and unavailability of records result in lower reported costs than actually were incurred. The U.S. Geological Survey has developed a method to estimate the cost of landslide damages in regional and local areas and has applied the method in three urban areas and one rural area. Costs are for different periods and are unadjusted for inflation; therefore, strict comparisons of data from different years should be avoided. Estimates of the average annual cost of landslide damage for the urban areas studied are $5,900,000 in the San Francisco Bay area; $4,000,000 in Allegheny County, Pa.; and $5,170,000 in Hamilton County, Ohio. Adjusting these figures for the population of each area, the annual cost of damages per capita are $1.30 in the nine-county San Francisco Bay region; $2.50 in Allegheny County, Pa.; and $5.80 in Hamilton County, Ohio. On the basis of data from other sources, the estimated annual damages on a per capita basis for the City of Los Angeles, Calif., are about $1.60. If the costs were available for the damages from landslides in Los Angeles in 1977-78 and 1979-80, the annual per

  6. 41 CFR 302-4.304 - For relocation outside the continental United States (OCONUS), may my agency allow actual expense...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...), may my agency allow actual expense reimbursement instead of the POV mileage rate for PCS travel? Yes... the continental United States (OCONUS), may my agency allow actual expense reimbursement instead of the POV mileage rate for PCS travel? 302-4.304 Section 302-4.304 Public Contracts and...

  7. 41 CFR 302-4.304 - For relocation outside the continental United States (OCONUS), may my agency allow actual expense...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...), may my agency allow actual expense reimbursement instead of the POV mileage rate for PCS travel? Yes... the continental United States (OCONUS), may my agency allow actual expense reimbursement instead of the POV mileage rate for PCS travel? 302-4.304 Section 302-4.304 Public Contracts and...

  8. Making appropriate comparisons of estimated and actual costs of reducing SO{sub 2} emissions under Title IV

    SciTech Connect

    Smith, A.E.

    1998-12-31

    A current sentiment within some parts of the environmental policy community is that market-based regulatory approaches such as emissions trading have proven so effective that actual costs will be only a small fraction of what ex ante cost estimation procedures would project. With this line of reasoning, some have dismissed available cost estimates for major proposed new regulations, such as the new PM and ozone NAAQS, as not meaningful for policy decisions. The most commonly used evidence in support of this position is the experience with SO{sub 2} reductions under Title IV of the 1990 Clean Air Act Amendments. In Title IV, a market for emissions allowances has been used to achieve reductions in sulfur dioxides (SO{sub 2}) to ameliorate acid rain. It is commonly asserted today that the cost of achieving the SO{sub 2} emissions reductions has been only one-tenth or less of what Title IV was originally expected to cost. This paper demonstrates that, to the contrary, actual costs for SO{sub 2} reductions remain roughly in line with original estimates associated with Title IV. Erroneous conclusions about Title IV`s costs are due to inappropriate comparisons of a variety of different measures that appear to be comparable only because they are all stated in dollars per ton. Program cost estimates include the total costs of a fully-implemented regulatory program. The very low costs of Title IV that are commonly cited today are neither directly reflective of a fully implemented Title IV, (which is still many years away) nor reflective of all the costs already incurred. Further, a careful review of history finds that the initial cost estimates that many cite were never associated with Title IV. Technically speaking, people are comparing the estimated control costs for the most-costly power plant associated with earlier acid rain regulatory proposals with prices from a market that do not directly reflect total costs.

  9. Using Work Breakdown Structure Models to Develop Unit Treatment Costs

    EPA Science Inventory

    This article presents a new cost modeling approach called work breakdown structure (WBS), designed to develop unit costs for drinking water technologies. WBS involves breaking the technology into its discrete components for the purposes of estimating unit costs. The article dem...

  10. 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…

  11. Unit costs of waste management operations

    SciTech Connect

    Kisieleski, W.E.; Folga, S.M.; Gillette, J.L.; Buehring, W.A.

    1994-04-01

    This report provides estimates of generic costs for the management, disposal, and surveillance of various waste types, from the time they are generated to the end of their institutional control. Costs include monitoring and surveillance costs required after waste disposal. Available data on costs for the treatment, storage, disposal, and transportation of spent nuclear fuel and high-level radioactive, low-level radioactive, transuranic radioactive, hazardous, mixed (low-level radioactive plus hazardous), and sanitary wastes are presented. The costs cover all major elements that contribute to the total system life-cycle (i.e., ``cradle to grave``) cost for each waste type. This total cost is the sum of fixed and variable cost components. Variable costs are affected by operating rates and throughput capacities and vary in direct proportion to changes in the level of activity. Fixed costs remain constant regardless of changes in the amount of waste, operating rates, or throughput capacities. Key factors that influence cost, such as the size and throughput capacity of facilities, are identified. In many cases, ranges of values for the key variables are presented. For some waste types, the planned or estimated costs for storage and disposal, projected to the year 2000, are presented as graphics.

  12. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... acquired property, related fees, or a pro rata portion of fees, paid by NASA to the contractor. Situations... designs, develops, fabricates or purchases property for NASA and part of the fees paid to the contractor by NASA are related to that effort. (c) Acquisition cost shall be developed using actual costs to...

  13. Fuzzy case based reasoning in sports facilities unit cost estimating

    NASA Astrophysics Data System (ADS)

    Zima, Krzysztof

    2016-06-01

    This article presents an example of estimating costs in the early phase of the project using fuzzy case-based reasoning. The fragment of database containing descriptions and unit cost of sports facilities was shown. The formulas used in Case Based Reasoning method were presented, too. The article presents similarity measurement using a few formulas, including fuzzy similarity. The outcome of cost calculations based on CBR method was presented as a fuzzy number of unit cost of construction work.

  14. Calculating Unit Costs in Francophone Universities.

    ERIC Educational Resources Information Center

    Bottomley, Anthony; Cook, Rupert

    1979-01-01

    A series of studies in cost effectiveness at Francophonic universities were conducted. The objectives of these studies are identified and the methodology is examined and compared with work done in Britain, U.S.A., and Canada. Cost comparisions are offered between French universities and Bradford University. (Author/MLW)

  15. California Charter Oversight: Key Elements and Actual Costs. CRB Briefly Stated

    ERIC Educational Resources Information Center

    Blanton, Rebecca E.

    2012-01-01

    The Legislature mandated the California Research Bureau (CRB) explore known best practices for charter school authorizers and survey California authorizers about their practices and costs. Additionally, the Legislature mandated CRB provide an analysis of current reimbursement for charter school oversight and include suggestions for improving…

  16. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

    PubMed Central

    Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

    2016-01-01

    Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

  17. Relative value units and cost analysis, Part 3 of 4.

    PubMed

    Glass, Kathryn P; Anderson, Jeffery R

    2002-01-01

    In recent years, the interest in relative value unit (RVU) cost analysis has been on the rise. Why all the excitement? RVU cost analysis places the knowledge, and therefore the power, in the hands of the administrator to negotiate revenues, analyze expenditures, and control costs. Cost analysis at the per (relative)-unit level allows for procedure profitability (or loss) analysis, setting internal fee schedules based on costs, contract negotiation based on RVU cost and utilization, equitable provider compensation packages based on productivity and overhead coverage, and tracking ancillary and referral utilization risks. In short, RVU cost accounting uses the Resource-Based Relative Value Scale (RBRVS) instead of stopwatches and clipboards when measuring clinical costs and activity.

  18. Unit costs for decontamination and dismantlement of structures.

    SciTech Connect

    Folga, S.; Davis, M. J.; Janke, R. J.; Decision and Information Sciences; DOE

    1997-04-01

    A series of relationships have been developed for estimating unit costs for decontamination and dismantlement (D&D) of a number of structure types. These relationships may be applied in the absence of other data to obtain rough order-of-magnitude cost estimates for D&D activities. The relationships were developed using D&D costs estimated for various types of buildings at the U.S. Department of Energy Fernald site. These unit costs take into account the level of radiological contamination as well as the building size and type.

  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. The unit cost factors and calculation methods for decommissioning - Cost estimation of nuclear research facilities

    SciTech Connect

    Kwan-Seong Jeong; Dong-Gyu Lee; Chong-Hun Jung; Kune-Woo Lee

    2007-07-01

    Available in abstract form only. Full text of publication follows: The uncertainties of decommissioning costs increase high due to several conditions. Decommissioning cost estimation depends on the complexity of nuclear installations, its site-specific physical and radiological inventories. Therefore, the decommissioning costs of nuclear research facilities must be estimated in accordance with the detailed sub-tasks and resources by the tasks of decommissioning activities. By selecting the classified activities and resources, costs are calculated by the items and then the total costs of all decommissioning activities are reshuffled to match with its usage and objectives. And the decommissioning cost of nuclear research facilities is calculated by applying a unit cost factor method on which classification of decommissioning works fitted with the features and specifications of decommissioning objects and establishment of composition factors are based. Decommissioning costs of nuclear research facilities are composed of labor cost, equipment and materials cost. Of these three categorical costs, the calculation of labor costs are very important because decommissioning activities mainly depend on labor force. Labor costs in decommissioning activities are calculated on the basis of working time consumed in decommissioning objects and works. The working times are figured out of unit cost factors and work difficulty factors. Finally, labor costs are figured out by using these factors as parameters of calculation. The accuracy of decommissioning cost estimation results is much higher compared to the real decommissioning works. (authors)

  1. COST ESTIMATION MODELS FOR DRINKING WATER TREATMENT UNIT PROCESSES

    EPA Science Inventory

    Cost models for unit processes typically utilized in a conventional water treatment plant and in package treatment plant technology are compiled in this paper. The cost curves are represented as a function of specified design parameters and are categorized into four major catego...

  2. Applying activity-based costing to the nuclear medicine unit.

    PubMed

    Suthummanon, Sakesun; Omachonu, Vincent K; Akcin, Mehmet

    2005-08-01

    Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better. PMID:16102243

  3. Applying activity-based costing to the nuclear medicine unit.

    PubMed

    Suthummanon, Sakesun; Omachonu, Vincent K; Akcin, Mehmet

    2005-08-01

    Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.

  4. Designing a low cost bedside workstation for intensive care units.

    PubMed Central

    Michel, A.; Zörb, L.; Dudeck, J.

    1996-01-01

    The paper describes the design and implementation of a software architecture for a low cost bedside workstation for intensive care units. The development is fully integrated into the information infrastructure of the existing hospital information system (HIS) at the University Hospital of Giessen. It provides cost efficient and reliable access for data entry and review from the HIS database from within patient rooms, even in very space limited environments. The architecture further supports automatical data input from medical devices. First results from three different intensive care units are reported. PMID:8947771

  5. Cost of nursing staffing adequacy in a neonatal unit.

    PubMed

    Fugulin, Fernanda Maria Togeiro; Lima, Antonio Fernandes Costa; Castilho, Valéria; Bochembuzio, Luciana; Costa, Janaína Anchieta; Castro, Liliana; Silva, Natália Célia Lima; Gaidzinski, Raquel Rapone

    2011-12-01

    The objectives of this descriptive, quantitative study were: to identify the mean nursing care time provided and required by newborns (NB) hospitalized at the Neonatal Unit of the University of São Paulo University Hospital; to calculate the cost of the mean nursing care time provided and required, by NB; to assess the cost of the nursing staffing adequacy required to assist the NB. The mean nursing care times, provided by the nursing staff and required by NBs, were calculated using equations available in the literature and by applying the Nursing Activities Score. The costs of the mean nursing care times and to make nursing staffing adequate were calculated based on the hourly cost of nurses and nursing technicians. The financial impact of nursing staffing adequacy accounted for a 30% increase over the cost of the current situation.

  6. Fiscal Year 2000 Unit Cost Report for the Illinois Public Community Colleges.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    This report shows net instructional unit costs from fiscal year 1995 through fiscal year 2000. The five sections are: (1) Comparison of Fiscal Year 2000 Net Instructional Unit Cost with Previous Years; (2) Net Instructional Unit Cost in Illinois Public Community Colleges Since Fiscal Year 1995; (3) Fiscal Year 2000 Net Instructional Unit Cost,…

  7. Low-Cost Sensor Units for Measuring Urban Air Quality

    NASA Astrophysics Data System (ADS)

    Popoola, O. A.; Mead, M.; Stewart, G.; Hodgson, T.; McLoed, M.; Baldovi, J.; Landshoff, P.; Hayes, M.; Calleja, M.; Jones, R.

    2010-12-01

    Measurements of selected key air quality gases (CO, NO & NO2) have been made with a range of miniature low-cost sensors based on electrochemical gas sensing technology incorporating GPS and GPRS for position and communication respectively. Two types of simple to operate sensors units have been designed to be deployed in relatively large numbers. Mobile handheld sensor units designed for operation by members of the public have been deployed on numerous occasions including in Cambridge, London and Valencia. Static sensor units have also been designed for long-term autonomous deployment on existing street furniture. A study was recently completed in which 45 sensor units were deployed in the Cambridge area for a period of 3 months. Results from these studies indicate that air quality varies widely both spatially and temporally. The widely varying concentrations found suggest that the urban environment cannot be fully understood using limited static site (AURN) networks and that a higher resolution, more dispersed network is required to better define air quality in the urban environment. The results also suggest that higher spatial and temporal resolution measurements could improve knowledge of the levels of individual exposure in the urban environment.

  8. Cost containment and mechanical ventilation in the United States.

    PubMed

    Cohen, I L; Booth, F V

    1994-08-01

    In many ICUs, admission and discharge hinge on the need for intubation and ventilatory support. As few as 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes > or = 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics. In the United States, the need for prolonged mechanical ventilation is increasingly recognized as separate and distinct from the initial diagnosis and/or procedure that leads to hospitalization. This distinction has led to improved reimbursement under the prospective diagnosis-related group (DRG) system, and demands more precise accounting from healthcare providers responsible for these patients. Using both published and theoretical examples, mechanical ventilation in the United States is discussed, with a focus on cost containment. Included in the discussion are ventilator teams, standards of care, management protocols, stepdown units, rehabilitation units, and home care. The expanding role of total quality management (TQM) is also presented. PMID:8087585

  9. 41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... appropriate en route travel time. ... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal...

  10. 41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... appropriate en route travel time. ... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal...

  11. 41 CFR 301-70.506 - How do we define actual cost and constructive cost when an employee interrupts a travel...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... appropriate en route travel time. ... cost and constructive cost when an employee interrupts a travel assignment because of an incapacitating illness or injury? 301-70.506 Section 301-70.506 Public Contracts and Property Management Federal...

  12. A Master Plan for Unit Cost Studies Among Community Junior Colleges.

    ERIC Educational Resources Information Center

    Sims, Howard D.

    The need for higher education programs is being challenged, and unit cost studies may become an integral part of the funding process for junior colleges. This paper describes the major tasks in a cost study and reviews the problems encountered in the unit costing efforts. The main tasks are: (1) identifying units of measurement (the language used…

  13. A low-cost evolutionary algorithm for the unit commitment problem considering probabilistic unit outages

    NASA Astrophysics Data System (ADS)

    Asouti, V. G.; Giannakoglou, K. C.

    2012-07-01

    This article presents a solution method to the unit commitment problem with probabilistic unit failures and repairs, which is based on evolutionary algorithms and Monte Carlo simulations. Regarding the latter, thousands of availability-unavailability trial time patterns along the scheduling horizon are generated. The objective function to be minimised is the expected total operating cost, computed after adapting any candidate solution, i.e. any series of generating/non-generating (ON/OFF) unit states, to the availability-unavailability patterns and performing evaluations by considering fuel, start-up and shutdown costs as well as the cost for buying electricity from external resources, if necessary. The proposed method introduces a new efficient chromosome representation: the decision variables are integer IDs corresponding to the binary-to-decimal converted ON/OFF (1/0) scenarios that cover the demand in each hour. In contrast to previous methods using binary strings as chromosomes, the new chromosome must be penalised only if any of the constraints regarding start-up, shutdown and ramp times cannot be met, chromosome repair is avoided and, consequently, the dispatch problems are solved once in the preparatory phase instead of during the evolution. For all these reasons, with or without probabilistic outages, the proposed algorithm has much lower CPU cost. In addition, if probabilistic outages are taken into account, a hierarchical evaluation scheme offers extra noticeable gain in CPU cost: the population members are approximately pre-evaluated using a small 'representative' set of the Monte Carlo simulations and only a few top population members undergo evaluations through the full Monte Carlo simulations. The hierarchical scheme makes the proposed method about one order of magnitude faster than its conventional counterpart.

  14. 77 FR 24940 - Energy Conservation Program for Consumer Products: Representative Average Unit Costs of Energy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-26

    ...: Representative Average Unit Costs of Energy'', dated March 10, 2011, 76 FR 13168. May 29, 2012, the cost figures... pursuant to the Energy Policy and Conservation Act. The five sources are electricity, natural gas, No. 2... after-tax costs found in this notice. The representative average unit after-tax costs for...

  15. Energy Savings and Breakeven Costs for Residential Heat Pump Water Heaters in the United States

    SciTech Connect

    Maguire, Jeff; Burch, Jay; Merrigan, Tim; Ong, Sean

    2013-07-01

    Heat pump water heaters (HPWHs) have recently re-emerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, NREL performed simulations of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern United States. When replacing an electric water heater, the HPWH is likely to break even in California, the southern United States, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

  16. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... acquisition cost is under $100,000, it shall be reported as under $100,000. (g) Software acquisition costs include software costs incurred up through acceptance testing and material internal costs incurred to implement the software and otherwise make the software ready for use. Costs incurred after...

  17. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... acquisition cost is under $100,000, it shall be reported as under $100,000. (g) Software acquisition costs include software costs incurred up through acceptance testing and material internal costs incurred to implement the software and otherwise make the software ready for use. Costs incurred after...

  18. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... production costs (for assets produced or constructed). (5) Engineering, architectural, and other outside... acquisition cost is under $100,000, it shall be reported as under $100,000. (g) Software acquisition costs include software costs incurred up through acceptance testing and material internal costs incurred...

  19. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.

    PubMed

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E

    1996-10-01

    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

  20. 75 FR 13123 - Energy Conservation Program for Consumer Products: Representative Average Unit Costs of Energy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ...: Representative Average Unit Costs of Energy'', dated June 3, 2009, 74 FR 26675. Effective April 19, 2010, the... pursuant to the Energy Policy and Conservation Act. The five sources are electricity, natural gas, No. 2...-tax costs found in this notice. The representative average unit after-tax costs for...

  1. Fiscal Year 1989 Unit Cost Report for the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    Fiscal year (FY) 1989 results of the annual unit cost study of the Illinois public community colleges are presented in this report, based on data on course offerings, enrollments, and costs provided by the colleges. After an initial summary overview, data and analyses are presented showing net instructional unit costs for FY 1989 compared with…

  2. FY 1979 Unit Cost Analysis for the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Illinois Community Coll. Board, Springfield.

    A unit cost analysis for fiscal year (FY) 1979 was conducted by the Illinois Community College Board using mid-term enrollment data and uniform accounting information from each of the state's 51 community colleges. Unit costs for instructional areas were determined at three incremental levels: (1) net instructional cost (NIC), which includes…

  3. Is DNA Barcoding Actually Cheaper and Faster than Traditional Morphological Methods: Results from a Survey of Freshwater Bioassessment Efforts in the United States?

    PubMed Central

    Stein, Eric D.; Martinez, Maria C.; Stiles, Sara; Miller, Peter E.; Zakharov, Evgeny V.

    2014-01-01

    Taxonomic identification accounts for a substantial portion of cost associated with bioassessment programs across the United States. New analytical approaches, such as DNA barcoding have been promoted as a way to reduce monitoring costs and improve efficiency, yet this assumption has not been thoroughly evaluated. We address this question by comparing costs for traditional morphology-based bioassessment, the standard Sanger sequencing-based DNA barcoding approach, and emerging next-generation (NGS) molecular methods. Market demand for molecular approaches is also assessed through a survey of the level of freshwater bioassessment effort in the United States across multiple habitat types (lakes, streams, wetlands) and indicators (benthic invertebrates, fish, algae). All state and regional level programs administered by public agencies and reported via agency web sites were included in the survey. Costs were based on surveys of labs and programs willing to provide such information. More than 19,500 sites are sampled annually across the United States, with the majority of effort occurring in streams. Benthic invertebrates are the most commonly used indicator, but algae and fish comprise between 35% and 21% of total sampling effort, respectively. We estimate that between $104 and $193 million is spent annually on routine freshwater bioassessment in the United States. Approximately 30% of the bioassessment costs are comprised of the cost to conduct traditional morphology-based taxonomy. Current barcoding costs using Sanger sequencing are between 1.7 and 3.4 times as expensive as traditional taxonomic approaches, excluding the cost of field sampling (which is common to both approaches). However, the cost of NGS methods are comparable (or slightly less expensive) than traditional methods depending on the indicator. The promise of barcoding as a cheaper alternative to current practices is not yet realized, although molecular methods may provide other benefits, such as a

  4. ABC estimation of unit costs for emergency department services.

    PubMed

    Holmes, R L; Schroeder, R E

    1996-04-01

    Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC. PMID:10156656

  5. Quality and Growth Implications of Incremental Costing Models for Distance Education Units

    ERIC Educational Resources Information Center

    Crawford, C. B.; Gould, Lawrence V.; King, Dennis; Parker, Carl

    2010-01-01

    The purpose of this article is to explore quality and growth implications emergent from various incremental costing models applied to distance education units. Prior research relative to costing models and three competing costing models useful in the current distance education environment are discussed. Specifically, the simple costing model, unit…

  6. Costs of Occupational Injuries in Construction in the United States

    PubMed Central

    Waehrer, Geetha M.; Dong, Xiuwen S.; Miller, Ted; Haile, Elizabeth; Men, Yurong

    2008-01-01

    This paper presents costs of fatal and non-fatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and non-fatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry’s total fatal and non-fatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs. PMID:17920850

  7. Costs of occupational injuries in construction in the United States.

    PubMed

    Waehrer, Geetha M; Dong, Xiuwen S; Miller, Ted; Haile, Elizabeth; Men, Yurong

    2007-11-01

    This paper presents costs of fatal and nonfatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and nonfatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry's total fatal and nonfatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs.

  8. Energy Savings and Breakeven Cost for Residential Heat Pump Water Heaters in the United States

    SciTech Connect

    Maguire, J.; Burch, J.; Merrigan, T.; Ong, S.

    2013-07-01

    Heat pump water heaters (HPWHs) have recently reemerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, simulations were performed of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern US. When replacing an electric water heater, the HPWH is likely to break even in California, the southern US, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

  9. Unit cost analysis in a university hospital: an example from Srinagarind Hospital, Khon Kaen.

    PubMed

    Vatanasapt, V; Kosuwon, W; Pengsaa, P

    1993-12-01

    This is the first analytic study to identify the unit cost in the University Hospital using the standard method of analysis in health economics. The unit costs in the report can be used to calculate the cost of each service for any disease. The costs of the hospital administration cost center and the supportive cost center were both allocated to the patient care service center by the simultaneous allocation method. The cost of teaching personnel was excluded from the analysis because it is quite difficult to estimate and differentiate the ratio of teaching costs to service costs. The hotel cost of the inpatient ward varied from 77.81 baht to 604.7 baht per day. The unit cost per service per day is different from the charge which is presently used at Srinagarind Hospital. Some services, such as in-house transportation are not included in the charge. This study was conducted to identify the unit cost of each service. The decision to establish charges can depend partly on this data and partly on the administrator's judgement. Other factors, such as patient poverty can dictate the final decision. In any case, the hospital and health service center should identify their own unit costs to be able to plan for effective budget management.

  10. Unit cost analysis in a university hospital: an example from Srinagarind Hospital, Khon Kaen.

    PubMed

    Vatanasapt, V; Kosuwon, W; Pengsaa, P

    1993-12-01

    This is the first analytic study to identify the unit cost in the University Hospital using the standard method of analysis in health economics. The unit costs in the report can be used to calculate the cost of each service for any disease. The costs of the hospital administration cost center and the supportive cost center were both allocated to the patient care service center by the simultaneous allocation method. The cost of teaching personnel was excluded from the analysis because it is quite difficult to estimate and differentiate the ratio of teaching costs to service costs. The hotel cost of the inpatient ward varied from 77.81 baht to 604.7 baht per day. The unit cost per service per day is different from the charge which is presently used at Srinagarind Hospital. Some services, such as in-house transportation are not included in the charge. This study was conducted to identify the unit cost of each service. The decision to establish charges can depend partly on this data and partly on the administrator's judgement. Other factors, such as patient poverty can dictate the final decision. In any case, the hospital and health service center should identify their own unit costs to be able to plan for effective budget management. PMID:7798815

  11. Cost-Effectiveness and Cost-Reduction in United States Colleges and Universities.

    ERIC Educational Resources Information Center

    Miller, Richard I.; Miller, Peggy M.

    1991-01-01

    The relationship in college administration between cost effectiveness/cost reduction and planning, management, and evaluation is explored, and approaches to cost accounting and financial ratio analysis are discussed. It is concluded that it is important to emphasize institutional mission and people rather than cost containment and productivity.…

  12. 47 CFR 51.511 - Forward-looking economic cost per unit.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Forward-looking economic cost per unit. 51.511 Section 51.511 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a)...

  13. Drug Prohibition in the United States: Costs, Consequences, and Alternatives

    NASA Astrophysics Data System (ADS)

    Nadelmann, Ethan A.

    1989-09-01

    ``Drug legalization'' increasingly merits serious consideration as both an analytical model and a policy option for addressing the ``drug problem.'' Criminal justice approaches to the drug problem have proven limited in their capacity to curtail drug abuse. They also have proven increasingly costly and counterproductive. Drug legalization policies that are wisely implemented can minimize the risks of legalization, dramatically reduce the costs of current policies, and directly address the problems of drug abuse.

  14. Unit Costs Provide Basis for Meaningful Evaluation of Efficiency of TV Courses.

    ERIC Educational Resources Information Center

    Jones, Gardner; And Others

    1969-01-01

    Efficient use of television for teaching cannot be achieved without meaningful cost comparisons with conventional classroom methods. Considerable effort has been spent at the University of Michigan in developing a unit cost basis for televised filmed lectures to include not only salaries, but administrative costs, supplies, amortization of…

  15. Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

    PubMed

    Feyrer, R; Rösch, J; Weyand, M; Kunzmann, U

    2005-10-01

    Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.

  16. 48 CFR 1845.7101-3 - Unit acquisition cost.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... acquired property, related fees, or a pro rata portion of fees, paid by NASA to the contractor. Situations... modifications that improve an item's capacity or extend its useful life two years or more and that cost $100,000... of the enhancement is $1,000,000 or more, and the expected useful life of the enhanced software is...

  17. Renewable Energy Cost Modeling. A Toolkit for Establishing Cost-Based Incentives in the United States

    SciTech Connect

    Gifford, Jason S.; Grace, Robert C.; Rickerson, Wilson H.

    2011-05-01

    This report serves as a resource for policymakers who wish to learn more about levelized cost of energy (LCOE) calculations, including cost-based incentives. The report identifies key renewable energy cost modeling options, highlights the policy implications of choosing one approach over the other, and presents recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, FITs, or similar policies. These recommendations shaped the design of NREL's Cost of Renewable Energy Spreadsheet Tool (CREST), which is used by state policymakers, regulators, utilities, developers, and other stakeholders to assist with analyses of policy and renewable energy incentive payment structures. Authored by Jason S. Gifford and Robert C. Grace of Sustainable Energy Advantage LLC and Wilson H. Rickerson of Meister Consultants Group, Inc.

  18. Improvements in and actual performance of the Plant Experiment Unit onboard Kibo, the Japanese experiment module on the international space station

    NASA Astrophysics Data System (ADS)

    Yano, Sachiko; Kasahara, Haruo; Masuda, Daisuke; Tanigaki, Fumiaki; Shimazu, Toru; Suzuki, Hiromi; Karahara, Ichirou; Soga, Kouichi; Hoson, Takayuki; Tayama, Ichiro; Tsuchiya, Yoshikazu; Kamisaka, Seiichiro

    2013-03-01

    In 2004, Japan Aerospace Exploration Agency developed the engineered model of the Plant Experiment Unit and the Cell Biology Experiment Facility. The Plant Experiment Unit was designed to be installed in the Cell Biology Experiment Facility and to support the seed-to-seed life cycle experiment of Arabidopsis plants in space in the project named Space Seed. Ground-based experiments to test the Plant Experiment Unit showed that the unit needed further improvement of a system to control the water content of a seedbed using an infrared moisture analyzer and that it was difficult to keep the relative humidity inside the Plant Experiment Unit between 70 and 80% because the Cell Biology Experiment Facility had neither a ventilation system nor a dehumidifying system. Therefore, excess moisture inside the Cell Biology Experiment Facility was removed with desiccant bags containing calcium chloride. Eight flight models of the Plant Experiment Unit in which dry Arabidopsis seeds were fixed to the seedbed with gum arabic were launched to the International Space Station in the space shuttle STS-128 (17A) on August 28, 2009. Plant Experiment Unit were installed in the Cell Biology Experiment Facility with desiccant boxes, and then the Space Seed experiment was started in the Japanese Experiment Module, named Kibo, which was part of the International Space Station, on September 10, 2009 by watering the seedbed and terminated 2 months later on November 11, 2009. On April 19, 2010, the Arabidopsis plants harvested in Kibo were retrieved and brought back to Earth by the space shuttle mission STS-131 (19A). The present paper describes the Space Seed experiment with particular reference to the development of the Plant Experiment Unit and its actual performance in Kibo onboard the International Space Station. Downlinked images from Kibo showed that the seeds had started germinating 3 days after the initial watering. The plants continued growing, producing rosette leaves, inflorescence

  19. Treatment of an actual slaughterhouse wastewater by integration of biological and advanced oxidation processes: Modeling, optimization, and cost-effectiveness analysis.

    PubMed

    Bustillo-Lecompte, Ciro Fernando; Mehrvar, Mehrab

    2016-11-01

    Biological and advanced oxidation processes are combined to treat an actual slaughterhouse wastewater (SWW) by a sequence of an anaerobic baffled reactor, an aerobic activated sludge reactor, and a UV/H2O2 photoreactor with recycle in continuous mode at laboratory scale. In the first part of this study, quadratic modeling along with response surface methodology are used for the statistical analysis and optimization of the combined process. The effects of the influent total organic carbon (TOC) concentration, the flow rate, the pH, the inlet H2O2 concentration, and their interaction on the overall treatment efficiency, CH4 yield, and H2O2 residual in the effluent of the photoreactor are investigated. The models are validated at different operating conditions using experimental data. Maximum TOC and total nitrogen (TN) removals of 91.29 and 86.05%, respectively, maximum CH4 yield of 55.72%, and minimum H2O2 residual of 1.45% in the photoreactor effluent were found at optimal operating conditions. In the second part of this study, continuous distribution kinetics is applied to establish a mathematical model for the degradation of SWW as a function of time. The agreement between model predictions and experimental values indicates that the proposed model could describe the performance of the combined anaerobic-aerobic-UV/H2O2 processes for the treatment of SWW. In the final part of the study, the optimized combined anaerobic-aerobic-UV/H2O2 processes with recycle were evaluated using a cost-effectiveness analysis to minimize the retention time, the electrical energy consumption, and the overall incurred treatment costs required for the efficient treatment of slaughterhouse wastewater effluents. PMID:27568982

  20. Replacement energy costs for nuclear electricity-generating units in the United States: 1997--2001. Volume 4

    SciTech Connect

    VanKuiken, J.C.; Guziel, K.A.; Tompkins, M.M.; Buehring, W.A.

    1997-09-01

    This report updates previous estimates of replacement energy costs for potential short-term shutdowns of 109 US nuclear electricity-generating units. This information was developed to assist the US Nuclear Regulatory Commission (NRC) in its regulatory impact analyses, specifically those that examine the impacts of proposed regulations requiring retrofitting of or safety modifications to nuclear reactors. Such actions might necessitate shutdowns of nuclear power plants while these changes are being implemented. The change in energy cost represents one factor that the NRC must consider when deciding to require a particular modification. Cost estimates were derived from probabilistic production cost simulations of pooled utility system operations. Factors affecting replacement energy costs, such as random unit failures, maintenance and refueling requirements, and load variations, are treated in the analysis. This report describes an abbreviated analytical approach as it was adopted to update the cost estimates published in NUREG/CR-4012, Vol. 3. The updates were made to extend the time frame of cost estimates and to account for recent changes in utility system conditions, such as change in fuel prices, construction and retirement schedules, and system demand projects.

  1. Fiscal Year 2004 Unit Cost Report for the Illinois Public Community Colleges

    ERIC Educational Resources Information Center

    Illinois Community College Board, 2005

    2005-01-01

    The Unit Cost Study is an annual project involving the direct participation of all public community colleges in Illinois. Each college submits basic data on course offerings, enrollments, and costs to the Illinois Community College Board staff, who in turn check the data for consistency with credit hour claims and financial reports and then…

  2. FY 1980 Unit Cost Analysis for the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Lach, Ivan J.

    An analysis is presented of the Illinois Public Community College Unit Cost Study for Fiscal Year (FY) 1980, an annual study using basic enrollment and cost data supplied by college for each instructional area offered. After introductory material, including study highlights and a glossary of terms, district and school data are provided on net…

  3. 16 CFR Appendix K to Part 305 - Representative Average Unit Energy Costs

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Representative Average Unit Energy Costs K... CONGRESS ENERGY AND WATER USE LABELING FOR CONSUMER PRODUCTS UNDER THE ENERGY POLICY AND CONSERVATION ACT (âENERGY LABELING RULEâ) Pt. 305, App. K Appendix K to Part 305—Representative Average Unit...

  4. 14 CFR 152.205 - United States share of project costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false United States share of project costs. 152.205 Section 152.205 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Funding of Approved Projects § 152.205 United...

  5. 14 CFR 152.205 - United States share of project costs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false United States share of project costs. 152.205 Section 152.205 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Funding of Approved Projects § 152.205 United...

  6. 14 CFR 152.205 - United States share of project costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false United States share of project costs. 152.205 Section 152.205 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Funding of Approved Projects § 152.205 United...

  7. 14 CFR 152.205 - United States share of project costs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false United States share of project costs. 152.205 Section 152.205 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Funding of Approved Projects § 152.205 United...

  8. 14 CFR 152.205 - United States share of project costs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false United States share of project costs. 152.205 Section 152.205 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Funding of Approved Projects § 152.205 United...

  9. Six climate change-related events in the United States accounted for about $14 billion in lost lives and health costs.

    PubMed

    Knowlton, Kim; Rotkin-Ellman, Miriam; Geballe, Linda; Max, Wendy; Solomon, Gina M

    2011-11-01

    The future health costs associated with predicted climate change-related events such as hurricanes, heat waves, and floods are projected to be enormous. This article estimates the health costs associated with six climate change-related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change-related events projected to worsen with continued global warming-ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14 billion, with 95 percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740 million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights the growing need for public health preparedness.

  10. Medical costs of smoking in the United States: estimates, their validity, and their implications

    PubMed Central

    Warner, K.; Hodgson, T.; Carroll, C.

    1999-01-01

    OBJECTIVE—To compare estimates of the medical costs of smoking in the United States and to consider their relevance to assessing the costs of smoking in developing countries and the net economic burden of smoking.
DATA SOURCES—A Medline search through early 1999 using keywords "smoking" and "cost", with review of article reference lists.
STUDY SELECTION—Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population.
DATA EXTRACTION—Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings.
DATA SYNTHESIS—With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. The exception, a recent study, found much larger attributable expenditures. The lower estimates may reflect the limitation of analysis to costs associated with the principal smoking-related diseases. The higher estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range.
CONCLUSIONS—The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing the magnitude of their current cost-of-smoking burden and their future burdens, with differences in tobacco use histories and the availability of chronic disease treatment affecting country-specific estimates. The debate over the use of gross or net medical cost estimates is likely to intensify with the proliferation of lawsuits against the tobacco industry to recover expenditures on tobacco-produced disease.


Keywords: medical

  11. Patterns of costs and spending among orthopedic surgeons across the United States: a national survey.

    PubMed

    Sathiyakumar, Vasanth; Jahangir, A Alex; Mir, Hassan R; Obremskey, William T; Lee, Young M; Thakore, Rachel V; Sethi, Manish K

    2014-01-01

    Due to rising medical costs, the purpose of this study was to investigate the spending patterns of orthopedic surgeons across the United States and the financial implications of such behavior. Overall, 2,000 randomly chosen orthopedic surgeons from the American Academy of Orthopedic Surgeons (AAOS) were invited to answer web-based surveys on their utilization of healthcare resources; 1,214 (61%) completed the survey. There was a significant difference (P < .001) in monthly expenditure based on 8 domains of orthopedic care for the average orthopedist: x-ray costs were $7,536, computed tomography costs were $2,340, magnetic resonance imaging costs were $14,975, ultrasound costs were $686, laboratory test costs were $969, specialty referral costs were $1,389, biopsy costs were $1,314, and hospital admission costs were $6,808. Significant differences in monthly expenditure existed based on orthopedist practice setting (P < .001), subspecialty (P < .001), gender (P < .001), and age (P < .001). Demographics with the highest monthly spending included orthopedic private group setting ($36,278), orthopedic oncology subspecialty ($41,795), male gender ($33,843), and age 50 to 59 ($35,559). The average monthly expenditure for orthopedists nationally was calculated to be $33,436 per physician. Given there are approximately 20,400 practicing orthopedists, the annual United States expenditure in orthopedic surgery was calculated to be $8.2 billion. Orthopedic spending is a significant component of national healthcare expenditure.

  12. The cost-effectiveness of supported employment for adults with autism in the United Kingdom.

    PubMed

    Mavranezouli, Ifigeneia; Megnin-Viggars, Odette; Cheema, Nadir; Howlin, Patricia; Baron-Cohen, Simon; Pilling, Stephen

    2014-11-01

    Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings.

  13. The Economic Cost of Methamphetamine Use in the United States, 2005

    ERIC Educational Resources Information Center

    Nicosia, Nancy; Pacula, Rosalie Liccardo; Kilmer, Beau; Lundberg, Russell; Chiesa, James

    2009-01-01

    This first national estimate suggests that the economic cost of methamphetamine (meth) use in the United States reached $23.4 billion in 2005. Given the uncertainty in estimating the costs of meth use, this book provides a lower-bound estimate of $16.2 billion and an upper-bound estimate of $48.3 billion. The analysis considers a wide range of…

  14. Is a chest pain observation unit likely to be cost saving in a British hospital?

    PubMed Central

    Goodacre, S.; Morris, F.; Arnold, J.; Angelini, K.

    2001-01-01

    Background—Studies from the United States (US) suggest that using a chest pain observation unit (CPOU) saves from $567 to $2030 per case compared with hospital admission. These savings will only be reproduced in the United Kingdom (UK) if the cost of routine hospital admission is similar. This study aimed to review current practice to determine the proportion of patients suitable for CPOU evaluation, the cost per case of routine admission and compare this with control groups in US studies. Methods—300 patients were randomly selected from those admitted with chest pain between January and June 1998. Two independent observers reviewed the case notes to determine who would have been suitable for CPOU management. Resource use of those selected was then determined. Results—Notes were retrieved for 285 patients. A total of 106 (37.2%) were suitable for CPOU care. Mean length of stay was 51 hours (median 24). Only two patients were admitted to the coronary care unit. Interventional cardiology was limited to two angiograms, one angioplasty and one bypass graft. Estimated mean cost per patient was £458 ($733) with interventional cardiology included, £356 ($570) without. Conclusion—Potential exists for the introduction of CPOU care to reduce health service costs in the UK. However, the magnitude of cost savings demonstrated in US studies were achieved by comparison to relatively high inpatient costs and should not be extrapolated. Economic evaluation of the CPOU should be repeated in the UK. The inclusion of interventional cardiology costs is an important determinant of cost effectiveness. PMID:11310454

  15. CONSUMPTION AND RESPONSE OUTPUT AS A FUNCTION OF UNIT PRICE: MANIPULATION OF COST AND BENEFIT COMPONENTS

    PubMed Central

    Delmendo, Xeres; Borrero, John C; Beauchamp, Kenneth L; Francisco, Monica T

    2009-01-01

    We conducted preference assessments with 4 typically developing children to identify potential reinforcers and assessed the reinforcing efficacy of those stimuli. Next, we tested two predictions of economic theory: that overall consumption (reinforcers obtained) would decrease as the unit price (response requirement per reinforcer) increased and that the cost and benefit components that defined unit price would not influence overall consumption considerably when unit price values were equal. We tested these predictions by arranging unit price such that the denominator was one (e.g., two responses produced one reinforcer) or two (e.g., four responses produced two reinforcers). Results showed that consumption decreased as unit price increased and that unit price values with different components produced similar consumption. PMID:20190922

  16. Consumption and response output as a function of unit price: manipulation of cost and benefit components.

    PubMed

    Delmendo, Xeres; Borrero, John C; Beauchamp, Kenneth L; Francisco, Monica T

    2009-01-01

    We conducted preference assessments with 4 typically developing children to identify potential reinforcers and assessed the reinforcing efficacy of those stimuli. Next, we tested two predictions of economic theory: that overall consumption (reinforcers obtained) would decrease as the unit price (response requirement per reinforcer) increased and that the cost and benefit components that defined unit price would not influence overall consumption considerably when unit price values were equal. We tested these predictions by arranging unit price such that the denominator was one (e.g., two responses produced one reinforcer) or two (e.g., four responses produced two reinforcers). Results showed that consumption decreased as unit price increased and that unit price values with different components produced similar consumption.

  17. Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden.

    PubMed

    Verhoef, T I; Redekop, W K; Langenskiold, S; Kamali, F; Wadelius, M; Burnside, G; Maitland-van der Zee, A-H; Hughes, D A; Pirmohamed, M

    2016-10-01

    We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per quality-adjusted life-year (QALY) gained by pharmacogenetic-guided warfarin dosing versus standard treatment over a lifetime horizon. Incremental lifetime costs were £26 and 382 Swedish kronor (SEK) and incremental QALYs were 0.0039 and 0.0015 in the United Kingdom and Sweden, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were £6 702 and 253 848 SEK per QALY gained. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 93% of the simulations in the United Kingdom and below 500 000 SEK in 67% of the simulations in Sweden. Our data suggest that pharmacogenetic-guided dosing of warfarin is a cost-effective strategy to improve outcomes of patients with AF treated with warfarin in the United Kingdom and in Sweden.

  18. Evaluation of syngas production unit cost of bio-gasification facility using regression analysis techniques

    SciTech Connect

    Deng, Yangyang; Parajuli, Prem B.

    2011-08-10

    Evaluation of economic feasibility of a bio-gasification facility needs understanding of its unit cost under different production capacities. The objective of this study was to evaluate the unit cost of syngas production at capacities from 60 through 1800Nm 3/h using an economic model with three regression analysis techniques (simple regression, reciprocal regression, and log-log regression). The preliminary result of this study showed that reciprocal regression analysis technique had the best fit curve between per unit cost and production capacity, with sum of error squares (SES) lower than 0.001 and coefficient of determination of (R 2) 0.996. The regression analysis techniques determined the minimum unit cost of syngas production for micro-scale bio-gasification facilities of $0.052/Nm 3, under the capacity of 2,880 Nm 3/h. The results of this study suggest that to reduce cost, facilities should run at a high production capacity. In addition, the contribution of this technique could be the new categorical criterion to evaluate micro-scale bio-gasification facility from the perspective of economic analysis.

  19. A cost-effective methodology for the design of massively-parallel VLSI functional units

    NASA Technical Reports Server (NTRS)

    Venkateswaran, N.; Sriram, G.; Desouza, J.

    1993-01-01

    In this paper we propose a generalized methodology for the design of cost-effective massively-parallel VLSI Functional Units. This methodology is based on a technique of generating and reducing a massive bit-array on the mask-programmable PAcube VLSI array. This methodology unifies (maintains identical data flow and control) the execution of complex arithmetic functions on PAcube arrays. It is highly regular, expandable and uniform with respect to problem-size and wordlength, thereby reducing the communication complexity. The memory-functional unit interface is regular and expandable. Using this technique functional units of dedicated processors can be mask-programmed on the naked PAcube arrays, reducing the turn-around time. The production cost of such dedicated processors can be drastically reduced since the naked PAcube arrays can be mass-produced. Analysis of the the performance of functional units designed by our method yields promising results.

