Science.gov

Sample records for airway costs allocation

  1. What Does it Really Cost? Allocating Indirect Costs.

    ERIC Educational Resources Information Center

    Snyder, Herbert; Davenport, Elisabeth

    1997-01-01

    Better managerial control in terms of decision making and understanding the costs of a system/service result from allocating indirect costs. Allocation requires a three-step process: selecting cost objectives, pooling related overhead costs, and selecting costs bases to connect the objectives to the pooled costs. Argues that activity-based costing…

  2. 45 CFR 304.15 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... FEDERAL FINANCIAL PARTICIPATION § 304.15 Cost allocation. A State agency in support of its claims under title IV-D of the Social Security Act must have an approved cost allocation plan on file with the Department in accordance with the requirements contained in Subpart E of 45 CFR part 95. Subpart E also...

  3. 45 CFR 304.15 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... FEDERAL FINANCIAL PARTICIPATION § 304.15 Cost allocation. A State agency in support of its claims under title IV-D of the Social Security Act must have an approved cost allocation plan on file with the Department in accordance with the requirements contained in Subpart E of 45 CFR part 95. Subpart E also...

  4. 45 CFR 98.55 - Cost allocation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Cost allocation. 98.55 Section 98.55 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.55 Cost allocation. (a) The Lead Agency and...

  5. 45 CFR 98.55 - Cost allocation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Cost allocation. 98.55 Section 98.55 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.55 Cost allocation. (a) The Lead Agency and...

  6. 45 CFR 98.55 - Cost allocation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Cost allocation. 98.55 Section 98.55 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.55 Cost allocation. (a) The Lead Agency and...

  7. 45 CFR 98.55 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Cost allocation. 98.55 Section 98.55 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.55 Cost allocation. (a) The Lead Agency and...

  8. 45 CFR 98.55 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Cost allocation. 98.55 Section 98.55 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.55 Cost allocation. (a) The Lead Agency and...

  9. 45 CFR 304.15 - Cost allocation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Regulations Relating to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT... FEDERAL FINANCIAL PARTICIPATION § 304.15 Cost allocation. A State agency in support of its claims under title IV-D of the Social Security Act must have an approved cost allocation plan on file with...

  10. 45 CFR 205.150 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ASSISTANCE PROGRAMS § 205.150 Cost allocation. A State plan under title I, IV-A, X, XIV, or XVI (AABD) of the Social Security Act must provide that the State agency will have an approved cost allocation plan on file with the Department in accordance with the requirements contained in subpart E of 45 CFR part...

  11. 42 CFR 457.228 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... accordance with the requirements contained in subpart E of 45 CFR part 95. Subpart E also sets forth the... 42 Public Health 4 2011-10-01 2011-10-01 false Cost allocation. 457.228 Section 457.228 Public...; Reduction of Federal Medical Payments § 457.228 Cost allocation. A State plan must provide that the...

  12. 42 CFR 433.34 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Department in accordance with the requirements contained in subpart E of 45 CFR part 95. Subpart E also sets... 42 Public Health 4 2011-10-01 2011-10-01 false Cost allocation. 433.34 Section 433.34 Public... Provisions § 433.34 Cost allocation. A State plan under Title XIX of the Social Security Act must...

  13. Making sense of peak load cost allocations

    SciTech Connect

    Power, T.M.

    1995-03-15

    When it comes to cost allocation, common wisdom assigns costs in proportion to class contributions to peak loads, The justification is simple: Since the equipment had to be sized to meet peak day loads, those costs should be allocated on the same basis. Many different peak allocators have been developed on this assumption: single coincident peak contribution, sum of coincident peaks, noncoincident peak, average and excess demand, peak and average demand, base and extra capacity, and so on. Such pure peak-load allocators may not be politically acceptable, but conceptually, at least, they appear to offer the only defensible approach. Nevertheless, where capacity can be added with significant economies of scale, making cost allocations in proportion to peak loads violates well-known relationships between economics and engineering. What is missing is any tracing of the way in which the peak-load design criteria actually influence the cost incurred.

  14. 45 CFR 400.13 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... costs, both direct and indirect, appropriately between the Refugee Resettlement Program (RRP) and other programs which it administers. (b) Within the RRP, a State must allocate costs appropriately among its CMA grant, social services grant, and any other Refugee Resettlement Program (RRP) grants which it...