  20. Break-Even Cost for Residential Photovoltaics in the United States: Key Drivers and Sensitivities

    SciTech Connect

    Denholm, P.; Margolis, R. M.; Ong, S.; Roberts, B.

    2009-12-01

    Grid parity--or break-even cost--for photovoltaic (PV) technology is defined as the point where the cost of PV-generated electricity equals the cost of electricity purchased from the grid. Break-even cost is expressed in $/W of an installed system. Achieving break-even cost is a function of many variables. Consequently, break-even costs vary by location and time for a country, such as the United States, with a diverse set of resources, electricity prices, and other variables. In this report, we analyze PV break-even costs for U.S. residential customers. We evaluate some key drivers of grid parity both regionally and over time. We also examine the impact of moving from flat to time-of-use (TOU) rates, and we evaluate individual components of the break-even cost, including effect of rate structure and various incentives. Finally, we examine how PV markets might evolve on a regional basis considering the sensitivity of the break-even cost to four major drivers: technical performance, financing parameters, electricity prices and rates, and policies. We find that local incentives rather than ?technical? parameters are in general the key drivers of the break-even cost of PV. Additionally, this analysis provides insight about the potential viability of PV markets.

  1. Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

    PubMed

    Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto

    2016-01-01

    Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs. PMID:27111688

  2. Pedestrian and Pedalcyclist Injury Costs in the United States by Age and Injury Severity

    PubMed Central

    Miller, Ted R.; Zaloshnja, Eduard; Lawrence, Bruce A.; Crandall, Jeff; Ivarsson, Johan; Finkelstein, A. Eric

    2004-01-01

    This paper estimates the incidence, unit costs, and annual costs of pedestrian and pedalcycle crash injuries in the United States. It includes medical care costs, household and wage work losses, and the value of pain, suffering, and lost quality of life. The estimates are broken down by body region and severity. They rely heavily on data from the health care system. Costs of pedestrian and pedalcycle injuries in 2000 will total $40 billion over the lifetimes of the injured. Most pedalcyclist injury costs and half of pedestrian injury costs do not involve motor vehicles. Youth ages 5–14 face greater annual risks when walking or driving their own pedaled vehicles than when being driven. Children under age 5 experience higher costs than their elders when injured as pedestrians. Our results suggest European and Japanese component tests used to design pedestrian injury countermeasures for motor vehicles are too narrow. Separate lower limb testing is needed for younger children. Testing for torso/vertebral column injury of adults also seems desirable. PMID:15319130

  3. Cost Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, Philip

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous United States. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  4. Cost-effectiveness of pazopanib in advanced soft tissue sarcoma in the United kingdom.

    PubMed

    Amdahl, Jordan; Manson, Stephanie C; Isbell, Robert; Chit, Ayman; Diaz, Jose; Lewis, Lily; Delea, Thomas E

    2014-01-01

    In the phase III PALETTE trial, pazopanib improved progression-free survival (PFS) compared with placebo in patients with advanced/metastatic soft tissue sarcomas (mSTS) who had received prior chemotherapy. We used a multistate model to estimate expected PFS, overall survival (OS), lifetime STS treatment costs, and quality-adjusted life-years (QALYs) for patients receiving pazopanib, placebo, trabectedin, ifosfamide, or gemcitabine plus docetaxel as second-line mSTS therapies. The cost-effectiveness of pazopanib was expressed as the incremental costs per QALY gained. Estimates of PFS/OS, adverse events, and utilities for pazopanib and placebo were from the PALETTE trial. Estimates of relative effectiveness of the other comparators were from an unadjusted indirect comparison versus pazopanib. Costs were from published sources. Pazopanib is estimated to increase QALYs by 0.128 and costs by £7,976 versus placebo; cost per QALY gained with pazopanib versus placebo is estimated to be £62,000. Compared with the other chemotherapies, pazopanib provides similar QALYs at a lower cost. Pazopanib may not be cost-effective versus placebo but may be cost-effective versus the most commonly used active treatments, although this conclusion is uncertain. Given the unmet need for effective treatments for mSTS, pazopanib may be an appropriate alternative to some currently used medications in the United Kingdom. PMID:25024640

  5. 42 CFR 447.206 - Cost limit for providers operated by units of government.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Institutional governmentally-operated health care providers (i.e., hospitals, nursing facilities, and ICFs/MR... 42 Public Health 4 2010-10-01 2010-10-01 false Cost limit for providers operated by units of government. 447.206 Section 447.206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

  6. The Cost-Effectiveness of Supported Employment for Adults with Autism in the United Kingdom

    ERIC Educational Resources Information Center

    Mavranezouli, Ifigeneia; Megnin-Viggars, Odette; Cheema, Nadir; Howlin, Patricia; Baron-Cohen, Simon; Pilling, Stephen

    2014-01-01

    Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom.…

  7. Cost of Wind Energy in the United States: Trends from 2007 to 2012 (Presentation)

    SciTech Connect

    Hand, M.

    2015-01-01

    This presentation provides an overview of recent technology trends observed in the United States including project size, turbine size, rotor diameter, hub height, annual average wind speed, and annual energy production. It also highlights area where system analysis is required to fully understand how these technology trends relate to the cost of wind energy.

  8. 76 FR 13168 - Energy Conservation Program for Consumer Products: Representative Average Unit Costs of Energy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-10

    ... of Energy Efficiency and Renewable Energy Energy Conservation Program for Consumer Products: Representative Average Unit Costs of Energy AGENCY: Office of Energy Efficiency and Renewable Energy, Department... FURTHER INFORMATION CONTACT: Mohammed Khan, U.S. Department of Energy, Office of Energy Efficiency...

  9. 16 CFR Appendix K to Part 305 - Representative Average Unit Energy Costs

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Representative Average Unit Energy Costs K... CONGRESS RULE CONCERNING DISCLOSURES REGARDING ENERGY CONSUMPTION AND WATER USE OF CERTAIN HOME APPLIANCES AND OTHER PRODUCTS REQUIRED UNDER THE ENERGY POLICY AND CONSERVATION ACT (âAPPLIANCE LABELING...

  10. 16 CFR Appendix K to Part 305 - Representative Average Unit Energy Costs

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Representative Average Unit Energy Costs K... CONGRESS RULE CONCERNING DISCLOSURES REGARDING ENERGY CONSUMPTION AND WATER USE OF CERTAIN HOME APPLIANCES AND OTHER PRODUCTS REQUIRED UNDER THE ENERGY POLICY AND CONSERVATION ACT (âAPPLIANCE LABELING...

  11. 16 CFR Appendix K to Part 305 - Representative Average Unit Energy Costs

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Representative Average Unit Energy Costs K... CONGRESS RULE CONCERNING DISCLOSURES REGARDING ENERGY CONSUMPTION AND WATER USE OF CERTAIN HOME APPLIANCES AND OTHER PRODUCTS REQUIRED UNDER THE ENERGY POLICY AND CONSERVATION ACT (âAPPLIANCE LABELING...

  12. 16 CFR Appendix K to Part 305 - Representative Average Unit Energy Costs

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Representative Average Unit Energy Costs K... CONGRESS RULE CONCERNING DISCLOSURES REGARDING ENERGY CONSUMPTION AND WATER USE OF CERTAIN HOME APPLIANCES AND OTHER PRODUCTS REQUIRED UNDER THE ENERGY POLICY AND CONSERVATION ACT (âAPPLIANCE LABELING...

  13. 78 FR 17648 - Energy Conservation Program for Consumer Products: Representative Average Unit Costs of Energy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-22

    ... Renewable Energy Forrestal Building, Mail Station EE-2J 1000 Independence Avenue SW., Washington, DC 20585... Energy, Office of General Counsel Forrestal Building, Mail Station GC-72, 1000 Independence Avenue SW...: Representative Average Unit Costs of Energy'', dated April 26, 2012, 77 FR 24940. On April 22, 2013, the...

  14. 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

  15. Cost-effectiveness of Total Knee Arthroplasty in the United States

    PubMed Central

    Losina, Elena; Walensky, Rochelle P.; Kessler, Courtenay L.; Emrani, Parastu S.; Reichmann, William M.; Wright, Elizabeth A.; Holt, Holly L.; Solomon, Daniel H.; Yelin, Edward; Paltiel, A. David; Katz, Jeffrey N.

    2009-01-01

    Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters’ influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers. PMID:19546411

  16. 48 CFR 52.222-32 - Construction Wage Rate Requirements-Price Adjustment (Actual Method).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... include any allowance for any increased cost for which adjustment is being requested. (c) The Contracting... be limited to increases or decreases in wages and fringe benefits as described in paragraph (c) of... DBA craft New WD Hourly rate paid Diff. Actual hrs. Actual units (sq. yard) Increase/sq. yard...

  17. 48 CFR 9904.410 - Allocation of business unit general and administrative expenses to final cost objectives.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... unit general and administrative expenses to final cost objectives. 9904.410 Section 9904.410 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST...

  18. Economic Cost of Campylobacter, Norovirus and Rotavirus Disease in the United Kingdom

    PubMed Central

    Tam, Clarence C; O’Brien, Sarah J

    2016-01-01

    Objectives To estimate the annual cost to patients, the health service and society of infectious intestinal disease (IID) from Campylobacter, norovirus and rotavirus. Design Secondary data analysis. Setting The United Kingdom population, 2008–9. Main outcome measures Cases and frequency of health services usage due to these three pathogens; associated healthcare costs; direct, out-of-pocket expenses; indirect costs to patients and caregivers. Results The median estimated costs to patients and the health service at 2008–9 prices were: Campylobacter £50 million (95% CI: £33m–£75m), norovirus £81 million (95% CI: £63m–£106m), rotavirus £25m (95% CI: £18m–£35m). The costs per case were approximately £30 for norovirus and rotavirus, and £85 for Campylobacter. This was mostly borne by patients and caregivers through lost income or out-of-pocket expenditure. The cost of Campylobacter-related Guillain-Barré syndrome hospitalisation was £1.26 million (95% CI: £0.4m–£4.2m). Conclusions Norovirus causes greater economic burden than Campylobacter and rotavirus combined. Efforts to control IID must prioritise norovirus. For Campylobacter, estimated costs should be considered in the context of expenditure to control this pathogen in agriculture, food production and retail. Our estimates, prior to routine rotavirus immunisation in the UK, provide a baseline vaccine cost-effectiveness analyses. PMID:26828435

  19. 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.

  20. Optimal number of minimal repairs with cumulative repair cost limit for a two-unit system with failure rate interactions

    NASA Astrophysics Data System (ADS)

    Lai, Min-Tsai; Yan, Huey

    2016-01-01

    A discrete replacement model is presented that includes a cumulative repair cost limit for a two-unit system with failure rate interactions between the units. We assume a failure in unit 1 causes the failure rate in unit 2 to increase, whereas a failure in unit 2 causes a failure in unit 1, resulting in a total system failure. If unit 1 fails and the cumulative repair cost till to this failure is less than a limit L, then unit 1 is repaired. If there is a failure in unit 1 and the cumulative repair cost exceeds L or the number of failures equals n, the entire system is preventively replaced. The system is also replaced at a total failure, and such replacement cost is higher than the preventive replacement cost. The long-term expected cost per unit time is derived using the expected costs as the optimality criterion. The minimum-cost policy is derived, and existence and uniqueness are proved.

  1. Stranded cost recovery: Reregulating the electricity markets in the United States

    NASA Astrophysics Data System (ADS)

    Wagle, Pushkar Ghanashyam

    2000-10-01

    For the past few years, Stranded Cost recovery has been one of the most contentious issues regarding the restructuring of electricity markets among the regulators, researchers, and the other interested parties. Among the states that have moved towards retail competition, some have already made decisions regarding the levels of the stranded cost recovery. So the question is: how have these states handled the "stranded cost problem"? Following the introduction and the historical perspective of the industry in the first chapter, the second chapter takes a broad view for understanding the overall process of deregulation. It attempts to analyze why some states have made a rapid transition to competition in the electric utility industry, while other states are just beginning to consider the issue. White (1996) and Ando & Palmer (1998) have conducted a similar exercise. We present a more comprehensive and theoretically informed econometric analysis that sheds light over some of the crucial issues involved in restructuring, such as, stranded cost recovery, regulation of transmission and distribution sectors, and establishment of Independent System Operator, etc. This chapter offers the rationale for alternative econometric techniques, and extends the political economy analysis to incorporate actual timings of retail competition. Once we have identified the role of stranded cost in restructuring and the theoretical foundations, we study empirically the political economy of states' decisions to grant stranded cost recovery. This constitutes the third chapter. Here, we concentrate on California and Pennsylvania, two states that are at the frontiers of deregulation, and compare their respective treatments of the stranded cost. We probe the reasons behind Pennsylvania's lead over California on the path towards deregulation.

  2. Cost of wind energy: comparing distant wind resources to local resources in the midwestern United States.

    PubMed

    Hoppock, David C; Patiño-Echeverri, Dalia

    2010-11-15

    The best wind sites in the United States are often located far from electricity demand centers and lack transmission access. Local sites that have lower quality wind resources but do not require as much power transmission capacity are an alternative to distant wind resources. In this paper, we explore the trade-offs between developing new wind generation at local sites and installing wind farms at remote sites. We first examine the general relationship between the high capital costs required for local wind development and the relatively lower capital costs required to install a wind farm capable of generating the same electrical output at a remote site,with the results representing the maximum amount an investor should be willing to pay for transmission access. We suggest that this analysis can be used as a first step in comparing potential wind resources to meet a state renewable portfolio standard (RPS). To illustrate, we compare the cost of local wind (∼50 km from the load) to the cost of distant wind requiring new transmission (∼550-750 km from the load) to meet the Illinois RPS. We find that local, lower capacity factor wind sites are the lowest cost option for meeting the Illinois RPS if new long distance transmission is required to access distant, higher capacity factor wind resources. If higher capacity wind sites can be connected to the existing grid at minimal cost, in many cases they will have lower costs.

  3. Cost-control issues within the hospital environment in the United Kingdom.

    PubMed

    Freeman, R

    1993-01-01

    Health care in the United Kingdom is dominated by the National Health Service, which operates under a system in which care is delivered free at the point of need and is funded by taxation. Experimentation with a number of different models has occurred since 1980 and has culminated in recent National Health Service reforms characterized by the separation of purchaser and provider functions. An inescapable result of this is the formal definition of the relationship between need and service provision (contracts or performance arrangements), and the equally unavoidable costing of "patient episodes" or equivalent as a tool for estimating both supply and demand. This change has completely altered the way in which individual capital and revenue costs are viewed in the National Health Service. With regard to drugs, costs can now be seen as part of a patient's consumption of resources as opposed to a hospital budget heading. The new system acknowledges that higher drug costs can be incurred if the overall patient-episode cost is reduced as a result. Such a reduction in average patient costs might then lead to more contract work and a higher revenue for the hospital. Quality of care specifications by purchasers may also affect drug costs.

  4. Cost-effectiveness analysis of universal influenza vaccination with quadrivalent inactivated vaccine in the United States

    PubMed Central

    Clements, Karen M; Meier, Genevieve; McGarry, Lisa J; Pruttivarasin, Narin; Misurski, Derek A

    2014-01-01

    To address influenza B lineage mismatch and co-circulation, several quadrivalent inactivated influenza vaccines (IIV4s) containing two type A strains and both type B lineages have recently been approved in the United States. Currently available trivalent inactivated vaccines (IIV3s) or trivalent live attenuated influenza vaccines (LAIV3s) comprise two influenza A strains and one of the two influenza B lineages that have co-circulated in the United States since 2001. The objective of this analysis was to evaluate the cost-effectiveness of a policy of universal vaccination with IIV4 vs. IIV3/LAIV3 during 1 year in the United States. On average per influenza season, IIV4 was predicted to result in 30 251 fewer influenza cases, 3512 fewer hospitalizations, 722 fewer deaths, 4812 fewer life-years lost, and 3596 fewer quality-adjusted life-years (QALYs) lost vs. IIV3/LAIV3. Using the Fluarix QuadrivalentTM (GlaxoSmithKline) prices and the weighted average IIV3/LAIV3 prices, the model predicts that the vaccination program costs would increase by $452.2 million, while direct medical and indirect costs would decrease by $111.6 million and $218.7 million, respectively, with IIV4. The incremental cost-effectiveness ratio (ICER) comparing IIV4 to IIV3/LAIV3 is predicted to be $90 301/QALY gained. Deterministic sensitivity analyses found that influenza B vaccine-matched and mismatched efficacies among adults aged ≥65 years had the greatest impact on the ICER. Probabilistic sensitivity analysis showed that the cost per QALY remained below $100 000 for 61% of iterations. In conclusion, vaccination with IIV4 in the US is predicted to reduce morbidity and mortality. This strategy is also predicted to be cost-effective vs. IIV3/LAIV3 at conventional willingness-to-pay thresholds. PMID:24609063

  5. Thermal analysis of Malaysian double storey housing - low/medium cost unit

    NASA Astrophysics Data System (ADS)

    Normah, M. G.; Lau, K. Y.; Yusoff, S. Mohd.

    2012-06-01

    Almost half of the total energy used today is consumed in buildings. In the tropical climate, air-conditioning a housing unit takes much of the energy bill. Malaysia is no exception. Malaysian double storey terrace housing is popular among developers and buyers. Surveys have shown that housing occupants are much dissatisfied with the thermal comfort and artificial cooling is often sought. The objective of this study is to assess the thermal comfort of the low and medium-cost double storey housing in the area surrounding Universiti Teknologi Malaysia. A simulation program using the Weighting Factor Method calculates the heat transfer interaction, temperature distribution, and PMV level in three types of housing units in relation to the size. Fanger's PMV model based on ISO Standard 7730 is used here because it accounts for all parameters that affect the thermal sensation of a human within its equation. Results showed that both the low and medium-cost housing units studied are out of the comfortable range described by ASHRAE Standard 55 with the units all complied with the local bylaws. In view of the uncertainties in energy supply, future housing units should consider natural ventilation as part of the passive energy management.

  6. Cost-effectiveness of Human Papillomavirus Vaccination in the United States

    PubMed Central

    Ekwueme, Donatus U.; Saraiya, Mona; Markowitz, Lauri E.

    2008-01-01

    We describe a simplified model, based on the current economic and health effects of human papillomavirus (HPV), to estimate the cost-effectiveness of HPV vaccination of 12-year-old girls in the United States. Under base-case parameter values, the estimated cost per quality-adjusted life year gained by vaccination in the context of current cervical cancer screening practices in the United States ranged from $3,906 to $14,723 (2005 US dollars), depending on factors such as whether herd immunity effects were assumed; the types of HPV targeted by the vaccine; and whether the benefits of preventing anal, vaginal, vulvar, and oropharyngeal cancers were included. The results of our simplified model were consistent with published studies based on more complex models when key assumptions were similar. This consistency is reassuring because models of varying complexity will be essential tools for policy makers in the development of optimal HPV vaccination strategies. PMID:18258117

  7. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review.

    PubMed

    Halpern, Neil A; Pastores, Stephen M

    2015-11-01

    This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs. PMID:26308432

  8. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review.

    PubMed

    Halpern, Neil A; Pastores, Stephen M

    2015-11-01

    This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the ICU bed supply, use, occupancy, and costs in the United States. Data for total ICU beds, use, and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System maintained by the federal Centers for Medicare and Medicaid Services and the proprietary Hospital Statistics of the American Hospital Association. Two costing methodologies can be used to calculate U.S. ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of U.S. ICU bed supply, use, occupancy, and costs helps provide clarity to the width and scope of the critical care medicine enterprise within the U.S. healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to critical care medicine and be better prepared to participate in their own local hospital organizations or regional critical care medicine programs.

  9. Efficiency-optimized low-cost TDPAC spectrometer using a versatile routing/coincidence unit

    NASA Astrophysics Data System (ADS)

    Rentería, M.; Bibiloni, A. G.; Darriba, G. N.; Errico, L. A.; Muñoz, E. L.; Richard, D.; Runco, J.

    2008-01-01

    A highly efficient, reliable, and low-cost γ γ TDPAC spectrometer, PACAr, optimized for 181Hf-implanted low-activity samples, is presented. A versatile EPROM-based routing/coincidence unit was developed and implemented to be use with the memory-card-based multichannel analyzer hosted in a personal computer. The excellent energy resolution and very good overall resolution and efficiency of PACAr are analyzed and compare with advanced and already tested fast fast and slow fast PAC spectrometers.

  10. A Model for Estimating Student Unit Cost and Staffing Requirements for University Academic Programmes with Reference to Kenyan Public Universities.

    ERIC Educational Resources Information Center

    Aduol, F. W. O.

    2001-01-01

    Presents model for estimation of student unit costs and staffing requirements. Begins with specification of a "staff distribution matrix" setting out proportions of staff levels in a given staff category that are needed for a degree level. Student unit cost and staffing requirements are computed through manipulations on the matrix. The model is…

  11. Estimated parameters as independent variables - with an application to the costs of electric-generating units

    SciTech Connect

    Schmalensee, R.; Joskow, P.L.

    1984-01-01

    The cost of a piece of capital equipment, like an electric-generating unit, is a function of a variety of unit-specific attributes. Some of these attributes can be observed directly without error (such as size), but others (such as the reliability or efficiency of the equipment), cannot be. However, estimates of the unobservable quality attributes can often be obtained from time-series data on expost performance, and these estimates can in turn be used as data on the unobservable attributes that appear as exogenous variables in a cost equation. The authors consider estimation of linear models in which observation-specific (firm, plant, household, individual) attributes appear as exogenous variables, but these attributes cannot be observed directly. Rather, they assume that estimates of the relevant observation-specific attributes, along with the associated covariance matrix, can be computed using data on variables (such as ex post performance) that do not appear directly in the primary model of interest. A maximum-likelihood technique for using such estimates as independent variables in cross-section regression analysis is derived. The solution to the measurement-error problem is interpretable as nonlinear (Theil-Goldberger) mixed estimation. The method is applied to the estimation of a construction cost relationship for electric-generating units.

  12. ERISA, agency costs, and the future of health care in the United States.

    PubMed

    Bronsteen, John; Maher, Brendan S; Stris, Peter K

    2008-04-01

    Because so many Americans receive health insurance through their employers, the Employee Retirement Income Security Act (ERISA) of 1974 plays a dominant role in the delivery of health care in the United States. The ERISA system enables employers and insurers to save money by providing inadequate health care to employees, thereby creating incentives for these agents to act contrary to the interests of their principals. Such agency costs play a significant role in the current health care crisis and require attention when considering reform. We evaluate the two major health care reform movements by exploring the extent to which each reduces agency costs. We find that agency cost analysis clarifies the benefits, limits, and uncertainties of each approach.

  13. Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States.

    PubMed

    Atkins, Katherine E; Fitzpatrick, Meagan C; Galvani, Alison P; Townsend, Jeffrey P

    2016-06-15

    Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible. PMID:27188951

  14. Cost-Effectiveness of Screening and Treating Foreign-Born Students for Tuberculosis before Entering the United States

    PubMed Central

    Wingate, La’Marcus T.; Posey, Drew L.; Zhou, Weigong; Olson, Christine K.; Maskery, Brian

    2015-01-01

    Introduction The Centers for Disease Control and Prevention is considering implementation of overseas medical screening of student-visa applicants to reduce the numbers of active tuberculosis cases entering the United States. Objective To evaluate the costs, cases averted, and cost-effectiveness of screening for, and treating, tuberculosis in United States-bound students from countries with varying tuberculosis prevalence. Methods Costs and benefits were evaluated from two perspectives, combined and United States only. The combined perspective totaled overseas and United States costs and benefits from a societal perspective. The United States only perspective was a domestic measure of costs and benefits. A decision tree was developed to determine the cost-effectiveness of tuberculosis screening and treatment from the combined perspective. Results From the United States only perspective, overseas screening programs of Chinese and Indian students would prevent the importation of 157 tuberculosis cases annually, and result in $2.7 million in savings. From the combined perspective, screening programs for Chinese students would cost more than $2.8 million annually and screening programs for Indian students nearly $440,000 annually. From the combined perspective, the incremental cost for each tuberculosis case averted by screening Chinese and Indian students was $22,187 and $15,063, respectively. Implementing screening programs for German students would prevent no cases in most years, and would result in increased costs both overseas and in the United States. The domestic costs would occur because public health departments would need to follow up on students identified overseas as having an elevated risk of tuberculosis. Conclusions Tuberculosis screening and treatment programs for students seeking long term visas to attend United States schools would reduce the number of tuberculosis cases imported. Implementing screening in high-incidence countries could save the

  15. Methods of Calculating Unit Activity and Output Costs in French Universities. Technical Report. Programme on Institutional Management in Higher Education.

    ERIC Educational Resources Information Center

    Babeau, Andre; And Others

    Proposals for calculating unit costs are advocated that are based on a body of methods common to the member universities. Production inputs and cost components in French universities are studied in terms of resources at the disposal of the university, and staffing, capital, operating, and transfer costs. Identification of activities and…

  16. 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

    ..., or dental care. This change responds to the increase in medical costs since 1992, when the current... Part 43 Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States... intervening period, the cost of medical care and treatment has increased substantially. That increase...

  17. Cost of managing an episode of relapse in multiple sclerosis in the United States

    PubMed Central

    O'Brien, Judith A; Ward, Alexandra J; Patrick, Amanda R; Caro, Jaime

    2003-01-01

    Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses. PMID:12952552

  18. A cost effective model for appropriate administration of red cell units and salvaging un-transfused red cell units by using temperature sensitive indicators for blood component transportation in a hospital setting

    PubMed Central

    Tiwari, Aseem K.; Sharma, Pooja; Pandey, Prashant K.; Rawat, Ganesh S.; Dixit, Surbhi; Raina, Vimarsh; Bhargava, Richa

    2015-01-01

    Background: A rule called “30-min rule” defines that red cell unit cannot be used if it has been out of blood bank refrigerator for over 30 min. This rule is useful to guide initiation of transfusion, but is inadequate for deciding whether to reuse or discard units received-back at blood transfusion services (BTS). A simple cost-effective temperature-sensitive indicator was evaluated to decide upon reuse (cold chain was uninterrupted) or discard (where cold chain was interrupted) in a simulation exercise. Materials and Methods: Temperature-sensitive indicators TH-F™ that irreversibly changed color from white to red demonstrated that heat excursion has occurred and the cumulative temperature has exceeded 10°C for over 30 min, were used in outdated red cells for simulating units, which are not used and received-back. These units were also tagged with a standard temperature monitoring device, which was a re-usable credit card sized device, which would log the actual time and temperature. In few units percent hemolysis was also calculated. Results: Statistically insignificant elevation in average temperature was noted in 102 simulated units at the time of return to BTS (Δ 0.04°C), despite the fact that these units were in the transport box for over 4 h. The average supernatant hemoglobin in these units was 0.24%, much below the prescribed threshold. Conclusion: Transportation of blood in controlled conditions with temperature-sensitive indicator is a cost-effective model to save blood, a precious human resource. PMID:25722571

  19. Cost of reactive nitrogen release from human activities to the environment in the United States

    NASA Astrophysics Data System (ADS)

    Sobota, Daniel J.; Compton, Jana E.; McCrackin, Michelle L.; Singh, Shweta

    2015-02-01

    Leakage of reactive nitrogen (N) from human activities to the environment can cause human health and ecological problems. Often these harmful effects are not reflected in the costs of food, fuel, and fiber that derive from N use. Spatial analyses of damage costs attributable to source at management-relevant scales could inform decisions in areas where anthropogenic N leakage causes harm. We used recently compiled data describing N inputs in the conterminous United States (US) to assess potential damage costs associated with anthropogenic N. We estimated fates of N leaked to the environment (air/deposition, surface freshwater, groundwater, and coastal zones) in the early 2000s by multiplying watershed-level N inputs (8-digit US Geologic Survey Hydrologic Unit Codes; HUC8s) with published coefficients describing nutrient uptake efficiency, leaching losses, and gaseous emissions. We scaled these N leakage estimates with mitigation, remediation, direct damage, and substitution costs associated with human health, agriculture, ecosystems, and climate (per kg of N) to calculate annual damage cost (US dollars in 2008 or as reported) of anthropogenic N per HUC8. Estimates of N leakage by HUC8 ranged from <1 to 125 kg N ha-1 yr-1, with most N leaked to freshwater ecosystems. Estimates of potential damages (based on median estimates) ranged from 1.94 to 2255 ha-1 yr-1 across watersheds, with a median of 252 ha-1 yr-1. Eutrophication of freshwater ecosystems and respiratory effects of atmospheric N pollution were important across HUC8s. However, significant data gaps remain in our ability to fully assess N damages, such as damage costs from harmful algal blooms and drinking water contamination. Nationally, potential health and environmental damages of anthropogenic N in the early 2000s totaled 210 billion yr-1 USD (range: 81-441 billion yr-1). While a number of gaps and uncertainties remain in these estimates, overall this work represents a starting point to inform decisions

  20. Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States.

    PubMed

    Li, Qian; Chen, Shih-Yin; Burstin, Stuart J; Levin, Myron J; Suaya, Jose A

    2016-04-01

    Background.  This retrospective study investigates the healthcare costs of herpes zoster (HZ) in patients with selected immune-compromised (IC) conditions in the United States (US). Methods.  Patients with incident HZ diagnosis (index date) were selected from nationwide administrative claims databases from 2005 to 2009. Baseline IC groups, analyzed separately, included adults aged 18-64 years with the following: human immunodeficiency virus infection (HIV), solid organ transplant (SOT), bone marrow or stem cell transplant (BMSCT), or cancer; and older adults (aged ≥65 years) with cancer. Herpes zoster patients (n = 2020, n = 1053, n = 286, n = 13 178, and n = 9089, respectively) were 1-to-1 matched to controls without HZ (with randomly selected index date) in the same baseline group. The healthcare resource utilization and costs (2014 US dollars) during the first 2 postindex quarters were compared between matched cohorts with continuous enrollment during the quarter. Results.  Herpes zoster patients generally had greater use of inpatient, emergency room and outpatient services, and pain medications than matched controls (P < .05). The incremental costs of HZ during the first postindex quarter were $3056, $2649, $13 332, $2549, and $3108 for HIV, SOT, BMSCT, cancer in adults aged 18-64 years, and cancer in older adults, respectively (each P < .05). The incremental costs of HZ during the second quarter were only significant for adults aged 18-64 years with cancer ($1748, P < .05). The national incremental costs of HZ were projected to be $298 million annually across the 5 IC groups. Conclusions.  The healthcare cost associated with HZ among patients with studied IC conditions was sizable and occurred mainly during the first 90 days after diagnosis. PMID:27419151

  1. Economic costs of the foot and mouth disease outbreak in the United Kingdom in 2001.

    PubMed

    Thompson, D; Muriel, P; Russell, D; Osborne, P; Bromley, A; Rowland, M; Creigh-Tyte, S; Brown, C

    2002-12-01

    The authors present estimates of the economic costs to agriculture and industries affected by tourism of the outbreak of foot and mouth disease (FMD) in the United Kingdom (UK) in 2001. The losses to agriculture and the food chain amount to about Pound Sterling3.1 billion. The majority of the costs to agriculture have been met by the Government through compensation for slaughter and disposal as well as clean-up costs. Nonetheless, agricultural producers will have suffered losses, estimated at Pound Sterling355 million, which represents about 20% of the estimated total income from farming in 2001. Based on data from surveys of tourism, businesses directly affected by tourist expenditure are estimated to have lost a similar total amount (between Pound Sterling2.7 and Pound Sterling3.2 billion) as a result of reduced numbers of people visiting the countryside. The industries which supply agriculture, the food industries and tourist-related businesses will also have suffered losses. However, the overall costs to the UK economy are substantially less than the sum of these components, as much of the expenditure by tourists was not lost, but merely displaced to other sectors of the economy. Overall, the net effect of FMD is estimated to have reduced the gross domestic product in the UK by less than 0.2% in 2001. PMID:12523706

  2. Economic costs of the foot and mouth disease outbreak in the United Kingdom in 2001.

    PubMed

    Thompson, D; Muriel, P; Russell, D; Osborne, P; Bromley, A; Rowland, M; Creigh-Tyte, S; Brown, C

    2002-12-01

    The authors present estimates of the economic costs to agriculture and industries affected by tourism of the outbreak of foot and mouth disease (FMD) in the United Kingdom (UK) in 2001. The losses to agriculture and the food chain amount to about Pound Sterling3.1 billion. The majority of the costs to agriculture have been met by the Government through compensation for slaughter and disposal as well as clean-up costs. Nonetheless, agricultural producers will have suffered losses, estimated at Pound Sterling355 million, which represents about 20% of the estimated total income from farming in 2001. Based on data from surveys of tourism, businesses directly affected by tourist expenditure are estimated to have lost a similar total amount (between Pound Sterling2.7 and Pound Sterling3.2 billion) as a result of reduced numbers of people visiting the countryside. The industries which supply agriculture, the food industries and tourist-related businesses will also have suffered losses. However, the overall costs to the UK economy are substantially less than the sum of these components, as much of the expenditure by tourists was not lost, but merely displaced to other sectors of the economy. Overall, the net effect of FMD is estimated to have reduced the gross domestic product in the UK by less than 0.2% in 2001.

  3. Total Elbow Arthroplasty in the United States: Evaluation of Cost, Patient Demographics, and Complication Rates.

    PubMed

    Zhou, Hanbing; Orvets, Nathan D; Merlin, Gabriel; Shaw, Joshua; Dines, Joshua S; Price, Mark D; Eichinger, Josef K; Li, Xinning

    2016-03-21

    Total elbow arthroplasty (TEA) is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated in-patient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS), hospital direct cost, in-hospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female) with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers) in the United States. The racial demographics included 2334 (74%) Caucasian, 285 (9%) black, 236 (7.5%) Hispanic, 16 (0.5%) Asian, and 283 (9%) other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%), re-operation (0.5%), and infection (0.4%). The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries. PMID:27114806

  4. Efficiency-optimized low-cost TDPAC spectrometer using a versatile routing/coincidence unit

    NASA Astrophysics Data System (ADS)

    Rentería, M.; Bibiloni, A. G.; Darriba, G. N.; Errico, L. A.; Muñoz, E. L.; Richard, D.; Runco, J.

    A highly efficient, reliable, and low-cost μ-μ TDPAC spectrometer, PACAr, optimized for 181Hf-implanted low-activity samples, is presented. A versatile EPROM-based routing/coincidence unit was developed and implemented to be use with the memory-card-based multichannel analyzer hosted in a personal computer. The excellent energy resolution and very good overall resolution and efficiency of PACAr are analyzed and compare with advanced and already tested fast-fast and slow-fast PAC spectrometers.

  5. Could CT screening for lung cancer ever be cost effective in the United Kingdom?

    PubMed Central

    Whynes, David K

    2008-01-01

    Background The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. Method I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. Results The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around

  6. A preliminary design and BOP cost analysis of M-C Power`s MCFC commerical unit

    SciTech Connect

    Chen, T.P.

    1996-12-31

    M-C Power Corporation plans to introduce its molten carbonate fuel cell (MCFC) market entry unit in the year 2000 for distributed and on-site power generation. Extensive efforts have been made to analyze the cell stack manufacturing costs. The major objective of this study is to conduct a detailed analysis of BOP costs based on an initial design of the market entry unit.

  7. The cost-effectiveness of a modestly effective HIV vaccine in the United States

    PubMed Central

    Long, Elisa F.; Owens, Douglas K.

    2011-01-01

    Background The recent RV144 clinical trial showed that an ALVAC/AIDSVAX prime-boost HIV vaccine regimen may confer partial immunity in recipients and reduce transmission by 31%. Trial data suggest that efficacy may initially exceed 70% but decline over the following 3.5 years. Estimating the potential health benefits associated with a one-time vaccination campaign, as well as the projected benefits of repeat booster vaccination, may inform future HIV vaccine research and licensing decisions. Methods We developed a mathematical model to project the future course of the HIV epidemic in the United States under varying HIV vaccine scenarios. The model accounts for disease progression, infection transmission, antiretroviral therapy, and HIV-related morbidity and mortality. We projected HIV prevalence and incidence over time in multiple risk groups, and we estimated quality-adjusted life years (QALYs) and costs over a 10-year time horizon. We used an exponentially declining efficacy curve fit to trial data, and we assumed subsequent vaccine boosters confer similar immunity. Variations in vaccine parameters were examined in sensitivity analysis. Results Under existing HIV prevention and treatment efforts, an estimated 590,000 HIV infections occur over 10 years. One-time vaccination achieving 60% coverage of adults could prevent 9.8% of projected new infections over 10 years (and prevent 34% of new infections in the first year) and cost approximately $91,000/QALY gained relative to the status quo, assuming a vaccination price of $500. Targeted vaccination of high-risk groups results in net cost savings for vaccines costing less than $750. One-time vaccination of 60% of all adults coupled with three-year boosters only for men who have sex with men and injection drug users could prevent 21% of infections for $81,000/QALY gained relative to vaccination of high-risk groups only. A program attaining 90% vaccination coverage prevents 15% of new HIV cases over 10 years (and

  8. The Cost of Public and Community Residential Care for Mentally Retarded People in the United States. Project Report No. 9.

    ERIC Educational Resources Information Center

    Wieck, Colleen A.; Bruininks, Robert H.

    The direction and scope of deinstitutionalization in 75 public and 161 community residential programs for mentally retarded people in the Unites States were examined by analysis of current levels of expenditures, projected costs, efficacy of existing funding mechanisms, and identification of critical factors affecting cost variation. Results of a…

  9. Analysis of Unit Costs in a University. The Fribourg Example. Program on Institutional Management in Higher Education.

    ERIC Educational Resources Information Center

    Pasquier, Jacques; Sachse, Matthias

    Costing principles are applied to a university by estimating unit costs and their component factors for the university's different inputs, activities, and outputs. The information system used is designed for Fribourg University but could be applicable to other Swiss universities and could serve Switzerland's universities policy. In general, it…

  10. Feasibility and Costs of Natural Gas as a Bridge to Deep Decarbonization in the United States

    NASA Astrophysics Data System (ADS)

    Jones, A. D.; McJeon, H. C.; Muratori, M.; Shi, W.

    2015-12-01

    Achieving emissions reductions consistent with a 2 degree Celsius global warming target requires nearly complete replacement of traditional fossil fuel combustion with near-zero carbon energy technologies in the United States by 2050. There are multiple technological change pathways consistent with this deep decarbonization, including strategies that rely on renewable energy, nuclear, and carbon capture and storage (CCS) technologies. The replacement of coal-fired power plants with natural gas-fired power plants has also been suggested as a bridge strategy to achieve near-term emissions reduction targets. These gas plants, however, would need to be replaced by near-zero energy technologies or retrofitted with CCS by 2050 in order to achieve longer-term targets. Here we examine the costs and feasibility of a natural gas bridge strategy. Using the Global Change Assessment (GCAM) model, we develop multiple scenarios that each meet the recent US Intended Nationally Determined Contribution (INDC) to reduce GHG emissions by 26%-28% below its 2005 levels in 2025, as well as a deep decarbonization target of 80% emissions reductions below 1990 levels by 2050. We find that the gas bridge strategy requires that gas plants be retired on average 20 years earlier than their designed lifetime of 45 years, a potentially challenging outcome to achieve from a policy perspective. Using a more idealized model, we examine the net energy system costs of this gas bridge strategy compared to one in which near-zero energy technologies are deployed in the near tem. We explore the sensitivity of these cost results to four factors: the discount rate applied to future costs, the length (or start year) of the gas bridge, the relative capital cost of natural gas vs. near-zero energy technology, and the fuel price of natural gas. The discount rate and cost factors are found to be more important than the length of the bridge. However, we find an important interaction as well. At low discount rates

  11. Renewable Energy Cost Modeling: A Toolkit for Establishing Cost-Based Incentives in the United States; March 2010 -- March 2011

    SciTech Connect

    Gifford, J. S.; Grace, R. C.; Rickerson, W. H.

    2011-05-01

    This report is intended to serve as a resource for policymakers who wish to learn more about establishing cost-based incentives. The report will identify key renewable energy cost modeling options, highlight the policy implications of choosing one approach over the other, and present recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, feed-in tariffs (FITs), or similar policies. These recommendations will be utilized in designing the Cost of Renewable Energy Spreadsheet Tool (CREST). Three CREST models will be publicly available and capable of analyzing the cost of energy associated with solar, wind, and geothermal electricity generators. The CREST models will be developed for use by state policymakers, regulators, utilities, developers, and other stakeholders to assist them in current and future rate-setting processes for both FIT and other renewable energy incentive payment structures and policy analyses.

  12. Economic impacts of oil spills: Spill unit costs for tankers, pipelines, refineries, and offshore facilities. [Task 1, Final report

    SciTech Connect

    Not Available

    1993-10-15

    The impacts of oil spills -- ranging from the large, widely publicized Exxon Valdez tanker incident to smaller pipeline and refinery spills -- have been costly to both the oil industry and the public. For example, the estimated costs to Exxon of the Valdez tanker spill are on the order of $4 billion, including $2.8 billion (in 1993 dollars) for direct cleanup costs and $1.125 billion (in 1992 dollars) for settlement of damages claims caused by the spill. Application of contingent valuation costs and civil lawsuits pending in the State of Alaska could raise these costs appreciably. Even the costs of the much smaller 1991 oil spill at Texaco`s refinery near Anacortes, Washington led to costs of $8 to 9 million. As a result, inexpensive waming, response and remediation technologies could lower oil spin costs, helping both the oil industry, the associated marine industries, and the environment. One means for reducing the impact and costs of oil spills is to undertake research and development on key aspects of the oil spill prevention, warming, and response and remediation systems. To target these funds to their best use, it is important to have sound data on the nature and size of spills, their likely occurrence and their unit costs. This information could then allow scarce R&D dollars to be spent on areas and activities having the largest impact. This report is intended to provide the ``unit cost`` portion of this crucial information. The report examines the three key components of the US oil supply system, namely, tankers and barges; pipelines and refineries; and offshore production facilities. The specific purpose of the study was to establish the unit costs of oil spills. By manipulating this key information into a larger matrix that includes the size and frequency of occurrence of oil spills, it will be possible` to estimate the likely future impacts, costs, and sources of oil spills.

  13. The economic costs of chronic pain among a cohort of treatment seeking adolescents in the United States

    PubMed Central

    Groenewald, Cornelius B.; Essner, Bonnie S.; Wright, Davene; Fesinmeyer, Megan D.; Palermo, Tonya M.

    2014-01-01

    The aim of this study was to assess the economic cost of chronic pain among adolescents receiving interdisciplinary pain treatment. Information was gathered from 149 adolescents (ages 10-17) presenting for evaluation and treatment at interdisciplinary pain clinics in the United States. Parents completed a validated measure of family economic attributes, the Client Service Receipt Inventory, to report on health service use and productivity losses due to their child's chronic pain retrospectively over 12 months. Health care costs were calculated by multiplying reported utilization estimates by unit visit costs from the 2010 Medical Expenditure Panel Survey. The estimated mean and median costs per participant were $11,787 and $6,770 respectively. Costs were concentrated in a small group of participants, the top 5 % of those patients incurring the highest costs accounted for 30 % of total costs while the lower 75 % of participants accounted for only 34 % of costs. Total costs to society for adolescents with moderate to severe chronic pain were extrapolated to $19.5 billion annually in the U.S. The cost of childhood chronic pain presents a substantial economic burden to families and society. Future research should focus on predictors of increased health services use and costs in adolescents with chronic pain. Perspective This cost of illness study comprehensively estimates the economic costs of chronic pain in a cohort of treatment-seeking adolescents. The primary driver of costs was direct medical costs followed by productivity losses. Because of its economic impact, policy makers should invest resources in the prevention, diagnosis, and treatment of chronic pediatric pain. PMID:24953887

  14. Cost-Efficiency of Indigenously Fabricated Mobile-Portable Dental Unit in Delivery of Primary Healthcare in Rural India

    PubMed Central

    Goel, Ashok; Torwane, Nilesh Arjun

    2014-01-01

    Aim: Innovation in primary oral healthcare delivery is a potential yet relatively unexplored area in Dental literature. Aim of the present study was to assess the economic gains that can be made by designing and operating an indigenously fabricated portable dental unit in rural areas. Materials and Methods: Cost-efficiency was determined by comparing total revenue (number of patients treated) with total costs (direct – capital cost of fabrication; and indirect – dental materials, disposables, transport, miscellaneous) over a period of seven years (2005 to 2012). Operational efficiency of portable dental units was also compared with dental vans on various categories of performance indicators. Data analysis was based on institutional records of Rajasthan Dental College (RDC), Jaipur, India. Results: Results show that a total of 52,900 patients who attended 223 camps during this period were provided various primary oral healthcare services using four such portable dental units that were developed @ Rs. 24,000 ($ 417) per unit. Based on a cost-efficiency of Rs 35.53 ($ 0.65) per person, which is among the lowest reported from any part of the world, the authors conclude that indigenously fabricated portable dental units provide a cost-efficient service. The other aspects most relevant to portable equipment were ease of transportation and feasibility in domiciliary care provision. Conclusion: The Limitations of productivity due to time spent in setting up the unit and need for additional space/equipment was their main drawbacks vis-à-vis dental vans. PMID:25177627

  15. Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

    PubMed Central

    Alexandrov, Anne W.; Coleman, Kisha C.; Palazzo, Paola; Shahripour, Reza Bavarsad; Alexandrov, Andrei V.

    2016-01-01

    Background: In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients. Methods: We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined. Results: We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3. Conclusions: IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit. PMID:27366237

  16. 50 CFR 253.16 - Actual cost.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... such land is utilized by the facility; and (3) The net present value of the payments due under a long...'s useful life, using a 10-percent salvage value; and (2) The current market value of appurtenant... straightline basis over the Project Property's useful life, using a 10-percent salvage value; (2) The...

  17. 50 CFR 253.16 - Actual cost.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... such land is utilized by the facility; and (3) The net present value of the payments due under a long...'s useful life, using a 10-percent salvage value; and (2) The current market value of appurtenant... straightline basis over the Project Property's useful life, using a 10-percent salvage value; (2) The...

  18. 50 CFR 253.16 - Actual cost.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... such land is utilized by the facility; and (3) The net present value of the payments due under a long...'s useful life, using a 10-percent salvage value; and (2) The current market value of appurtenant... straightline basis over the Project Property's useful life, using a 10-percent salvage value; (2) The...

  19. 50 CFR 253.16 - Actual cost.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... such land is utilized by the facility; and (3) The net present value of the payments due under a long...'s useful life, using a 10-percent salvage value; and (2) The current market value of appurtenant... straightline basis over the Project Property's useful life, using a 10-percent salvage value; (2) The...

  20. Australia's 'fourth hurdle' drug review comparing costs and benefits holds lessons for the United States.

    PubMed

    Lopert, Ruth; Elshaug, Adam G

    2013-04-01

    Two decades ago Australia introduced an assessment of value as a prerequisite for adding new medicines to its national drug formulary. Australia's program--a "fourth hurdle" process after a drug is assessed for safety, efficacy, and quality--stands in stark contrast to the situation in the United States, where comparing the clinical and economic value of a proposed new drug to those of existing ones only rarely plays a role in the drug coverage determination process. This article describes the role that Australia's Pharmaceutical Benefits Advisory Committee, a statutory independent expert committee, plays in determining which new drugs the government will help pay for in the nation's pharmaceutical benefit program. The program does not directly control drug prices or ration prescription drugs-policy options that are widely opposed in the United States. Australia's program supports patients' access to important, innovative medications deemed to be cost-effective. The US system could benefit if policy makers examined Australia's experience and adopted a comparative clinical and value review suited to the US political and economic landscape.

  1. Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study

    PubMed Central

    Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

    2014-01-01

    Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at

  2. Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India

    PubMed Central

    Kumar, Parmeshwar; Jithesh, Vishwanathan; Gupta, Shakti Kumar

    2015-01-01

    Context: Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher's two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed. PMID:25829909

  3. Break-Even Cost for Residential Solar Water Heating in the United States: Key Drivers and Sensitivities

    SciTech Connect

    Cassard, H.; Denholm, P.; Ong, S.

    2011-02-01

    This paper examines the break-even cost for residential rooftop solar water heating (SWH) technology, defined as the point where the cost of the energy saved with a SWH system equals the cost of a conventional heating fuel purchased from the grid (either electricity or natural gas). We examine the break-even cost for the largest 1,000 electric and natural gas utilities serving residential customers in the United States as of 2008. Currently, the break-even cost of SWH in the United States varies by more than a factor of five for both electricity and natural gas, despite a much smaller variation in the amount of energy saved by the systems (a factor of approximately one and a half). The break-even price for natural gas is lower than that for electricity due to a lower fuel cost. We also consider the relationship between SWH price and solar fraction and examine the key drivers behind break-even costs. Overall, the key drivers of the break-even cost of SWH are a combination of fuel price, local incentives, and technical factors including the solar resource location, system size, and hot water draw.

  4. DUCKS: Low cost thermal monitoring units for near-vent deployment

    USGS Publications Warehouse

    Harris, A.; Pirie, D.; Horton, K.; Garbeil, H.; Pilger, E.; Ramm, H.; Hoblitt, R.; Thornber, C.; Ripepe, M.; Marchetti, E.; Poggi, P.

    2005-01-01

    During 1999 we designed and tested a thermal monitoring system to provide a cheap, robust, modular, real-time system capable of surviving the hostile conditions encountered proximal to active volcanic vents. In November 2000 the first system was deployed at Pu'u 'O'o (Kilauea, Hawai'i) to target persistently active vents. Aside from some minor problems, such as sensor damage due to tampering, this system remained operational until January 2004. The success of the prototype system led us to use the blueprint for a second installation at Stromboli (Aeolian Islands, Italy). This was deployed, dug into a bomb-proof bunker, during May 2002 and survived the April 2003 paroxysmal eruption despite being located just 250 m from the vent. In both cases, careful waterproofing of connectors and selection of suitable protection has prevented water damage and corrosion in the harsh atmosphere encountered at the crater rim. The Pu'u 'O'o system cost ???US$10,000 and comprises four modules: sensors, transmission and power hub, repeater station and reception site. The sensor component consists of three thermal infrared thermometers housed in Pelican??? cases fitted with Germanium-Arsenide-Selenium windows. Two 1?? field of view (FOV) sensors allow specific vents to be targeted and a 60?? FOV sensor provides a crater floor overview. A hard wire connection links to a Pelican???-case-housed microprocessor, modem and power module. From here data are transmitted, via a repeater site, to a dedicated PC at the Hawaiian Volcano Observatory. Here data are displayed with a delay of ???3 s between acquisition and display. The modular design allows for great flexibility. At Stromboli, 1?? and 15?? FOV sensor modules can be switched depending changes in activity style and crater geometry. In addition a direct line of site to the Stromboli reception center negates the repeater site requirement, reducing the cost to US$5500 for a single sensor system. We have also constructed self-contained units

  5. Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital

    PubMed Central

    Kara, İskender; Yıldırım, Fatma; Başak, Dilek Yumuş; Küçük, Hamit; Türkoğlu, Melda; Aygencel, Gülbin; Katı, İsmail; Karabıyık, Lale

    2015-01-01

    Objective The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. Methods In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. Results After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012–August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. Conclusion At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure. PMID:27366486

  6. Estimating the Cost of Standardized Student Testing in the United States.

    ERIC Educational Resources Information Center

    Phelps, Richard P.

    2000-01-01

    Describes and contrasts different methods of estimating costs of standardized testing. Using a cost-accounting approach, compares gross and marginal costs and considers testing objects (test materials and services, personnel and student time, and administrative/building overhead). Social marginal costs of replacing existing tests with a national…

  7. Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000.

    PubMed

    Zaloshnja, Eduard; Miller, Ted; Romano, Eduardo; Spicer, Rebecca

    2004-05-01

    This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim's injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.

  8. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India

    PubMed Central

    Kumar, Parmeshwar; Jithesh, V.; Gupta, Shakti Kumar

    2016-01-01

    Context: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Statistical analysis was performed by Fisher's two tailed t-test. Results: Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed. PMID:27555693

  9. A systematic review of the unit costs of allied health and community services used by older people in Australia

    PubMed Central

    2013-01-01

    Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation. PMID:23421756

  10. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

    PubMed Central

    2010-01-01

    Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were € 18,241 and € 9,087, respectively (p < 0.001). On average, the extra cost for drugs was € 843 (p < 0.001), for supplies € 133 (p = 0.116), for lab tests € 171 (p < 0.001), and for specialist visits € 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was € 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management. Conclusions CLABSI results in

  11. Low cost solar array project production process and equipment task. A Module Experimental Process System Development Unit (MEPSDU)

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Technical readiness for the production of photovoltaic modules using single crystal silicon dendritic web sheet material is demonstrated by: (1) selection, design and implementation of solar cell and photovoltaic module process sequence in a Module Experimental Process System Development Unit; (2) demonstration runs; (3) passing of acceptance and qualification tests; and (4) achievement of a cost effective module.

  12. An Analysis of the Factors Which Affect Instructional Unit Cost in the Public Community Colleges of Illinois.

    ERIC Educational Resources Information Center

    Wallhaus, Penny; Lach, Ivan J.

    Methodology and findings are reported for a series of statistical analyses conducted to identify those factors that account for variations in instructional unit costs (IUC) among the Illinois community colleges. The first analysis described in the report correlates five measures of district wealth with total IUC (i.e., total instructional costs…

  13. Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest

    PubMed Central

    Graf, Jürgen; Mühlhoff, Cecile; Doig, Gordon S; Reinartz, Sebastian; Bode, Kirsten; Dujardin, Robert; Koch, Karl-Christian; Roeb, Elke; Janssens, Uwe

    2008-01-01

    Introduction The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation. Methods Five-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs, hospital costs and post-hospital health care costs per survivor, costs per life year gained, and costs per quality-adjusted life year gained of patients admitted to a single ICU were assessed. Results One hundred ten of 354 patients (31%) were alive 5 years after hospital discharge. The mean health status index of 5-year survivors was 0.77 (95% confidence interval 0.70 to 0.85). Women rated their health-related quality of life significantly better than men did (0.87 versus 0.74; P < 0.05). Costs per hospital discharge survivor were 49,952 €. Including the costs of post-hospital discharge health care incurred during their remaining life span, the total costs per life year gained were 10,107 €. Considering 5-year survivors only, the costs per life year gained were calculated as 9,816 € or 14,487 € per quality-adjusted life year gained. Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 €. Conclusion Patients who leave the hospital following cardiac arrest without severe neurological disabilities may expect a reasonable quality of life compared with age- and gender-matched controls. Quality-adjusted costs for this patient group appear to be within ranges considered reasonable for other groups of patients. PMID:18638367

  14. [Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

    PubMed

    Yamamoto, Hideo; Yoneda, Tarou; Satou, Shuji; Ishikawa, Toru; Hara, Misako

    2009-12-20

    By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

  15. Employment trends of young mothers and the opportunity cost of babies in the United States.

    PubMed

    Cramer, J C

    1979-05-01

    The central concept of microeconomic theories of fertility is opportunity cost--the product of wife's employment lost due to childbearing and the value of her employment. This paper presents a model for analyzing opportunity cost using panel data. The average loss of employment attributable to a second- or higher-order birth, calculated at around age 2, is over 400 hours per year. This time cost represents an income loss of about $1050 in 1969 dollars. Time cost is independent of such demographic factors as birth order and age of oldest sibling. Neither does time cost depend on husband's wage rate or wife's education or potential wage rate. This indicates that many microeconomic models of fertility have been seriously misspecified. The paper also compares results from static and dynamic models, explores possible problems due to simultaneity bias, investigates the relationship between changes in employment (including time cost) and initial employment level, and identifies the difficulties of theorizing about opportunity cost.

  16. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  17. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  18. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  19. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  20. 7 CFR 1437.101 - Actual production history.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Actual production history. 1437.101 Section 1437.101... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The...

  1. Health care utilization, costs, and the burden of disease related to eosinophilic esophagitis in the United States

    PubMed Central

    Jensen, Elizabeth T.; Kappelman, Michael D.; Martin, Christopher F.; Dellon, Evan S.

    2015-01-01

    Objectives Eosinophilic esophagitis (EoE) has rapidly become a major cause of upper GI morbidity, but health care costs related to EoE have not been described. This study aimed to estimate EoE-related health care costs and utilization in the United States. Methods We performed a study of health care utilization of EoE cases compared to age- and sex-matched controls using administrative claims data, representative of the commercially insured population in the U.S. Cases of EoE were identified using a previously validated definition. We assessed inpatient, outpatient, emergency department, outpatient prescription, and endoscopy-related costs for patients with EoE, and estimated total costs related to EoE extrapolated to the U.S. population. Results We identified 8,135 cases of EoE and 32,540 controls. The median total annual cost per EoE case was $3,304 compared to $1,001 for controls (p<0.001). For EoE, median costs included $2,508/year for outpatient visits, $157 for endoscopies, and $325 for pharmacy claims, compared to $699, $0, and $76 for controls (p<0.001 for all). The overall median costs associated with EoE were $2,302/year/patient. Total costs in the U.S. ranged from $503 million to $1.36 billion/year, depending on the prevalence estimate, with costs attributable to EoE ranging from $350-$947 million/year. Conclusions Patients with EoE have an estimated annual health care cost of as much as $1.4 billion in the U.S. This represents a remarkable burden of disease for an entity that was essentially unknown two decades ago. These cost data can be used by policy makers to guide resource allocation. PMID:25267327

  2. Form and Actuality

    NASA Astrophysics Data System (ADS)

    Bitbol, Michel

    A basic choice underlies physics. It consists of banishing actual situations from theoretical descriptions, in order to reach a universal formal construct. Actualities are then thought of as mere local appearances of a transcendent reality supposedly described by the formal construct. Despite its impressive success, this method has left major loopholes in the foundations of science. In this paper, I document two of these loopholes. One is the problem of time asymmetry in statistical thermodynamics, and the other is the measurement problem of quantum mechanics. Then, adopting a broader philosophical standpoint, I try to turn the whole picture upside down. Here, full priority is given to actuality (construed as a mode of the immanent reality self-reflectively being itself) over formal constructs. The characteristic aporias of this variety of "Copernican revolution" are discussed.

  3. Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

    PubMed Central

    Hanson, Kara; Kikumbih, Nassor; Armstrong Schellenberg, Joanna; Mponda, Haji; Nathan, Rose; Lake, Sally; Mills, Anne; Tanner, Marcel; Lengeler, Christian

    2003-01-01

    OBJECTIVE: To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. METHODS: Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. FINDINGS: The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. CONCLUSION: The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria. PMID:12764493

  4. Classification of geokhod units and systems based on product cost analysis and estimation for a prototype model production

    NASA Astrophysics Data System (ADS)

    Aksenov, V. V.; Walter, A. V.; Gordeyev, A. A.; Kosovets, A. V.

    2015-09-01

    The paper considers data systematization on a new shield-type heading machine - geokhod. The target of the paper is to classify geokhod components on the basis of their technical and economical production parameters. A prototype model reveals the structure of a geokhod as an assembly unit and identifies its basic characteristics. The paper overviews the methods of product cost estimations, justifies the application of an operation-based approach for a prototype model, provides the results containing product cost data for various geokhod components and technological processes, and gives the data for a material cost structure. Taking into consideration the product cost analysis, geokhod components are classified according to their technical and economical production parameters. Moreover the paper outlines the ways of a classification application for a geokhod manufacturing techniques improvement.

  5. Geothermal Energy Development in the Eastern United States, Sensitivity analysis-cost of geothermal energy

    SciTech Connect

    Kane, S.M.; Kroll, P.; Nilo, B.

    1982-12-01

    The Geothermal Resources Interactive Temporal Simulation (GRITS) model is a computer code designed to estimate the costs of geothermal energy systems. The interactive program allows the user to vary resource, demand, and financial parameters to observe their effects on delivered costs of direct-use geothermal energy. Due to the large number and interdependent nature of the variables that influence these costs, the variables can be handled practically only through computer modeling. This report documents a sensitivity analysis of the cost of direct-use geothermal energy where each major element is varied to measure the responsiveness of cost to changes in that element. It is hoped that this analysis will assist those persons interested in geothermal energy to understand the most significant cost element as well as those individuals interested in using the GRITS program in the future.

  6. Benchmarking Soft Costs for PV Systems in the United States (Presentation)

    SciTech Connect

    Ardani, K.

    2012-06-01

    This paper presents results from the first U.S. based data collection effort to quantify non-hardware, business process costs for PV systems at the residential and commercial scales, using a bottom-up approach. Annual expenditure and labor hour productivity data are analyzed to benchmark business process costs in the specific areas of: (1) customer acquisition; (2) permitting, inspection, and interconnection; (3) labor costs of third party financing; and (4) installation labor.

  7. Cost-Effectiveness of Frequent HIV Testing of High-Risk Populations in the United States

    PubMed Central

    Farnham, Paul G.; Sansom, Stephanie L.; Yaylali, Emine; Mermin, Jonathan H.

    2016-01-01

    Purpose: Data showing a high incidence of HIV infection among men who have sex with men (MSM) who had annual testing suggest that more frequent HIV testing may be warranted. Testing technology is also a consideration given the availability of sensitive testing modalities and the increased use of less-sensitive rapid, point-of-care antibody tests. We assessed the cost-effectiveness of HIV testing of MSM and injection drug users (IDUs) at 3- and 6-month intervals using fourth-generation and rapid tests. Methods: We used a published mathematical model of HIV transmission to evaluate testing intervals for each population using cohorts of 10,000 MSM and IDU. We incorporated HIV transmissions averted due to serostatus awareness and viral suppression. We included costs for HIV testing and treatment initiation, and also treatment costs saved from averted transmissions. Results: For MSM, HIV testing was cost saving or cost effective over a 1-year period for both 6-month compared with annual testing and quarterly compared with 6-month testing using either test. Testing IDU every 6 months compared with annually was moderately cost effective over a 1-year period with a fourth-generation test, while testing with rapid, point-of-care tests or quarterly was not cost effective. MSM results remained robust in sensitivity analysis, whereas IDU results were sensitive to changes in HIV incidence and continuum-of-care parameters. Threshold analyses on costs suggested that additional implementation costs could be incurred for more frequent testing for MSM while remaining cost effective. Conclusions: HIV testing of MSM as frequently as quarterly is cost effective compared with annual testing, but testing IDU more frequently than annually is generally not cost effective. PMID:26361172

  8. Design, construction and testing of a low-cost automated (68)Gallium-labeling synthesis unit for clinical use.

    PubMed

    Heidari, Pedram; Szretter, Alicia; Rushford, Laura E; Stevens, Maria; Collier, Lee; Sore, Judit; Hooker, Jacob; Mahmood, Umar

    2016-01-01

    The interest in (68)Gallium labeled PET probes continues to increase around the world. Widespread use in Europe and Asia has led to great interest for use at numerous sites in the US. One barrier to entry is the cost of the automated synthesis units for relatively simple labeling procedures. We describe the construction and testing of a relatively low-cost automated (68)Ga-labeling unit for human-use. We provide a guide for construction, including part lists and synthesis timelists to facilitate local implementation. Such inexpensive systems could help increase use around the globe and in the US in particular by removing one of the barriers to greater widespread availability. The developed automated synthesis unit reproducibly synthesized (68)Ga-DOTATOC with average yield of 71 ± 8% and a radiochemical purity ≥ 95% in a synthesis time of 25 ± 1 minutes. Automated product yields are comparable to that of manual synthesis. We demonstrate in-house construction and use of a low-cost automated synthesis unit for labeling of DOTATOC and similar peptides with (68)Gallium. PMID:27508104

  9. Design, construction and testing of a low-cost automated 68Gallium-labeling synthesis unit for clinical use

    PubMed Central

    Heidari, Pedram; Szretter, Alicia; Rushford, Laura E; Stevens, Maria; Collier, Lee; Sore, Judit; Hooker, Jacob; Mahmood, Umar

    2016-01-01

    The interest in 68Gallium labeled PET probes continues to increase around the world. Widespread use in Europe and Asia has led to great interest for use at numerous sites in the US. One barrier to entry is the cost of the automated synthesis units for relatively simple labeling procedures. We describe the construction and testing of a relatively low-cost automated 68Ga-labeling unit for human-use. We provide a guide for construction, including part lists and synthesis timelists to facilitate local implementation. Such inexpensive systems could help increase use around the globe and in the US in particular by removing one of the barriers to greater widespread availability. The developed automated synthesis unit reproducibly synthesized 68Ga-DOTATOC with average yield of 71 ± 8% and a radiochemical purity ≥ 95% in a synthesis time of 25 ± 1 minutes. Automated product yields are comparable to that of manual synthesis. We demonstrate in-house construction and use of a low-cost automated synthesis unit for labeling of DOTATOC and similar peptides with 68Gallium. PMID:27508104

  10. Acute Care For Elders Units Produced Shorter Hospital Stays At Lower Cost While Maintaining Patients’ Functional Status

    PubMed Central

    Barnes, Deborah E.; Palmer, Robert M.; Kresevic, Denise M.; Fortinsky, Richard H.; Kowal, Jerome; Chren, Mary-Margaret; Landefeld, C. Seth

    2013-01-01

    Acute Care for Elders Units offer enhanced care for older adults in specially designed hospital units. The care is delivered by interdisciplinary teams, which can include geriatricians, advanced practice nurses, social workers, pharmacists, and physical therapists. In a randomized controlled trial of 1,632 elderly patients, length-of-stay was significantly shorter—6.7 days per patient versus 7.3 days per patient—among those receiving care in the Acute Care for Elders Unit compared to usual care. This difference produced lower total inpatient costs—$9,477 per patient versus $10,451 per patient—while maintaining patients’ functional abilities and not increasing hospital readmission rates. The practices of Acute Care for Elders Units, and the principles they embody, can provide hospitals with effective strategies for lowering costs while preserving quality of care for hospitalized elders. PMID:22665834

  11. 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

  12. Geological studies of the COST GE-1 well, United States South Atlantic outer continental shelf area

    USGS Publications Warehouse

    Scholle, Peter A.

    1979-01-01

    The COST No. GE-1 well is the first deep stratigraphic test to be drilled in the southern part of the U.S. Atlantic Outer Continental Shelf (AOCS) area. The well was drilled within the Southeast Georgia Embayment to a total depth of 13,254 ft (4,040 m). It penetrated a section composed largely of chalky limestones to a depth of about 3,300 ft (1,000 m) below the drill platform. Limestones and calcareous shales with some dolomite predominate between 3,300 and 7,200 ft (1,000 and 2,200 m), whereas interbedded sandstones and shales are dominant from 7,200 to 11,000 ft (2,200 to 3,350 m). From 11,000 ft (3,350 m) to the bottom, the section consists of highly indurated to weakly metamorphosed pelitic sedimentary rocks and meta-igneous flows or intrusives. Biostratigraphic examination has shown that the section down to approximately 3,500 ft (1,060 m) is Tertiary, the interval from 3,500 to 5,900 ft (1,060 to 1,800 m) is Upper Cretaceous, and the section from 5,900 to 11,000 ft (1,800 to 3,350 m) is apparently Lower Cretaceous. The indurated to weakly metamorphosed section below 11,000 ft (3,350 m) is barren of fauna or flora but is presumed to be Paleozoic based on radiometric age determinations. Rocks deposited at upper-slope water depths were encountered in the Upper Cretaceous, Oligocene, and Miocene parts of the section. All other units were deposited in outer-shelf to terrestrial environments. Examination of cores, well cuttings, and electric logs shows that potential hydrocarbon-reservoir units are present within the chalks in the uppermost part of the section as well as in sandstone beds to a depth of at least 10,000 ft (3,000 m). Sandstones below that depth, and the metamorphic section between 11,000 and 13.250 ft (3,350 and 4,040 m) have extremely low permeabilities and are unlikely to contain potential reservoir rock. Studies of organic geochemistry, vitrinite reflectance, and color alteration of visible organic matter indicate that the chalk section down to

  13. Cost of reactive nitrogen release from human activities to the environment in the United States

    EPA Science Inventory

    The leakage of reactive nitrogen (N) from human activities to the environment can cause human health and ecological problems. Often these harmful effects are not reflected in the costs of food, fuel, and fiber that derive from N use. Spatial analyses of economic costs and benef...

  14. Intra-unit patient transports: time, motion, and cost impact on hospital efficiency.

    PubMed

    Hendrich, Ann L; Lee, Nelson

    2005-01-01

    The costly and inefficient movement of patients within the hospital challenges health systems across the country as they strive to simultaneously contain rising costs and provide high-quality patient care. Solid evidence to support the improvement of hospital and patient care efficiency through the identification and suggested elimination of waste patterns within the transport process is presented.

  15. Excess costs associated with common healthcare-associated infections in an Iranian cardiac surgical unit.

    PubMed

    Nosrati, M; Boroumand, M; Tahmasebi, S; Sotoudeh, M; Sheikhfathollahi, M; Goodarzynejad, H

    2010-12-01

    Healthcare-associated infection (HCAI) following open heart surgery is not only a major cause of mortality and morbidity, but also carries higher costs. There are limited data on the additional costs due to HCAI in non-western countries. To estimate the direct cost of the four most common HCAIs in an Iranian sample, we studied 1191 patients admitted for elective open heart surgery. HCAIs were defined using the National Nosocomial Infections Surveillance criteria (Centers for Disease Control and Prevention, Atlanta, GA, USA). The financial costs of length of stay per day in hospital, paraclinical services, medications, instruments, and operating room were provided by the hospital's finance department. The contribution of HCAI to excess direct medical costs in patients with HCAI was assessed by multivariable linear regression. In the study population, the mean age was 57.3±11.9 years, 857 (72.0%) were men, and 64 (5.4%) developed HCAI. In total there were 73 infections of which the most common was surgical site infection (49.3%), followed by urinary tract infection (20.5%), bloodstream infection (16.5%), and pneumonia (13.7%). After adjustment for other confounders HCAI remained associated with excess direct medical costs (β=1707.06, SE=90.84; P < 0.001). The medical costs in patients with HCAI were almost twice those in patients without HCAI. More than half of the excess cost was attributable to prolonged hospitalisation. PMID:20833445

  16. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    PubMed Central

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D.K.; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-01-01

    Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were 2,04,787 (US$ 3,413) and 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care. PMID:27377508

  17. Hospitalization cost after spine surgery in the United States of America.

    PubMed

    Missios, Symeon; Bekelis, Kimon

    2015-10-01

    The objective of this study was to develop and validate a predictive model of hospitalization costs after spine surgery. Several initiatives have been put in place to minimize healthcare expenditures but there are limited data on the magnitude of the contribution of procedure-specific drivers of cost. We performed a retrospective cohort study involving 672,591 patients who underwent spine surgery and were registered in the National Inpatient Sample from 2005-2010. The cohort underwent 1:1 randomization to create derivation and validation subsamples. Regression techniques were used for the creation of a parsimonious predictive model of total hospitalization cost after spine surgery. Included were 356,783 patients (53.1%) who underwent fusions, and 315,808 (46.9%) non-fusion surgeries. The median hospitalization cost was $14,202 (interquartile range $4772-23,632). Common drivers of cost identified in the multivariate analysis included the length of stay, number of admission diagnoses and procedures, hospital size and region, patient income, fusion surgery, acute renal failure, sex, and coagulopathy. The model was validated in an independent cohort and demonstrated a final coefficient of determination that was very similar to the initial model. The predicted and observed values in the validation cohort demonstrated good correlations. This national study quantified the magnitude of significant drivers of hospitalization cost after spine surgery. We developed a predictive model that can be utilized as an adjunct in the cost containment debate and the creation of data driven policies.

  18. The Cost of PLATO in a University Environment.

    ERIC Educational Resources Information Center

    Hofstetter, Fred T.

    1983-01-01

    This analysis of the cost-effectiveness of the University of Delaware's own PLATO system discusses the initial expense of acquiring the system, decreases in unit cost as number of users increased, capital investment in hardware, expenditures and funding sources, comparisons of actual and projected costs, and benefits of individualized instruction.…

  19. Cost of Stem Cell-Based Tissue-Engineered Airway Transplants in the United Kingdom: Case Series.

    PubMed

    Culme-Seymour, Emily J; Mason, Katrina; Vallejo-Torres, Laura; Carvalho, Carla; Partington, Leanne; Crowley, Claire; Hamilton, Nick J; Toll, Ed C; Butler, Colin R; Elliott, Martin J; Birchall, Martin A; Lowdell, Mark W; Mason, Chris

    2016-02-01

    Stem cell-based tissue-engineered tracheas are at an early stage in their product development cycle. Tens of patients have been treated worldwide in predominantly compassionate use settings, demonstrating significant promise. This potentially life-saving treatment is complex, and the cost and its implications for such treatments are yet to be fully understood. The costs are compounded by varying strategies for graft preparation and transplant, resulting in differing clinical and laboratory costs from different research groups. In this study, we present a detailed breakdown of the clinical and manufacturing costs for three of the United Kingdom (UK) patients treated with such transplants. All three patients were treated under Compassionate Use legislation, within the UK National Health Service (NHS) hospital setting. The total costs for the three UK patients treated ranged from $174,420 to $740,500. All three patients were in a state of poor health at time of treatment and had a number of complexities in addition to the restricted airway. This is the first time a cost analysis has been made for a tissue-engineered organ and provides a benchmark for future studies, as well as comparative data for use in reimbursement considerations.

  20. Taxes, divorce-transactions costs, economic conditions, and divorce rates: an exploratory empirical inquiry for the United States.

    PubMed

    Cebula, R J; Belton, W J

    1995-01-01

    "This study argues that, given the tax deductibility of alimony payments in the United States, higher marginal federal income tax rates may reduce the expected transactions costs of divorce and act thereby to increase the divorce rate. After allowing for a variety of other factors, including inflation, female labor force participation, AIDS, the Vietnam War, age, the availability of legal assistance, and transfer payments, both first-differences estimates and Granger-causality tests strongly support the hypothesis."

  1. Tracking the Sun III; The Installed Cost of Photovoltaics in the United States from 1998-2009

    SciTech Connect

    Barbose, Galen; Darghouth, Naim; Wiser, Ryan

    2010-12-13

    Installations of solar photovoltaic (PV) systems have been growing at a rapid pace in recent years. In 2009, approximately 7,500 megawatts (MW) of PV were installed globally, up from approximately 6,000 MW in 2008, consisting primarily of grid-connected applications. With 335 MW of grid-connected PV capacity added in 2009, the United States was the world's fourth largest PV market in 2009, behind Germany, Italy, and Japan. The market for PV in the United States is driven by national, state, and local government incentives, including up-front cash rebates, production-based incentives, requirements that electricity suppliers purchase a certain amount of solar energy, and federal and state tax benefits. These programs are, in part, motivated by the popular appeal of solar energy, and by the positive attributes of PV - modest environmental impacts, avoidance of fuel price risks, coincidence with peak electrical demand, and the possible deployment of PV at the point of use. Given the relatively high cost of PV, however, a key goal of these policies is to encourage cost reductions over time. Therefore, as policy incentives have become more significant and as PV deployment has accelerated, so too has the desire to track the installed cost of PV systems over time, by system characteristics, by system location, and by component. Despite the significant year-on-year growth, however, the share of global and U.S. electricity supply met with PV remains small, and annual PV additions are currently modest in the context of the overall electric system. To address this need, Lawrence Berkeley National Laboratory initiated a report series focused on describing trends in the installed cost of grid-connected PV systems in the United States. The present report, the third in the series, describes installed cost trends from 1998 through 2009, and provides preliminary cost data for systems installed in 2010. The analysis is based on project-level cost data from approximately 78

  2. A cost-effectiveness analysis of a residential radon remediation programme in the United Kingdom

    PubMed Central

    Kennedy, C A; Gray, A M; Denman, A R; Phillips, P S

    1999-01-01

    As residential radon programmes of identification and remediation have proceeded, so questions have been raised about their costs and benefits. This study presents a generalizable model for estimating the cost-effectiveness of a radon mitigation programme using the methodological framework now considered appropriate in the economic evaluation of health interventions. Its use will help to inform future discussion of radon remediation and lung cancer prevention programmes. Data from Northamptonshire were analysed, resulting in a societal cost-effectiveness ratio of £13250 per life-year gained in 1997. The percentage of houses found to be over the action level, and the percentage of householders who decide to remediate are shown to be important parameters for the cost-effectiveness analysis. Questions are raised about the particular importance of perspective in this type of analysis and suggestions are made for future research directions. © 1999 Cancer Research Campaign PMID:10584889

  3. A synthesis of regional inputs and damage costs of reactive nitrogen in the United States

    EPA Science Inventory

    We estimated the fate of N in crops and in the environment (air, land, freshwater, groundwater, and coastal zones) with published coefficients describing nutrient uptake efficiency, gaseous emissions, and leaching losses. Benefits and damage costs of anthropogenic N inputs were ...

  4. Cost effectiveness of olanzapine in prevention of affective episodes in bipolar disorder in the United Kingdom.

    PubMed

    McKendrick, J; Cerri, K H; Lloyd, A; D'Ausilio, A; Dando, S; Chinn, C

    2007-08-01

    This study evaluated the cost effectiveness of olanzapine compared with lithium as maintenance therapy for patients with bipolar I disorder (BP1) in the UK. A Markov model was developed to assess costs and outcomes from the perspective of the UK National Health Service over a 1-year period. Patients enter the model after stabilization of a manic episode and are then treated with olanzapine or lithium. Using the findings of a recent randomized clinical trial, the model considers the monthly risk of manic or depressive episodes and of dropping out from allocated therapy. health care resources associated with acute episodes were derived primarily from a recent UK chart review. Costs of maintenance therapy and monitoring were also considered. Key factors influencing cost effectiveness were identified and included in a stochastic sensitivity analysis. The model estimated that, compared to lithium, olanzapine significantly reduced the annual number of acute mood episodes per patient from 0.81 to 0.58 (difference -0.23; 95% CI: -0.34, -0.12). Per patient average annual care costs fell by 799 UK pounds (95% CI: - 1,824 UK pounds, 59 UK pounds) driven by reduced inpatient days--but the cost difference was not statistically significant. Sensitivity analysis found the results to be robust to plausible variation in the model's parameters. The model estimated that using olanzapine instead of lithium as maintenance therapy for BP1 would significantly reduce the rate of acute mood events resulting in reduced hospital costs. Based on available evidence, there is a high likelihood that olanzapine would reduce costs of care compared to lithium.

  5. Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit.

    PubMed

    Chang, Beverly; Lorenzo, Javier; Macario, Alex

    2015-12-01

    As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  6. Return to 1990: The cost of mitigating United States carbon emissions in the post-2000 period

    SciTech Connect

    Edmonds, J.A.; Kim, S.H.; MacCracken, C.N.; Sands, R.D.; Wise, M.A.

    1997-10-01

    The Second Generation Model (SGM) is employed to examine four hypothetical agreements to reduce emissions in Annex 1 nations (OECD nations plus most of the nations of Eastern Europe and the former Soviet Union) to levels in the neighborhood of those which existed in 1990, with obligations taking effect in the year 2010. The authors estimate the cost to the US of complying with such agreements under three distinct conditions: no trading of emissions rights, trading of emissions rights only among Annex 1 nations, and a fully global trading regime. The authors find that the marginal cost of returning to 1990 emissions levels in the US in the absence of trading opportunities is approximately $108 per metric ton carbon in 2010. The total cost in that year is approximately 0.2% of GDP. International trade in emissions permits lowers the cost of achieving any mitigation objective by equalizing the marginal cost of carbon mitigation among countries. For the four mitigation scenarios in this study, economic costs to the US remain below 1% of GDP through at least the year 2020.

  7. Net Costs Due to Seasonal Influenza Vaccination — United States, 2005–2009

    PubMed Central

    Carias, Cristina; Reed, Carrie; Kim, Inkyu K.; Foppa, Ivo M.; Biggerstaff, Matthew; Meltzer, Martin I.; Finelli, Lyn; Swerdlow, David L.

    2015-01-01

    Background Seasonal influenza causes considerable morbidity and mortality across all age groups, and influenza vaccination was recommended in 2010 for all persons aged 6 months and above. We estimated the averted costs due to influenza vaccination, taking into account the seasonal economic burden of the disease. Methods We used recently published values for averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$), and took into account medical costs and productivity losses. Results When taking into account direct medical costs (payer perspective), influenza vaccination was cost saving only for the older age group (65≥) in seasons 2005-06 and 2007-08. Using the same perspective, influenza vaccination resulted in total costs of $US 1.7 billion (95%CI: $US 0.3–4.0 billion) in 2006-07 and $US 1.8 billion (95%CI: $US 0.1–4.1 billion) in 2008-09. When taking into account a societal perspective (and including the averted lost earnings due to premature death) averted deaths in the older age group influenced the results, resulting in cost savings for all ages combined in season 07-08. Discussion Influenza vaccination was cost saving in the older age group (65≥) when taking into account productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings. Indirect vaccination effects and the possibility of diminished case severity due to influenza vaccination were not considered, thus the averted burden due to influenza vaccine may be even greater than reported. PMID:26230271

  8. Cost-benefit analysis: patient care at neurological intensive care unit.

    PubMed

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  9. Cost implications of African swine fever in smallholder farrow-to-finish units: economic benefits of disease prevention through biosecurity.

    PubMed

    Fasina, F O; Lazarus, D D; Spencer, B T; Makinde, A A; Bastos, A D S

    2012-06-01

    African swine fever remains the greatest limitation to the development of the pig industry in Africa, and parts of Asia and Europe. It is especially important in West and Central African countries where the disease has become endemic. Biosecurity is the implementation of a set of measures that reduce the risk of infection through segregation, cleaning and disinfection. Using a 122-sow piggery unit, a financial model and costing were used to estimate the economic benefits of effective biosecurity against African swine fever. The outcomes suggest that pig production is a profitable venture that can generate a profit of approximately US$109,637.40 per annum and that an outbreak of African swine fever (ASF) has the potential to cause losses of up to US$910,836.70 in a single year. The implementation of biosecurity and its effective monitoring can prevent losses owing to ASF and is calculated to give a benefit-cost ratio of 29. A full implementation of biosecurity will result in a 9.70% reduction in total annual profit, but is justified in view of the substantial costs incurred in the event of an ASF outbreak. Biosecurity implementation is robust and capable of withstanding changes in input costs including moderate feed price increases, higher management costs and marginal reductions in total outputs. It is concluded that biosecurity is a key to successful pig production in an endemic situation.

  10. Cost-effectiveness of strategies to prevent MRSA transmission and infection in an intensive care unit

    PubMed Central

    Gidengil, Courtney; Gay, Charlene; Huang, Susan S; Platt, Richard; Yokoe, Deborah; Lee, Grace M.

    2014-01-01

    Objective We created a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent MRSA transmission and infection. Design Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. Patients and setting Hypothetical cohort of 10,000 adult patients admitted to a U.S. ICU. Methods We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures (ASC); (2) ASC plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate (CHG) baths; (5) universal decolonization; (6) UCP + CHG baths; and (7) UCP + decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. Results 1,989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared to all strategies except UCP + decolonization and UCP + CHG. UCP + decolonization was more effective than universal decolonization, but would cost $2,469 per colonization averted and $9,007 per infection averted. If MRSA colonization prevalence drops from 12% to 5%, ASC plus selective decolonization becomes the least expensive strategy. Conclusions Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission. PMID:25627757

  11. A German national prevalence study on the cost of intensive care: an evaluation from 51 intensive care units

    PubMed Central

    Moerer, Onnen; Plock, Enno; Mgbor, Uchenna; Schmid, Alexandra; Schneider, Heinz; Wischnewsky, Manfred Bernd; Burchardi, Hilmar

    2007-01-01

    Introduction Intensive care unit (ICU) costs account for up to 20% of a hospital's costs. We aimed to analyse the individual patient-related cost of intensive care at various hospital levels and for different groups of disease. Methods Data from 51 ICUs all over Germany (15 primary care hospitals and 14 general care hospitals, 10 maximal care hospitals and 12 focused care hospitals) were collected in an observational, cross-sectional, one-day point prevalence study by two external study physicians (January–October 2003). All ICU patients (length of stay > 24 hours) treated on the study day were included. The reason for admission, severity of illness, surgical/diagnostic procedures, resource consumption, ICU/hospital length of stay, outcome and ICU staffing structure were documented. Results Altogether 453 patients were included. ICU (hospital) mortality was 12.1% (15.7%). The reason for admission and the severity of illness differed between the hospital levels of care, with a higher amount of unscheduled surgical procedures and patients needing mechanical ventilation in maximal care hospital and focused care hospital facilities. The mean total costs per day were €791 ± 305 (primary care hospitals, €685 ± 234; general care hospitals, €672 ± 199; focused care hospitals, €816 ± 363; maximal care hospitals, €923 ± 306), with the highest cost in septic patients (€1,090 ± 422). Differences were associated with staffing, the amount of prescribed drugs/blood products and diagnostic procedures. Conclusion The reason for admission, the severity of illness and the occurrence of severe sepsis are directly related to the level of ICU cost. A high fraction of costs result from staffing (up to 62%). Specialized and maximum care hospitals treat a higher proportion of the more severely ill and most expensive patients. PMID:17594475

  12. Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania.

    PubMed Central

    Rommelmann, Vanessa; Setel, Philip W.; Hemed, Yusuf; Angeles, Gustavo; Mponezya, Hamisi; Whiting, David; Boerma, Ties

    2005-01-01

    OBJECTIVE: To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS: Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS: In 2002-03 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION: Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. PMID:16184275

  13. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States

    PubMed Central

    Long, Elisa F.; Brandeau, Margaret L.; Owens, Douglas K.

    2011-01-01

    Background Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral treatment (ART) are limited and all eligible people are not currently being treated. Objective To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior. Design Dynamic mathematical model of HIV transmission and disease progression, and cost-effectiveness analysis. Data Sources Published literature. Target Population High-risk (injection drug users, men who have sex with men) and low-risk individuals aged 15 to 64 in the U.S. Time Horizon 20 years and lifetime (costs and QALYs). Perspective Societal. Interventions Expanded HIV screening and counseling, treatment with ART, or both. Outcome Measures New HIV infections, discounted costs and quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Results Base-Case Analysis One-time HIV screening of low-risk individuals coupled with annual screening of high-risk individuals could prevent 6.7% of a projected 1.23 million new infections and cost $22,382/QALY gained, assuming a 20% reduction in sexual activity post-screening. Expanding ART utilization to 75% of eligible individuals prevents 10.3% of infections and costs $20,300/QALY gained. A combination strategy prevents 17.3% of infections and costs $21,580/QALY gained. Results Sensitivity Analysis With no reduction in sexual activity, expanded screening prevents 3.7% of infections. Earlier ART initiation when CD4>350 cells/mL prevents 20–28% of infections. Additional efforts to halve high-risk behavior could reduce infections by 65%. Limitations Simplified model of disease progression and treatment; exclusion of acute HIV screening. Conclusions Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U

  14. Incidence and cost of alcohol-involved crashes in the United States.

    PubMed

    Miller, T R; Blincoe, L J

    1994-10-01

    The incidence of alcohol-involved highway crashes (those in which a driver or nonoccupant had been drinking) was estimated from federal data bases. The estimates were adjusted for police underreporting of alcohol involvement. In 1990, 22% of motor vehicle crash victims--1.2 million--were injured in crashes involving alcohol. Over 22,000 of these victims were killed. The comprehensive cost of alcohol-involved crashes was $148 billion in 1990, including $46 billion in monetary costs and $102 billion in lost quality of life. This represents $1.09 per drink of alcohol consumed. Crashes where blood alcohol concentration (BAC) exceeded .10% accounted for 32% of comprehensive crash costs, and crashes with lower positive BAC accounted for another 8%. Excluding drunk drivers and drunk nonoccupants, alcohol-involved crashes caused 8,500 deaths and left 21,000 people permanently disabled and another 605,000 less seriously injured. Averaged across all drinks, other people collectively pay $0.63 in crash costs every time someone takes a drink. A combination of increased public awareness and strong legal sanctions has been effective in reducing the incidence of alcohol-involved driving. The proportion of injuries in crashes that police reported were alcohol-involved dropped by 37% between 1982-1984 and 1990. PMID:7999203

  15. How People Actually Use Thermostats

    SciTech Connect

    Meier, Alan; Aragon, Cecilia; Hurwitz, Becky; Mujumdar, Dhawal; Peffer, Therese; Perry, Daniel; Pritoni, Marco

    2010-08-15

    Residential thermostats have been a key element in controlling heating and cooling systems for over sixty years. However, today's modern programmable thermostats (PTs) are complicated and difficult for users to understand, leading to errors in operation and wasted energy. Four separate tests of usability were conducted in preparation for a larger study. These tests included personal interviews, an on-line survey, photographing actual thermostat settings, and measurements of ability to accomplish four tasks related to effective use of a PT. The interviews revealed that many occupants used the PT as an on-off switch and most demonstrated little knowledge of how to operate it. The on-line survey found that 89% of the respondents rarely or never used the PT to set a weekday or weekend program. The photographic survey (in low income homes) found that only 30% of the PTs were actually programmed. In the usability test, we found that we could quantify the difference in usability of two PTs as measured in time to accomplish tasks. Users accomplished the tasks in consistently shorter times with the touchscreen unit than with buttons. None of these studies are representative of the entire population of users but, together, they illustrate the importance of improving user interfaces in PTs.