  15. 47 CFR 76.924 - Allocation to service cost categories.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... allocator has been specified by the Commission are to be allocated among the service cost categories and the... analysis is not possible, common costs for which no allocator has been specified by the Commission...

  16. 47 CFR 76.924 - Allocation to service cost categories.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... allocator has been specified by the Commission are to be allocated among the service cost categories and the... analysis is not possible, common costs for which no allocator has been specified by the Commission...

  17. 47 CFR 76.924 - Allocation to service cost categories.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... allocator has been specified by the Commission are to be allocated among the service cost categories and the... analysis is not possible, common costs for which no allocator has been specified by the Commission...

  18. 47 CFR 64.903 - Cost allocation manuals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Cost allocation manuals. 64.903 Section 64.903... RULES RELATING TO COMMON CARRIERS Allocation of Costs § 64.903 Cost allocation manuals. (a) Each... mid-sized incumbent local exchange carriers is required to file a cost allocation manual...

  19. 45 CFR 1355.57 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL § 1355.57 Cost allocation....

  20. 42 CFR 457.228 - Cost allocation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Cost allocation. 457.228 Section 457.228 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

  1. 42 CFR 433.34 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Department in accordance with the requirements contained in subpart E of 45 CFR part 95. Subpart E also sets... 42 Public Health 4 2010-10-01 2010-10-01 false Cost allocation. 433.34 Section 433.34 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  2. 42 CFR 457.228 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... accordance with the requirements contained in subpart E of 45 CFR part 95. Subpart E also sets forth the... 42 Public Health 4 2010-10-01 2010-10-01 false Cost allocation. 457.228 Section 457.228 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  3. 45 CFR 400.13 - Cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Grants to States for Refugee Resettlement Award of Grants to States § 400.13 Cost allocation. (a) A State must...

  4. 47 CFR 76.924 - Allocation to service cost categories.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... equipment basket based on direct analysis of the origin of the costs. (ii) Where allocation based on direct analysis is not possible, common costs for which no allocator has been specified by the Commission shall... be found, common costs shall be allocated to each service cost category based on the ratio of...

  5. 77 FR 54482 - Allocation of Costs Under the Simplified Methods

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-05

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BG07 Allocation of Costs Under the Simplified Methods... document contains proposed regulations on allocating costs to certain property produced by the taxpayer or... resellers of property that are required to capitalize certain costs to the property and that allocate...

  6. Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?

    PubMed

    Slinn, Simon J; Froom, Stephen R; Stacey, Mark R W; Gildersleve, Christopher D

    2015-01-01

    Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care. PMID:25370686

  7. 28 CFR 100.14 - Directly allocable costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 100.14 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) COST RECOVERY REGULATIONS, COMMUNICATIONS ASSISTANCE FOR LAW ENFORCEMENT ACT OF 1994 § 100.14 Directly allocable costs. (a) A cost is directly allocable to the CALEA compliance effort: (1) If it is a plant cost incurred specifically to...

  8. 28 CFR 100.14 - Directly allocable costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... the benefits accruing to the multiple cost objectives. (6) The base period for allocating allocable... incurred for the same purpose in like circumstances have been included as a direct cost of that, or any... of the benefits accruing to the multiple cost objectives. (ii) Similarly, the particular case...

  9. 47 CFR 1.1417 - Allocation of Unusable Space Costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Allocation of Unusable Space Costs. 1.1417... Attachment Complaint Procedures § 1.1417 Allocation of Unusable Space Costs. (a) With respect to the formula referenced in § 1.1409(e)(2), a utility shall apportion the cost of providing unusable space on a pole...

  10. 47 CFR 64.903 - Cost allocation manuals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... mid-sized incumbent local exchange carriers is required to file a cost allocation manual describing how it separates regulated from nonregulated costs. The manual shall contain the following information... shall ensure that the information contained in its cost allocation manual is accurate. Carriers...