  16. Consumption and Response Output as a Function of Unit Price: Manipulation of Cost and Benefit Components

    ERIC Educational Resources Information Center

    Delmendo, Xeres; Borrero, John C.; Beauchamp, Kenneth L.; Francisco, Monica T.

    2009-01-01

    We conducted preference assessments with 4 typically developing children to identify potential reinforcers and assessed the reinforcing efficacy of those stimuli. Next, we tested two predictions of economic theory: that overall consumption (reinforcers obtained) would decrease as the unit price (response requirement per reinforcer) increased and…

  17. A MORE COST-EFFECTIVE EMAP-W BENTHIC MACROFAUNAL SAMPLE UNIT

    EPA Science Inventory

    The standard EPA West Coast Environmental Monitoring and Assessment Program (EMAP-W) benthic macrofaunal sampling protocol is to collect 30-50 random benthic samples per reporting unit (e.g., estuary, region) using a 0.1 m2 grab and to sort out macrofauna using a 1.0 mm mesh scre...

  18. Cost of Power Interruptions to Electricity Consumers in the UnitedStates (U.S.)

    SciTech Connect

    Hamachi LaCommare, Kristina; Eto, Joseph H.

    2006-02-16

    The massive electric power blackout in the northeastern U.S.and Canada on August 14-15, 2003 catalyzed discussions about modernizingthe U.S. electricity grid. Industry sources suggested that investments of$50 to $100 billion would be needed. This work seeks to better understandan important piece of information that has been missing from thesediscussions: What do power interruptions and fluctuations in powerquality (power-quality events) cost electricity consumers? We developed abottom-up approach for assessing the cost to U.S. electricity consumersof power interruptions and power-quality events (referred to collectivelyas "reliability events"). The approach can be used to help assess thepotential benefits of investments in improving the reliability of thegrid. We developed a new estimate based on publicly availableinformation, and assessed how uncertainties in these data affect thisestimate using sensitivity analysis.

  19. Cost implications of alternative sources of (n-3) fatty acid consumption in the United States.

    PubMed

    Kennedy, Eileen T; Luo, Hanqi; Ausman, Lynne M

    2012-03-01

    The Dietary Guidelines for Americans 2010 provides authoritative advice on what Americans should eat to stay healthy. These guidelines provide a quantitative recommendation to consume 250 mg/d of (n-3) fatty acids (also known as omega-3 fatty acids). To achieve this goal, Americans would need to more than triple the amount of EPA and DHA currently consumed. This paper assessed the cost implications of increased levels of EPA and DHA from marine and nonmarine food sources using data from the 2007-2008 NHANES, USDA nutrient data base, and the USDA Center for the Nutrition Policy and Promotion food price data. Stearidonic acid (SDA)-enhanced soybean oil is a lower cost alternative to commonly consumed marine food as a source of EPA. In addition, given that SDA-enhanced soybean oil is intended to be used as an ingredient in a variety of products, this may enable consumers to increase consumption of EPA through commonly consumed foods.

  20. International trade and air pollution: estimating the economic costs of air emissions from waterborne commerce vessels in the United States.

    PubMed

    Gallagher, Kevin P

    2005-10-01

    Although there is a burgeoning literature on the effects of international trade on the environment, relatively little work has been done on where trade most directly effects the environment: the transportation sector. This article shows how international trade is affecting air pollution emissions in the United States' shipping sector. Recent work has shown that cargo ships have been long overlooked regarding their contribution to air pollution. Indeed, ship emissions have recently been deemed "the last unregulated source of traditional air pollutants". Air pollution from ships has a number of significant local, national, and global environmental effects. Building on past studies, we examine the economic costs of this increasing and unregulated form of environmental damage. We find that total emissions from ships are largely increasing due to the increase in foreign commerce (or international trade). The economic costs of SO2 pollution range from dollars 697 million to dollars 3.9 billion during the period examined, or dollars 77 to dollars 435 million on an annual basis. The bulk of the cost is from foreign commerce, where the annual costs average to dollars 42 to dollars 241 million. For NOx emissions the costs are dollars 3.7 billion over the entire period or dollars 412 million per year. Because foreign trade is driving the growth in US shipping, we also estimate the effect of the Uruguay Round on emissions. Separating out the effects of global trade agreements reveals that the trade agreement-led emissions amounted to dollars 96 to dollars 542 million for SO2 between 1993 and 2001, or dollars 10 to dollars 60 million per year. For NOx they were dollars 745 million for the whole period or dollars 82 million per year. Without adequate policy responses, we predict that these trends and costs will continue into the future.

  1. Expanded HIV Testing in Low-Prevalence, High-Income Countries: A Cost-Effectiveness Analysis for the United Kingdom

    PubMed Central

    Long, Elisa F.; Mandalia, Roshni; Mandalia, Sundhiya; Alistar, Sabina S.

    2014-01-01

    Objective In many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed. Design We developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries. Methods We estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness. Results Annual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000–£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4–15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained. Conclusions Annual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries. PMID:24763373

  2. The benefits and costs of new fuels and engines for light-duty vehicles in the United States.

    PubMed

    Keefe, Ryan; Griffin, James P; Graham, John D

    2008-10-01

    Rising oil prices and concerns about energy security and climate change are spurring reconsideration of both automobile propulsion systems and the fuels that supply energy to them. In addition to the gasoline internal combustion engine, recent years have seen alternatives develop in the automotive marketplace. Currently, hybrid-electric vehicles, advanced diesels, and flex-fuel vehicles running on a high percentage mixture of ethanol and gasoline (E85) are appearing at auto shows and in driveways. We conduct a rigorous benefit-cost analysis from both the private and societal perspective of the marginal benefits and costs of each technology--using the conventional gasoline engine as a baseline. The private perspective considers only those factors that influence the decisions of individual consumers, while the societal perspective accounts for environmental, energy, and congestion externalities as well. Our analysis illustrates that both hybrids and diesels show promise for particular light-duty applications (sport utility vehicles and pickup trucks), but that vehicles running continuously on E85 consistently have greater costs than benefits. The results for diesels were particularly robust over a wide range of sensitivity analyses. The results from the societal analysis are qualitatively similar to the private analysis, demonstrating that the most relevant factors to the benefit-cost calculations are the factors that drive the individual consumer's decision. We conclude with a brief discussion of marketplace and public policy trends that will both illustrate and influence the relative adoption of these alternative technologies in the United States in the coming decade. PMID:18684162

  3. The benefits and costs of new fuels and engines for light-duty vehicles in the United States.

    PubMed

    Keefe, Ryan; Griffin, James P; Graham, John D

    2008-10-01

    Rising oil prices and concerns about energy security and climate change are spurring reconsideration of both automobile propulsion systems and the fuels that supply energy to them. In addition to the gasoline internal combustion engine, recent years have seen alternatives develop in the automotive marketplace. Currently, hybrid-electric vehicles, advanced diesels, and flex-fuel vehicles running on a high percentage mixture of ethanol and gasoline (E85) are appearing at auto shows and in driveways. We conduct a rigorous benefit-cost analysis from both the private and societal perspective of the marginal benefits and costs of each technology--using the conventional gasoline engine as a baseline. The private perspective considers only those factors that influence the decisions of individual consumers, while the societal perspective accounts for environmental, energy, and congestion externalities as well. Our analysis illustrates that both hybrids and diesels show promise for particular light-duty applications (sport utility vehicles and pickup trucks), but that vehicles running continuously on E85 consistently have greater costs than benefits. The results for diesels were particularly robust over a wide range of sensitivity analyses. The results from the societal analysis are qualitatively similar to the private analysis, demonstrating that the most relevant factors to the benefit-cost calculations are the factors that drive the individual consumer's decision. We conclude with a brief discussion of marketplace and public policy trends that will both illustrate and influence the relative adoption of these alternative technologies in the United States in the coming decade.

  4. Evaluation of plug-in electric vehicles impact on cost-based unit commitment

    NASA Astrophysics Data System (ADS)

    Talebizadeh, Ehsan; Rashidinejad, Masoud; Abdollahi, Amir

    2014-02-01

    Incorporating plug in electric vehicles (PEVs) to power systems may address both additional demand as well as mobile storage to support electric grid spatially. Better utilization of such potential depends on the optimal scheduling of charging and discharging PEVs. Charging management malfunction of PEVs may increase the peak load which leads to additional generation. Therefore, charging and discharging of PEVs must be scheduled intelligently to prevent overloading of the network at peak hours, take advantages of off peak charging benefits and delaying any load shedding. A charging and discharging schedule of PEVs with respect to load curve variations is proposed in this paper. The proposed methodology incorporates integrated PEVs; the so-called parking lots; into the unit commitment problem. An IEEE 10-unit test system is employed to investigate the impacts of PEVs on generation scheduling. The results obtained from simulation analysis show a significant techno-economic saving.

  5. Design considerations and implementation of a cost-effective, portable remote monitoring unit using 3G wireless data networks.

    PubMed

    Gupta, Shashank; Ganz, Aura

    2004-01-01

    This paper describes the design and implementation of a light-weight, autonomous, patient-centric, portable medical unit that allows for anytime/anywhere monitoring and can find use in many monitoring scenarios like home-care, hospital wards, emergency help and disaster relief. The proposed unit called "TelePatient" achieves portability by exploiting a PDA and allows mobility through the use of cellular technology, enabling complete ubiquity. The design is based on open standards and is cost-effective. We incorporate transcoding software to fit data to limited bandwidth, as well as conserve energy on the power constrained PDA. We validate our design over real network 3G CDMA conditions and also test its use over WLAN802.11b, which can together cover a number of Telemedicine scenarios. PMID:17270983

  6. Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit

    NASA Astrophysics Data System (ADS)

    Langlotz, Curtis P.; Kundel, Harold L.; Brikman, Inna; Pratt, Hugh M.; Redfern, Regina O.; Horii, Steven C.; Schwartz, J. Sanford

    1996-05-01

    Our purpose was to determine the economic effects associated with the introduction of PACS and computed radiology (CR) in a medical intensive care unit (MICU). Clinical and financial data were collected over a period of 6 months, both before and after the introduction of PACS/CR in our medical intensive care unit. Administrative claims data resulting from the MICU stay of each patient enrolled in our study were transferred online to our research database from the administrative databases of our hospital and its affiliated clinical practices. These data included all charge entries, sociodemographic data, admissions/discharge/transfer chronologies, ICD9 diagnostic and procedure codes, and diagnostic related groups. APACHE III scores and other case mix adjusters were computed from the diagnostic codes, and from the contemporaneous medical record. Departmental charge to cost ratios and the Medicare Resource-Based Relative Value Scale fee schedule were used to estimate costs from hospital and professional charges. Data were analyzed using both the patient and the exam as the unit of analysis. Univariate analyses by patient show that patients enrolled during the PACS periods were similar to those enrolled during the Film periods in age, sex, APACHE III score, and other measures of case mix. No significant differences in unadjusted median length of stay between the two Film and two PACS periods were detected. Likewise, no significant differences in unadjusted total hospital and professional costs were found between the Film and PACS periods. In our univariate analyses by exam, we focused on the subgroup of exams that had triggered primary clinical actions in any period. Those action-triggering exams were divided into two groups according to whether the referring clinician elected to obtain imaging results from the workstation or from the usual channels. Patients whose imaging results were obtain from the workstation had significantly lower professional costs in the 7 days

  7. Utility-Scale Solar 2014. An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    SciTech Connect

    Bolinger, Mark; Seel, Joachim

    2015-09-01

    Other than the nine Solar Energy Generation Systems (“SEGS”) parabolic trough projects built in the 1980s, virtually no large-scale or “utility-scale” solar projects – defined here to include any groundmounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar thermal power (“CSP”) project larger than 5 MWAC – existed in the United States prior to 2007. By 2012 – just five years later – utility-scale had become the largest sector of the overall PV market in the United States, a distinction that was repeated in both 2013 and 2014 and that is expected to continue for at least the next few years. Over this same short period, CSP also experienced a bit of a renaissance in the United States, with a number of large new parabolic trough and power tower systems – some including thermal storage – achieving commercial operation. With this critical mass of new utility-scale projects now online and in some cases having operated for a number of years (generating not only electricity, but also empirical data that can be mined), the rapidly growing utility-scale sector is ripe for analysis. This report, the third edition in an ongoing annual series, meets this need through in-depth, annually updated, data-driven analysis of not just installed project costs or prices – i.e., the traditional realm of solar economics analyses – but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects in the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are presented where appropriate.

  8. Efficiency in the United States electric industry: Transaction costs, deregulation, and governance structures

    NASA Astrophysics Data System (ADS)

    Peterson, Carl

    Transaction costs economics (TCE) posits that firms have an incentive to bypass the market mechanisms in situations where the cost of using the market is prohibitive. Vertical integration, among other governance mechanisms, can be used to minimize the transactions costs associated with the market mechanism. The study analyses different governance mechanisms, which range from complete vertical integration to the use of market mechanisms, for firms in the US electric sector. This sector has undergone tremendous change in the past decade including the introduction of retail competition in some jurisdictions. As a result of the push toward deregulation of the industry, vertically integration, while still significant in the sector, has steadily been replaced by alternative governance structures. Using a sample of 136 investor-owned electric utilities that reported data the US Federal Energy Regulatory Commission between 1996 and 2002, this study estimates firm level efficiency using Data Envelopment Analysis (DEA) and relates these estimates to governance structure and public policies. The analysis finds that vertical integration is positively related to firm efficiency, although in a non-linear fashion suggesting that hybrid governance structures tend to be associated with lower efficiency scores. In addition, while some evidence is found for negative short-term effects on firm efficiency from the choice to deregulate, this result is sensitive to DEA model choice. Further, competition in retail markets is found to be positively related to firm level efficiency, but the retreat from deregulation, which occurred after 2000, is negatively associated with firm-level efficiency. These results are important in the ongoing academic and public policy debates concerning deregulation of the electric section and indicate that vertical economies remain in the industry, but that competition has provided incentives for improving firm level efficiency.

  9. Carbon dioxide control costs for gasification combined-cycle plants in the United States

    SciTech Connect

    Brown, D.R.; Humphreys, K.K.; Vail, L.W.

    1993-06-01

    This study focused on evaluating the cost of recovering CO{sub 2} from coal gasification, combined-cycle (GCC) power plants and transporting the CO{sub 2} in pipelines for disposal in deep ocean water, depleted oil and gas reservoirs, or aquifers. Other fuels and conversion technologies were not evaluated. Technical feasibility, environmental acceptability, and other implementation issues were not addressed in detail. Ocean disposal of CO{sub 2} offers essentially unlimited capacity, but is distant from most US coal-fired power plants and presents environmental concerns at the disposal point. Depleted oil and gas reservoirs are also distant from most US coal-fired power plants and have a more limited disposal capacity,, but were calculated to have a potential capacity more than double that required to dispose of all CO{sub 2} from 830 GCC power plants (380-mwe each) for a period of 40 years. The existence of oil and gas reservoirs provides ``proof`` of the long-term CO{sub 2} confinement potential in these formations. In contrast, aquifer disposal is believed to be significantly riskier. Key concerns are lack of geologic knowledge at depths adequate for CO{sub 2} disposal; uncertainty about geochemical impacts from decreased water pH; and long-term confinement, which is unproven for non-petroleum formations. Carbon dioxide recovery at GCC plants increased the levelized energy cost (LEC) by about one third relative to a reference GCC plant without CO{sub 2} recovery. The transmission distance is the key factor affecting total CO{sub 2} control costs.

  10. A Module Experimental Process System Development Unit (MEPSDU). [development of low cost solar arrays

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The technical readiness of a cost effective process sequence that has the potential for the production of flat plate photovoltaic modules which met the price goal in 1986 of $.70 or less per Watt peak was demonstrated. The proposed process sequence was reviewed and laboratory verification experiments were conducted. The preliminary process includes the following features: semicrystalline silicon (10 cm by 10 cm) as the silicon input material; spray on dopant diffusion source; Al paste BSF formation; spray on AR coating; electroless Ni plate solder dip metallization; laser scribe edges; K & S tabbing and stringing machine; and laminated EVA modules.

  11. Mapping water availability, projected use and cost in the western United States

    SciTech Connect

    Vincent C. Tidwell; Barbara D. Moreland; Katie M. Zemlick; Barry L. Roberts; Howard D. Passell; Daniel Jensen; Christopher Forsgren; Gerald Sehlke; Margaret A. Cook; Carey W. King

    2014-06-01

    New demands for water can be satisfied through a variety of source options. In some basins surface and/or groundwater may be available through permitting with the state water management agency (termed unappropriated water), alternatively water might be purchased and transferred out of its current use to another (termed appropriated water), or non-traditional water sources can be captured and treated (e.g., wastewater). The relative availability and cost of each source are key factors in the development decision. Unfortunately, these measures are location dependent with no consistent or comparable set of data available for evaluating competing water sources. With the help of western water managers, water availability was mapped for over 1200 watersheds throughout the western US. Five water sources were individually examined, including unappropriated surface water, unappropriated groundwater, appropriated water, municipal wastewater and brackish groundwater. Also mapped was projected change in consumptive water use from 2010 to 2030. Associated costs to acquire, convey and treat the water, as necessary, for each of the five sources were estimated. These metrics were developed to support regional water planning and policy analysis with initial application to electric transmission planning in the western US.

  12. Cost-Effectiveness of Blood Donor Screening for Babesia microti in Endemic Regions of the United States

    PubMed Central

    Simon, Matthew S.; Leff, Jared A.; Pandya, Ankur; Cushing, Melissa; Shaz, Beth H.; Calfee, David P.; Schackman, Bruce R.; Mushlin, Alvin I.

    2014-01-01

    Background Babesia microti is the leading reported cause of red blood cell (RBC) transfusion-transmitted infection in the United States (US). Donor screening assays are in development. Study Design and Methods A decision analytic model estimated the cost-effectiveness of screening strategies for preventing transfusion-transmitted babesiosis (TTB) in a hypothetical cohort of transfusion recipients in Babesia-endemic areas of the US. Strategies included: (1) No screening, (2) Uniform Donor Health History Questionnaire (UDHQ), “status quo”, (3) Recipient risk-targeting using donor antibody (Ab) and polymerase chain reaction (PCR) screening, (4) Universal endemic donor Ab screening, (5) Universal endemic donor Ab and PCR screening. Outcome measures were TTB cases averted, costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios ($/QALY). We assumed a societal willingness to pay of $1 million/QALY based on screening for other transfusion-transmitted infections. Results Compared to no screening, the UDHQ avoids 0.02 TTB cases per 100,000 RBC transfusions at an incremental cost effectiveness ratio (ICER) of $160,000/QALY whereas recipient risk-targeted strategy using Ab/PCR avoids 1.62 TTB cases per 100,000 RBC transfusions at an ICER of $713,000/QALY compared to the UDHQ. Universal endemic Ab screening avoids 3.39 cases at an ICER of $760,000/QALY compared to the recipient-risk targeted strategy. Universal endemic Ab/PCR screening avoids 3.60 cases and has an ICER of $8.8 million/QALY compared to universal endemic Ab screening. Results are sensitive to blood donor Babesia prevalence, TTB transmission probability, screening test costs, risk and severity of TTB complications, and impact of babesiosis diagnosis on donor quality of life. Conclusion Antibody screening for Babesia in endemic regions is appropriate from an economic perspective based on the societal willingness to pay for preventing infectious threats to blood safety. PMID

  13. Antimicrobial agents’ utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

    PubMed Central

    Anand, Nikhilesh; Nagendra Nayak, I. M.; Advaitha, M. V.; Thaikattil, Noble J.; Kantanavar, Kiran A.; Anand, Sanjit

    2016-01-01

    Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs) in an Intensive Care Unit (ICU) increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification) as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77%) was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%), metronidazole (12%), amoxicillin/clavulanic acid (6.44%), and azithromycin (4.34%). Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR). Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed. PMID:27275075

  14. Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007 - 2012; NREL (National Renewable Energy Laboratory)

    SciTech Connect

    Hand, Maureen

    2015-06-15

    This presentation provides a summary of IEA Wind Task 26 report on Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007-2012

  15. A Low-Cost Energy-Efficient Cableless Geophone Unit for Passive Surface Wave Surveys

    PubMed Central

    Dai, Kaoshan; Li, Xiaofeng; Lu, Chuan; You, Qingyu; Huang, Zhenhua; Wu, H. Felix

    2015-01-01

    The passive surface wave survey is a practical, non-invasive seismic exploration method that has increasingly been used in geotechnical engineering. However, in situ deployment of traditional wired geophones is labor intensive for a dense sensor array. Alternatively, stand-alone seismometers can be used, but they are bulky, heavy, and expensive because they are usually designed for long-term monitoring. To better facilitate field applications of the passive surface wave survey, a low-cost energy-efficient geophone system was developed in this study. The hardware design is presented in this paper. To validate the system’s functionality, both laboratory and field experiments were conducted. The unique feature of this newly-developed cableless geophone system allows for rapid field applications of the passive surface wave survey with dense array measurements. PMID:26404270

  16. Experience with 500 extracorporeal shockwave lithotripsy patients using a low-cost unit: the "Econolith".

    PubMed

    Simon, D

    1995-06-01

    The Econolith (Medispec Ltd.) is a modular extracorporeal shockwave (SWL) system that uses the spark gap as its source for lithotripsy. In this study, the immediate and late results and complications in 500 patients (640 treatments) treated with this machine during the last 2 years were summarized. An average fragmentation rate of 86% was achieved after the first treatment. A stone-free situation at 3 months was achieved in 75% of the cases; 18% had small (< 5mm) fragments, and 7% had larger fragments. Auxiliary procedures were required in 8% of the patients. Minor complications such as hematuria, colic, and urinary tract infection were seen in 6% of the patients. The Econolith system is safe and effective. Its mobility and low cost enable any urologist to use this technology even with a low monthly turnover of patients.

  17. A Low-Cost Energy-Efficient Cableless Geophone Unit for Passive Surface Wave Surveys.

    PubMed

    Dai, Kaoshan; Li, Xiaofeng; Lu, Chuan; You, Qingyu; Huang, Zhenhua; Wu, H Felix

    2015-09-25

    The passive surface wave survey is a practical, non-invasive seismic exploration method that has increasingly been used in geotechnical engineering. However, in situ deployment of traditional wired geophones is labor intensive for a dense sensor array. Alternatively, stand-alone seismometers can be used, but they are bulky, heavy, and expensive because they are usually designed for long-term monitoring. To better facilitate field applications of the passive surface wave survey, a low-cost energy-efficient geophone system was developed in this study. The hardware design is presented in this paper. To validate the system's functionality, both laboratory and field experiments were conducted. The unique feature of this newly-developed cableless geophone system allows for rapid field applications of the passive surface wave survey with dense array measurements.

  18. A Low-Cost Energy-Efficient Cableless Geophone Unit for Passive Surface Wave Surveys.

    PubMed

    Dai, Kaoshan; Li, Xiaofeng; Lu, Chuan; You, Qingyu; Huang, Zhenhua; Wu, H Felix

    2015-01-01

    The passive surface wave survey is a practical, non-invasive seismic exploration method that has increasingly been used in geotechnical engineering. However, in situ deployment of traditional wired geophones is labor intensive for a dense sensor array. Alternatively, stand-alone seismometers can be used, but they are bulky, heavy, and expensive because they are usually designed for long-term monitoring. To better facilitate field applications of the passive surface wave survey, a low-cost energy-efficient geophone system was developed in this study. The hardware design is presented in this paper. To validate the system's functionality, both laboratory and field experiments were conducted. The unique feature of this newly-developed cableless geophone system allows for rapid field applications of the passive surface wave survey with dense array measurements. PMID:26404270

  19. Building a market for small wind: The break-even turnkey cost of residential wind systems in the United States

    SciTech Connect

    Edwards, Jennifer L.; Wiser, Ryan; Bolinger, Mark; Forsyth, Trudy

    2004-03-01

    Although small wind turbine technology and economics have improved in recent years, the small wind market in the United States continues to be driven in large part by state incentives, such as cash rebates, favorable loan programs, and tax credits. This paper examines the state-by-state economic attractiveness of small residential wind systems. Economic attractiveness is evaluated primarily using the break-even turnkey cost (BTC) of a residential wind system as the figure of merit. The BTC is defined here as the aggregate installed cost of a small wind system that could be supported such that the system owner would break even (and receive a specified return on investment) over the life of the turbine, taking into account current available incentives, the wind resource, and the retail electricity rate offset by on-site generation. Based on the analysis presented in this paper, we conclude that: (1) the economics of residential, grid-connected small wind systems is highly variable by state and wind resource class, (2) significant cost reductions will be necessary to stimulate widespread market acceptance absent significant changes in the level of policy support, and (3) a number of policies could help stimulate the market, but state cash incentives currently have the most significant impact, and will be a critical element of continued growth in this market.

  20. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States.

    PubMed

    Durham, David P; Ndeffo-Mbah, Martial L; Skrip, Laura A; Jones, Forrest K; Bauch, Chris T; Galvani, Alison P

    2016-05-01

    Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms. PMID:27091978

  1. Fuel miles and the blend wall: costs and emissions from ethanol distribution in the United States.

    PubMed

    Strogen, Bret; Horvath, Arpad; McKone, Thomas E

    2012-05-15

    From 1991 to 2009, U.S. production of ethanol increased 10-fold, largely due to government programs motivated by climate change, energy security, and economic development goals. As low-level ethanol-gasoline blends have not consistently outperformed ethanol-free gasoline in vehicle performance or tailpipe emissions, national-level economic and environmental goals could be accomplished more efficiently by concentrating consumption of gasoline containing 10% ethanol (i.e., E10) near producers to minimize freight activity. As the domestic transportation of ethanol increased 10-fold in metric ton-kilometers (t-km) from 2000 to 2009, the portion of t-km potentially justified by the E10 blend wall increased from less than 40% to 80%. However, we estimate 10 billion t-km took place annually from 2004 to 2009 for reasons other than the blend wall. This "unnecessary" transportation resulted in more than $240 million in freight costs, 90 million L of diesel consumption, 300,000 metric tons of CO(2)-e emissions, and 440 g of human intake of PM(2.5). By 2009, the marginal savings from enabling Iowa to surpass E10 would have exceeded 2.5 g CO(2)-e/MJ and $0.12/gallon of ethanol, as the next-closest customer was 1600 km away. The use of a national network model enables estimation of marginal transportation impacts from subnational policies, and benefits from policies encouraging concentrated consumption of renewable fuels.

  2. Food costs, diet quality and energy balance in the United States.

    PubMed

    Carlson, Andrea; Frazão, Elizabeth

    2014-07-01

    The high obesity rates and poor diet quality in the United States, particularly among low income populations, are often attributed to low income, low food access, and high food prices of healthy foods. This paper discusses these associations and questions some of the metrics used to measure food prices. The paper argues that 1. On average, Americans consume diets that need improvement and there is only a very limited relationship between income and diet quality; 2. The way the food price is measured makes a difference in the perception of how expensive healthy and less healthy food is; 3. The way Americans allocate their food budgets between healthy and less healthy foods is not in line with healthy diets; and 4. At any food spending level there are households that purchase healthy (and unhealthy) diets, including budgets at or below the maximum allotment for the Supplemental Nutrition Assistance Program (SNAP) which provides a means for low-income households to purchase food. Our key finding is that healthy foods and diets are affordable, but policy makers, nutrition educators, researchers and the media need to focus on promoting this message, and providing additional guidance on making the changes for Americans to switch to a healthy and affordable diet.

  3. 48 CFR 9904.410 - Allocation of business unit general and administrative expenses to final cost objectives.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... general and administrative expenses to final cost objectives. 9904.410 Section 9904.410 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST...

  4. 23 CFR 645.117 - Cost development and reimbursement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ....117 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC... accepted industry practices and be reasonably supported by recent actual expenditures. Unit costs should be... consistent with the provisions of 48 CFR part 31. (2) Costs not eligible for Federal reimbursement...

  5. Value-based cost sharing in the United States and elsewhere can increase patients' use of high-value goods and services.

    PubMed

    Thomson, Sarah; Schang, Laura; Chernew, Michael E

    2013-04-01

    This article reviews efforts in the United States and several other member countries of the Organization for Economic Cooperation and Development to encourage patients, through cost sharing, to use goods such as medications, services, and providers that offer better value than other options--an approach known as value-based cost sharing. Among the countries we reviewed, we found that value-based approaches were most commonly applied to drug cost sharing. A few countries, including the United States, employed financial incentives, such as lower copayments, to encourage use of preferred providers or preventive services. Evidence suggests that these efforts can increase patients' use of high-value services--although they may also be associated with high administrative costs and could exacerbate health inequalities among various groups. With careful design, implementation, and evaluation, value-based cost sharing can be an important tool for aligning patient and provider incentives to pursue high-value care.

  6. Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States.

    PubMed

    Stewart, Alexandra M; Lindley, Megan C; Chang, Kristen H M; Cox, Marisa A

    2014-01-23

    Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs' policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.

  7. Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States.

    PubMed

    Stewart, Alexandra M; Lindley, Megan C; Chang, Kristen H M; Cox, Marisa A

    2014-01-23

    Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs' policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees. PMID:24291539

  8. Cost and appropriateness of treating asthma with fixed-combination drugs in local health care units in Italy

    PubMed Central

    Ruggeri, Isabella; Bragato, Donatello; Colombo, Giorgio L; Valla, Emanuela; Di Matteo, Sergio

    2012-01-01

    Background Bronchial asthma is a chronic airways disease and is considered to be one of the major health problems in the Western world. During the last decade, a significant increase in the use of β2-agonists in combination with inhaled corticosteroids has been observed. The aim of this study was to assess the appropriateness of expenditure on these agents in an asthmatic population treated in a real practice setting. Methods This study used data for a resident population of 635,906 citizens in the integrated patient database (Banca Dati Assistito) of a local health care unit (Milano 2 Azienda Sanitaria Locale) in the Lombardy region over 3 years (2007–2009). The sample included 3787–4808 patients selected from all citizens aged ≥ 18 years entitled to social security benefits, having a prescription for a corticosteroid + β2-agonist combination, and an ATC code corresponding to R03AK, divided into three groups, ie, pressurized (spray) drugs, inhaled powders, and extrafine formulations. Patients with chronic obstructive lung disease were excluded. Indicators of appropriateness were 1–3 packs per year (underdosed, inappropriate), 4–12 packs per year (presumably appropriate), and ≥13 packs per year (overtreatment, inappropriate). Results The corticosteroid + β2-agonist combination per treated asthmatic patient increased from 37% in 2007 to 45% in 2009 for the total of prescribed antiasthma drugs, and 28%–32% of patients used the drugs in an appropriate manner (4–12 packs per years). The cost of inappropriately used packs increased combination drug expenditure by about 40%, leading to inefficient use of health care resources. This trend improved during the 3-year observation period. The mean annual cost per patient was higher for powders (€223.95) and sprays (€224.83) than for extrafine formulation (€142.71). Conclusion Based on this analysis, we suggest implementation of better health care planning and more appropriate prescription practices

  9. A case study using the United Republic of Tanzania: costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Tool

    PubMed Central

    2012-01-01

    Background The purpose, methods, data sources and assumptions behind the World Health Organization (WHO) Cervical Cancer Prevention and Control Costing (C4P) tool that was developed to assist low- and middle-income countries (LMICs) with planning and costing their nationwide human papillomavirus (HPV) vaccination program are presented. Tanzania is presented as a case study where the WHO C4P tool was used to cost and plan the roll-out of HPV vaccines nationwide as part of the national comprehensive cervical cancer prevention and control strategy. Methods The WHO C4P tool focuses on estimating the incremental costs to the health system of vaccinating adolescent girls through school-, health facility- and/or outreach-based strategies. No costs to the user (school girls, parents or caregivers) are included. Both financial (or costs to the Ministry of Health) and economic costs are estimated. The cost components for service delivery include training, vaccination (health personnel time and transport, stationery for tally sheets and vaccination cards, and so on), social mobilization/IEC (information, education and communication), supervision, and monitoring and evaluation (M&E). The costs of all the resources used for HPV vaccination are totaled and shown with and without the estimated cost of the vaccine. The total cost is also divided by the number of doses administered and number of fully immunized girls (FIGs) to estimate the cost per dose and cost per FIG. Results Over five years (2011 to 2015), the cost of establishing an HPV vaccine program that delivers three doses of vaccine to girls at schools via phased national introduction (three regions in year 1, ten regions in year 2 and all 26 regions in years 3 to 5) in Tanzania is estimated to be US$9.2 million (excluding vaccine costs) and US$31.5 million (with vaccine) assuming a vaccine price of US$5 (GAVI 2011, formerly the Global Alliance for Vaccines and Immunizations). This is equivalent to a financial cost of US

  10. Educational Costs.

    ERIC Educational Resources Information Center

    Arnold, Robert

    Problems in educational cost accounting and a new cost accounting approach are described in this paper. The limitations of the individualized cost (student units) approach and the comparative cost approach (in the form of fund-function-object) are illustrated. A new strategy, an activity-based system of accounting, is advocated. Borrowed from…

  11. Geological studies of the COST No. B-3 Well, United States Mid-Atlantic continental slope area

    USGS Publications Warehouse

    Scholle, Peter A.

    1980-01-01

    The COST No. B-3 well is the first deep stratigraphic test to be drilled on the Continental Slope off the Eastern United States. The well was drilled in 2,686 ft (819 m) of water in the Baltimore Canyon trough area to a total depth of 15,820 ft (4,844 m) below the drill platform. It penetrated a section composed of mudstones, calcareous mudstones, and limestones of generally deep water origin to a depth of about 8.200 ft (2,500 m) below the drill floor. Light-colored, medium- to coarse-grained sandstones with intercalated gray and brown shales, micritic limestones, and minor coal and dolomite predominate from about 8,200 to 12,300 ft (2,500 to 3,750 m). From about 12,300 ft (3,750 m) to the bottom, the section consists of limestones (including oolitic and intraclastic grainstones) with interbedded fine-to medium-grained sandstones, dark-colored fissile shales, and numerous coal seams. Biostratigraphic examination has shown that the section down to approximately 6,000 ft (1,830 m) is Tertiary. The boundary between the Lower and Upper Cretaceous sections is placed between 8,600 and 9,200 ft (2,620 and 2,800 m) by various workers. Placement of the Jurassic-Cretaceous boundary shows an even greater range based on different organisms; it is placed variously between 12,250 and 13,450 ft (3,730 and 5,000 m). The oldest unit penetrated in the well is considered to be Upper Jurassic (Kimmeridgian) by some workers and Middle Jurassic (Callovian) by others. The Lower Cretaceous and Jurassic parts of the section represent nonmarine to shallow-marine shelf sedimentation. Upper Cretaceous and Tertiary units reflect generally deeper water conditions at the B-3 well site and show a general transition from deposition at shelf to slope water depths. Examination of cores, well cuttings, and electric logs indicates that potential hydrocarbon-reservoir units are present throughout the Jurassic and Cretaceous section. Porous and moderately permeable limestones and sandstones have been

  12. Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

    PubMed Central

    Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

    2014-01-01

    Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777

  13. Tracking the Sun IV: An Historical Summary of the Installed Cost of Photovoltaics in the United States from 1998 to 2010

    SciTech Connect

    Darghouth, Naim; Wiser, Ryan

    2011-09-07

    The present report describes installed cost trends for grid-connected PV projects installed from 1998 through 2010 (with some limited and preliminary results presented for projects installed in the first six months of 2011). The analysis is based on project-level cost data from approximately 116,500 residential, non-residential, and utility-sector PV systems in the United States. The inclusion of utility-sector PV is a new element in this year’s report. The combined capacity of all systems in the data sample totals 1,685 MW, equal to 79% of all grid-connected PV capacity installed in the United States through 2010 and representing one of the most comprehensive sources of installed PV cost data for the U.S. Based on this dataset, the report describes historical installed cost trends over time, and by location, market segment, technology type, and component. The report also briefly compares recent PV installed costs in the United States to those in Germany and Japan, and describes trends in customer incentives for PV installations and net installed costs after receipt of such incentives. The analysis presented here focuses on descriptive trends in the underlying data, serving primarily to summarize the data in tabular and graphical form.

  14. IEA Wind Task 26. Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007–2012

    SciTech Connect

    Vitina, Aisma; Lüers, Silke; Wallasch, Anna-Kathrin; Berkhout, Volker; Duffy, Aidan; Cleary, Brendan; Husabø, Lief I.; Weir, David E.; Lacal-Arántegui, Roberto; Hand, Maureen; Lantz, Eric; Belyeu, Kathy; Wiser, Ryan H; Bolinger, Mark; Hoen, Ben

    2015-06-01

    The International Energy Agency Implementing Agreement for cooperation in Research, Development, and Deployment of Wind Energy Systems (IEA Wind) Task 26—The Cost of Wind Energy represents an international collaboration dedicated to exploring past, present and future cost of wind energy. This report provides an overview of recent trends in wind plant technology, cost, and performance in those countries that are currently represented by participating organizations in IEA Wind Task 26: Denmark, Germany, Ireland, Norway, and the United States as well as the European Union.

  15. Further Validation of the Psychosocial Costs of Racism to Whites Scale on a Sample of University Students in the Southeastern United States

    ERIC Educational Resources Information Center

    Sifford, Amy; Ng, Kok-Mun; Wang, Chuang

    2009-01-01

    We examined the factor structure of the Psychosocial Costs of Racism to Whites Scale (PCRW; Spanierman & Heppner, 2004) on 766 White American university students from the southeastern United States. Results from confirmatory factor analyses supported the 3-factor model proposed by Spanierman and Heppner (2004). The construct validity of the PCRW…

  16. A brief review of the estimated economic burden of sexually transmitted diseases in the United States: inflation-adjusted updates of previously published cost studies.

    PubMed

    Chesson, Harrell W; Gift, Thomas L; Owusu-Edusei, Kwame; Tao, Guoyu; Johnson, Ana P; Kent, Charlotte K

    2011-10-01

    We conducted a literature review of studies of the economic burden of sexually transmitted diseases in the United States. The annual direct medical cost of sexually transmitted diseases (including human immunodeficiency virus) has been estimated to be $16.9 billion (range: $13.9-$23.0 billion) in 2010 US dollars.

  17. 48 CFR 9904.410 - Allocation of business unit general and administrative expenses to final cost objectives.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Allocation of business... Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST...

  18. Cost analysis for reimbursement-rate setting of hospital pharmaceutical services in Thailand.

    PubMed

    Riewpaiboon, Arthorn; Kumluang, Suthasinee

    2011-10-01

    OBJECTIVES  This study aimed to develop a hospital pharmaceutical service model, together with a costing template for unit cost analysis and to analyse unit costs of hospital pharmaceutical services. METHODS  The study was designed on the basis of activity-based costing. A model of the services was set up by consensus of the working group. Pharmaceutical services among the study hospitals were standardised. A Microsoft Excel-based costing template was developed. Finally, the costing template was used for the unit cost analysis. Sensitivity analysis and descriptive statistics were used for further analysis. KEY FINDINGS  Four general and seven regional hospitals participated in the study. Hospital pharmaceutical services were divided into nine supporting activities and nine patient-service activities. Unit costs of drug dispensing per prescription by regional hospitals were approximately double that of general hospitals. In contrast, the cost of aseptic dispensing per item in regional hospitals was lower than those in general hospitals. In comparing the unit costs from standard labour costs with those from actual labour costs, both increases and decreases were found. CONCLUSIONS  Costing and the use of Microsoft Excel can be applied to the development of a costing template for unit cost analysis of hospital pharmaceutical services. This programme can provide accurate unit costs for services. The results can be used when considering pharmacy service reimbursement, efficiency and service development.

  19. Cost analysis for reimbursement-rate setting of hospital pharmaceutical services in Thailand.

    PubMed

    Riewpaiboon, Arthorn; Kumluang, Suthasinee

    2011-10-01

    OBJECTIVES  This study aimed to develop a hospital pharmaceutical service model, together with a costing template for unit cost analysis and to analyse unit costs of hospital pharmaceutical services. METHODS  The study was designed on the basis of activity-based costing. A model of the services was set up by consensus of the working group. Pharmaceutical services among the study hospitals were standardised. A Microsoft Excel-based costing template was developed. Finally, the costing template was used for the unit cost analysis. Sensitivity analysis and descriptive statistics were used for further analysis. KEY FINDINGS  Four general and seven regional hospitals participated in the study. Hospital pharmaceutical services were divided into nine supporting activities and nine patient-service activities. Unit costs of drug dispensing per prescription by regional hospitals were approximately double that of general hospitals. In contrast, the cost of aseptic dispensing per item in regional hospitals was lower than those in general hospitals. In comparing the unit costs from standard labour costs with those from actual labour costs, both increases and decreases were found. CONCLUSIONS  Costing and the use of Microsoft Excel can be applied to the development of a costing template for unit cost analysis of hospital pharmaceutical services. This programme can provide accurate unit costs for services. The results can be used when considering pharmacy service reimbursement, efficiency and service development. PMID:21899613

  20. Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States

    PubMed Central

    Furiak, Nicolas M; Ascher-Svanum, Haya; Klein, Robert W; Smolen, Lee J; Lawson, Anthony H; Conley, Robert R; Culler, Steven D

    2009-01-01

    Background Schizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator), quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system. Methods A 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs), treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental cost-effectiveness values per QALY gained. Results The results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544) followed by generic risperidone ($9,080). In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719). The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in terms of incremental cost-effectiveness per QALY gained. Conclusion The utilization of olanzapine is predicted in this model to result in better clinical outcomes and lower total direct health care costs compared to generic risperidone, quetiapine, ziprasidone, and aripiprazole. Olanzapine

  1. Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study

    PubMed Central

    2010-01-01

    Introduction Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU). Methods We performed a post hoc analysis of a prospective observational study among 53 centers from 23 countries, from September 2000 to December 2001. We estimated costs based on staffing, as well as dialysate and replacement fluid, anticoagulation and extracorporeal circuit. Results We found that the theoretic range of costs were from $3,629.80/day more with CRRT to $378.60/day more with IRRT. The median difference in cost between CRRT and IRRT was $289.60 (IQR 830.8-116.8) per day (greater with CRRT). Costs also varied greatly by region. Reducing replacement fluid volumes in CRRT to ≤ 25 ml/min (approximately 25 ml/kg/hr) would result in $67.20/day (23.2%) mean savings. Conclusions Cost considerations with RRT are important and vary substantially among centers. We identified the relative impact of four cost domains (nurse staffing, fluid, anticoagulation, and extracorporeal circuit) on overall cost differences, and hospitals can look to these areas to reduce costs associated with RRT. PMID:20346163

  2. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States.

    PubMed

    Voigt, Jeff; Sasha John, M; Taylor, Andrew; Krucoff, Mitchell; Reynolds, Matthew R; Michael Gibson, C

    2014-05-01

    The annual cost of heart failure (HF) is estimated at $39.2 billion. This has been acknowledged to underestimate the true costs for care. The objective of this analysis is to more accurately assess these costs. Publicly available data sources were used. Cost calculations incorporated relevant factors such as Medicare hospital cost-to-charge ratios, reimbursement from both government and private insurance, and out-of-pocket expenditures. A recently published Atherosclerosis Risk in Communities (ARIC) HF scheme was used to adjust the HF classification scheme. Costs were calculated with HF as the primary diagnosis (HF in isolation, or HFI) or HF as one of the diagnoses/part of a disease milieu (HF syndrome, or HFS). Total direct costs for HF were calculated at $60.2 billion (HFI) and $115.4 billion (HFS). Indirect costs were $10.6 billion for both. Costs attributable to HF may represent a much larger burden to US health care than what is commonly referenced. These revised and increased costs have implications for policy makers.

  3. Residential, Commercial, and Utility-Scale Photovoltaic (PV) System Prices in the United States: Current Drivers and Cost-Reduction Opportunities

    SciTech Connect

    Goodrich, A.; James, T.; Woodhouse, M.

    2012-02-01

    The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has dropped precipitously in recent years, led by substantial reductions in global PV module prices. However, system cost reductions are not necessarily realized or realized in a timely manner by many customers. Many reasons exist for the apparent disconnects between installation costs, component prices, and system prices; most notable is the impact of fair market value considerations on system prices. To guide policy and research and development strategy decisions, it is necessary to develop a granular perspective on the factors that underlie PV system prices and to eliminate subjective pricing parameters. This report's analysis of the overnight capital costs (cash purchase) paid for PV systems attempts to establish an objective methodology that most closely approximates the book value of PV system assets.

  4. IEA Wind Task 26. Wind Technology, Cost and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States. 2007 - 2012

    SciTech Connect

    Vitina, Aisma; Luers, Silke; Wallasch, Anna-Kathrin; Berkhout, Volker; Duffy, Aidan; Cleary, Brendan; Husabo, Leif I.; Weir, David E.; Lacal-Arantegui, Roberto; Hand, M. Maureen; Lantz, Eric; Belyeu, Kathy; Wiser, Ryan; Bolinger, Mark; Hoen, Ben

    2015-06-12

    This report builds from a similar previous analysis (Schwabe et al., 2011) exploring the differences in cost of wind energy in 2008 among countries participating in IEA Wind Task 26 at that time. The levelized cost of energy (LCOE) is a widely recognized metric for understanding how technology, capital investment, operations, and financing impact the life-cycle cost of building and operating a wind plant. Schwabe et al. (2011) apply a spreadsheet-based cash flow model developed by the Energy Research Centre of the Netherlands (ECN) to estimate LCOE. This model is a detailed, discounted cash flow model used to represent the various cost structures in each of the participating countries from the perspective of a financial investor in a domestic wind energy project. This model is used for the present analysis as well, and comparisons are made for those countries who contributed to both reports, Denmark, Germany, and the United States.

  5. An economic model demonstrating the long-term cost benefits of incorporating fertility control into wild horse (Equus caballus) management programs on public lands in the United States.

    PubMed

    de Seve, Charles W; Griffin, Stephanie L Boyles

    2013-12-01

    In recent years, the Bureau of Land Management's (BLM) Wild Horse and Burro Management program costs have increased dramatically due to a rise in the number of animals removed from public lands coupled with significantly decreased adoption rates. To assist with development and implementation of effective, cost-containing management programs, a robust economic model to project the costs and optimize outcomes of various management scenarios was created. For example, preliminary demonstration model runs show that by gradually replacing "removal-only" programs with contraception-and-removal programs on one hypothetical Herd Management Area (HMA), the BLM could save about US$8 million over 12 years while maintaining an area target population of 874 horses. Because the BLM estimates that more than 38,000 wild horses roam on 179 HMAs in the United States, the use of this economic model could result in a cost-savings of tens of millions of dollars if applied broadly across all HMAs.

  6. Using lysimeters to test the Penman Monteith actual evapotranspiration.

    NASA Astrophysics Data System (ADS)

    Ben Asher, Jiftah; Volinski, Roman; Zilberman, Arkadi; Bar Yosef, Beni; Silber, Avner

    2015-04-01

    Differences in actual transpiration (ETa) of banana plants were quantified in a lysimeter experiment. ETA was computed using instantaneous data from two weighing lysimeters and compared to PM (Penman-Monteith) model for ETa. Two critical problems were faced in this test. A) Estimating canopy and aerodynamic resistances ("rc" and "ra" respectively ) and B) converting the lysimeter changes in water volume ( LYv cm3 ) to ETa length units ( cm ). The two unknowns " rc" and "ra" were obtained from continuous measurements of the differences between canopy and air temperature (Tc - Ta). This difference was established by means of the infrared thermometry which was followed by numerical and analytical calculation of ETa using the modification suggested by R. Jackson to the PM model. The conversion of lysimeter volumetric units (LYv) to ETa length units was derived from the slope of cumulative LYv/ETa. This relationship was significantly linear (r2=0.97and 0.98.). Its slope was interpreted as "evaporating leaf area" which accounted for 1.8E4 cm2 in lysimeter 1 and 2.3E4 cm2.in lysimeter 2 . The comparison between LYv and PM model was acceptable even under very low ETa. The average of two lysimeters was 1.1mm/day (1.4 mm/day , LYv 1 and 0.8 LYv 2) while ETa calculated on the basis of PM model was 1.2 mm/day. It was concluded that although lysimeters are most accurate systems to measure ETa one of its disadvantages ( beside the high cost) is the volumetric output that in many cases should be supported by a one dimensional energy balance system. The PM model was found to be a reliable complementary tool to convert lysimeters volumetric output into conventional length units of ETa.

  7. Light-rail-transit capital-cost study

    SciTech Connect

    Schneck, D.C.; Amodei, R.M.; Ferreri, M.G.

    1991-04-05

    The Fixed Guideway Capital Cost Study is an attempt to develop a capital cost data base of actual unit costs to construct and procure the various assets necessary to operate mass transit busway and rail systems. The report documents the initial effort at the overall objective by concentrating on the light rail mode of passenger rail systems. The term light rail refers more to the mode's relative simplicity and operational flexibility rather than actual vehicle weight or cost. With an overhead power supply source, light rail systems can operate in mixed traffic and various alignment configurations. Service can be operated in single or multi-unit trains of standards and articulated vehicle fleets that permit close service level design in line with passenger demand. Seven light rail systems that were developed over the past ten years, were the focus of the project. However, only five of the system operating agencies responded with pertinent capital cost information that formed the basis of the study.

  8. Cost-Benefit Analysis of Nanoparticle Albumin-Bound Paclitaxel versus Solvent-Based Paclitaxel for the Treatment of Metastatic Breast Cancer in the United States

    NASA Astrophysics Data System (ADS)

    Vichansavakul, Kittaya

    had some limitations because they were conducted from a narrow perspective such as payer and provider point of views. The studies also considered only direct costs in their analysis. In fact, conducting economic evaluations from a narrow perspective and leaving out indirect costs might undermine the true benefit of the interventions for society. A cost-benefit analysis measures all costs and benefits in monetary units. It incorporates both health outcomes gained from individuals and the value gained to society in order to maximize the usage of resources effectively. This thesis conducted a cost-benefit analysis to compare nab-paclitaxel and generic paclitaxel in treating metastatic breast cancer from a societal perspective in the United States. The results showed that nab-paclitaxel is a cost-benefit strategy regardless of the different costs and benefits due to the extra 3 years of living it provides. In all models, when nab-paclitaxel was compared to generic paclitaxel, nab-paclitaxel showed cost-benefit to society. However, the results of generic paclitaxel were dependent on the total medical costs. Performing a cost-benefit analysis of nab-paclitaxel from a societal perspective is important to understand the true benefit of interventions. Furthermore, considering both direct and indirect costs, as well as benefits, of this drug is vital because the economic profile of nab-paclitaxel would be improved.

  9. NREL Analysis: Cost-Effective and Reliable Integration of High-Penetration Solar in the Western United States (Poster)

    SciTech Connect

    Lew, D.; Brinkman, G.; Ibanez, E.; Hodge, B.; Lefton, S.; Kumar, N.; Agan, D.; Jordan, G.; Venkatataman, S.

    2012-07-01

    SunShot Initiative awardee posters describing the different technologies within the four subprograms of the DOE Solar Program (Photovoltaics, Concentrating Solar Power, Soft Costs, and Systems Integration).

  10. Linguistic Theory and Actual Language.

    ERIC Educational Resources Information Center

    Segerdahl, Par

    1995-01-01

    Examines Noam Chomsky's (1957) discussion of "grammaticalness" and the role of linguistics in the "correct" way of speaking and writing. It is argued that the concern of linguistics with the tools of grammar has resulted in confusion, with the tools becoming mixed up with the actual language, thereby becoming the central element in a metaphysical…

  11. El Observatorio Gemini - Status actual

    NASA Astrophysics Data System (ADS)

    Levato, H.

    Se hace una breve descripción de la situación actual del Observatorio Gemini y de las últimas decisiones del Board para incrementar la eficiencia operativa. Se hace también una breve referencia al uso argentino del observatorio.

  12. A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States

    PubMed Central

    Walker, Brandon S.; Nelson, Richard E.; Jackson, Brian R.; Grenache, David G.; Ashwood, Edward R.; Schmidt, Robert L.

    2015-01-01

    Background Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS. Study Design Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer. Results From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective. Conclusions From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS. PMID:26133556

  13. Child Care: How Do Military and Civilian Center Costs Compare? United States General Accounting Office Report to Congressional Requesters.

    ERIC Educational Resources Information Center

    Fagnoni, Cynthia M.

    The Department of Defense's (DOD) child development program has been identified as a model for the rest of the nation. To provide a benchmark cost estimate for Congress as it addresses child care issues, this report identifies the objectives of the military child development program, describes its operation, determines the full costs of DOD…

  14. The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

    ERIC Educational Resources Information Center

    Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

    2011-01-01

    The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

  15. Cost-Effectiveness of Home Energy Retrofits in Pre-Code Vintage Homes in the United States

    SciTech Connect

    Fairey, P.; Parker, D.

    2012-11-01

    This analytical study examines the opportunities for cost-effective energy efficiency and renewable energy retrofits in residential archetypes constructed prior to 1980 (Pre-Code) in fourteen U.S. cities. These fourteen cities are representative of each of the International Energy Conservation Code (IECC) climate zones in the contiguous U.S. The analysis is conducted using an in-house version of EnergyGauge USA v.2.8.05 named CostOpt that has been programmed to perform iterative, incremental economic optimization on a large list of residential energy efficiency and renewable energy retrofit measures. The principle objectives of the study are as follows: to determine the opportunities for cost effective source energy reductions in this large cohort of existing residential building stock as a function of local climate and energy costs; and to examine how retrofit financing alternatives impact the source energy reductions that are cost effectively achievable.

  16. Lifetime medical costs of knee osteoarthritis management in the United States: Impact of extending indications for total knee arthroplasty

    PubMed Central

    Losina, Elena; Paltiel, A. David; Weinstein, Alexander M.; Yelin, Edward; Hunter, David J.; Chen, Stephanie P.; Klara, Kristina; Suter, Lisa G.; Solomon, Daniel H.; Burbine, Sara A.; Walensky, Rochelle P.; Katz, Jeffrey N.

    2015-01-01

    Objective The impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee OA is under-studied. Methods We used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Utilization Project (HCUP) data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 USD were derived from Medicare reimbursement schedules and Red Book Online®. Time costs were derived from published literature and the US Bureau of Labor Statistics. Results Estimated average discounted (3%/year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent, on average, 13 (SD 10) years waiting for TKA after failing non-surgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to K-L 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage. Conclusion Due to low efficacy of non-surgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for a population, underscoring the need for more effective non-operative therapies. PMID:25048053

  17. HIV Screening via Fourth-Generation Immunoassay or Nucleic Acid Amplification Test in the United States: A Cost-Effectiveness Analysis

    PubMed Central

    Long, Elisa F.

    2011-01-01

    Background At least 10% of the 56,000 annual new HIV infections in the United States are caused by individuals with acute HIV infection (AHI). It unknown whether the health benefits and costs of routine nucleic acid amplification testing (NAAT) are justified, given the availability of newer fourth-generation immunoassay tests. Methods Using a dynamic HIV transmission model instantiated with U.S. epidemiologic, demographic, and behavioral data, I estimated the number of acute infections identified, HIV infections prevented, quality-adjusted life years (QALYs) gained, and the cost-effectiveness of alternative screening strategies. I varied the target population (everyone aged 15-64, injection drug users [IDUs] and men who have sex with men [MSM], or MSM only), screening frequency (annually, or every six months), and test(s) utilized (fourth-generation immunoassay only, or immunoassay followed by pooled NAAT). Results Annual immunoassay testing of MSM reduces incidence by 9.5% and costs <$10,000 per QALY gained. Adding pooled NAAT identifies 410 AHI per year, prevents 9.6% of new cases, costs $92,000 per QALY gained, and remains <$100,000 per QALY gained in settings where undiagnosed HIV prevalence exceeds 4%. Screening IDUs and MSM annually with fourth-generation immunoassay reduces incidence by 13% with cost-effectiveness <$10,000 per QALY gained. Increasing the screening frequency to every six months reduces incidence by 11% (MSM only) or 16% (MSM and IDUs) and costs <$20,000 per QALY gained. Conclusions Pooled NAAT testing every 12 months of MSM and IDUs in the United States prevents a modest number of infections, but may be cost-effective given sufficiently high HIV prevalence levels. However, testing via fourth-generation immunoassay every six months prevents a greater number of infections, is more economically efficient, and may obviate the benefits of acute HIV screening via NAAT. PMID:22110698

  18. 19 CFR 351.407 - Calculation of constructed value and cost of production.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... actual production experience of the merchandise in question, measuring production on the basis of units... production costs to be items such as depreciation of equipment and plant, labor costs, insurance, rent and... production. 351.407 Section 351.407 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF...

  19. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... systems, pro rata share of dismantling costs, and improvements included, but not required, in the... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge...

  20. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... systems, pro rata share of dismantling costs, and improvements included, but not required, in the... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge...

  1. 33 CFR 116.50 - Apportionment of costs under the Truman-Hobbs Act.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... traffic, and actual capital costs of the used service life. The United States will bear the balance of the... systems, pro rata share of dismantling costs, and improvements included, but not required, in the... service life of old bridge ____ $____ Subtotal ____ $____ Share to be borne by the bridge...

  2. Impacts assessment and trade-offs of fuel cell-based auxiliary power units. Part I: System performance and cost modeling

    NASA Astrophysics Data System (ADS)

    Baratto, Francesco; Diwekar, Urmila M.; Manca, Davide

    Auxiliary power units (APUs) are devices that can provide all or part of the non-propulsion power of a vehicle. They do not replace the main internal combustion engine, but they complement it offering low consumption, high comfort and low emissions during the idling periods of the vehicle. This work presents an integrated framework to evaluate the trade-offs between cost effectiveness, efficiency and health and environmental impacts of fuel cell power systems considering various stages of the life cycle of the device. The integrated framework has six main components, namely system level modeling, cost modeling, environmental impact assessment, health impact assessment, life cycle assessment and multi-objective optimization. In part I of these two papers, concerning the integrated framework, the first two components are described and applied to a solid oxide fuel cell-based auxiliary power unit. All the results are validated with experimental data or other published models.

  3. 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

  4. Low cost solar array project: Experimental process system development unit for producing semiconductor-grade silicon using silane-to-silicon process

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The design, fabrication, and installation of an experimental process system development unit (EPSDU) were analyzed. Supporting research and development were performed to provide an information data base usable for the EPSDU and for technological design and economical analysis for potential scale-up of the process. Iterative economic analyses were conducted for the estimated product cost for the production of semiconductor grade silicon in a facility capable of producing 1000-MT/Yr.

  5. Exposure to websites that encourage self-harm and suicide: prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States.

    PubMed

    Mitchell, Kimberly J; Wells, Melissa; Priebe, Gisela; Ybarra, Michele L

    2014-12-01

    This article provides 12-month prevalence rates of youth exposure to websites which encourage self-harm or suicide and examines whether such exposure is related to thoughts of self-harm and thoughts of suicide in the past 30 days. Data were collected via telephone from a nationally representative survey of 1560 Internet-using youth, ages 10-17 residing in the United States. One percent (95% CI: 0.5%, 1.5%) of youth reported visiting a website that encouraged self-harm or suicide. Youth who visited such websites were seven times more likely to say they had thought about killing themselves; and 11 times more likely to think about hurting themselves, even after adjusting for several known risk factors for thoughts of self-harm and thoughts of suicide. Given that youth thinking about self-harm and suicide are more likely to visit these sites, they may represent an opportunity for identification of youth in need of crisis intervention.

  6. [Cost analysis of twenty-nine nuclear medicine procedures].

    PubMed

    Kastanioti, Catherine K; Alphalbouharali, Gihand; Fotopoulos, Andreas

    2004-01-01

    The aim of this study was to compare actual cost estimates for diagnostic procedures as applied in the nuclear medicine department of our University Hospital, with cost estimates obtained through an analytical activity-based costing methodology. Activity data on the use of twenty-nine nuclear medicine procedures were collected. The actual hospital prices for the fiscal years of 2003-2004 were obtained from the Accounting Department of the Hospital. Cost estimates were calculated per patient. Activity-based data were compared with hospital prices and also with unit costs from the activity-based costing methodology. Our results showed a significant statistical difference between unit cost estimates per patient based on hospital prices, as compared with those based on unit costs. This study shows that in our university hospital, reliance on generic hospital prices for nuclear medicine procedures, considerable underestimates their real cost by a mean value of 40% as derived through the activity-based costing methodology and can lead to substantial financial hospital deficits.

  7. Generalisability and Cost-Impact of Antibiotic-Impregnated Central Venous Catheters for Reducing Risk of Bloodstream Infection in Paediatric Intensive Care Units in England

    PubMed Central

    Harron, Katie; Mok, Quen; Hughes, Dyfrig; Muller-Pebody, Berit; Parslow, Roger; Ramnarayan, Padmanabhan; Gilbert, Ruth

    2016-01-01

    Background We determined the generalisability and cost-impact of adopting antibiotic-impregnated CVCs in all paediatric intensive care units (PICUs) in England, based on results from a large randomised controlled trial (the CATCH trial; ISRCTN34884569). Methods BSI rates using standard CVCs were estimated through linkage of national PICU audit data (PICANet) with laboratory surveillance data. We estimated the number of BSI averted if PICUs switched from standard to antibiotic-impregnated CVCs by applying the CATCH trial rate-ratio (0.40; 95% CI 0.17,0.97) to the BSI rate using standard CVCs. The value of healthcare resources made available by averting one BSI as estimated from the trial economic analysis was £10,975; 95% CI -£2,801,£24,751. Results The BSI rate using standard CVCs was 4.58 (95% CI 4.42,4.74) per 1000 CVC-days in 2012. Applying the rate-ratio gave 232 BSI averted using antibiotic CVCs. The additional cost of purchasing antibiotic-impregnated compared with standard CVCs was £36 for each child, corresponding to additional costs of £317,916 for an estimated 8831 CVCs required in PICUs in 2012. Based on 2012 BSI rates, management of BSI in PICUs cost £2.5 million annually (95% uncertainty interval: -£160,986, £5,603,005). The additional cost of antibiotic CVCs would be less than the value of resources associated with managing BSI in PICUs with standard BSI rates >1.2 per 1000 CVC-days. Conclusions The cost of introducing antibiotic-impregnated CVCs is less than the cost associated with managing BSIs occurring with standard CVCs. The long-term benefits of preventing BSI could mean that antibiotic CVCs are cost-effective even in PICUs with extremely low BSI rates. PMID:26999045

  8. Factory Cost Model

    SciTech Connect

    Bomber, Tom

    1996-12-17

    The Factory Cost Model (FCM) is an economic analysis tool intended to provide flat panel display (FPD) and other similar discrete component manufacturers with the ability to make first-order estimates of the cost of unit production. This software has several intended uses. Primary among these is the ability to provide first-order economic analysis for future factories. Consequently, the model requires a minimal level of input detail, and accomodates situations where actual production data are not available. This software is designed to be activity based such that most of the calculated direct costs are associated with the steps of a manufacturibg process. The FCM architecture has the ability to accomodate the analysis of existing manufacturing facilities. The FCM can provide assistance with strategic economic decisions surrounding production related matters. For instance, the program can project the effect on costs and resources of a new product''s introduction, or it can assess the potential cost reduction produced by step yield improvements in the manufacturing process.

  9. Factory Cost Model

    1996-12-17

    The Factory Cost Model (FCM) is an economic analysis tool intended to provide flat panel display (FPD) and other similar discrete component manufacturers with the ability to make first-order estimates of the cost of unit production. This software has several intended uses. Primary among these is the ability to provide first-order economic analysis for future factories. Consequently, the model requires a minimal level of input detail, and accomodates situations where actual production data are notmore » available. This software is designed to be activity based such that most of the calculated direct costs are associated with the steps of a manufacturibg process. The FCM architecture has the ability to accomodate the analysis of existing manufacturing facilities. The FCM can provide assistance with strategic economic decisions surrounding production related matters. For instance, the program can project the effect on costs and resources of a new product''s introduction, or it can assess the potential cost reduction produced by step yield improvements in the manufacturing process.« less

  10. Medicaid program; cost limit for providers operated by units of government and provisions to ensure the integrity of federal-state financial partnership. Final rule with comment period.

    PubMed

    2007-05-29

    This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government.

  11. Economic savings versus health losses: The cost-effectiveness of generic antiretroviral therapy in the United States

    PubMed Central

    Walensky, Rochelle P.; Sax, Paul E.; Nakamura, Yoriko M.; Weinstein, Milton C.; Pei, Pamela P.; Freedberg, Kenneth A.; Paltiel, A. David; Schackman, Bruce R.

    2013-01-01

    Background US HIV treatment guidelines recommend branded once-daily, one-pill efavirenz/emtricitabine/tenofovir as preferred first-line antiretroviral treatment (ART). With the anticipated approval of generic efavirenz in 2012 in the US, the cost of a once-daily, three-pill alternative (generic efavirenz, generic lamivudine, tenofovir) will decrease, but adherence and virologic suppression may be reduced. Objectives To assess the clinical impact, costs, and cost-effectiveness of the generic-based three-pill regimen compared to the branded, co-formulated regimen. To project the potential national savings in the first year of a switch to generic-based ART. Design Mathematical simulation of HIV disease. Data Sources Published data from US clinical trials and observational cohorts. Target Population HIV-infected patients eligible to start on or switch to an efavirenz-based generic ART regimen. Time Horizon Lifetime, One-year Perspective US health system Interventions No ART (for comparison), Three-pill Generic ART, and Branded ART Outcome Measures Quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICER, $/quality-adjusted life expectancy [QALY]). Results of Base-Case Analysis Compared to No ART, Generic ART has an ICER of $21,100/QALY. Compared to Generic ART, Branded ART increases lifetime costs by $42,500, and per-person survival gains by 0.37 QALYs, for an ICER of $114,800/QALY. Estimated first-year savings, if all eligible US patients start on or switch to Generic ART, are $920 million. Results of Sensitivity Analysis Most plausible assumptions about Generic ART efficacy and costs lead to Branded ART ICERs >$100,000/QALY. Limitations The efficacy and price reduction associated with generics are unknown; estimates are intended to be conservative. Conclusions Compared to a slightly less effective generic-based regimen, the cost-effectiveness of first-line Branded ART exceeds $100,000/QALY. Generic-based ART in the US could yield

  12. Pro/Con debate: Are barrier precautions cost-effective in improving patient outcomes in the intensive care unit?

    PubMed Central

    2012-01-01

    You are responsible for a large medical surgical ICU. Your hospital administration has been very focused on reducing rates of hospital-acquired infections particularly in the wake of increasing public attention. However, it is time for budget preparation and your financial officer is concerned about the escalating costs associated with patient isolation and barrier precautions/personal protective equipment. Having become aware of the high costs associated with these interventions, you start to wonder about the wisdom of spending so much in this area. Your hospital administration wants your direction on next year's expenditures. You are debating whether the expense is worthwhile and advise your hospital administration accordingly. PMID:22264293

  13. United States biomass energy: An assessment of costs and infrastructure for alternative uses of biomass energy crops as an energy feedstock

    NASA Astrophysics Data System (ADS)

    Morrow, William Russell, III

    Reduction of the negative environmental and human health externalities resulting from both the electricity and transportation sectors can be achieved through technologies such as clean coal, natural gas, nuclear, hydro, wind, and solar photovoltaic technologies for electricity; reformulated gasoline and other fossil fuels, hydrogen, and electrical options for transportation. Negative externalities can also be reduced through demand reductions and efficiency improvements in both sectors. However, most of these options come with cost increases for two primary reasons: (1) most environmental and human health consequences have historically been excluded from energy prices; (2) fossil energy markets have been optimizing costs for over 100 years and thus have achieved dramatic cost savings over time. Comparing the benefits and costs of alternatives requires understanding of the tradeoffs associated with competing technology and lifestyle choices. As bioenergy is proposed as a large-scale feedstock within the United States, a question of "best use" of bioenergy becomes important. Bioenergy advocates propose its use as an alternative energy resource for electricity generation and transportation fuel production, primarily focusing on ethanol. These advocates argue that bioenergy offers environmental and economic benefits over current fossil energy use in each of these two sectors as well as in the U.S. agriculture sector. Unfortunately, bioenergy research has offered very few comparisons of these two alternative uses. This thesis helps fill this gap. This thesis compares the economics of bioenergy utilization by a method for estimating total financial costs for each proposed bioenergy use. Locations for potential feedstocks and bio-processing facilities (co-firing switchgrass and coal in existing coal fired power plants and new ethanol refineries) are estimated and linear programs are developed to estimate large-scale transportation infrastructure costs for each sector

  14. How much does care in palliative care wards cost in Poland?

    PubMed Central

    Pokropska, Wieslawa; Łuczak, Jacek; Kaptacz, Anna; Stachowiak, Andrzej; Hurich, Krystyna; Koszela, Monika

    2016-01-01

    Introduction The main task of palliative care units is to provide a dignified life for people with advanced progressive chronic disease through appropriate symptom management, communication between medical specialists and the patient and his family, as well as the coordination of care. Many palliative care units struggle with low incomes from the National Health Fund (NHF), which causes serious economic problems. The aim of the study was to estimate of direct and administrative costs of care and the actual cost per patient per day in selected palliative care units and comparison of the results to the valuation of the NHF. Material and methods The study of the costs of hospitalization of 175 patients was conducted prospectively in five palliative care units (PCUs). The costs directly associated with care were recorded on the specially prepared forms in each unit and also personnel and administrative costs provided by the accounting departments. Results The total costs of analyzed units amounted to 209 002 EUR (898 712 PLN), while the payment for palliative care services from the NHF amounted to 126 010 EUR (541 844 PLN), which accounted for only 60% of the costs incurred by the units. The average cost per person per day of hospitalization, calculated according to the actual duration of hospitalization in the unit, was 83 EUR (357 PLN), and the average payment from the NHF was 52.8 EUR (227 PLN). Underpayment per person per day was approximately 29.2 EUR (125 PLN). Conclusions The study showed a significant difference between the actual cost of palliative care units and the level of refund from the NHF. Based on the analysis of costs, the application has been submitted to the NHF to change the reimbursement amount of palliative care services in 2013. PMID:27186194

  15. Catastrophic Health Care Costs. Hearing before the Special Committee on Aging. United States Senate, One Hundredth Congress, First Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Special Committee on Aging.

    This document provides witnesses' testimonies and prepared statements from the Senate hearing called to examine the problems of catastrophic health care costs. Statements are included from Senators John Melcher, Quentin Burdick, Larry Pressler, John Heinz, and Pete Wilson. Prepared statements are included from Senators David Pryor and Charles…

  16. Budget Control Procedures and Methods for Evaluating the Unit Costs of Activities and Outputs of Higher Educational Institutions. Interim Report.

    ERIC Educational Resources Information Center

    Phase 2 Bulletin, 1974

    1974-01-01

    In 1972, a group of French universities began a joint project under the aegis of the Centre for Educational Research and Innovation. Common concerns of the universities - specifically, the rising cost of education, the need for assessing effectiveness and efficiency of programs, and a 1968 law giving increased autonomy to French universities - led…

  17. A Cost-Effectiveness Analysis of Individual Learning Units in a Junior High School Basic Mathematics Program.

    ERIC Educational Resources Information Center

    LaPlaca, Nicholas Anthony

    This study compares the cost-effectiveness of an individualized basic mathematics program with a traditional program at the junior high school level. Eighth-grade basic mathematics students (N=118) were identified in two schools. The racial and ethnic makeup, socioeconomic level of residents and school size differed between schools. Teachers were…

  18. Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion.

    PubMed

    Roehrig, Charles

    2016-06-01

    Estimates of annual health spending for a comprehensive set of medical conditions are presented for the entire US population and with totals benchmarked to the National Health Expenditure Accounts. In 2013 mental disorders topped the list of most costly conditions, with spending at $201 billion. PMID:27193027

  19. Food Assistance: Financial Information on WIC Nutrition Services and Administrative Costs. United States General Accounting Office Report to Congressional Committees.

    ERIC Educational Resources Information Center

    Robertson, Robert E.

    The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded nutrition assistance program administered by the Department of Agriculture's (USDA) Food and Nutrition Service (FNS). Responding to Congressional requests for information regarding program costs, this report provides information on: (1) funding…

  20. Cost-Effectiveness of LDL-C Lowering With Evolocumab in Patients With High Cardiovascular Risk in the United States.

    PubMed

    Gandra, Shravanthi R; Villa, Guillermo; Fonarow, Gregg C; Lothgren, Mickael; Lindgren, Peter; Somaratne, Ransi; van Hout, Ben

    2016-06-01

    Randomized trials have shown marked reductions in low-density lipoprotein cholesterol (LDL-C), a risk factor for cardiovascular disease (CVD), when evolocumab is administered. We hypothesized that evolocumab added to standard of care (SOC) vs SOC alone is cost-effective in the treatment of patients with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic CVD (ASCVD) with or without statin intolerance and LDL-C >100 mg/dL. Using a Markov cohort state transition model, primary and recurrent CVD event rates were predicted considering population-specific trial-based mean risk factors and calibrated against observed rates in the real world. The LDL-C-lowering effect from population-specific phase 3 randomized studies for evolocumab was used together with estimated LDL-C-lowering effect on CVD event rates per 38.67-mg/dL LDL-C lowering from a statin-trial meta-analysis. Costs and utilities were included from published sources. Evolocumab treatment was associated with both increased cost and improved quality-adjusted life-years (QALY): HeFH (incremental cost: US$153 289, incremental QALY: 2.02, incremental cost-effectiveness ratio: US$75 863/QALY); ASCVD (US$158 307, 1.12, US$141 699/QALY); and ASCVD with statin intolerance (US$136 903, 1.36, US$100 309/QALY). Evolocumab met both the American College of Cardiology/American Heart Association (ACC/AHA) and World Health Organization (WHO) thresholds in each population evaluated. Sensitivity and scenario analyses confirmed that model results were robust to changes in model parameters. Among patients with HeFH and ASCVD with or without statin intolerance, evolocumab added to SOC may provide a cost-effective treatment option for lowering LDL-C using ACC/AHA intermediate/high value and WHO cost-effectiveness thresholds. More definitive information on the clinical and economic value of evolocumab will be available from the forthcoming CVD outcomes study.

  1. Estimated Lifetime Medical and Work-Loss Costs of Emergency Department-Treated Nonfatal Injuries--United States, 2013.

    PubMed

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

    2015-10-01

    A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies.

  2. Increased Mechanical Cost of Walking in Children with Diplegia: The Role of the Passenger Unit Cannot Be Neglected

    ERIC Educational Resources Information Center

    Van de Walle, P.; Hallemans, A.; Truijen, S.; Gosselink, R.; Heyrman, L.; Molenaers, G.; Desloovere, K.

    2012-01-01

    Gait efficiency in children with cerebral palsy is decreased. To date, most research did not include the upper body as a separate functional unit when exploring these changes in gait efficiency. Since children with spastic diplegia often experience problems with trunk control, they could benefit from separate evaluation of the so-called "passenger…

  3. The Japanese Labor Market in a Comparative Perspective with the United States. A Transaction-Cost Interpretation.

    ERIC Educational Resources Information Center

    Hashimoto, Masanori

    A comparison is made of some of the notable features of the Japanese and U.S. labor markets. In Japan, as compared to the United States, for example, levels of employment tenure are higher, employer-employee attachment stronger, earnings-tenure profiles more steeply sloped, layoffs and dismissals much less frequent, and joint consultation and…

  4. A Bicultural Analysis of the Cost of Caring: Nursing Burnout in the United States and the Philippines.

    ERIC Educational Resources Information Center

    Turnipseed, David L.; Turnipseed, Patricia H.

    1997-01-01

    Questionnaires completed by 129 U.S. nurses and 71 from the Philippines revealed higher levels of emotional exhaustion and feelings of personal accomplishment in the United States. The Filipino work environment was rated higher for supervisor support, autonomy, control, and innovation. U.S. nurses reported greater work pressure. (SK)

  5. 42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the inpatient population the hospital planned to treat during that cost reporting period, if the inpatient population actually treated in the hospital during that cost reporting period did not meet the... under § 412.29(c) regarding the inpatient population the hospital planned to treat in that unit...

  6. Impact of Age and Sex on Outcomes and Hospital Cost of Acute Asthma in the United States, 2011-2012

    PubMed Central

    Teague, W. Gerald; Koroukian, Siran M.; Schlitz, Nicholas K.; Bleecker, Eugene R.; Busse, William B.; Calhoun, William J.; Castro, Mario; Comhair, Suzy A.; Fitzpatrick, Anne M.; Israel, Elliot; Wenzel, Sally E.; Holguin, Fernando; Gaston, Benjamin M.

    2016-01-01

    Background Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure. Methods We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002–2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition. Results Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women. Conclusions Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma. PMID:27294365

  7. Characteristics and costs of multidrug-resistant tuberculosis in-patient care in the United States, 2005–2007

    PubMed Central

    Marks, S. M.; Hirsch-Moverman, Y.; Salcedo, K.; Graviss, E. A.; Oh, P.; Seaworth, B.; Flood, J.; Armstrong, L.; Armitige, L.; Mase, S.

    2016-01-01

    SUMMARY OBJECTIVE A population-based study of 135 multidrug-resistant tuberculosis (MDR-TB) patients reported to the Centers for Disease Control and Prevention (CDC) during 2005–2007 found 73% were hospitalized. We analyzed factors associated with hospitalization. METHODS We assessed statistically significant multivariable associations with US in-patient TB diagnosis, frequency of hospitalization, length of hospital stay, and in-patient direct costs to the health care system. RESULTS Of 98 hospitalized patients, 83 (85%) were foreign-born. Blacks, diabetics, or smokers were more likely, and patients with disseminated disease less likely, to receive their TB diagnosis while hospitalized. Patients aged ⩾65 years, those with the acquired immune-deficiency syndrome (AIDS), or with private insurance, were hospitalized more frequently. Excluding deaths, length of stay was greater for patients aged ⩾65 years, those with extensively drug-resistant TB (XDR-TB), those residing in Texas, those with AIDS, those who were unemployed, or those who had TB resistant to all first-line medications vs. others. Average hospitalization cost per XDR-TB patient (US$285 000) was 3.5 times that per MDR-TB patient (US$81 000), in 2010 dollars. Hospitalization episode costs for MDR-TB rank third highest and those for XDR-TB highest among the principal diagnoses. CONCLUSIONS Hospitalization was common and remains a critical care component for patients who were older, had comorbidities, or required complex management due to XDR-TB. MDR-TB in-patient costs are among the highest for any disease. PMID:26970150

  8. Role of lignin in reducing life-cycle carbon emissions, water use, and cost for United States cellulosic biofuels.

    PubMed

    Scown, Corinne D; Gokhale, Amit A; Willems, Paul A; Horvath, Arpad; McKone, Thomas E

    2014-01-01

    Cellulosic ethanol can achieve estimated greenhouse gas (GHG) emission reductions greater than 80% relative to gasoline, largely as a result of the combustion of lignin for process heat and electricity in biorefineries. Most studies assume lignin is combusted onsite, but exporting lignin to be cofired at coal power plants has the potential to substantially reduce biorefinery capital costs. We assess the life-cycle GHG emissions, water use, and capital costs associated with four representative biorefinery test cases. Each case is evaluated in the context of a U.S. national scenario in which corn stover, wheat straw, and Miscanthus are converted to 1.4 EJ (60 billion liters) of ethanol annually. Life-cycle GHG emissions range from 4.7 to 61 g CO2e/MJ of ethanol (compared with ∼ 95 g CO2e/MJ of gasoline), depending on biorefinery configurations and marginal electricity sources. Exporting lignin can achieve GHG emission reductions comparable to onsite combustion in some cases, reduce life-cycle water consumption by up to 40%, and reduce combined heat and power-related capital costs by up to 63%. However, nearly 50% of current U.S. coal-fired power generating capacity is expected to be retired by 2050, which will limit the capacity for lignin cofiring and may double transportation distances between biorefineries and coal power plants.

  9. Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States

    PubMed Central

    Padula, William V.; Larson, Richard A.; Dusetzina, Stacie B.; Apperley, Jane F.; Hehlmann, Rudiger; Baccarani, Michele; Eigendorff, Ekkehard; Guilhot, Joelle; Guilhot, Francois; Hehlmann, Rudiger; Mahon, Francois-Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C.; Niederwieser, Dietger; Saussele, Susanne; Schiffer, Charles A.; Silver, Richard T.; Simonsson, Bengt

    2016-01-01

    Background: We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib’s price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness (“imatinib-first”) would be cost-effective compared with the current standard of care: “physicians’ choice” of initiating treatment with any one of the three TKIs. Methods: We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician’s choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models’ clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven’s MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study’s conduct. Results: Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician’s choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. Conclusion: When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP. PMID:26944912

  10. Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States

    PubMed Central

    Younossi, Zobair M.; Park, Haesuk; Dieterich, Douglas; Saab, Sammy; Ahmed, Aijaz; Gordon, Stuart C.

    2016-01-01

    Abstract Background: New direct-acting antiviral (DAA) therapy has dramatically increased cure rates for patients infected with hepatitis C virus (HCV), but has also substantially raised treatment costs. Aim: The aim of this analysis was to evaluate the therapeutic benefit and net costs (i.e. efficiency frontier) and the quality-adjusted cost of care associated with the evolution of treatment regimens for patients with HCV genotype 1 in the United States. Design: A decision-analytic Markov model. Data source: Published literature and clinical trial data. Time horizon: Life Time. Perspective: Third-party payer. Intervention: This study compared four approved regimens in treatment-naïve genotype 1 chronic hepatitis C patients, including pegylated interferon and ribavirin (PR), first generation triple therapy (boceprevir + PR and telaprevir + PR), second generation triple therapy (sofosbuvir + PR and simeprevir + PR) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir + paritaprevir/ritonavir + dasabuvir ± ribavirin). Outcome measure: Quality-adjusted cost of care (QACC). QACC was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY. Results: All-oral therapy improved the average sustained virologic response (SVR) rate to 96%, thereby offsetting the high drug acquisition cost of $85,714, which resulted in the highest benefit based on the efficiency frontier. Furthermore, while oral therapies increased HCV drug costs by $48,350, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy. When the value of a QALY was varied from $100,000 to $300,000, the quality adjusted cost of care compared to dual therapy ranged from − $21,234 to − $107,861, − $89,007 to − $293,130, − $176,280 to − $500,599 for first generation triple, second generation triple, and all-oral therapies

  11. Report to the United States Congress on radionuclides in drinking water: Multimedia risk and cost assessment of radon in drinking water. Draft report

    SciTech Connect

    Not Available

    1993-07-15

    EPA prepared the report in response to the Congressional mandate in Public Law 102-389 (the Chafee-Lautenberg Amendment to EPA's Appropriation Bill, enacted October 6, 1992) which directs the Administrator of the US Environmental Protection Agency (EPA) to report to Congress on EPA's findings regarding the risks of human exposure to radon, the costs for controlling or mitigating that exposure, and the risks posed by treating water to remove radon. The Chafee-Lautenberg Amendment called for an explicit multimedia comparison of the risks from radon in indoor air and drinking water. Congress placed the requirement on the Agency because of the concern voiced in the United States over the costs to be incurred by public water systems in the control of radon in drinking water while a larger threat from indoor air was not being addressed except through voluntary measures. Amendments to the Safe Drinking Water Act in 1986 called for the regulation of radon in drinking water.

  12. A value-based, no-cost-to-patient health model in the developing world: Critical appraisal of a unique patient-centric neurosurgery unit

    PubMed Central

    Thakar, Sumit; Dadlani, Ravi; Sivaraju, Laxminadh; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Rajarathnam, Ravikiran; Shyam, Maya; Sadanand, Venkatraman; Hegde, Alangar S.

    2015-01-01

    Background: It is well-accepted that the current healthcare scenario worldwide is due for a radical change, given that it is fraught with mounting costs and varying quality. Various modifications in health policies have been instituted toward this end. An alternative model, the low-cost, value-based health model, focuses on maximizing value for patients by moving away from a physician-centered, supply-driven system to a patient-centered system. Methods: The authors discuss the successful inception, functioning, sustainability, and replicability of a novel health model in neurosurgery built and sustained by inspired humanitarianism and that provides all treatment at no cost to the patients irrespective of their socioeconomic strata, color or creed. Results: The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) at Whitefield, Bengaluru, India, a private charitable hospital established in 2001, functions on the ideals of providing free state-of-the-art healthcare to all in a compassionate and holistic manner. With modern equipment and respectable outcome benchmarks, its neurosurgery unit has operated on around 18,000 patients since its inception, and as such, has contributed INR 5310 million (USD 88.5 million) to society from an economic standpoint. Conclusions: The inception and sustainability of the SSSIHMS model are based on self-perpetuating philanthropy, a cost-conscious culture and the dissemination of human values. Replicated worldwide, at least in the developing nations, this unique healthcare model may well change the face of healthcare economics. PMID:26322241

  13. Utility-Scale Solar 2013: An empirical analysis of project cost, performance, and pricing trends in the United States

    SciTech Connect

    Bolinger, Mark; Weaver, Samantha

    2014-09-17

    Other than the SEGS I-IX parabolic trough projects built in the 1980s, virtually no large-scale or "utility-scale" solar projects-defined here to include any ground-mounted photovoltaic ("PV"), concentrating photovoltaic ("CPV"), or concentrating solar power ("CSP" or solar thermal) project larger than 5 MWAC-existed in the United States prior to 2007.

  14. Estimating the Population Benefits and Costs of Rituximab Therapy in the United States from 1998 to 2013 Using Real-World Data

    PubMed Central

    Reyes, Carolina M.; Gleeson, Michelle L.; Halperin, Marc; Skettino, Sandra L.; Mikhael, Joseph

    2016-01-01

    Background: Rituximab was approved in 1997 and is regularly one of the largest drug expenditures for Medicare; however, its benefits and costs have not been estimated from a population perspective. Objectives: To estimate both the clinical and the economic outcomes of rituximab for its approved hematological uses at the population level. Research Design: Analyses using cancer registry incidence data from the Surveillance, Epidemiology, and End Results (SEER) program, and outcomes data from SEER data linked with Medicare administrative claims (SEER-Medicare data). These results were incorporated into an epidemiological simulation model of the population over time. Subjects: We modeled all United States patients from 1998 to 2013 diagnosed with diffuse large B-cell lymphoma, follicular lymphoma, or chronic lymphocytic leukemia. Measures: Using this model, we estimated the life-years saved, as well as their economic benefit, in the United States population. We also estimated the incremental cost of adding rituximab to chemotherapy. All economic inputs were based on Medicare reimbursed amounts inflated to 2013 dollars. Results: There were 279,704 cumulative life-years saved which were valued at $25.44 billion. The incremental direct medical cost of rituximab was estimated to be $8.92 billion, resulting in an incremental economic gain of $16.52 billion. Conclusions: These analyses, based on real-world evidence, show that the introduction of rituximab into clinical practice has produced a substantial number of incremental life-years. Importantly, the economic benefit of the life-years gained greatly exceeds the added costs of treatment. PMID:26759977

  15. CRADA with United Solar Technologies and Pacific Northwest Laboratory (PNL-021): Thin film materialsfor low-cost high performance solar concentrators

    NASA Astrophysics Data System (ADS)

    Martin, P. M.; Affinito, J. D.; Gross, M. E.; Bennett, W. D.

    1995-03-01

    The objectives of this project were to develop and evaluate promising low-cost dielectric and polymer-protected thin-film reflective metal coatings to be applied to preformed continuously-curved solar reflector panels to enhance their solar reflectance, and to demonstrate protected solar reflective coatings on preformed solar concentrator panels. The opportunity for this project arose from a search by United Solar Technologies (UST) for organizations and facilities capable of applying reflective coatings to large preformed panels. PNL was identified as being uniquely qualified to participate in this collaborative project.

  16. Low cost solar array project production process and equipment task: A Module Experimental Process System Development Unit (MEPSDU)

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Several major modifications were made to the design presented at the PDR. The frame was deleted in favor of a "frameless" design which will provide a substantially improved cell packing factor. Potential shaded cell damage resulting from operation into a short circuit can be eliminated by a change in the cell series/parallel electrical interconnect configuration. The baseline process sequence defined for the MEPSON was refined and equipment design and specification work was completed. SAMICS cost analysis work accelerated, format A's were prepared and computer simulations completed. Design work on the automated cell interconnect station was focused on bond technique selection experiments.

  17. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    PubMed Central

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

  18. Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole.

    PubMed

    Heimann, S M; Cornely, O A; Wisplinghoff, H; Kochanek, M; Stippel, D; Padosch, S A; Langebartels, G; Reuter, H; Reiner, M; Vierzig, A; Seifert, H; Vehreschild, M J G T; Glossmann, J; Franke, B; Vehreschild, J J

    2015-02-01

    Direct treatment costs caused by candidemia in German intensive care unit (ICU) patients are currently unknown. We analyzed treatment costs and the impact of antifungal drug choice. Comprehensive data of patients who had at least one episode of candidemia while staying in the ICU between 01/2005 and 12/2010 were documented in a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). A detailed analysis of all disease-associated treatment costs was performed. Patients treated with echinocandins (i.e., anidulafungin, caspofungin, micafungin) or fluconazole were analyzed separately and compared. Forty-one and 64 patients received echinocandins and fluconazole, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score was 114 (95 % confidence interval [CI]: 106-122) vs. 95 (95 % CI: 90-101, p = <0.001). Twenty-three (56 %) and 33 (52 %, p = 0.448) patients survived hospitalization, while 17 (41 %) and 22 (34 %, p = 0.574) survived one year after diagnosis. In the echinocandin and fluconazole groups, the mean costs per patient of ICU treatment were 20,338 (95 % CI: 12,893-27,883) vs. 11,932 (95 % CI: 8,016-15,849, p = 0.110), and the total direct treatment costs per patient were 37,995 (95 % CI: 26,614-49,376) vs. 22,305 (95 % CI: 16,817-27,793, p = 0.012), resulting in daily costs per patient of 1,158 (95 % CI: 1,036-1,280) vs. 927 (95 % CI: 828-1,026, p = 0.001). Our health economic analysis shows the high treatment costs of patients with candidemia in the ICU. Sicker patients had a prolonged hospitalization and were more likely to receive echinocandins, leading to higher treatment costs. Outcomes were comparable to those achieved in less sick patients with fluconazole.

  19. Contractor-style tunnel cost estimating

    SciTech Connect

    Scapuzzi, D. )

    1990-06-01

    Keeping pace with recent advances in construction technology is a challenge for the cost estimating engineer. Using an estimating style that simulates the actual construction process and is similar in style to the contractor's estimate will give a realistic view of underground construction costs. For a contractor-style estimate, a mining method is chosen; labor crews, plant and equipment are selected, and advance rates are calculated for the various phases of work which are used to determine the length of time necessary to complete each phase of work. The durations are multiplied by the cost or labor and equipment per unit of time and, along with the costs for materials and supplies, combine to complete the estimate. Variations in advance rates, ground support, labor crew size, or other areas are more easily analyzed for their overall effect on the cost and schedule of a project. 14 figs.

  20. CHARACTERIZING COSTS, SAVINGS AND BENEFITS OF A SELECTION OF ENERGY EFFICIENT EMERGING TECHNOLOGIES IN THE UNITED STATES

    SciTech Connect

    Xu, T.; Slaa, J.W.; Sathaye, J.

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing CO2 emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world. Successful implementation of emerging technologies not only can help advance productivities and competitiveness but also can play a significant role in mitigation efforts by saving energy. Providing evaluation and estimation of the costs and energy savings potential of emerging technologies is the focus of our work in this project. The overall goal of the project is to identify and select emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. This report contains the results from performing Task 2"Technology evaluation" for the project titled"Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies," which was sponsored by California Energy Commission and managed by CIEE. The project purpose is to analyze market status, market potential, and economic viability of selected technologies applicable to the U.S. In this report, LBNL first performed re-assessments of all of the 33 emerging energy-efficient industrial technologies, including re-evaluation of the 26 technologies that were previously identified by Martin et al. (2000) and

  1. Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study

    PubMed Central

    Conklin, Annalijn I.; Monsivais, Pablo; Khaw, Kay-Tee; Forouhi, Nita G.

    2016-01-01

    Background Diet is a key modifiable risk factor for multiple chronic conditions, including type 2 diabetes (T2D). Consuming a range of foods from the five major food groups is advocated as critical to healthy eating, but the association of diversity across major food groups with T2D is not clear and the relationship of within-food-group diversity is unknown. In addition, there is a growing price gap between more and less healthy foods, which may limit the uptake of varied diets. The current study had two aims: first, to examine the association of reported diversity of intake of food groups as well as their subtypes with risk of developing T2D, and second, to estimate the monetary cost associated with dietary diversity. Methods and Findings A prospective study of 23,238 participants in the population-based EPIC-Norfolk cohort completed a baseline Food Frequency Questionnaire in 1993–1997 and were followed up for a median of 10 y. We derived a total diet diversity score and additional scores for diversity within each food group (dairy products, fruits, vegetables, meat and alternatives, and grains). We used multivariable Cox regression analyses for incident diabetes (892 new cases), and multivariable linear regression for diet cost. Greater total diet diversity was associated with 30% lower risk of developing T2D (Hazard ratio [HR] 0.70 [95% CI 0.51 to 0.95]) comparing diets comprising all five food groups to those with three or fewer, adjusting for confounders including obesity and socioeconomic status. In analyses of diversity within each food group, greater diversity in dairy products (HR 0.61 [0.45 to 0.81]), fruits (HR 0.69 [0.52 to 0.90]), and vegetables (HR 0.67 [0.52 to 0.87]) were each associated with lower incident diabetes. The cost of consuming a diet covering all 5 food groups was 18% higher (£4.15/day [4.14 to 4.16]) than one comprising three or fewer groups. Key limitations are the self-reported dietary data and the binary scoring approach whereby

  2. The actual goals of geoethics

    NASA Astrophysics Data System (ADS)

    Nemec, Vaclav

    2014-05-01

    The most actual goals of geoethics have been formulated as results of the International Conference on Geoethics (October 2013) held at the geoethics birth-place Pribram (Czech Republic): In the sphere of education and public enlightenment an appropriate needed minimum know how of Earth sciences should be intensively promoted together with cultivating ethical way of thinking and acting for the sustainable well-being of the society. The actual activities of the Intergovernmental Panel of Climate Changes are not sustainable with the existing knowledge of the Earth sciences (as presented in the results of the 33rd and 34th International Geological Congresses). This knowledge should be incorporated into any further work of the IPCC. In the sphere of legislation in a large international co-operation following steps are needed: - to re-formulate the term of a "false alarm" and its legal consequences, - to demand very consequently the needed evaluation of existing risks, - to solve problems of rights of individuals and minorities in cases of the optimum use of mineral resources and of the optimum protection of the local population against emergency dangers and disasters; common good (well-being) must be considered as the priority when solving ethical dilemmas. The precaution principle should be applied in any decision making process. Earth scientists presenting their expert opinions are not exempted from civil, administrative or even criminal liabilities. Details must be established by national law and jurisprudence. The well known case of the L'Aquila earthquake (2009) should serve as a serious warning because of the proven misuse of geoethics for protecting top Italian seismologists responsible and sentenced for their inadequate superficial behaviour causing lot of human victims. Another recent scandal with the Himalayan fossil fraud will be also documented. A support is needed for any effort to analyze and to disclose the problems of the deformation of the contemporary

  3. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    PubMed Central

    Alyeshmerni, Daniel; Froehlich, James B.; Lewin, Jack; Eagle, Kim A.

    2014-01-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act. PMID:25120917

  4. Public Health Impact and Economic Costs of Volkswagen's Lack of Compliance with the United States' Emission Standards.

    PubMed

    Hou, Lifang; Zhang, Kai; Luthin, Moira A; Baccarelli, Andrea A

    2016-01-01

    The U.S. Environmental Protection Agency (EPA) recently issued a notice of violation against Volkswagen (VW) for installing a defective device in certain models of diesel cars to circumvent emission tests for nitrogen oxides (NOx). We quantified the health and economic impacts of extra NOx emissions attributable to non-compliant vehicles in the U.S. using the EPA's Co-Benefits Risk Assessment model. We estimated that the total extra NOx emitted over one year of operation would result in 5 to 50 premature deaths, 687 to 17,526 work days with restricted activity, and economic costs of $43,479,189 to $423,268,502, based on various assumptions regarding emission scenarios and risks. This study highlights the potential impacts of VW vehicles' lack of compliance on the health and well-being of the U.S. PMID:27618076

  5. Public Health Impact and Economic Costs of Volkswagen's Lack of Compliance with the United States' Emission Standards.

    PubMed

    Hou, Lifang; Zhang, Kai; Luthin, Moira A; Baccarelli, Andrea A

    2016-09-08

    The U.S. Environmental Protection Agency (EPA) recently issued a notice of violation against Volkswagen (VW) for installing a defective device in certain models of diesel cars to circumvent emission tests for nitrogen oxides (NOx). We quantified the health and economic impacts of extra NOx emissions attributable to non-compliant vehicles in the U.S. using the EPA's Co-Benefits Risk Assessment model. We estimated that the total extra NOx emitted over one year of operation would result in 5 to 50 premature deaths, 687 to 17,526 work days with restricted activity, and economic costs of $43,479,189 to $423,268,502, based on various assumptions regarding emission scenarios and risks. This study highlights the potential impacts of VW vehicles' lack of compliance on the health and well-being of the U.S.

  6. Public Health Impact and Economic Costs of Volkswagen’s Lack of Compliance with the United States’ Emission Standards

    PubMed Central

    Hou, Lifang; Zhang, Kai; Luthin, Moira A.; Baccarelli, Andrea A.

    2016-01-01

    The U.S. Environmental Protection Agency (EPA) recently issued a notice of violation against Volkswagen (VW) for installing a defective device in certain models of diesel cars to circumvent emission tests for nitrogen oxides (NOx). We quantified the health and economic impacts of extra NOx emissions attributable to non-compliant vehicles in the U.S. using the EPA’s Co-Benefits Risk Assessment model. We estimated that the total extra NOx emitted over one year of operation would result in 5 to 50 premature deaths, 687 to 17,526 work days with restricted activity, and economic costs of $43,479,189 to $423,268,502, based on various assumptions regarding emission scenarios and risks. This study highlights the potential impacts of VW vehicles’ lack of compliance on the health and well-being of the U.S. population. PMID:27618076

  7. Conceptual design and cost analysis of hydraulic output unit for 15 kW free-piston Stirling engine

    NASA Technical Reports Server (NTRS)

    White, M. A.

    1982-01-01

    A long-life hydraulic converter with unique features was conceptually designed to interface with a specified 15 kW(e) free-piston Stirling engine in a solar thermal dish application. Hydraulic fluid at 34.5 MPa (5000 psi) is produced to drive a conventional hydraulic motor and rotary alternator. Efficiency of the low-maintenance converter design was calculated at 93.5% for a counterbalanced version and 97.0% without the counterbalance feature. If the converter were coupled to a Stirling engine with design parameters more typcial of high-technology Stirling engines, counterbalanced converter efficiency could be increased to 99.6%. Dynamic computer simulation studies were conducted to evaluate performance and system sensitivities. Production costs of the complete Stirling hydraulic/electric power system were evaluated at $6506 which compared with $8746 for an alternative Stirling engine/linear alternator system.

  8. Helmet use among motorcyclists who died in crashes and economic cost savings associated with state motorcycle helmet laws--United States, 2008-2010.

    PubMed

    2012-06-15

    In 2010, the 4,502 motorcyclists (operators and passengers) killed in motorcycle crashes made up 14% of all road traffic deaths, yet motorcycles accounted for <1% of all vehicle miles traveled. Helmet use consistently has been shown to reduce motorcycle crash-related injuries and deaths, and the most effective strategy to increase helmet use is enactment of universal helmet laws. Universal helmet laws require all motorcyclists to wear helmets whenever they ride. To examine the association between states' motorcycle helmet laws and helmet use or nonuse among fatally injured motorcyclists, CDC analyzed 2008-2010 National Highway Traffic Safety Administration (NHTSA) data from the Fatality Analysis Reporting System (FARS), a census of fatal traffic crashes in the United States. Additionally, economic cost data from NHTSA were obtained to compare the costs saved as a result of helmet use, by type of state motorcycle helmet law. The findings indicated that, on average, 12% of fatally injured motorcyclists were not wearing helmets in states with universal helmet laws, compared with 64% in partial helmet law states (laws that only required specific groups, usually young riders, to wear helmets) and 79% in states without a helmet law. Additionally, in 2010, economic costs saved from helmet use by society in states with a universal helmet law were, on average, $725 per registered motorcycle, nearly four times greater than in states without such a law ($198).

  9. Hydrologic Change during the Colonial Era of the United States: Beavers and the Energy Cost of Impoundments (Invited)

    NASA Astrophysics Data System (ADS)

    Green, M. B.; Bain, D. J.; Arrigo, J. S.; Duncan, J. M.; Kumar, S.; Parolari, A.; Salant, N.; Vorosmarty, C. J.; Aloysius, N. R.; Bray, E. N.; Ruffing, C. M.; Witherell, B. B.

    2009-12-01

    Europeans colonized North America in the early 17th century with intentions ranging between long-term inhabitation and quick extraction of resources for economic gain in Europe. Whatever the intentions, the colonists relied on the landscape for resources resulting in dramatic change to the forest and fur-bearing mammal population. We demonstrate that initial exploitation of North American forest and furs caused a substantial decrease in mean water residence time (τ) between 1600 and 1800 A.D. That loss, which regionally changed from 51 to 41 days, contrasts with conventional wisdom that humans tend to diminish variability in water resources by increasing storage capacity and thus increasing τ. The loss of τ resulted from over-hunted beaver for the hat market in Europe. Analysis suggests that colonial era demographics and economics did not allow human resource allocation to impoundment construction on a level matching the historic beaver effort. However, the τ appears to have regionally increased during the 19th century, suggesting that humans eventually began replacing the water storage lost with the beaver. The analysis highlights the energy cost of impounding water, which is likely to continue to be an important factor given the increasing need for stable water resources and finite energy resources.

  10. A GIS cost model to assess the availability of freshwater, seawater, and saline groundwater for algal biofuel production in the United States.

    PubMed

    Venteris, Erik R; Skaggs, Richard L; Coleman, Andre M; Wigmosta, Mark S

    2013-05-01

    A key advantage of using microalgae for biofuel production is the ability of some algal strains to thrive in waters unsuitable for conventional crop irrigation such as saline groundwater or seawater. Nonetheless, the availability of sustainable water supplies will provide significant challenges for scale-up and development of algal biofuels. We conduct a partial techno-economic assessment based on the availability of freshwater, saline groundwater, and seawater for use in open pond algae cultivation systems. We explore water issues through GIS-based models of algae biofuel production, freshwater supply (constrained to less than 5% of mean annual flow per watershed) and costs, and cost-distance models for supplying seawater and saline groundwater. We estimate that, combined, these resources can support 9.46 × 10(7) m(3) yr(-1) (25 billion gallons yr(-1)) of renewable biodiesel production in the coterminous United States. Achievement of larger targets requires the utilization of less water efficient sites and relatively expensive saline waters. Despite the addition of freshwater supply constraints and saline water resources, the geographic conclusions are similar to our previous results. Freshwater availability and saline water delivery costs are most favorable for the coast of the Gulf of Mexico and Florida peninsula, where evaporation relative to precipitation is moderate. As a whole, the barren and scrub lands of the southwestern U.S. have limited freshwater supplies, and large net evaporation rates greatly increase the cost of saline alternatives due to the added makeup water required to maintain pond salinity. However, this and similar analyses are particularly sensitive to knowledge gaps in algae growth/lipid production performance and the proportion of freshwater resources available, key topics for future investigation. PMID:23495893

  11. A GIS cost model to assess the availability of freshwater, seawater, and saline groundwater for algal biofuel production in the United States.

    PubMed

    Venteris, Erik R; Skaggs, Richard L; Coleman, Andre M; Wigmosta, Mark S

    2013-05-01

    A key advantage of using microalgae for biofuel production is the ability of some algal strains to thrive in waters unsuitable for conventional crop irrigation such as saline groundwater or seawater. Nonetheless, the availability of sustainable water supplies will provide significant challenges for scale-up and development of algal biofuels. We conduct a partial techno-economic assessment based on the availability of freshwater, saline groundwater, and seawater for use in open pond algae cultivation systems. We explore water issues through GIS-based models of algae biofuel production, freshwater supply (constrained to less than 5% of mean annual flow per watershed) and costs, and cost-distance models for supplying seawater and saline groundwater. We estimate that, combined, these resources can support 9.46 × 10(7) m(3) yr(-1) (25 billion gallons yr(-1)) of renewable biodiesel production in the coterminous United States. Achievement of larger targets requires the utilization of less water efficient sites and relatively expensive saline waters. Despite the addition of freshwater supply constraints and saline water resources, the geographic conclusions are similar to our previous results. Freshwater availability and saline water delivery costs are most favorable for the coast of the Gulf of Mexico and Florida peninsula, where evaporation relative to precipitation is moderate. As a whole, the barren and scrub lands of the southwestern U.S. have limited freshwater supplies, and large net evaporation rates greatly increase the cost of saline alternatives due to the added makeup water required to maintain pond salinity. However, this and similar analyses are particularly sensitive to knowledge gaps in algae growth/lipid production performance and the proportion of freshwater resources available, key topics for future investigation.

  12. The Epidemiology, Diagnosis, and Cost of Dyspepsia and Helicobater pylori Gastritis: A Case–Control Analysis in the Southwestern United States

    PubMed Central

    Mapel, Douglas; Roberts, Melissa; Overhiser, Andrew; Mason, Andrew

    2013-01-01

    Background Dyspepsia is among the most common complaints evaluated by gastroenterologists, but there are few studies examining its current epidemiology, evaluation, and costs. We examined these issues in a large managed care system in the Southwestern United States. Methods We conducted a retrospective case–control analysis of adults with incident dyspepsia or a Helicobacter pylori-related condition in years 2006 through 2010 using utilization data. Medical record abstraction of 400 cases was conducted to obtain additional clinical information. Results A total of 6989 cases met all inclusion and exclusion criteria. Women had a substantially higher risk of dyspepsia than men (14 per 1000 per year vs 10 per 1000; p < .001), and the incidence of dyspepsia increased with age such that persons in their seventh decade had almost twice the risk of those aged 18–29. Hispanic persons had a significantly higher risk of dyspepsia and positive H. pylori testing. Dyspepsia cases had a higher prevalence of other chronic comorbidities than their matched controls. Dyspepsia patients had healthcare costs 54% higher than controls even before the diagnosis was made, and costs in the initial diagnostic period were $483 greater per person, but subsequent costs were not greatly affected. Among those aged 55 and younger, the “test and treat” approach was used in 53% and another 18% had an initial esophagogastroduodenoscopy, as compared to 47 and 27%, respectively, among those over the age of 55. Conclusions Women and older adults have a higher incidence of dyspepsia than previously appreciated, and Hispanics in this region also have a higher risk. Current guidelines for dyspepsia evaluation are only loosely followed. PMID:23067108

  13. Sensor fusion system to estimate the trajectory of a low cost mobile robotic platform using an Inertial Measurement Unit

    NASA Astrophysics Data System (ADS)

    Botero V., J.-S.; M. Rico, G.; Villegas C, J.-P.

    2016-07-01

    In this paper, the development and implementation of an algorithm is presented to identify the trajectory of a mobile robot based on data from an Inertial Measurement Unit with nine degrees of freedom consisting of a 3-axis accelerometers, an 3-axis gyroscopes, an 3- axis magnetometers, and an additional temperature sensor to compensate for temperature errors. The combined information from this set of sensors allows determining the trajectory and orientation of the robot at any moment to complement the information from its navigation system. Initially, it was necessary to build controlled test environments that allow observing and getting to know the trajectory and the dimensions thereof for capturing the raw data of the mobile robotic platform. Then, the data obtained form the sensor was processed off-line applying a Kalman filter with the aim to remove Gaussian noise; to estimating the trajectory and the absolute orientation of the mobile robotic platform the proposed algorithm was implemented. This implementation used the hardware elements are inexpensive, thus allowing the necessary testing, the data analysis and the interpretation of the outcome to be replicable and to be used as an educational tool within courses of undergraduate and master level. The elements of hardware used in this implementation are cheap, allowing its reproduction for the analysis and interpretation of data and can be used as an educational tool in courses of undergraduate and master level.

  14. Secondary Measures of Access to Abortion Services in the United States, 2011 and 2012: Gestational Age Limits, Cost, and Harassment

    PubMed Central

    Jerman, Jenna; Jones, Rachel K.

    2016-01-01

    Background Aspects of U.S. clinical abortion service provision such as gestational age limits, charges for abortion services, and anti-abortion harassment can impact the accessibility of abortion; this study documents changes in these measures between 2008 and 2012. Methods In 2012 and 2013, we surveyed all known abortion-providing facilities in the United States (n = 1,720). This study summarizes information obtained about gestational age limits, charges, and exposure to anti-abortion harassment among clinics; response rates for relevant items ranged from 54% (gestational limits) to 80% (exposure to harassment). Weights were constructed to compensate for nonresponding facilities. We also examine the distribution of abortions and abortion facilities by region. Findings Almost all abortion facilities (95%) offered abortions at 8 weeks’ gestation; 72% did so at 12 weeks, 34% at 20 weeks, and 16% at 24 weeks in 2012. In 2011 and 2012, the median charge for a surgical abortion at 10 weeks gestation was $495, and $500 for an early medication abortion, compared with $503 and $524 (adjusted for inflation) in 2009. In 2011, 84% of clinics experienced at least one form of harassment, only slightly higher than found in 2009. Hospitals and physicians’ offices accounted for a substantially smaller proportion of facilities in the Midwest and South. Clinics in the Midwest and South were exposed to more harassment than their counterparts in the Northeast and West. Conclusions Although there was a substantial decline in abortion incidence between 2008 and 2011, the secondary measures of abortion access examined in this study changed little during this time period. PMID:24981401

  15. Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down’s syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units

    PubMed Central

    Wright, David; Hill, Melissa; Verhoef, Talitha I; Daley, Rebecca; Lewis, Celine; Mason, Sarah; McKay, Fiona; Jenkins, Lucy; Howarth, Abigail; Cameron, Louise; McEwan, Alec; Fisher, Jane; Kroese, Mark; Morris, Stephen

    2016-01-01

    Objective To investigate the benefits and costs of implementing non-invasive prenatal testing (NIPT) for Down’s syndrome into the NHS maternity care pathway. Design Prospective cohort study. Setting Eight maternity units across the United Kingdom between 1 November 2013 and 28 February 2015. Participants All pregnant women with a current Down’s syndrome risk on screening of at least 1/1000. Main outcome measures Outcomes were uptake of NIPT, number of cases of Down’s syndrome detected, invasive tests performed, and miscarriages avoided. Pregnancy outcomes and costs associated with implementation of NIPT, compared with current screening, were determined using study data on NIPT uptake and invasive testing in combination with national datasets. Results NIPT was prospectively offered to 3175 pregnant women. In 934 women with a Down’s syndrome risk greater than 1/150, 695 (74.4%) chose NIPT, 166 (17.8%) chose invasive testing, and 73 (7.8%) declined further testing. Of 2241 women with risks between 1/151 and 1/1000, 1799 (80.3%) chose NIPT. Of 71 pregnancies with a confirmed diagnosis of Down’s syndrome, 13/42 (31%) with the diagnosis after NIPT and 2/29 (7%) after direct invasive testing continued, resulting in 12 live births. In an annual screening population of 698 500, offering NIPT as a contingent test to women with a Down’s syndrome screening risk of at least 1/150 would increase detection by 195 (95% uncertainty interval −34 to 480) cases with 3368 (2279 to 4027) fewer invasive tests and 17 (7 to 30) fewer procedure related miscarriages, for a non-significant difference in total costs (£−46 000, £−1 802 000 to £2 661 000). The marginal cost of NIPT testing strategies versus current screening is very sensitive to NIPT costs; at a screening threshold of 1/150, NIPT would be cheaper than current screening if it cost less than £256. Lowering the risk threshold increases the number of Down’s syndrome cases detected and

  16. Troubleshooting Costs

    NASA Astrophysics Data System (ADS)

    Kornacki, Jeffrey L.

    Seventy-six million cases of foodborne disease occur each year in the United States alone. Medical and lost productivity costs of the most common pathogens are estimated to be 5.6-9.4 billion. Product recalls, whether from foodborne illness or spoilage, result in added costs to manufacturers in a variety of ways. These may include expenses associated with lawsuits from real or allegedly stricken individuals and lawsuits from shorted customers. Other costs include those associated with efforts involved in finding the source of the contamination and eliminating it and include time when lines are shut down and therefore non-productive, additional non-routine testing, consultant fees, time and personnel required to overhaul the entire food safety system, lost market share to competitors, and the cost associated with redesign of the factory and redesign or acquisition of more hygienic equipment. The cost associated with an effective quality assurance plan is well worth the effort to prevent the situations described.

  17. A comparison of applicant and matriculant trends, and rising costs of medical education in United States medical schools and at the University of Kentucky College of Medicine.

    PubMed

    Elam, Carol L; Scott, Kimberly L; Gilbert, Linda A; Hartmann, Beth A

    2003-05-01

    This paper addresses fluctuations in the applicant and matriculant pools both across United States medical schools and at the University of Kentucky College of Medicine (UKCOM) for 1992-2002. It also presents data regarding the increasing costs of a medical education. Over the past decade, both nationally and at the UKCOM, there has been an over-all reduction in the number of applicants to medical school. In this changing applicant pool, the percentage of female matriculants has increased both nationally and at the UKCOM. However, the number of underrepresented minorities applying to and matriculating in the US and at the UKCOM has dropped since the mid-1990s. Although the applicant pool has decreased in size over the time period examined, the academic quality of applicants as measured by the undergraduate grade point average and Medical College Admission Test scores has increased both nationally and at UKCOM. Costs of a medical education have risen over time, as has the debt burden of medical school graduates due to increasing undergraduate debt, consumer debt, and medical school tuition. Potential causes for and implication of these changing trends are discussed. PMID:12762172

  18. Public Health Costs of Primary PM2.5 and Inorganic PM2.5 Precursor Emissions in the United States.

    PubMed

    Heo, Jinhyok; Adams, Peter J; Gao, H Oliver

    2016-06-01

    Current methods of estimating the public health effects of emissions are computationally too expensive or do not fully address complex atmospheric processes, frequently limiting their applications to policy research. Using a reduced-form model derived from tagged chemical transport model (CTM) simulations, we present PM2.5 mortality costs per tonne of inorganic air pollutants with the 36 km × 36 km spatial resolution of source location in the United States, providing the most comprehensive set of such estimates comparable to CTM-based estimates. Our estimates vary by 2 orders of magnitude. Emission-weighted seasonal averages were estimated at $88,000-130,000/t PM2.5 (inert primary), $14,000-24,000/t SO2, $3,800-14,000/t NOx, and $23,000-66,000/t NH3. The aggregate social costs for year 2005 emissions were estimated at $1.0 trillion dollars. Compared to other studies, our estimates have similar magnitudes and spatial distributions for primary PM2.5 but substantially different spatial patterns for precursor species where secondary chemistry is important. For example, differences of more than a factor of 10 were found in many areas of Texas, New Mexico, and New England states for NOx and of California, Texas, and Maine for NH3. Our method allows for updates as emissions inventories and CTMs improve, enhancing the potential to link policy research to up-to-date atmospheric science. PMID:27153150

  19. A Critical Assessment of Sea-Level Rise Projections for the Northeast United States in the 21st Century: Discrepancies and Their Cost

    NASA Astrophysics Data System (ADS)

    Zhang, M.

    2015-12-01

    Several studies have projected the magnitudes of sea-level rise (SLR) in the Northeast United States for the 21th Century as a result of anthropogenic climate change. Among them are those by NOAA, the New York City Panel on Climate Change (NPCC), and the US Army Corps of Engineers (COE). The projected magnitudes of SLR from some of these sources are being used by policymakers to make difficult choices of investments on infrastructure that can be resilient against anticipated SLR. While there is no question that SLR will happen and resilience measures against SLR is very necessary, this presentation questions the rigor of science behind some of these projections that can have significant costs to the society. A critical assessment of available SLR projections for the northeast US and their discrepancies is presented. It is concluded from the current understanding of science that the mean values and upper bounds of SLR from NOAA, NPCC and COE are likely exaggerated for the region. It is also argued that scientists should treat the SLR projection as a separate problem from policies so that the best cost-benefit analysis can be performed in the decision process.

  20. Economic cost of primary prevention of cardiovascular diseases in Tanzania

    PubMed Central

    Ngalesoni, Frida; Ruhago, George; Norheim, Ole F; Robberstad, Bjarne

    2015-01-01

    Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in

  1. Economic cost of primary prevention of cardiovascular diseases in Tanzania.

    PubMed

    Ngalesoni, Frida; Ruhago, George; Norheim, Ole F; Robberstad, Bjarne

    2015-09-01

    Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)'s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers' costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30-41 to US$52-71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO's absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers' costs were estimated from two main viewpoints: 'what is', that is the current practice, and 'what if', reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression

  2. Consequences of Predicted or Actual Asteroid Impacts

    NASA Astrophysics Data System (ADS)

    Chapman, C. R.

    2003-12-01

    Earth impact by an asteroid could have enormous physical and environmental consequences. Impactors larger than 2 km diameter could be so destructive as to threaten civilization. Since such events greatly exceed any other natural or man-made catastrophe, much extrapolation is necessary just to understand environmental implications (e.g. sudden global cooling, tsunami magnitude, toxic effects). Responses of vital elements of the ecosystem (e.g. agriculture) and of human society to such an impact are conjectural. For instance, response to the Blackout of 2003 was restrained, but response to 9/11 terrorism was arguably exaggerated and dysfunctional; would society be fragile or robust in the face of global catastrophe? Even small impacts, or predictions of impacts (accurate or faulty), could generate disproportionate responses, especially if news media reports are hyped or inaccurate or if responsible entities (e.g. military organizations in regions of conflict) are inadequately aware of the phenomenology of small impacts. Asteroid impact is the one geophysical hazard of high potential consequence with which we, fortunately, have essentially no historical experience. It is thus important that decision makers familiarize themselves with the hazard and that society (perhaps using a formal procedure, like a National Academy of Sciences study) evaluate the priority of addressing the hazard by (a) further telescopic searches for dangerous but still-undiscovered asteroids and (b) development of mitigation strategies (including deflection of an oncoming asteroid and on- Earth civil defense). I exemplify these issues by discussing several representative cases that span the range of parameters. Many of the specific physical consequences of impact involve effects like those of other geophysical disasters (flood, fire, earthquake, etc.), but the psychological and sociological aspects of predicted and actual impacts are distinctive. Standard economic cost/benefit analyses may not

  3. 63. VIEW OF AUTOTRANSFERS. THE ACTUAL AUTOTRANSFERS ARE ENCLOSED IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    63. VIEW OF AUTOTRANSFERS. THE ACTUAL AUTOTRANSFERS ARE ENCLOSED IN THE OIL FILLED CYLINDERS ON THE RIGHT OF THE PHOTOGRAPH. THESE ELECTRICAL DEVICES BOOSTED THE GENERATOR OUTPUT OF 11,000 VOLTS TO 22,000 VOLTS PRIOR TO TRANSMISSION OUT TO THE MAIN FEEDER LINES. A SPARE INNER UNIT IS CONTAINED IN THE METAL BOX AT THE LEFT OF THE PHOTOGRAPH. - New York, New Haven & Hartford Railroad, Cos Cob Power Plant, Sound Shore Drive, Greenwich, Fairfield County, CT

  4. Cost of energy evaluation

    NASA Technical Reports Server (NTRS)

    Hasbrouck, T. M.

    1979-01-01

    The estimated cost per kilowatt hour, the wind resources in the utilities service area, and the reliability of the units are considered in computing the cost of energy of the wind turbine generator system.

  5. Waste processing cost recovery at Los Alamos National Laboratory--analysis and recommendations

    SciTech Connect

    Booth, Steven Richard

    2008-01-01

    Los Alamos National Laboratory is implementing full cost recovery for waste processing in fiscal year 2009 (FY2009), after a transition year in FY2008. Waste processing cost recovery has been implemented in various forms across the nuclear weapons complex and in corporate America. The fundamental reasoning of sending accurate price signals to waste generators is economically sound, and leads to waste minimization and reduced waste expense over time. However, Los Alamos faces significant implementation challenges because of its status as a government-owned, contractor-operated national scientific institution with a diverse suite of experimental and environmental cleanup activities, and the fact that this represents a fundamental change in how waste processing is viewed by the institution. This paper describes the issues involved during the transition to cost recovery and the ultimate selection of the business model. Of the six alternative cost recovery models evaluated, the business model chosen to be implemented in FY2009 is Recharge Plus Generators Pay Distributed Direct. Under this model, all generators who produce waste must pay a distributed direct share associated with their specific waste type to use a waste processing capability. This cost share is calculated using the distributed direct method on the fixed cost only, i.e., the fixed cost share is based on each program's forecast proportion of the total Los Alamos volume forecast of each waste type. (Fixed activities are those required to establish the waste processing capability, i.e., to make the process ready, permitted, certified, and prepared to handle the first unit ofwaste. Therefore, the fixed cost ends at the point just before waste begins 'to be processed. The activities to actually process the waste are considered variable.) The volume of waste actually sent for processing is charged a unit cost based solely on the variable cost of disposing of that waste. The total cost recovered each year is the

  6. Prevention--a cost-effective way to fight the non-communicable disease epidemic: an academic perspective of the United Nations High-level NCD Meeting.

    PubMed

    Probst-Hensch, Nicole; Tanner, Marcel; Kessler, Claudia; Burri, Christian; Künzli, Nino

    2011-09-07

    The United Nations General Assembly has convened a Summit on non-communicable diseases (NCDs), an historic moment in the global combat of these disorders. Lifestyles in increasingly urban and globalised environments have led to a steep surge in NCD incidence in low and middle income countries, where two thirds of all NCD deaths occur (most importantly from cancer, cardiovascular and respiratory disease as well as diabetes). Treatment of NCDs is usually long term and expensive, thus threatening patients' and nations' budgets and putting them at high risk for poverty. The NCD Summit offers an opportunity for strengthening and shaping primary prevention, the most cost-effective instrument to fight major risk factors such as tobacco smoking, alcohol abuse, physical inactivity and unhealthy diet. From a Swiss perspective, we also emphasised the efforts for new laws on prevention and diagnosis registration, in accordance with the recommendations of the NCD summit in order to strengthen primary prevention and disease monitoring. In addition, the need for structural prevention across all policy sectors with leadership in environmental policy making to prevent NCDs as well as the need to adapt and strengthen primary health care are equally relevant for Switzerland. To compliment efforts in primary prevention, the field of NCDs requires special R&D platforms for affordable NCD drugs and diagnostics for neglected population segments in both Switzerland and low and middle income countries. Switzerland has a track record in research and development against diseases of poverty on a global scale that now needs to be applied to NCDs.

  7. Self-Actualization, Liberalism, and Humanistic Education.

    ERIC Educational Resources Information Center

    Porter, Charles Mack

    1979-01-01

    The relationship between personality factors and political orientation has long been of interest to psychologists. This study tests the hypothesis that there is no significant relationship between self-actualization and liberalism-conservatism. The hypothesis is supported. (Author)

  8. General methodology: Costing, budgeting, and techniques for benefit-cost and cost-effectiveness analysis

    NASA Technical Reports Server (NTRS)

    Stretchberry, D. M.; Hein, G. F.

    1972-01-01

    The general concepts of costing, budgeting, and benefit-cost ratio and cost-effectiveness analysis are discussed. The three common methods of costing are presented. Budgeting distributions are discussed. The use of discounting procedures is outlined. The benefit-cost ratio and cost-effectiveness analysis is defined and their current application to NASA planning is pointed out. Specific practices and techniques are discussed, and actual costing and budgeting procedures are outlined. The recommended method of calculating benefit-cost ratios is described. A standardized method of cost-effectiveness analysis and long-range planning are also discussed.

  9. Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

    PubMed

    Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

    2009-01-01

    More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.

  10. Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

    PubMed

    Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

    2009-01-01

    More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year. PMID:19092521

  11. Indirect Costs of Health Research--How They are Computed, What Actions are Needed. Report by the Comptroller General of the United States.

    ERIC Educational Resources Information Center

    Comptroller General of the U.S., Washington, DC.

    A review by the General Accounting Office of various aspects of indirect costs associated with federal health research grants is presented. After an introduction detailing the scope of the review and defining indirect costs and federal participation, the report focuses on the causes of the rapid increase of indirect costs. Among findings was that…

  12. Prevention--a cost-effective way to fight the non-communicable disease epidemic: an academic perspective of the United Nations High-level NCD Meeting.

    PubMed

    Probst-Hensch, Nicole; Tanner, Marcel; Kessler, Claudia; Burri, Christian; Künzli, Nino

    2011-01-01

    The United Nations General Assembly has convened a Summit on non-communicable diseases (NCDs), an historic moment in the global combat of these disorders. Lifestyles in increasingly urban and globalised environments have led to a steep surge in NCD incidence in low and middle income countries, where two thirds of all NCD deaths occur (most importantly from cancer, cardiovascular and respiratory disease as well as diabetes). Treatment of NCDs is usually long term and expensive, thus threatening patients' and nations' budgets and putting them at high risk for poverty. The NCD Summit offers an opportunity for strengthening and shaping primary prevention, the most cost-effective instrument to fight major risk factors such as tobacco smoking, alcohol abuse, physical inactivity and unhealthy diet. From a Swiss perspective, we also emphasised the efforts for new laws on prevention and diagnosis registration, in accordance with the recommendations of the NCD summit in order to strengthen primary prevention and disease monitoring. In addition, the need for structural prevention across all policy sectors with leadership in environmental policy making to prevent NCDs as well as the need to adapt and strengthen primary health care are equally relevant for Switzerland. To compliment efforts in primary prevention, the field of NCDs requires special R&D platforms for affordable NCD drugs and diagnostics for neglected population segments in both Switzerland and low and middle income countries. Switzerland has a track record in research and development against diseases of poverty on a global scale that now needs to be applied to NCDs. PMID:21901650

  13. Realizing actual feedback control of complex network

    NASA Astrophysics Data System (ADS)

    Tu, Chengyi; Cheng, Yuhua

    2014-06-01

    In this paper, we present the concept of feedbackability and how to identify the Minimum Feedbackability Set of an arbitrary complex directed network. Furthermore, we design an estimator and a feedback controller accessing one MFS to realize actual feedback control, i.e. control the system to our desired state according to the estimated system internal state from the output of estimator. Last but not least, we perform numerical simulations of a small linear time-invariant dynamics network and a real simple food network to verify the theoretical results. The framework presented here could make an arbitrary complex directed network realize actual feedback control and deepen our understanding of complex systems.

  14. 50 CFR 37.46 - Cost reimbursement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Cost reimbursement. 37.46 Section 37.46... NATIONAL WILDLIFE REFUGE, ALASKA General Administration § 37.46 Cost reimbursement. (a) Each applicant for... actual costs incurred, including, but not limited to, its direct costs and indirect costs as...

  15. Updated Conceptual Cost Estimating

    NASA Technical Reports Server (NTRS)

    Brown, J. A.

    1987-01-01

    16-page report discusses development and use of NASA TR-1508, the Kennedy Space Center Aerospace Construction Price Book for preparing conceptual, budget, funding, cost-estimating, and preliminary cost-engineering reports. Updated annually from 1974 through 1985 with actual bid prices and government estimates. Includes labor and material quantities and prices with contractor and subcontractor markups for buildings, facilities, and systems at Kennedy Space Center. While data pertains to aerospace facilities, format and cost-estimating techniques guide estimation of costs in other construction applications.

  16. Developing Human Resources through Actualizing Human Potential

    ERIC Educational Resources Information Center

    Clarken, Rodney H.

    2012-01-01

    The key to human resource development is in actualizing individual and collective thinking, feeling and choosing potentials related to our minds, hearts and wills respectively. These capacities and faculties must be balanced and regulated according to the standards of truth, love and justice for individual, community and institutional development,…

  17. [Actual diet of patients with gastrointestinal diseases].

    PubMed

    Loranskaia, T I; Shakhovskaia, A K; Pavliuchkova, M S

    2000-01-01

    The study of actual nutrition of patients with erosive-ulcerative lesions in the gastroduodenal zone and of patients with operated ulcer has revealed defects in intake of essential nutrients by these patients: overeating of animal fat and refined carbohydrates, deficiency of oil, vitamins A, B2, C, D and food fibers.

  18. Humanistic Education and Self-Actualization Theory.

    ERIC Educational Resources Information Center

    Farmer, Rod

    1984-01-01

    Stresses the need for theoretical justification for the development of humanistic education programs in today's schools. Explores Abraham Maslow's hierarchy of needs and theory of self-actualization. Argues that Maslow's theory may be the best available for educators concerned with educating the whole child. (JHZ)

  19. Group Counseling for Self-Actualization.

    ERIC Educational Resources Information Center

    Streich, William H.; Keeler, Douglas J.

    Self-concept, creativity, growth orientation, an integrated value system, and receptiveness to new experiences are considered to be crucial variables to the self-actualization process. A regular, year-long group counseling program was conducted with 85 randomly selected gifted secondary students in the Farmington, Connecticut Public Schools. A…

  20. Teenagers' Perceived and Actual Probabilities of Pregnancy.

    ERIC Educational Resources Information Center

    Namerow, Pearila Brickner; And Others

    1987-01-01

    Explored adolescent females' (N=425) actual and perceived probabilities of pregnancy. Subjects estimated their likelihood of becoming pregnant the last time they had intercourse, and indicated the dates of last intercourse and last menstrual period. Found that the distributions of perceived probability of pregnancy were nearly identical for both…

  1. Ion exchange removal of strontium from simulated and actual N-Springs well water at the Hanford 100-N Area

    SciTech Connect

    Brown, G.N.; Carson, K.J.; DesChane, J.R.; Elovich, R.J.; Kafka, T.M.; White, L.R.

    1996-06-01

    Experimental ion exchange studies are being conducted by the Pacific Northwest national Laboratory (PNNL) under the Efficient Separations and Processing (ESP) Crosscutting Program to evaluate newly emerging materials and technologies for removing cesium, strontium, technetium, and transuranic elements from simulated and actual wastes at Hanford. Previous work focused on applications to treat high-level alkaline tank wastes, but many of the technologies can also be applied in process and ground-water remediation. Ultimately, each process must be evaluated in terms of life-cycle costs, removal efficiency, process chemical consumption and recycle, stability of materials exposed to chemicals and radiation, compatibility with other process streams, secondary waste generation, process and maintenance costs, and final material disposal. This report assesses the performance of the 3M-designed Process Absorber Development Unit (PADU) and the AlliedSignal-produced sodium nonatitanate (NaTi) material in trace quantities of strontium from simulated and actual Hanford N-Springs ground water. The experimental objective was to determine the strontium-loading breakthrough profile of a proprietary 3M-engineered material in either disk or cartridge forms.

  2. Costs of RCRA corrective action: Interim report

    SciTech Connect

    Tonn, B.; Russell, M.; Hwang Ho-Ling; Goeltz, R. ); Warren, J. )

    1991-09-01

    This report estimates the cost of the corrective action provisions of the Resource Conservation and Recovery Act (RCRA) for all non-federal facilities in the United States. RCRA is the federal law which regulates the treatment, storage, disposal, and recovery of hazardous waste. The 1984 amendment to RCRA, known as the Hazardous and Solid Waste Amendments, stipulates that facilities that treat, store or dispose of hazardous wastes (TSDs) must remediate situations where hazardous wastes have escaped into the environment from their solid waste management units (SWMUs). The US Environmental Protection Agency (USEPA 1990a), among others, believes that the costs of RCRA corrective action could rival the costs of SUPERFUND. Evaluated herein are costs associated with actual remedial actions. The remedial action cost estimating program developed by CH2M Hill is known as the Cost of Remedial Action Model (CORA). It provides cost estimates, in 1987 dollars, by technology used to remediate hazardous waste sites. Rules were developed to categorize each SWMU in the RTI databases by the kinds of technologies that would be used to remediate them. Results were then run through CORA using various assumptions for variable values that could not be drawn from the RTI databases and that did not have CORA supplied default values. Cost estimates were developed under several scenarios. The base case assumes a TSD and SWMU universe equal to that captured in the RTI databases, a point of compliance at the SWMU boundary with no ability to shift wastes from SWMU to SWMU, and a best-as-practical clean-up to health-based standards. 11 refs., 12 figs., 12 tabs.

  3. Unit billed services for HANDI 2000 business management system

    SciTech Connect

    Wilson, D.

    1998-08-24

    Unit billed services are those services provided internally by project to other projects, except for those services furnished by Lockheed Martin Services,Inc., an Enterprise Company. These services are billed when the actual work is performed, based on a published rate for the service. Examples of this would be crane and rigging, duplicating, or lab analysis. The providers of these services collect their costs in a pool. The pool is then liquidated by the billings.

  4. “The National Surgery Quality Improvement Project” (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit

    PubMed Central

    2014-01-01

    Background The “National Surgical Quality Improvement Program” (NSQIP) is a nationally validated, risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonia (PNEU) and prolonged ventilator days ≥48 hours (V48) was observed on the surgical service. Methods The hospital studied is a 500 bed university-affiliated teaching hospital performing approximately 20,000 surgical operations per year. A multidisciplinary team was formed and a series of interventions were implemented to address high pneumonia rates and prolonged intubation. Specific interventions included enforcement of protocols and adherence to the Institute for Healthcare Improvement (IHI) ventilator bundles, including head of bed elevation, sedation holidays, extubate when ready, and early nutrition. NSQIP collected pre-operative through 30-day postoperative data prospectively on 1,081 surgical patients in the intensive care unit from January 1, 2010 – July 31, 2012. The variables pneumonia and V48 undergo logistic regression and risk adjusted results of observed versus expected are calculated. Mean and confidence intervals are represented in caterpillar charts and bar graphs. Statistical analysis was via Fisher exact t-test. Results Progressive improvements were observed over a two-year period via three semiannual reports (SAR). Corrective measures showed a decrease in V48 with an observed to expected odds ratio (O: E) improving from 1.5 to 1.04, or 1.9% ( 7/368 patients) July 31, 2011 to 1.11% (12/1080 patients) July 31, 2012 respectively. Similarly, pneumonia rates decreased 1.36% (5/368 patients) July 31, 2011 to 1.2% ( 13/1081 patients) July 31, 2012 with O: E = 1.4 and 1.25 respectively. Statistical significance was achieved (p < .05). Conclusion Given an estimated annual volume of 20,000 cases per year with a cost of $22,097 per episode of pneumonia and

  5. Regional Comparative Unit Cost Studies for Maintenance and Operation of Physical Plants in Universities and Colleges in Central States Region and Rocky Mountain Region.

    ERIC Educational Resources Information Center

    Association of Physical Plant Administrators, Corvallis, OR.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the central states region and the Rocky Mountain region. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and…

  6. Job Corps: Its Costs, Employment Outcomes, and Service to the Public. Briefing Report to the Chairman, Committee on Labor and Human Resources, United States Senate.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    This report evaluates the cost effectiveness of the Civilian Conservation Centers (CCCs) which are part of the Job Corps program but operated under inter-agency agreement by the Departments of Agriculture and the Interior. Data are from the program year beginning July 1, 1984. Information is presented on: (1) the costs, job placements, and…

  7. Impact of patient adherence on the cost-effectiveness of noninvasive tests for the initial diagnosis of Helicobacter pylori infection in the United States

    PubMed Central

    Boklage, Susan H; Mangel, Allen W; Ramamohan, Varun; Mladsi, Deirdre; Wang, Tao

    2016-01-01

    Objective Previous US-based economic models of noninvasive tests for diagnosis of Helicobacter pylori infection did not consider patient adherence or downstream costs of continuing infection. This analysis evaluated the long-term cost-effectiveness of the urea breath test (UBT), fecal antigen test (FAT), and serology for diagnosis of H. pylori infection after incorporating information regarding test adherence. Materials and methods A decision-analytic model incorporating adherence information evaluated the cost-effectiveness of the UBT, FAT, and serology for diagnosis of H. pylori infection. Positive test results led to first-line triple therapy; no further action was taken for nonadherence or negative results. Excess lifetime costs and reduced quality-adjusted life-years (QALYs) were estimated for patients with continuing H. pylori infection. Results In the base-case scenario with estimated adherence rates of 86%, 48%, and 86% for the UBT, monoclonal FAT, and serology, respectively, corresponding expected total costs were US$424.99, $466.41, and $404.98/patient. Test costs were higher for the UBT, but were fully or partially offset by higher excess lifetime costs for the monoclonal FAT and serology. The QALYs gained/patient with the UBT vs monoclonal FAT and serology were 0.86 and 0.27, respectively. The UBT was dominant vs the monoclonal FAT, leading to lower costs and higher QALYs; the UBT was cost-effective vs serology (incremental cost/QALY gained $74). Conclusion Based on a comprehensive modeled analysis that included consideration of patient test adherence and long-term consequences resulting from continuing H. pylori infection, the UBT provided the greatest economic value among noninvasive tests for diagnosis of H. pylori infection, because of high patient adherence and excellent test performance. PMID:26855566

  8. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

    PubMed Central

    Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

    2014-01-01

    Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

  9. Reproducing Actual Morphology of Planetary Lava Flows

    NASA Astrophysics Data System (ADS)

    Miyamoto, H.; Sasaki, S.

    1996-03-01

    Assuming that lava flows behave as non-isothermal laminar Bingham fluids, we developed a numerical code of lava flows. We take the self gravity effects and cooling mechanisms into account. The calculation method is a kind of cellular automata using a reduced random space method, which can eliminate the mesh shape dependence. We can calculate large scale lava flows precisely without numerical instability and reproduce morphology of actual lava flows.

  10. The Actual Apollo 13 Prime Crew

    NASA Technical Reports Server (NTRS)

    1970-01-01

    The actual Apollo 13 lunar landing mission prime crew from left to right are: Commander, James A. Lovell Jr., Command Module pilot, John L. Swigert Jr.and Lunar Module pilot, Fred W. Haise Jr. The original Command Module pilot for this mission was Thomas 'Ken' Mattingly Jr. but due to exposure to German measles he was replaced by his backup, Command Module pilot, John L. 'Jack' Swigert Jr.

  11. United States Air Force 611th Civil Engineer Squadron, Elmendorf AFB, Alaska. Final engineering evaluation/cost analysis potential tce impact to the drinking water supply, Galena Airport, Alaska

    SciTech Connect

    1996-02-05

    This decision document presents the selected removal action to address potential trichloroethene (TCE) impact to drinking water supply wells, located in the Installation Restoration Program (IRP) site ST009, otherwise known as the West Unit, at Galena Airport, Alaska. The information fron the RI Report is summarized, along with an analysis of potential removal action alternatives, in the Engineering Evaluation/Cost Analysis (EE/CA).

  12. Societal costs of exposure to toxic substances: economic and health costs of four case studies that are candidates for environmental causation.

    PubMed Central

    Muir, T; Zegarac, M

    2001-01-01

    Four outcomes that evidence suggests are candidates for "environmental causation" were chosen for analysis: diabetes, Parkinson's disease (PD), neurodevelopmental effects and hypothyroidism, and deficits in intelligence quotient (IQ). These are an enormous burden in the United States, Canada, and other industrial countries. We review findings on actual social and economic costs, construct estimates of some of the costs from pertinent sources, and provide several hypothetical examples consistent with published evidence. Many detailed costs are estimated, but these are fragmented and missing in coverage and jurisdiction. Nonetheless, the cumulative costs identified are very large, totaling $568 billion to $793 billion per year for Canada and the United States combined. Partial Canadian costs alone are $46 billion to $52 billion per year. Specifics include diabetes (United States and Canada), $128 billion per year; PD in the United States, $13 billion to $28.5 billion per year; neurodevelopmental deficits and hypothryoidism are endemic and, including estimates of costs of childhood disorders that evidence suggests are linked, amount to $81.5 billion to $167 billion per year for the United States and $2 billion per year in Ontario; loss of 5 IQ points cost $30 billion per year in Canada and $275 billion to $326 billion per year in the United States; and hypothetical dynamic economic impacts cost another $19 billion to $92 billion per year for the United States and Canada combined. Reasoned arguments based on the weight of evidence can support the hypothesis that at least 10%, up to 50% of these costs are environmentally induced--between $57 billion and $397 billion per year. PMID:11744507

  13. NCHEMS Costing and Data Management System and the Purdue University Cost Study: A Comparison of Narrowly Defined Direct Costs.

    ERIC Educational Resources Information Center

    Eikenberry, F. L.; Gleason, W. M.

    One critical aspect of costing system methodologies is examined: the effects of average costing by course level on program unit cost. The direct costing methodologies used in two costing systems are compared. One is the internally developed Purdue University Cost Study; the other, the NCHEMS Costing and Data Management System. The comparison…

  14. Cost-Effectiveness Analysis of Brief and Expanded Evidence-Based Risk Reduction Interventions for HIV-Infected People Who Inject Drugs in the United States

    PubMed Central

    Song, Dahye L.; Altice, Frederick L.; Copenhaver, Michael M.; Long, Elisa F.

    2015-01-01

    Aims Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. Methods A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. Results Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. Conclusions Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+. PMID:25658949

  15. Treatment of paediatric burns with a nanocrystalline silver dressing compared with standard wound care in a burns unit: a cost analysis.

    PubMed

    Cox, S G; Cullingworth, L; Rode, H

    2011-10-01

    Burns are a leading cause of non-natural death in South African infants and children. Conventional care of partial-thickness burns often requires painful, time consuming and costly twice-daily dressing changes to clean the wound and apply antimicrobial topical agents. A new topical nanocrystalline silver-coated NS dressing (Acticoat; Smith & Nephew) has been developed and is the first-line treatment of choice in many burn centres. However, because of its cost the Department of Health has been reluctant to introduce it as a standard of care. We retrospectively studied 4 randomly selected paediatric burn patients, calculating the cost associated with the use of NS dressings and comparing this with the projected costs of three previously standard burn wound treatment regimens. NS dressings were changed every 3 days based on their sustained and slow release of silver ions over 72 hours. Using NS clearly saved costs compared with the three other regimens. The demonstrated cost savings resulted primarily from the decreased number of dressings, and the presumed shorter hospital stay. PMID:22272852

  16. Weighing the Costs and Benefits of State Renewables Portfolio Standards in the United States: A Comparative Analysis of State-Level Policy Impact Projections

    SciTech Connect

    Chen, Cliff; Wiser, Ryan; Mills, Andrew; Bolinger, Mark

    2008-01-07

    State renewables portfolio standards (RPS) have emerged as one of the most important policy drivers of renewable energy capacity expansion in the U.S. As RPS policies have been proposed or adopted in an increasing number of states, a growing number of studies have attempted to quantify the potential impacts of these policies, focusing primarily on cost impacts, but sometimes also estimating macroeconomic, risk reduction, and environmental effects. This article synthesizes and analyzes the results and methodologies of 31 distinct state or utility-level RPS cost-impact analyses completed since 1998. Together, these studies model proposed or adopted RPS policies in 20 different states. We highlight the key findings of these studies on the projected costs of state RPS policies, examine the sensitivity of projected costs to model assumptions, evaluate the reasonableness of key input assumptions, and suggest possible areas of improvement for future RPS analyses. We conclude that while there is considerable uncertainty in the study results, the majority of the studies project modest cost impacts. Seventy percent of the state RPS cost studies project retail electricity rate increases of no greater than one percent. Nonetheless, there is considerable room for improving the analytic methods, and therefore accuracy, of these estimates.

  17. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada

    PubMed Central

    Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

    2016-01-01

    Background The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. Methods An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65–79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Findings Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65–79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65–79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Conclusions Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs. PMID:27648831

  18. Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

    PubMed

    Cassidy, J

    1993-05-01

    Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community. PMID:10125358

  19. Air resistance measurements on actual airplane parts

    NASA Technical Reports Server (NTRS)

    Weiselsberger, C

    1923-01-01

    For the calculation of the parasite resistance of an airplane, a knowledge of the resistance of the individual structural and accessory parts is necessary. The most reliable basis for this is given by tests with actual airplane parts at airspeeds which occur in practice. The data given here relate to the landing gear of a Siemanms-Schuckert DI airplane; the landing gear of a 'Luftfahrzeug-Gesellschaft' airplane (type Roland Dlla); landing gear of a 'Flugzeugbau Friedrichshafen' G airplane; a machine gun, and the exhaust manifold of a 269 HP engine.

  20. Explosive Percolation Transition is Actually Continuous

    NASA Astrophysics Data System (ADS)

    da Costa, R. A.; Dorogovtsev, S. N.; Goltsev, A. V.; Mendes, J. F. F.

    2010-12-01

    Recently a discontinuous percolation transition was reported in a new “explosive percolation” problem for irreversible systems [D. Achlioptas, R. M. D’Souza, and J. Spencer, Science 323, 1453 (2009)SCIEAS0036-807510.1126/science.1167782] in striking contrast to ordinary percolation. We consider a representative model which shows that the explosive percolation transition is actually a continuous, second order phase transition though with a uniquely small critical exponent of the percolation cluster size. We describe the unusual scaling properties of this transition and find its critical exponents and dimensions.

  1. Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States

    PubMed Central

    E. Sweet, Donna; L. Altice, Frederick; J. Cohen, Calvin; Vandewalle, Björn

    2016-01-01

    Background The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings. Methods A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years—QALYs) and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs). The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz. Results Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain) in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained. Conclusions STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S. PMID:26808503

  2. Instructional Cost Analysis: History and Present Inadequacies.

    ERIC Educational Resources Information Center

    Humphrey, David A.

    The cost analysis of instruction is conducted according to principles of teaching and learning that have often become historically dated. Using today's costing systems prevents determination of whether cost effectiveness actually exists. The patterns of instruction in higher education and the systems employed for instructional cost analysis are…

  3. Cost Analysis of Operation Theatre Services at an Apex Tertiary Care Trauma Centre of India.

    PubMed

    Siddharth, Vijaydeep; Kumar, Subodh; Vij, Aarti; Gupta, Shakti Kumar

    2015-12-01

    Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54). PMID:26730059

  4. Area-Specific Marginal Costing for Electric Utilities: a Case Study of Transmission and Distribution Costs

    NASA Astrophysics Data System (ADS)

    Orans, Ren

    1990-10-01

    Existing procedures used to develop marginal costs for electric utilities were not designed for applications in an increasingly competitive market for electric power. The utility's value of receiving power, or the costs of selling power, however, depend on the exact location of the buyer or seller, the magnitude of the power and the period of time over which the power is used. Yet no electric utility in the United States has disaggregate marginal costs that reflect differences in costs due to the time, size or location of the load associated with their power or energy transactions. The existing marginal costing methods used by electric utilities were developed in response to the Public Utilities Regulatory Policy Act (PURPA) in 1978. The "ratemaking standards" (Title 1) established by PURPA were primarily concerned with the appropriate segmentation of total revenues to various classes-of-service, designing time-of-use rating periods, and the promotion of efficient long-term resource planning. By design, the methods were very simple and inexpensive to implement. Now, more than a decade later, the costing issues facing electric utilities are becoming increasingly complex, and the benefits of developing more specific marginal costs will outweigh the costs of developing this information in many cases. This research develops a framework for estimating total marginal costs that vary by the size, timing, and the location of changes in loads within an electric distribution system. To complement the existing work at the Electric Power Research Institute (EPRI) and Pacific Gas and Electric Company (PGandE) on estimating disaggregate generation and transmission capacity costs, this dissertation focuses on the estimation of distribution capacity costs. While the costing procedure is suitable for the estimation of total (generation, transmission and distribution) marginal costs, the empirical work focuses on the geographic disaggregation of marginal costs related to electric

  5. The Economic Costs of Poverty in the United States: Subsequent Effects of Children Growing Up Poor. Discussion Paper No. 1327-07

    ERIC Educational Resources Information Center

    Holzer, Harry J.; Schanzenbach, Diane Whitmore; Duncan, Greg J.; Ludwig, Jens

    2007-01-01

    In this paper, we review a range of rigorous research studies that estimate the average statistical relationships between children growing up in poverty and their earnings, propensity to commit crime, and quality of health later in life. We also review estimates of the costs that crime and poor health per person impose on the economy. Then we…

  6. The Cost of Caring for the Chronically Ill: The Case for Insurance. Hearing before the Special Committee on Aging. United States Senate, Ninety-Eighth Congress, Second Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Special Committee on Aging.

    This document provides witness testimony and prepared statements from the Congressional hearing called to investigate the cost of long-term care for the chronically ill and disabled. The merits of a public-private initiative on long-term care insurance are considered by the witnesses, who include a woman struggling to care for herself and her son,…

  7. The Departmental Technical Curriculum Instructional Costs of Emergency Medical Technician-Paramedic Programs in Two-Year Public Colleges in the United States.

    ERIC Educational Resources Information Center

    Ruple, Judith A.

    This dissertation surveys, analyzes and reports the comparison of direct departmental costs associated with the technical core curriculum of emergency medical technology programs at nine public two-year community colleges for the academic years of 1989-90, 1990-91, and 1991-92. Data were collected using The Emergency Medical Training Technology…

  8. Pell Grant Validation Imposes Some Costs and Does Not Greatly Reduce Award Errors: New Strategies Are Needed. Report to the Honorable Paul Simon, United States Senate.

    ERIC Educational Resources Information Center

    Comptroller General of the U.S., Washington, DC.

    Efforts of the U.S. Department of Education to verify data submitted by applicants to the Pell Grant program were analyzed by the General Accounting Office. The effects of carrying out the Department's policy or methodology, called "validation," on financial aid applicants and colleges were assessed. Costs of 1982-1983 validation on schools were…

  9. Continued urbanization of the United States is causing the deterioration of the central city; costly suburban developments; and increases in congestion, pollution, crime, violence and alienation

    NASA Technical Reports Server (NTRS)

    1975-01-01

    It is shown that urban sprawl and the abuses of technological industries result in substantial environmental and economic costs at the expense of center city locations and populations. Socioeconomic deterioration and modification of the biosphere triggers climatic and environmental changes leading to ecosystem damage and destruction, health consequences and international conflict.

  10. The Benefits and Costs of Accreditation of Undergraduate Medical Education Programs Leading to the MD Degree in the United States and Its Territories

    ERIC Educational Resources Information Center

    Muhtadi, Dalal J.

    2013-01-01

    This study assessed the value of accreditation of all 126 fully-accredited four-year undergraduate medical education programs leading to the MD degree in the US through two lenses, "perceived benefits and costs" from the perspective of the leadership of internal stakeholders of the aforementioned programs. The online survey was sent to a…

  11. Program Tracks Cost Of Travel

    NASA Technical Reports Server (NTRS)

    Mauldin, Lemuel E., III

    1993-01-01

    Travel Forecaster is menu-driven, easy-to-use computer program that plans, forecasts cost, and tracks actual vs. planned cost of business-related travel of division or branch of organization and compiles information into data base to aid travel planner. Ability of program to handle multiple trip entries makes it valuable time-saving device.

  12. Profitable capitation requires accurate costing.

    PubMed

    West, D A; Hicks, L L; Balas, E A; West, T D

    1996-01-01

    In the name of costing accuracy, nurses are asked to track inventory use on per treatment basis when more significant costs, such as general overhead and nursing salaries, are usually allocated to patients or treatments on an average cost basis. Accurate treatment costing and financial viability require analysis of all resources actually consumed in treatment delivery, including nursing services and inventory. More precise costing information enables more profitable decisions as is demonstrated by comparing the ratio-of-cost-to-treatment method (aggregate costing) with alternative activity-based costing methods (ABC). Nurses must participate in this costing process to assure that capitation bids are based upon accurate costs rather than simple averages. PMID:8788799

  13. Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom12

    PubMed Central

    Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

    2015-01-01

    Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39–79 y from the European Prospective Investigation into Cancer and Nutrition–Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom–based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet

  14. Continued investigation of solid propulsion economics. Task 1B: Large solid rocket motor case fabrication methods - Supplement process complexity factor cost technique

    NASA Technical Reports Server (NTRS)

    Baird, J.

    1967-01-01

    This supplement to Task lB-Large Solid Rocket Motor Case Fabrication Methods supplies additional supporting cost data and discusses in detail the methodology that was applied to the task. For the case elements studied, the cost was found to be directly proportional to the Process Complexity Factor (PCF). The PCF was obtained for each element by identifying unit processes that are common to the elements and their alternative manufacturing routes, by assigning a weight to each unit process, and by summing the weighted counts. In three instances of actual manufacture, the actual cost per pound equaled the cost estimate based on PCF per pound, but this supplement, recognizes that the methodology is of limited, rather than general, application.

  15. Predicted Versus Actual Savings for a Low-Rise Multifamily Retrofit in Boulder, Colorado

    SciTech Connect

    Arena, L.; Williamson, J.

    2013-11-01

    To determine the most cost-effective methods of improving buildings, accurate analysis and prediction of the energy use of existing buildings is essential. However, multiple studies confirm that analysis methods tend to over-predict energy use in poorly insulated, leaky homes and thus, the savings associated with improving those homes. In NREL's report titled 'Assessing and Improving the Accuracy of Energy Analysis of Residential Buildings,' researchers propose a method for improving the accuracy of residential energy analysis methods. A key step in this process involves the comparisons of predicted versus metered energy use and savings. In support of this research need, CARB evaluated the retrofit of a multifamily building in Boulder, CO. The updated property is a 37 unit, 2 story apartment complex built in 1950, which underwent renovations in early 2009 to bring it into compliance with Boulder, CO's SmartRegs ordinance. Goals of the study were to: 1) evaluate predicted versus actual savings due to the improvements, 2) identify areas where the modeling assumptions may need to be changed, and 3) determine common changes made by renters that would negatively impact energy savings. In this study, CARB seeks to improve the accuracy of modeling software while assessing retrofit measures to specifically determine which are most effective for large multifamily complexes in the cold climate region. Other issues that were investigated include the effects of improving building efficiency on tenant comfort, the impact on tenant turnover rates, and the potential market barriers for this type of community scale project.

  16. Predicted Versus Actual Savings for a Low-Rise Multifamily Retrofit in Boulder, Colorado

    SciTech Connect

    Arena, L.; Williamson, J.

    2013-11-01

    To determine the most cost-effective methods of improving buildings, accurate analysis and prediction of the energy use of existing buildings is essential. However, multiple studies confirm that analysis methods tend to over-predict energy use in poorly insulated, leaky homes and thus, the savings associated with improving those homes. In this project, the Building America CARB team evaluated the retrofit of a multifamily building in Boulder, CO. The updated property is a 37 unit, 2 story apartment complex built in 1950, which underwent renovations in early 2009 to bring it into compliance with Boulder, CO's SmartRegs ordinance. Goals of the study were to: 1) evaluate predicted versus actual savings due to the improvements, 2) identify areas where the modeling assumptions may need to be changed, and 3) determine common changes made by renters that would negatively impact energy savings. Other issues that were investigated include the effects of improving building efficiency on tenant comfort, the impact on tenant turnover rates, and the potential market barriers for this type of community scale project.

  17. Actual and perceived impacts of tobacco regulation on restaurants and firms

    PubMed Central

    Cremieux, P.; Ouellette, P.

    2001-01-01

    OBJECTIVE—To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele.
SETTING AND DESIGN—A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not.
RESULTS—Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments.
CONCLUSION—Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.


Keywords: regulation; firms; restaurants; costs; survey PMID:11226358

  18. Low cost solar array project: Experimental process system development unit for producing semiconductor-grade silicon using the silane-to-silicon process

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The results of the free space reactor experimental work are summarized. Overall, the objectives were achieved and the unit can be confidently scaled to the EPSDU size based on the experimental work and supporting theoretical analyses. The piping and instrumentation of the fluidized bed reactor was completed.

  19. Comparative Analysis of Thermoeconomic Evaluation Criteria for an Actual Heat Engine

    NASA Astrophysics Data System (ADS)

    Özel, Gülcan; Açıkkalp, Emin; Savaş, Ahmet Fevzi; Yamık, Hasan

    2016-07-01

    In the present study, an actual heat engine is investigated by using different thermoeconomic evaluation criteria in the literature. A criteria that has not been investigated in detail is considered and it is called as ecologico-economical criteria (F_{EC}). It is the difference of power cost and exergy destruction rate cost of the system. All four criteria are applied to an irreversible Carnot heat engine, results are presented numerically and some suggestions are made.

  20. The actual status of Astronomy in Moldova

    NASA Astrophysics Data System (ADS)

    Gaina, A.

    The astronomical research in the Republic of Moldova after Nicolae Donitch (Donici)(1874-1956(?)) were renewed in 1957, when a satellites observations station was open in Chisinau. Fotometric observations and rotations of first Soviet artificial satellites were investigated under a program SPIN put in action by the Academy of Sciences of former Socialist Countries. The works were conducted by Assoc. prof. Dr. V. Grigorevskij, which conducted also research in variable stars. Later, at the beginning of 60-th, an astronomical Observatory at the Chisinau State University named after Lenin (actually: the State University of Moldova), placed in Lozovo-Ciuciuleni villages was open, which were coordinated by Odessa State University (Prof. V.P. Tsesevich) and the Astrosovet of the USSR. Two main groups worked in this area: first conducted by V. Grigorevskij (till 1971) and second conducted by L.I. Shakun (till 1988), both graduated from Odessa State University. Besides this research areas another astronomical observations were made: Comets observations, astroclimate and atmospheric optics in collaboration with the Institute of the Atmospheric optics of the Siberian branch of the USSR (V. Chernobai, I. Nacu, C. Usov and A.F. Poiata). Comets observations were also made since 1988 by D. I. Gorodetskij which came to Chisinau from Alma-Ata and collaborated with Ukrainean astronomers conducted by K.I. Churyumov. Another part of space research was made at the State University of Tiraspol since the beggining of 70-th by a group of teaching staff of the Tiraspol State Pedagogical University: M.D. Polanuer, V.S. Sholokhov. No a collaboration between Moldovan astronomers and Transdniestrian ones actually exist due to War in Transdniestria in 1992. An important area of research concerned the Radiophysics of the Ionosphere, which was conducted in Beltsy at the Beltsy State Pedagogical Institute by a group of teaching staff of the University since the beginning of 70-th: N. D. Filip, E

  1. MODIS Solar Diffuser: Modelled and Actual Performance

    NASA Technical Reports Server (NTRS)

    Waluschka, Eugene; Xiong, Xiao-Xiong; Esposito, Joe; Wang, Xin-Dong; Krebs, Carolyn (Technical Monitor)

    2001-01-01

    The Moderate Resolution Imaging Spectroradiometer (MODIS) instrument's solar diffuser is used in its radiometric calibration for the reflective solar bands (VIS, NTR, and SWIR) ranging from 0.41 to 2.1 micron. The sun illuminates the solar diffuser either directly or through a attenuation screen. The attenuation screen consists of a regular array of pin holes. The attenuated illumination pattern on the solar diffuser is not uniform, but consists of a multitude of pin-hole images of the sun. This non-uniform illumination produces small, but noticeable radiometric effects. A description of the computer model used to simulate the effects of the attenuation screen is given and the predictions of the model are compared with actual, on-orbit, calibration measurements.

  2. Does the Accountable Care Act aim to promote quality, health, and control costs or has it missed the mark? Comment on "Health system reform in the United States".

    PubMed

    Molinari, Carol

    2014-02-01

    McDonough's perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA) aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties) to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consume.

  3. Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis

    PubMed Central

    Rochau, Ursula; Kluibenschaedl, Martina; Stenehjem, David; Kuan-Ling, Kuo; Radich, Jerald; Oderda, Gary; Brixner, Diana; Siebert, Uwe

    2015-01-01

    Currently several tyrosine kinase inhibitors (TKIs) are approved for treatment of chronic myeloid leukemia (CML). Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT), and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs)) for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs) for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR) of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay. PMID:26783469

  4. Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States?☆

    PubMed Central

    Han, Xuesong; Yabroff, K. Robin; Guy, Gery P.; Zheng, Zhiyuan; Jemal, Ahmedin

    2015-01-01

    Background An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use. Methods We evaluated changes in the use of recommended preventive services from 2009 (before the implementation of ACA cost-sharing provision) to 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type. Results There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population aged 18–64 years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01–1.05) for blood pressure check, 1.13 (1.09–1.18) for cholesterol check and 1.04 (1.00–1.08) for flu vaccination (all p-values < 0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population. Conclusions These early observations suggest positive benefits from the ACA policy of eliminating cost-sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes. PMID:26209914

  5. Low cost solar array project. Experimental process system development unit for producing semiconductor-grade silicon using the silane-to-silicon process

    NASA Technical Reports Server (NTRS)

    1980-01-01

    Technical activities are reported in the design of process, facilities, and equipment for producing silicon at a rate and price comensurate with production goals for low cost solar cell modules. The silane-silicone process has potential for providing high purity poly-silicon on a commercial scale at a price of fourteen dollars per kilogram by 1986, (1980 dollars). Commercial process, economic analysis, process support research and development, and quality control are discussed.

  6. Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis.

    PubMed

    Rochau, Ursula; Kluibenschaedl, Martina; Stenehjem, David; Kuan-Ling, Kuo; Radich, Jerald; Oderda, Gary; Brixner, Diana; Siebert, Uwe

    2015-01-01

    Currently several tyrosine kinase inhibitors (TKIs) are approved for treatment of chronic myeloid leukemia (CML). Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT), and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs)) for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs) for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR) of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay. PMID:26783469

  7. Review of the cost components of introducing industrially fortified rice.

    PubMed

    Roks, Eveline

    2014-09-01

    Micronutrient deficiencies affect over two billion people worldwide, particularly in developing countries. Fortification of staple foods with multiple micronutrients is a cost-effective strategy to increase vitamin and mineral intake. The objective of this paper is to review the cost elements of industrially fortified rice by identifying the costs related to the implementation of rice fortification programs, using the experience of the United Nations World Food Programme in its pilot countries. The actual total costs of rice fortification are not easily captured. Core cost elements include the production of fortified rice kernels, transportation to the point of blending, blending of fortified with unfortified rice, costs related to sales or distribution, quality control and assurance, and additional planning. In the introduction phase, organizations or coalitions seeking to advance rice fortification will face additional costs related to the initiation of rice fortification. In the scale-up phase, greater efficiency in the supply chain and economies of scale can be expected. Different cost elements are normally borne by different stakeholders. This makes the implementation of rice fortification programs a feasible option to reach vulnerable populations with inadequate access to affordable nutrition solutions. PMID:24961588

  8. The Population Impact and Cost-Effectiveness of Statins for Primary Prevention in Adults 75 and Older in the United States

    PubMed Central

    Odden, Michelle C.; Pletcher, Mark J.; Coxson, Pamela G.; Thekkethala, Divya; Guzman, David; Heller, David; Goldman, Lee; Bibbins-Domingo, Kirsten

    2015-01-01

    BACKGROUND Over 40% of adults 75 and older are taking statins, yet there is little evidence to guide primary prevention in this population. OBJECTIVE To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years and older. DESIGN Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. DATA SOURCE Trial, cohort, and nationally-representative data sources. TARGET POPULATION U.S. adults aged 75–94 years. TIME HORIZON 10 years. PERSPECTIVE Health care system. INTERVENTION Statins for primary prevention based on: 1) Low density lipoprotein cholesterol ≥4.91 mmol/L (190 mg/dL), 2) ≥4.14 mmol/L (160 mg/dL), 3) ≥3.36 mmol/L (130 mg/dL), 4) diabetes, 5) 10-year risk score ≥7.5% (treat all). OUTCOME MEASURES Myocardial infarction (MI), coronary heart disease (CHD) death, disability adjusted life years, costs RESULT OF BASE-CASE ANALYSIS All adults aged 75 and older in NHANES have a 10-year risk score >7.5%. If statins have no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost effective. The broadest strategy, treatment of all adults aged 75–94 years would result in 8 million additional users, and prevent 105,000 (4.3%) incident MIs and 68,000 (2.3%) CHD deaths at an incremental cost per disability adjusted life year of $25,200. RESULT OF SENSITIVITY ANALYSIS An increased relative risk of functional limitation or mild cognitive impairment in the range of 1.10 to 1.30 could offset the cardiovascular benefits. LIMITATIONS Limited trial evidence targeting primary prevention in adults 75 and older. CONCLUSIONS At effectiveness similar to trial findings, statins are projected to be cost-effective for primary prevention in adults age 75–94 years; however, even a small increase in geriatric specific side effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to

  9. First-Grade Retention: Effects on Children's Actual and Perceived Performance throughout Elementary Education

    ERIC Educational Resources Information Center

    Goos, Mieke; Van Damme, Jan; Onghena, Patrick; Petry, Katja

    2011-01-01

    This study investigates the effects of repeating first grade on children's further academic growth, by tracking the actual performance and the teacher-rated performance of a cohort of Flemish first-graders until the end of elementary school. Two research questions are raised: (1) How do first-grade repeaters, at the cost of one extra year of…

  10. Removal of waterborne pathogens from liver transplant unit water taps in prevention of healthcare-associated infections: a proposal for a cost-effective, proactive infection control strategy.

    PubMed

    Zhou, Z Y; Hu, B J; Qin, L; Lin, Y E; Watanabe, H; Zhou, Q; Gao, X D

    2014-04-01

    Hospital water supplies often contain waterborne pathogens, which can become a reservoir for healthcare-associated infections (HAIs). We surveyed the extent of waterborne pathogen contamination in the water supply of a Liver Transplant Unit. The efficacy of point-of-use (POU) water filters was evaluated by comparative analysis in routine clinical use. Our baseline environmental surveillance showed that Legionella spp. (28%, 38/136), Pseudomonas aeruginosa (8%, 11/136), Mycobacterium spp. (87%, 118/136) and filamentous fungi (50%, 68/136) were isolated from the tap water of the Liver Transplant Unit. 28.9% of Legionella spp.-positive water samples (n = 38) showed high-level Legionella contamination (≥10(3) CFU/L). After installation of the POU water filter, none of these pathogens were found in the POU filtered water samples. Furthermore, colonizations/infections with Gram-negative bacteria determined from patient specimens were reduced by 47% during this period, even if only 27% (3/11) of the distal sites were installed with POU water filters. In conclusion, the presence of waterborne pathogens was common in the water supply of our Liver Transplant Unit. POU water filters effectively eradicated these pathogens from the water supply. Concomitantly, healthcare-associated colonization/infections declined after the POU filters were installed, indicating their potential benefit in reducing waterborne HAIs.

  11. Caustic-Side Solvent Extraction: Prediction of Cesium Extraction for Actual Wastes and Actual Waste Simulants

    SciTech Connect

    Delmau, L.H.; Haverlock, T.J.; Sloop, F.V., Jr.; Moyer, B.A.

    2003-02-01

    This report presents the work that followed the CSSX model development completed in FY2002. The developed cesium and potassium extraction model was based on extraction data obtained from simple aqueous media. It was tested to ensure the validity of the prediction for the cesium extraction from actual waste. Compositions of the actual tank waste were obtained from the Savannah River Site personnel and were used to prepare defined simulants and to predict cesium distribution ratios using the model. It was therefore possible to compare the cesium distribution ratios obtained from the actual waste, the simulant, and the predicted values. It was determined that the predicted values agree with the measured values for the simulants. Predicted values also agreed, with three exceptions, with measured values for the tank wastes. Discrepancies were attributed in part to the uncertainty in the cation/anion balance in the actual waste composition, but likely more so to the uncertainty in the potassium concentration in the waste, given the demonstrated large competing effect of this metal on cesium extraction. It was demonstrated that the upper limit for the potassium concentration in the feed ought to not exceed 0.05 M in order to maintain suitable cesium distribution ratios.

  12. Costs and benefits of industrial reporting and voluntary targets for energy efficiency. A report to the Congress of the United States. Volume I: Main report

    SciTech Connect

    Not Available

    1994-02-01

    Section 131(c) of the Energy Policy Act of 1992 (EPACT) (Public Law 102-486) requires the Department of Energy (DOE) to evaluate the costs and benefits of federally mandated energy efficiency reporting requirements and voluntary energy efficiency improvement targets for energy-intensive industries. It also requires DOE to evaluate the role of reporting and targets in improving energy efficiency. Specifically, the legislation states: Not later than one year after the data of the enactment of this Act, the Secretary shall, in consultation with affected industries, evaluate and report to the Congress regarding the establishment of Federally mandated energy efficiency reporting requirements and voluntary energy efficiency improvement targets for energy intensive industries. Such report shall include an evaluation of the costs and benefits of such reporting requirements and voluntary energy efficiency improvement targets, and recommendations regarding the role of such activities in improving energy efficiency in energy intensive industries. This report is DOE`s response to that directive. It is the culmination of a year-long study that included (1) analysis of documents pertaining to a previous reporting and targets effort, the industrial Energy Efficiency Improvements Program (or the CE-189 program, following the designation of the reporting form used to collect data in that program), administered by DOE from 1976 to 1985, as well as other important background information; (2) extensive consultations with government and industry officials regarding the CE-189 Program, experience with other programs that have reporting elements, and the attributes of possible alternative strategies for reporting and targets; and (3) analyses of the costs and benefits of the CE-189 Program and several alternatives to the CE-189 approach.

  13. Costs of dispersal.

    PubMed

    Bonte, Dries; Van Dyck, Hans; Bullock, James M; Coulon, Aurélie; Delgado, Maria; Gibbs, Melanie; Lehouck, Valerie; Matthysen, Erik; Mustin, Karin; Saastamoinen, Marjo; Schtickzelle, Nicolas; Stevens, Virginie M; Vandewoestijne, Sofie; Baguette, Michel; Barton, Kamil; Benton, Tim G; Chaput-Bardy, Audrey; Clobert, Jean; Dytham, Calvin; Hovestadt, Thomas; Meier, Christoph M; Palmer, Steve C F; Turlure, Camille; Travis, Justin M J

    2012-05-01

    Dispersal costs can be classified into energetic, time, risk and opportunity costs and may be levied directly or deferred during departure, transfer and settlement. They may equally be incurred during life stages before the actual dispersal event through investments in special morphologies. Because costs will eventually determine the performance of dispersing individuals and the evolution of dispersal, we here provide an extensive review on the different cost types that occur during dispersal in a wide array of organisms, ranging from micro-organisms to plants, invertebrates and vertebrates. In general, costs of transfer have been more widely documented in actively dispersing organisms, in contrast to a greater focus on costs during departure and settlement in plants and animals with a passive transfer phase. Costs related to the development of specific dispersal attributes appear to be much more prominent than previously accepted. Because costs induce trade-offs, they give rise to covariation between dispersal and other life-history traits at different scales of organismal organisation. The consequences of (i) the presence and magnitude of different costs during different phases of the dispersal process, and (ii) their internal organisation through covariation with other life-history traits, are synthesised with respect to potential consequences for species conservation and the need for development of a new generation of spatial simulation models. PMID:21929715

  14. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    PubMed Central

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2013-01-01

    Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare

  15. Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays.

    PubMed

    Wesolowski, Laura G; Nasrullah, Muazzam; Coombs, Robert W; Rosenberg, Eric; Ethridge, Steven F; Hutchinson, Angela B; Dragavon, Joan; Rychert, Jennifer; Nolte, Frederick S; Madory, James E; Werner, Barbara G

    2016-01-01

    Background.  To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods.  We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results.  From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions.  Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT.

  16. Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays.

    PubMed

    Wesolowski, Laura G; Nasrullah, Muazzam; Coombs, Robert W; Rosenberg, Eric; Ethridge, Steven F; Hutchinson, Angela B; Dragavon, Joan; Rychert, Jennifer; Nolte, Frederick S; Madory, James E; Werner, Barbara G

    2016-01-01

    Background.  To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods.  We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results.  From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions.  Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT. PMID:26798766

  17. Analysis of nuclear power plant construction costs

    SciTech Connect

    Not Available

    1986-01-01

    The objective of this report is to present the results of a statistical analysis of nuclear power plant construction costs and lead-times (where lead-time is defined as the duration of the construction period), using a sample of units that entered construction during the 1966-1977 period. For more than a decade, analysts have been attempting to understand the reasons for the divergence between predicted and actual construction costs and lead-times. More importantly, it is rapidly being recognized that the future of the nuclear power industry rests precariously on an improvement in the cost and lead-time situation. Thus, it is important to study the historical information on completed plants, not only to understand what has occurred to also to improve the ability to evaluate the economics of future plants. This requires an examination of the factors that have affected both the realized costs and lead-times and the expectations about these factors that have been formed during the construction process. 5 figs., 22 tabs.

  18. The cost of inefficiency in US hospitals, 1985-1997.

    PubMed

    Shah, Bimal R; Reed, Shelby D; Francis, Jennifer; Ridley, David B; Schulman, Kevin A

    2003-01-01

    We conducted a descriptive analysis of data from the Hospital Cost Report Information System from 1985 through 1997 on nonfederal, short-stay hospitals in the United States with 12-month reporting periods and valid data for the primary outcomes. The main outcome measures were change in number of beds, inpatient days, overhead cost per bed, and overhead cost per inpatient day. Actual outcomes were compared to predicted outcomes from: (1) a scenario holding the ratio of overhead cost per volume constant throughout the study period; and (2) a scenario holding overhead expenditures for 1985 constant as volume changed. The sample contained a mean of 3,605 hospitals per year. Volume declined annually by 2.2 beds (95 percent confidence interval [CI], 2.1 to 2.2; P < .001) and 997 inpatient days (95 percent CI, 992 to 1,003; P < .001). Overhead cost per bed increased by 3,388 dollars annually (95 percent CI, 3,049 to 3,737; P < .001) and overhead cost per inpatient day increased by 40 dollars annually (95 percent CI, 36 to 44; P < .001). In the constant ratio scenario, mean overhead cost per bed increased by 42,523 dollars (32 percent), and mean overhead cost per inpatient day increased by 435 dollars (59 percent). In the constant overhead cost scenario, overhead cost per bed increased 15 percent and overhead cost per inpatient day increased 19 percent. Hospital overhead costs are increasing faster than would be expected if efficiency were the primary goal of hospital management. PMID:12967239

  19. 48 CFR 16.402-1 - Cost incentives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... contracts (see 16.404 and 16.401 (e)), incentive contracts include a target cost, a target profit or fee... maximum fee) provides that— (1) Actual cost that meets the target will result in the target profit or fee; (2) Actual cost that exceeds the target will result in downward adjustment of target profit or...

  20. 48 CFR 16.402-1 - Cost incentives.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... contracts (see 16.404 and 16.401 (e)), incentive contracts include a target cost, a target profit or fee... maximum fee) provides that— (1) Actual cost that meets the target will result in the target profit or fee; (2) Actual cost that exceeds the target will result in downward adjustment of target profit or...

  1. 48 CFR 16.402-1 - Cost incentives.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... contracts (see 16.404 and 16.401 (e)), incentive contracts include a target cost, a target profit or fee... maximum fee) provides that— (1) Actual cost that meets the target will result in the target profit or fee; (2) Actual cost that exceeds the target will result in downward adjustment of target profit or...

  2. 12 CFR 408.5 - Ensuring environmental documents are actually considered in Agency decision-making.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... considered in Agency decision-making. 408.5 Section 408.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED... Procedures § 408.5 Ensuring environmental documents are actually considered in Agency decision-making... environmental documents in agency decision-making. To implement these requirements, Eximbank officials will:...

  3. 75 FR 28059 - Actual Effects of the Free Trade Agreements With Chile, Australia, and Singapore

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-19

    ... COMMISSION Actual Effects of the Free Trade Agreements With Chile, Australia, and Singapore AGENCY: United... Singapore. DATES: July 15, 2010: Deadline for filing written submissions. December 13, 2010: Transmittal of...) concluded with Chile, Singapore, and Australia. In its report the Commission will-- (1) With respect to...

  4. Sexualization of Awareness: Catchy, but Does It Actually Increase Knowledge of Breast Cancer?

    ERIC Educational Resources Information Center

    Burgess, Melinda C. R.; Murray, Ashley B.

    2014-01-01

    Currently, in the United States, there exist numerous public awareness campaigns about breast cancer. Many of these campaigns are highly sexualized, focusing on the breasts as an object of fun, as opposed to focusing on information about prevention/diagnosis/treatment. In spite of their popularity, it is unknown what effect they actually have on…

  5. Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

    PubMed Central

    Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

    2015-01-01

    Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the

  6. A better approach to cost estimation.

    PubMed

    Richmond, Russ

    2013-03-01

    Using ratios of costs to charges (RCCs) to estimate costs can cause hospitals to significantly over- or under-invest in service lines. A focus on improving cost estimation in cost centers where physicians have significant control over operating expenses, such as drugs or implants, can strengthen decision making and strategic planning. Connecting patient file information to purchasing data can lead to more accurate reflections of actual costs and help hospitals gain better visibility across service lines.

  7. Using activity-based costing in surgery.

    PubMed

    Grandlich, Cheryl

    2004-01-01

    ACTIVITY-BASED COSTING is an accounting technique that allows organizations to determine actual costs associated with their services based on the resources they consume. THIS TECHNIQUE can be used in a variety of ways, including targeting high-cost activities, forecasting financial baselines, and supporting resource allocation. FOUR STEPS should be followed when applying activity-based costing to surgical procedures. THIS ARTICLE explores how Froedtert Memorial Lutheran Hospital, Milwaukee, used activity-based costing.

  8. Correlation of Spacecraft Mission and Project Costs

    NASA Technical Reports Server (NTRS)

    Swan, Christopher; Jarrett, Shawn

    2007-01-01

    A key component of any cost risk analysis is the level of correlation between individual elements of cost. This analysis supplements the available historical records with the cost estimates from the JPL Advanced Design Team. The costs from actual JPL flight projects are then used to validate the results, clearly indicating that, on average, the correlation between elements of cost is between 0.4 and 0.7.

  9. Chronic hepatitis B and C infection in the United States: a review of current guidelines, disease burden and cost effectiveness of screening.

    PubMed

    Sarpel, Dost; Baichoo, Esha; Dieterich, Douglas T

    2016-01-01

    Chronic hepatitis B and C infection are the leading causes of hepatocellular carcinoma and liver related death in the world and in the United States respectively. Screening guidelines have been developed based on estimated prevalence determined by NHANES data. However, individuals with the most risk of chronic infection (incarcerated, homeless, immigrants, nursing home residents, and hospitalized persons) are underrepresented in this cohort leading to an underestimation of the true prevalence of chronic hepatitis B and C infection. This has led to recent updates in the screening guidelines. This review examines the change in the guidelines, the likely true seroprevalence of hepatitis B and C virus, as well as the burden of chronic infection in this population. PMID:27043049

  10. Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users’ engagement in activities

    PubMed Central

    2013-01-01

    Background This study focuses on people with complex and severe mental health problems who require inpatient rehabilitation. The majority have a diagnosis of schizophrenia whose recovery has been delayed due to non-response to first-line treatments, cognitive impairment, negative symptoms and co-existing problems such as substance misuse. These problems contribute to major impairments in social and everyday functioning necessitating lengthy admissions and high support needs on discharge to the community. Engagement in structured activities reduces negative symptoms of psychosis and may lead to improvement in function, but no trials have been conducted to test the efficacy of interventions that aim to achieve this. Methods/design This study aims to investigate the clinical and cost-effectiveness of a staff training intervention to increase service users’ engagement in activities. This is a single-blind, two-arm cluster randomised controlled trial involving 40 inpatient mental health rehabilitation units across England. Units are randomised on an equal basis to receive either standard care or a “hands-on”, manualised staff training programme comprising three distinct phases (predisposing, enabling and reinforcing) delivered by a small team of psychiatrists, occupational therapists, service users and activity workers. The primary outcome is service user engagement in activities 12 months after randomisation, assessed using a standardised measure. Secondary outcomes include social functioning and costs and cost-effectiveness of care. Discussion The study will provide much needed evidence for a practical staff training intervention that has potential to improve service user functioning, reducing the need for hospital treatment and supporting successful community discharge. The trial is registered with Current Controlled Trials (Ref ISRCTN25898179). PMID:23981710

  11. Hospital cost accounting: implementing the system successfully.

    PubMed

    Burik, D; Duvall, T J

    1985-05-01

    To successfully implement a cost accounting system, certain key steps should be undertaken. These steps include developing and installing software; developing cost center budgets and inter-cost center allocations; developing service item standard costs; generating cost center level and patient level standard cost reports and reconciling these costs to actual costs; generating product line profitability reports and reconciling these reports to the financial statements; and providing ad hoc reporting capabilities. By following these steps, potential problems in the implementation process can be anticipated and avoided.

  12. Radioactive Doses - Predicted and Actual - and Likely Health Effects.

    PubMed

    Nagataki, S; Takamura, N

    2016-04-01

    Five years have passed since the nuclear accident at Fukushima Daiichi Nuclear Power Stations on 11 March 2011. Here we refer to reports from international organisations as sources of predicted values obtained from environmental monitoring and dose estimation models, and reports from various institutes in Japan are used as sources of individual actual values. The World Health Organization, based on information available up to 11 September 2011 (and published in 2012), reported that characteristic effective doses in the first year after the accident, to all age groups, were estimated to be in the 10-50 mSv dose band in example locations in evacuation areas. Estimated characteristic thyroid doses to infants in Namie Town were within the 100-200 mSv dose band. A report from the United Nations Scientific Committee on the Effects of Atomic Radiation published in 2014 shows that the effective dose received by adults in evacuation areas during the first year after the accident was 1.1-13 mSv. The absorbed dose to the thyroid in evacuated settlements was 7.2-35 mSv in adults and 15-83 mSv in 1-year-old infants. Individual external radiation exposure in the initial 4 months after the accident, estimated by superimposing individual behaviour data on to a daily dose rate map, was less than 3 mSv in 93.9% of residents (maximum 15 mSv) in evacuation areas. Actual individual thyroid equivalent doses were less than 15 mSv in 98.8% of children (maximum 25 mSv) in evacuation areas. When uncertainty exists in dose estimation models, it may be sensible to err on the side of caution, and final estimated doses are often much greater than actual radiation doses. However, overestimation of the dose at the time of an accident has a great influence on the psychology of residents. More than 100 000 residents have not returned to the evacuation areas 5 years after the Fukushima accident because of the social and mental effects during the initial period of the disaster. Estimates of

  13. Radioactive Doses - Predicted and Actual - and Likely Health Effects.

    PubMed

    Nagataki, S; Takamura, N

    2016-04-01

    Five years have passed since the nuclear accident at Fukushima Daiichi Nuclear Power Stations on 11 March 2011. Here we refer to reports from international organisations as sources of predicted values obtained from environmental monitoring and dose estimation models, and reports from various institutes in Japan are used as sources of individual actual values. The World Health Organization, based on information available up to 11 September 2011 (and published in 2012), reported that characteristic effective doses in the first year after the accident, to all age groups, were estimated to be in the 10-50 mSv dose band in example locations in evacuation areas. Estimated characteristic thyroid doses to infants in Namie Town were within the 100-200 mSv dose band. A report from the United Nations Scientific Committee on the Effects of Atomic Radiation published in 2014 shows that the effective dose received by adults in evacuation areas during the first year after the accident was 1.1-13 mSv. The absorbed dose to the thyroid in evacuated settlements was 7.2-35 mSv in adults and 15-83 mSv in 1-year-old infants. Individual external radiation exposure in the initial 4 months after the accident, estimated by superimposing individual behaviour data on to a daily dose rate map, was less than 3 mSv in 93.9% of residents (maximum 15 mSv) in evacuation areas. Actual individual thyroid equivalent doses were less than 15 mSv in 98.8% of children (maximum 25 mSv) in evacuation areas. When uncertainty exists in dose estimation models, it may be sensible to err on the side of caution, and final estimated doses are often much greater than actual radiation doses. However, overestimation of the dose at the time of an accident has a great influence on the psychology of residents. More than 100 000 residents have not returned to the evacuation areas 5 years after the Fukushima accident because of the social and mental effects during the initial period of the disaster. Estimates of

  14. 23 CFR 140.906 - Labor costs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL... Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates, and... reimbursable when supported by adequate records. This shall include labor costs associated with...

  15. Modeling costs of plastics recycling

    SciTech Connect

    Not Available

    1993-10-01

    This article describes TCM, a computer spreadsheet technique to simulate process costs. In a technical cost model, cost is assigned to each unit operation in a process flow diagram. Costs are summarized corresponding to unit operations, each representing a single machine or station with an associated production rate. Each station is characterized by factors including number of laborers, equipment and tooling costs, and other investment and operating costs. Technical cost models can be used to: simulate costs of manufacturing; establish direct comparisons between material, process, and design alternatives; investigate the effect of changes in the process options on overall cost; identify limiting process steps and parameters; determine merits of specific process and design improvements.

  16. 40 CFR 74.22 - Actual SO2 emissions rate.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Actual SO2 emissions rate. 74.22... (CONTINUED) SULFUR DIOXIDE OPT-INS Allowance Calculations for Combustion Sources § 74.22 Actual SO2 emissions... actual SO2 emissions rate shall be 1985. (2) For combustion sources that commenced operation...

  17. Actualization and the Fear of Death: Retesting an Existential Hypothesis.

    ERIC Educational Resources Information Center

    Wood, Keith; Robinson, Paul J.

    1982-01-01

    Demonstrates that within a group of highly actualized individuals, the degree to which "own death" is integrated into constructs of self is a far more powerful predictor of fear of death than actualization. Findings suggest that actualization and integration are independent in their overall effect on fear of death. (Author)

  18. A GIS COST MODEL TO ASSESS THE AVAILABILITY OF FRESHWATER, SEAWATER, AND SALINE GROUNDWATER FOR ALGAL BIOFUEL PRODUCTION IN THE UNITED STATES

    SciTech Connect

    Venteris, Erik R.; Skaggs, Richard; Coleman, Andre M.; Wigmosta, Mark S.

    2013-03-15

    A key advantage of using microalgae for biofuel production is the ability of some algal strains to thrive in waters unsuitable for conventional crop irrigation such as saline groundwater or seawater. Nonetheless, the availability of sustainable water supplies will provide significant challenges for scale-up and development of algal biofuels. We conduct a limited techno-economic assessment based on the availability of freshwater, saline groundwater, and seawater for use in open pond algae cultivation systems. We explore water issues through GIS-based models of algae biofuel production, freshwater supply, and cost models for supplying seawater and saline groundwater. We estimate that combined, within the coterminous US these resources can support production on the order of 9.46E+7 m3 yr-1 (25 billion gallons yr-1) of renewable biodiesel. Achievement of larger targets requires the utilization of less water efficient sites and relatively expensive saline waters. Geographically, water availability is most favorable for the coast of the Gulf of Mexico and Florida peninsula, where evaporation relative to precipitation is moderate and various saline waters are economically available. As a whole, barren and scrub lands of the southwestern US have limited freshwater supplies so accurate assessment of alternative waters is critical.

  19. Elements of designing for cost

    NASA Technical Reports Server (NTRS)

    Dean, Edwin B.; Unal, Resit

    1992-01-01

    During recent history in the United States, government systems development has been performance driven. As a result, systems within a class have experienced exponentially increasing cost over time in fixed year dollars. Moreover, little emphasis has been placed on reducing cost. This paper defines designing for cost and presents several tools which, if used in the engineering process, offer the promise of reducing cost. Although other potential tools exist for designing for cost, this paper focuses on rules of thumb, quality function deployment, Taguchi methods, concurrent engineering, and activity-based costing. Each of these tools has been demonstrated to reduce cost if used within the engineering process.

  20. Elements of Designing for Cost

    NASA Technical Reports Server (NTRS)

    Dean, Edwin B.; Unal, Resit

    1992-01-01

    During recent history in the United States, government systems development has been performance driven. As a result, systems within a class have experienced exponentially increasing cost over time in fixed year dollars. Moreover, little emphasis has been placed on reducing cost. This paper defines designing for cost and presents several tools which, if used in the engineering process, offer the promise of reducing cost. Although other potential tools exist for designing for cost, this paper focuses on rules of thumb, quality function deployment, Taguchi methods, concurrent engineering, and activity based costing. Each of these tools has been demonstrated to reduce cost if used within the engineering process.

  1. [Comparison analysis between potential and actual pattern of artificial oases in arid region].

    PubMed

    Jia, B; Ci, L; Yang, X; Yang, J; Pan, B

    2000-12-01

    Based on theoretical analysis and demonstration research, the conception of potential pattern in the agriculture landscape of artificial oases in Xinjiang arid region and its analysis unit were discussed. The potential landscape pattern was defined as the one composed by spatial units with basic characteristics and properties which had no change or less change with the time. In agriculture landscape, soil was found to be a relatively stable element, and hence, different soil classification unit could be used to analyze the potential landscape pattern. A case study was carried out to analyze the potential and actual pattern of the artificial cases in Shihezi reclamation area by using the indexes of diversity, evenness, aggregation, mean patch elongation, patch shape fragmentation and mean patch fractal dimension. The result showed that the landscape pattern changed orderly from the potential to actual pattern, and the potential pattern could be used as the absolute criterion for researches on pattern changes in agriculture landscape.

  2. Low cost solar aray project: Experimental process system development unit for producing semiconductor-grade silicon using the silane-to-silicon process

    NASA Technical Reports Server (NTRS)

    1981-01-01

    This phase consists of the engineering design, fabrication, assembly, operation, economic analysis, and process support R&D for an Experimental Process System Development Unit (EPSDU). The mechanical bid package was issued and the bid responses are under evaluation. Similarly, the electrical bid package was issued, however, responses are not yet due. The majority of all equipment is on order or has been received at the EPSDU site. The pyrolysis/consolidation process design package was issued. Preparation of process and instrumentation diagram for the free-space reactor was started. In the area of melting/consolidation, Kayex successfully melted chunk silicon and have produced silicon shot. The free-space reactor powder was successfully transported pneumatically from a storage bin to the auger feeder twenty-five feet up and was melted. The fluid-bed PDU has successfully operated at silane feed concentrations up to 21%. The writing of the operating manual has started. Overall, the design phase is nearing completion.

  3. Aid Effectiveness, Transaction Costs and Conditionality in the Education Sector

    ERIC Educational Resources Information Center

    Ashford, Richard; Biswas, Shampa

    2010-01-01

    The reduction of transaction costs is a commonly mentioned yet rarely elaborated goal for aid effectiveness in educational development. The casual use of the concept of transaction costs conceals which costs may be reduced, which costs are required and, indeed, what transaction costs actually are. Examining issues related to harmonizing the…

  4. From Preferred to Actual Mate Characteristics: The Case of Human Body Shape

    PubMed Central

    Courtiol, Alexandre; Picq, Sandrine; Godelle, Bernard; Raymond, Michel; Ferdy, Jean-Baptiste

    2010-01-01

    The way individuals pair to produce reproductive units is a major factor determining evolution. This process is complex because it is determined not only by individual mating preferences, but also by numerous other factors such as competition between mates. Consequently, preferred and actual characteristics of mates obtained should differ, but this has rarely been addressed. We simultaneously measured mating preferences for stature, body mass, and body mass index, and recorded corresponding actual partner's characteristics for 116 human couples from France. Results show that preferred and actual partner's characteristics differ for male judges, but not for females. In addition, while the correlation between all preferred and actual partner's characteristics appeared to be weak for female judges, it was strong for males: while men prefer women slimmer than their actual partner, those who prefer the slimmest women also have partners who are slimmer than average. This study therefore suggests that the influences of preferences on pair formation can be sex-specific. It also illustrates that this process can lead to unexpected results on the real influences of mating preferences: traits considered as highly influencing attractiveness do not necessarily have a strong influence on the actual pairing, the reverse being also possible. PMID:20885953

  5. From preferred to actual mate characteristics: the case of human body shape.

    PubMed

    Courtiol, Alexandre; Picq, Sandrine; Godelle, Bernard; Raymond, Michel; Ferdy, Jean-Baptiste

    2010-09-27

    The way individuals pair to produce reproductive units is a major factor determining evolution. This process is complex because it is determined not only by individual mating preferences, but also by numerous other factors such as competition between mates. Consequently, preferred and actual characteristics of mates obtained should differ, but this has rarely been addressed. We simultaneously measured mating preferences for stature, body mass, and body mass index, and recorded corresponding actual partner's characteristics for 116 human couples from France. Results show that preferred and actual partner's characteristics differ for male judges, but not for females. In addition, while the correlation between all preferred and actual partner's characteristics appeared to be weak for female judges, it was strong for males: while men prefer women slimmer than their actual partner, those who prefer the slimmest women also have partners who are slimmer than average. This study therefore suggests that the influences of preferences on pair formation can be sex-specific. It also illustrates that this process can lead to unexpected results on the real influences of mating preferences: traits considered as highly influencing attractiveness do not necessarily have a strong influence on the actual pairing, the reverse being also possible.

  6. From preferred to actual mate characteristics: the case of human body shape.

    PubMed

    Courtiol, Alexandre; Picq, Sandrine; Godelle, Bernard; Raymond, Michel; Ferdy, Jean-Baptiste

    2010-01-01

    The way individuals pair to produce reproductive units is a major factor determining evolution. This process is complex because it is determined not only by individual mating preferences, but also by numerous other factors such as competition between mates. Consequently, preferred and actual characteristics of mates obtained should differ, but this has rarely been addressed. We simultaneously measured mating preferences for stature, body mass, and body mass index, and recorded corresponding actual partner's characteristics for 116 human couples from France. Results show that preferred and actual partner's characteristics differ for male judges, but not for females. In addition, while the correlation between all preferred and actual partner's characteristics appeared to be weak for female judges, it was strong for males: while men prefer women slimmer than their actual partner, those who prefer the slimmest women also have partners who are slimmer than average. This study therefore suggests that the influences of preferences on pair formation can be sex-specific. It also illustrates that this process can lead to unexpected results on the real influences of mating preferences: traits considered as highly influencing attractiveness do not necessarily have a strong influence on the actual pairing, the reverse being also possible. PMID:20885953

  7. [Dogs babesiosis--still actually problem].

    PubMed

    Adaszek, Łukasz; Winiarczyk, Stanisław

    2008-01-01

    Babesiosis (piroplasmosis) is a tick-borne disease with a symptoms of hemolytic anemia. For the first time babesiosis was described in dogs in United States in 1934. The etiological factor of this disease in Poland is protozoa Babesia canis, and its vector--Dermacentor-tick. The most common symptoms of babesiosis are: icterus, hemoglobinuria, occasionally vomits and diarrhea. The biochemical examination of blood serum from sick animals can reveal the increase of activity of AST, ALT, the increase of total bilirubine, urea and creatynine concentrations. The results of hematological examinations can show anemia, leucopenia and thrombocytopenia. The diagnosis of babesiosis bases on anamnesis, clinical examinations of dogs, microscopical examinations of blood smears from sick animals; IF-assay and PCR can also be helpful for the diagnosis of babesiosis. Till now does not exist the effective immunoprophylaxis against this disease. Babesiosis is well-known disease, however there are still problems with therapy of infected animals. Most effective drug in therapy of dog piroplasmosis is imidocarb, but sometimes can be observed side effects after it application. It is possible that the genetically differences which are detected in subspecies may have an influence on the severity of disease and the effectiveness of therapy.

  8. Direct and Indirect Effects of Completion versus Accuracy Contingencies on Practice-Exam and Actual-Exam Performance

    ERIC Educational Resources Information Center

    Oliver, Renee; Williams, Robert L.

    2005-01-01

    Students in four sections of an undergraduate educational course (two large and two small sections) took out-of-class practice exams prior to actual exams for each of five course units. Each course unit consisted of five class sessions focusing on a specific developmental theme. Some sections received practice-exam credit based on the number of…

  9. LIFE Cost of Electricity, Capital and Operating Costs

    SciTech Connect

    Anklam, T

    2011-04-14

    Successful commercialization of fusion energy requires economic viability as well as technical and scientific feasibility. To assess economic viability, we have conducted a pre-conceptual level evaluation of LIFE economics. Unit costs are estimated from a combination of bottom-up costs estimates, working with representative vendors, and scaled results from previous studies of fission and fusion plants. An integrated process model of a LIFE power plant was developed to integrate and optimize unit costs and calculate top level metrics such as cost of electricity and power plant capital cost. The scope of this activity was the entire power plant site. Separately, a development program to deliver the required specialized equipment has been assembled. Results show that LIFE power plant cost of electricity and plant capital cost compare favorably to estimates for new-build LWR's, coal and gas - particularly if indicative costs of carbon capture and sequestration are accounted for.

  10. 20 CFR 641.859 - What other special rules govern the classification of costs as administrative costs or program...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...), all costs incurred by vendors are program costs. (See 29 CFR 99.210 for a discussion of factors... documented distributions of actual time worked or other equitable cost allocation methods. (d) Specific costs... information systems including the purchase, systems development and operating (e.g., data entry) costs...

  11. STEAM REFORMING TECHNOLOGY DEMONSTRATION FOR THE DESTRUCTION OF ORGANICS ON ACTUAL DOE SAVANNAH RIVER SITE TANK 48H WASTE 9138

    SciTech Connect

    Burket, P

    2009-02-24

    This paper describes the design of the Bench-scale Steam Reformer (BSR); a processing unit for demonstrating steam reforming technology on actual radioactive waste [1]. It describes the operating conditions of the unit used for processing a sample of Savannah River Site (SRS) Tank 48H waste. Finally, it compares the results from processing the actual waste in the BSR to processing simulant waste in the BSR to processing simulant waste in a large pilot scale unit, the Fluidized Bed Steam Reformer (FBSR), operated at Hazen Research Inc. in Golden, CO. The purpose of this work was to prove that the actual waste reacted in the same manner as the simulant waste in order to validate the work performed in the pilot scale unit which could only use simulant waste.

  12. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    PubMed

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  13. A Pilot Study to Explore the Feasibility of Using the Clinical Care Classification System for Developing a Reliable Costing Method for Nursing Services

    PubMed Central

    Dykes, Patricia C.; Wantland, Dean; Whittenburg, Luann; Lipsitz, Stuart; Saba, Virginia K.

    2013-01-01

    While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services. PMID:24551343

  14. A pilot study to explore the feasibility of using theClinical Care Classification System for developing a reliable costing method for nursing services.

    PubMed

    Dykes, Patricia C; Wantland, Dean; Whittenburg, Luann; Lipsitz, Stuart; Saba, Virginia K

    2013-01-01

    While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services.

  15. Planter unit test stand

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A planter test stand was developed to evaluate individual row-crop metering units in early 2013. This test stand provided the ability to quantify actual seed metering in terms of population, seed spacing, skips, and multiples over a range of meter RPMs and vacuum pressures. Preliminary data has been...

  16. Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach

    PubMed Central

    2016-01-01

    Introduction The increasing burden of dengue fever (DF) in the Americas, and the current epidemic in previously unaffected countries, generate major costs for national healthcare systems. There is a need to quantify the average cost per DF case. In Mexico, few data are available on costs, despite DF being endemic in some areas. Extrapolations from studies in other countries may prove unreliable and are complicated by the two main Mexican healthcare systems (the Secretariat of Health [SS] and the Mexican Social Security Institute [IMSS]). The present study aimed to generate specific average DF cost-per-case data for Mexico using a micro-costing approach. Methods Expected medical costs associated with an ideal management protocol for DF (denoted ´ideal costs´) were compared with the medical costs of current treatment practice (denoted ´real costs´) in 2012. Real cost data were derived from chart review of DF cases and interviews with patients and key personnel from 64 selected hospitals and ambulatory care units in 16 states for IMSS and SS. In both institutions, ideal and real costs were estimated using the program, actions, activities, tasks, inputs (PAATI) approach, a micro-costing technique developed by us. Results Clinical pathways were obtained for 1,168 patients following review of 1,293 charts. Ideal and real costs for SS patients were US$165.72 and US$32.60, respectively, in the outpatient setting, and US$587.77 and US$490.93, respectively, in the hospital setting. For IMSS patients, ideal and real costs were US$337.50 and US$92.03, respectively, in the outpatient setting, and US$2,042.54 and US$1,644.69 in the hospital setting. Conclusions The markedly higher ideal versus real costs may indicate deficiencies in the actual care of patients with DF. It may be necessary to derive better estimates with micro-costing techniques and compare the ideal protocol with current practice when calculating these costs, as patients do not always receive optimal care

  17. 25 CFR 39.201 - Does ISEF reflect the actual cost of school operations?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... INDIAN SCHOOL EQUALIZATION PROGRAM Administrative Procedures, Student Counts, and Verifications § 39.201... relative distribution of available funds at the local school level by comparison with all other...

  18. 76 FR 22410 - Notice of Proposed Information Collection: Comment Request; Mortgagor's Certificate of Actual Cost

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-21

    ... Federal Information Relay Service, (1-800-877-8339). FOR FURTHER INFORMATION CONTACT: Joyce Allen... of 1995 (44 U.S.C. chapter 35, as amended). This Notice is soliciting comments from members of the... approved collection. Authority: The Paperwork Reduction Act of 1995, 44 U.S.C., Chapter 35, as...

  19. Cost goals

    NASA Technical Reports Server (NTRS)

    Hoag, J.

    1981-01-01

    Cost goal activities for the point focusing parabolic dish program are reported. Cost goals involve three tasks: (1) determination of the value of the dish systems to potential users; (2) the cost targets of the dish system are set out; (3) the value side and cost side are integrated to provide information concerning the potential size of the market for parabolic dishes. The latter two activities are emphasized.

  20. THE HIGH COST OF DISCRIMINATION.

    ERIC Educational Resources Information Center

    ROPER, ELMO

    ON THE BASIS OF EMPLOYEE SURVEYS AND IN-PLANT RESEARCH, THE TOTAL COST OF DISCRIMINATION TO AMERICAN BUSINESS AND INDUSTRY IN ACTUAL DOLLARS IS ESTIMATED AT ROUGHLY $30 BILLION ANNUALLY. DISCRIMINATION IN INDUSTRY BEGINS AT THE HIRING GATE WHERE MINORITY GROUPS ARE REFUSED EMPLOYMENT BECAUSE OF RACE, COLOR, RELIGION, NATIONALITY, POLITICAL…

  1. Tracking Costs

    ERIC Educational Resources Information Center

    Erickson, Paul W.

    2010-01-01

    Even though there's been a slight reprieve in energy costs, the reality is that the cost of non-renewable energy is increasing, and state education budgets are shrinking. One way to keep energy and operations costs from overshadowing education budgets is to develop a 10-year energy audit plan to eliminate waste. First, facility managers should…

  2. Avoidable waste management costs

    SciTech Connect

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP.

  3. An Introduction to the NCHEMS Costing and Data Management System. Technical Report No. 55.

    ERIC Educational Resources Information Center

    Haight, Mike; Martin, Ron

    The NCHEMS Costing and Data Management System is designed to assist institutions in the implementation of cost studies. There are at least two kinds of cost studies: historical cost studies which display cost-related data that reflect actual events over a specific prior time period, and predictive cost studies which forecast costs that will be…

  4. Relationship between perceived and actual motor competence among college students.

    PubMed

    Wang, Jianyu; Liu, Wenhao; Bian, Wei

    2013-02-01

    The relationship between perceived and actual motor competence was examined among college students. Participants were 114 college students (55 men, 59 women; M age = 22.3 yr., SD = 3.9). All participants completed a short survey on perception of motor competence in basketball and took a Control Basketball Dribble Test to assess their actual motor skill. Perceived motor competence in basketball was significantly related to basketball dribbling performance. Given the positive relationship between actual motor competence and perceived competence, enhancing an individual's actual motor competence may contribute to their perceived competence, which may improve an individual's physical activity participation.

  5. What Do Cost Functions Tell Us about the Cost of an Adequate Education?

    ERIC Educational Resources Information Center

    Costrell, Robert M.; Hanushek, Eric; Loeb, Susanna

    2008-01-01

    Econometric cost functions have begun to appear in education adequacy cases with greater frequency. Cost functions are superficially attractive because they give the impression of objectivity, holding out the promise of scientifically estimating the cost of achieving specified levels of performance from actual data on spending. By contrast, the…

  6. Self-Actualization Effects Of A Marathon Growth Group

    ERIC Educational Resources Information Center

    Jones, Dorothy S.; Medvene, Arnold M.

    1975-01-01

    This study examined the effects of a marathon group experience on university student's level of self-actualization two days and six weeks after the experience. Gains in self-actualization as a result of marathon group participation depended upon an individual's level of ego strength upon entering the group. (Author)

  7. The Self-Actualization of Polk Community College Students.

    ERIC Educational Resources Information Center

    Pearsall, Howard E.; Thompson, Paul V., Jr.

    This article investigates the concept of self-actualization introduced by Abraham Maslow (1954). A summary of Maslow's Needs Hierarchy, along with a description of the characteristics of the self-actualized person, is presented. An analysis of humanistic education reveals it has much to offer as a means of promoting the principles of…

  8. Depression and Self-Actualization in Gifted Adolescents.

    ERIC Educational Resources Information Center

    Berndt, David J.; And Others

    1982-01-01

    Investigated the relationship between depressive affect and self-actualization in gifted adolescents (N=248). Found that gifted students who were not self-actualizing types were more depressed; and guilt, low self-esteem, learned helplessness, and cognitive difficulty were important symptoms. Gifted adolescents tended to be more socially…

  9. SELF-ACTUALIZATION AND THE UTILIZATION OF TALENT.

    ERIC Educational Resources Information Center

    FRENCH, JOHN R.P.; MILLER, DANIEL R.

    THIS STUDY ATTEMPTED (1) TO DEVELOP A THEORY OF THE CAUSES AND CONSEQUENCES OF SELF-ACTUALIZATION AS RELATED TO THE UTILIZATION OF TALENT, (2) TO FIT THE THEORY TO EXISTING DATA, AND (3) TO PLAN ONE OR MORE RESEARCH PROJECTS TO TEST THE THEORY. TWO ARTICLES ON IDENTITY AND MOTIVATION AND SELF-ACTUALIZATION AND SELF-IDENTITY THEORY REPORTED THE…

  10. Facebook as a Library Tool: Perceived vs. Actual Use

    ERIC Educational Resources Information Center

    Jacobson, Terra B.

    2011-01-01

    As Facebook has come to dominate the social networking site arena, more libraries have created their own library pages on Facebook to create library awareness and to function as a marketing tool. This paper examines reported versus actual use of Facebook in libraries to identify discrepancies between intended goals and actual use. The results of a…

  11. A Study of Self-Actualization and Facilitative Communication.

    ERIC Educational Resources Information Center

    Omizo, Michael M.

    1981-01-01

    Examined the relationship between self-actualization measures and ability in facilitative communication of trainees from counseling, social work, and psychology programs to determine if differences existed between the three groups. Self-actualization indexes were significantly correlated with ability in facilitative communication. (RC)

  12. 26 CFR 1.962-3 - Treatment of actual distributions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 10 2013-04-01 2013-04-01 false Treatment of actual distributions. 1.962-3... TAX (CONTINUED) INCOME TAXES (CONTINUED) Controlled Foreign Corporations § 1.962-3 Treatment of actual... a foreign corporation. (ii) Treatment of section 962 earnings and profits under § 1.959-3....

  13. Reflex Estrogen Receptor (ER) and Progesterone Receptor (PR) Analysis of Ductal Carcinoma In Situ (DCIS) in Breast Needle Core Biopsy Specimens: An Unnecessary Exercise That Costs the United States $35 Million/y.

    PubMed

    VandenBussche, Christopher J; Cimino-Mathews, Ashley; Park, Ben Ho; Emens, Leisha A; Tsangaris, Theodore N; Argani, Pedram

    2016-08-01

    %), indicating that ER/PR testing costing $20,685.72 ($357/patient in the study) had been performed unnecessarily. PR testing could have been omitted in the 16 cases in which ER/PR results were used, which would have saved $5014.72, or $86.46 per patient. Extrapolating the increased cost of $583 per DCIS diagnosis on core needle biopsy to 60,000 new cases of DCIS in the United States each year, reflex core needle biopsy ER/PR testing unnecessarily increases costs by approximately $35 million. We recommend that ER/PR not be reflexively ordered on core needle biopsy specimens or surgical excision specimens containing DCIS, but instead that ER alone be performed on surgical excision specimens only when hormone therapy is a serious consideration after medical oncology consultation.

  14. Avoiding costly remediation

    SciTech Connect

    Scheels, R.H.

    1997-10-01

    Some oil and gas pipeline operations require equipment with hydraulic or oil circulation systems. These are subject to oil leaks or spills due to equipment malfunctions as well as normal operation. The potential liability and actual remediation and shutdown costs helped create the need for more environmentally friendly hydraulic fluids. Mobil has developed readily biodegradable, virtually nontoxic hydraulic fluids, Mobil EAL 224H and Mobil EAL Syndrajoc Series oils (EAL stands for Environmental Awareness Lubricants). The first is vegetable oil-based, while the others are formulated from high viscosity-index synthetic ester base stocks. Both use virtually nontoxic additive packages. These hydraulic fluids are described.

  15. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Methodology of Comparing Cost of... Comparing Cost of Public Housing With Cost of Tenant-Based Assistance I. Public Housing The costs used for... housing. That per unit monthly cost of public housing must be compared to the per unit monthly Section...

  16. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Methodology of Comparing Cost of... Comparing Cost of Public Housing With Cost of Tenant-Based Assistance I. Public Housing The costs used for... housing. That per unit monthly cost of public housing must be compared to the per unit monthly Section...

  17. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Methodology of Comparing Cost of... Comparing Cost of Public Housing With Cost of Tenant-Based Assistance I. Public Housing The costs used for... housing. That per unit monthly cost of public housing must be compared to the per unit monthly Section...

  18. 48 CFR 12.214 - Cost Accounting Standards.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Cost Accounting Standards... Items 12.214 Cost Accounting Standards. Cost Accounting Standards (CAS) do not apply to contracts and... actual costs incurred). See 48 CFR 30.201-1 for CAS applicability to fixed-price with economic...

  19. 48 CFR 12.214 - Cost Accounting Standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Cost Accounting Standards... Items 12.214 Cost Accounting Standards. Cost Accounting Standards (CAS) do not apply to contracts and... actual costs incurred). See 48 CFR 30.201-1 for CAS applicability to fixed-price with economic...

  20. 48 CFR 12.214 - Cost Accounting Standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Cost Accounting Standards... Items 12.214 Cost Accounting Standards. Cost Accounting Standards (CAS) do not apply to contracts and... actual costs incurred). See 48 CFR 30.201-1 for CAS applicability to fixed-price with economic...

  1. 48 CFR 12.214 - Cost Accounting Standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Cost Accounting Standards... Items 12.214 Cost Accounting Standards. Cost Accounting Standards (CAS) do not apply to contracts and... actual costs incurred). See 48 CFR 30.201-1 for CAS applicability to fixed-price with economic...

  2. 47 CFR 27.1180 - The cost-sharing formula.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...; engineering costs (design/path survey); installation; systems testing; FCC filing costs; site acquisition and civil works; zoning costs; training; disposal of old equipment; test equipment (vendor required); spare... system, such as equipment and engineering expenses. There is no cap on the actual costs of relocation....

  3. 47 CFR 27.1164 - The cost-sharing formula.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...; back-up power equipment; monitoring or control equipment; engineering costs (design/path survey); installation; systems testing; FCC filing costs; site acquisition and civil works; zoning costs; training... actual costs associated with providing a replacement system, such as equipment and engineering...

  4. The Yale Cost Model and cost centres: servant or master?

    PubMed

    Rigby, E

    1993-01-01

    Cost accounting describes that aspect of accounting which collects, allocates and controls the cost of producing a service. Costing information is primarily reported to management to enable control of costs and to ensure the financial viability of units, departments and divisions. As costing studies continue to produce estimates of Diagnosis Related Group (DRG) costs in New South Wales hospitals, as well as in other states, costs for different hospitals are being externally compared, using a tool which is usually related to internal management and reporting. Comparability of costs is assumed even though accounting systems differ. This paper examines the cost centre structures at five major teaching hospitals in Sydney. It describes the similarities and differences in how the cost centres were constituted, and then details the line items of expenditure that are charged to each cost centre. The results of a comparative study of a medical specialty are included as evidence of different costing methodologies in the hospitals. The picture that emerged from the study is that the hospitals are constituting their cost centres to meet their internal management needs, that is, to know the cost of running a ward or nursing unit, a medical specialty, department and so on. The rationale for the particular cost centre construction was that cost centre managers could manage and control costs and assign responsibility. There are variations in procedures for assigning costs to cost centres, and the question is asked 'Do these variations in procedures make a material difference to our ability to compare costs per Diagnosis Related Group at the various hospitals?' It is contended that the accounting information, which is produced as a result of different practices, is primarily for internal management, not external comparison. It would be better for hospitals to compare their estimated costs per Diagnosis Related Group to an internal standard cost rather than the costs from other

  5. 40 CFR 72.91 - Phase I unit adjusted utilization.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... this part. (2) “Actual utilization” is the actual annual heat input (in mmBtu) of the unit for the... annual average heat rate (Btu/Kwh) of the unit (determined in accordance with part 75 of this chapter... designated sulfur-free generators + shifts to designated compensating units where: (i) “Reduction from...

  6. 40 CFR 72.91 - Phase I unit adjusted utilization.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... this part. (2) “Actual utilization” is the actual annual heat input (in mmBtu) of the unit for the... annual average heat rate (Btu/Kwh) of the unit (determined in accordance with part 75 of this chapter... designated sulfur-free generators + shifts to designated compensating units where: (i) “Reduction from...

  7. Department of Energy Environmental Management cost infrastructure development program: Cost analysis requirements

    SciTech Connect

    Custer, W.R. Jr.; Messick, C.D.

    1996-03-31

    This report was prepared to support development of the Department of Energy Environmental Management cost infrastructure -- a new capability to independently estimate and analyze costs. Currently, the cost data are reported according to a structure that blends level of effort tasks with product and process oriented tasks. Also. the budgetary inputs are developed from prior year funding authorizations and from contractor-developed parametric estimates that have been adjusted to planned funding levels or appropriations. Consequently, it is difficult for headquarters and field-level activities to use actual cost data and technical requirements to independently assess the costs generated and identify trends, potential cost savings from process improvements, and cost reduction strategies.

  8. 23 CFR 140.906 - Labor costs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates,...

  9. 23 CFR 140.906 - Labor costs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates,...

  10. 23 CFR 140.906 - Labor costs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates,...

  11. 39 CFR 491.5 - Costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Costs. 491.5 Section 491.5 Postal Service UNITED... RATE COMMISSION § 491.5 Costs. The Postal Service's administrative costs in executing the garnishment action shall be added to each garnishment and the costs recovered shall be retained as...

  12. 39 CFR 491.5 - Costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Costs. 491.5 Section 491.5 Postal Service UNITED... RATE COMMISSION § 491.5 Costs. The Postal Service's administrative costs in executing the garnishment action shall be added to each garnishment and the costs recovered shall be retained as...

  13. 49 CFR 1139.3 - Cost study.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false Cost study. 1139.3 Section 1139.3 Transportation... Commodities § 1139.3 Cost study. (a) The respondents shall submit a cost study. Highway Form B may be used for this purpose. Service unit-costs shall be developed for each individual study carrier, adjusted by...

  14. 49 CFR 1139.3 - Cost study.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 8 2014-10-01 2014-10-01 false Cost study. 1139.3 Section 1139.3 Transportation... Commodities § 1139.3 Cost study. (a) The respondents shall submit a cost study. Highway Form B may be used for this purpose. Service unit-costs shall be developed for each individual study carrier, adjusted by...

  15. 49 CFR 1139.3 - Cost study.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 8 2011-10-01 2011-10-01 false Cost study. 1139.3 Section 1139.3 Transportation... Commodities § 1139.3 Cost study. (a) The respondents shall submit a cost study. Highway Form B may be used for this purpose. Service unit-costs shall be developed for each individual study carrier, adjusted by...

  16. 49 CFR 1139.3 - Cost study.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false Cost study. 1139.3 Section 1139.3 Transportation... Commodities § 1139.3 Cost study. (a) The respondents shall submit a cost study. Highway Form B may be used for this purpose. Service unit-costs shall be developed for each individual study carrier, adjusted by...

  17. Perceived and actual wildfire danger: an economic and spatial analysis study in Colorado (USA).

    PubMed

    Kaval, Pamela

    2009-04-01

    Over the last 20 years, costs for wildfire initial attack in the U.S. have increased significantly. The increased cost relates to wildfire suppression practices, as well as the growing number of homes in the wildland urban interface. Requiring wildland urban interface residents to pay an annual tax for their wildfire risk could lower costs to the general taxpayer. Willingness-to-pay for wildfire prevention, in relation to both perceived and actual wildfire danger, was the focus of this study. Surveyed Colorado wildland urban interface residents were found to have a high awareness of wildfire risk and were willing-to-pay over $400 annually to reduce this risk. Respondents' beliefs about wildfire frequency were comparable to the wildfire regimes of their areas' pre-European settlement.

  18. Costing the OMNIUM-G system 7500

    NASA Technical Reports Server (NTRS)

    Fortgang, H. R.

    1980-01-01

    A complete OMNIUM-G System 7500 was cost analyzed for annual production quantities ranging from 25 to 10,000 units per year. Parts and components were subjected to in-depth scrutiny to determine optimum manufacturing processes, coupled with make or buy decisions on materials and small parts. When production quantities increase both labor and material costs reduce substantially. A redesign of the system that was analyzed could result in lower costs when annual production runs approach 100,000 units/year. Material and labor costs for producing 25, 100, 25,000 and 100,00 units are given for 17 subassembly units.

  19. 48 CFR 252.225-7006 - Quarterly reporting of actual contract performance outside the United States.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...), OUSD(AT&L) DPAP/CPIC, Washington, DC 20301-3060. (e) Report format. The Contractor— (1) Shall submit..., construction, ores, natural gases, utilities, petroleum products and crudes, timber (logs), or subsistence;...

  20. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

    PubMed Central

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health