  11. 47 CFR 1.1417 - Allocation of Unusable Space Costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 1 2012-10-01 2012-10-01 false Allocation of Unusable Space Costs. 1.1417... by Random Selection Pole Attachment Complaint Procedures § 1.1417 Allocation of Unusable Space Costs... providing unusable space on a pole so that such apportionment equals two-thirds of the costs of...

  12. Survey of Transmission Cost Allocation Methodologies for Regional Transmission Organizations

    SciTech Connect

    Fink, S.; Porter, K.; Mudd, C.; Rogers, J.

    2011-02-01

    The report presents transmission cost allocation methodologies for reliability transmission projects, generation interconnection, and economic transmission projects for all Regional Transmission Organizations.

  13. 26 CFR 1.460-5 - Cost allocation rules.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... accounted for using the percentage-of-completion method described in § 1.460-4(b) (PCM), the completed... using a method other than the PCM or CCM are not subject to the cost allocation rules of this section... subject to the PCM. Paragraph (c) of this section describes an elective simplified cost allocation...

  14. 26 CFR 1.460-5 - Cost allocation rules.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... accounted for using the percentage-of-completion method described in § 1.460-4(b) (PCM), the completed... using a method other than the PCM or CCM are not subject to the cost allocation rules of this section... subject to the PCM. Paragraph (c) of this section describes an elective simplified cost allocation...

  15. Report on Transmission Cost Allocation for RTOs and Others (Presentation)

    SciTech Connect

    Coles, L.

    2011-06-01

    Presented at the MARC 2011 Annual Conference, 6 June 2011, Rapid City, South Dakota. This presentation provides an overview of the latest research findings and policy developments pertaining to cost allocation and new variable generation resources on the power grid.

  16. Transmission Cost Allocation Methodologies for Regional Transmission Organizations

    SciTech Connect

    Fink, S.; Rogers, J.; Porter, K.

    2010-07-01

    This report describes transmission cost allocation methodologies for transmission projects developed to maintain or enhance reliability, to interconnect new generators, or to access new resources and enhance competitive bulk power markets, otherwise known as economic transmission projects.

  17. 40 CFR 45.145 - Allocability and allowability of costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Allocability and allowability of costs. 45.145 Section 45.145 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER... and allowability of costs will be determined in accordance with 40 CFR 30.410. (b) Costs incurred...

  18. 40 CFR 45.145 - Allocability and allowability of costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Allocability and allowability of costs. 45.145 Section 45.145 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER... and allowability of costs will be determined in accordance with 40 CFR 30.410. (b) Costs incurred...

  19. 40 CFR 45.145 - Allocability and allowability of costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Allocability and allowability of costs. 45.145 Section 45.145 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER... and allowability of costs will be determined in accordance with 40 CFR 30.410. (b) Costs incurred...

  20. 47 CFR 64.901 - Allocation of costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Allocation of costs. 64.901 Section 64.901 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS... the origin of the cost themselves. (ii) When direct analysis is not possible, common cost...

  1. 26 CFR 1.460-5 - Cost allocation rules.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... subject matter of the contract. Similarly, the cost of a purchased component (including a component... matter of the contract. In all other cases, the cost of a component must be allocated to a long-term... manufacture or construct the subject matter of the contract. For this purpose, the costs associated with...

  2. 2 CFR 200.405 - Allocable costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GUIDANCE Reserved UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT... the contract pursuant to the Cost Accounting Standards. To the extent that CAS is applicable,...

  3. Adaptive function allocation reduces performance costs of static automation

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  4. 28 CFR 100.14 - Directly allocable costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., COMMUNICATIONS ASSISTANCE FOR LAW ENFORCEMENT ACT OF 1994 § 100.14 Directly allocable costs. (a) A cost is... the requirements of CALEA sections 103 and 104; or (2) If it benefits both the CALEA compliance effort and other work, and can be distributed to them in reasonable proportion to the benefits received....

  5. Demand response compensation, net Benefits and cost allocation: comments

    SciTech Connect

    Hogan, William W.

    2010-11-15

    FERC's Supplemental Notice of Public Rulemaking addresses the question of proper compensation for demand response in organized wholesale electricity markets. Assuming that the Commission would proceed with the proposal ''to require tariff provisions allowing demand response resources to participate in wholesale energy markets by reducing consumption of electricity from expected levels in response to price signals, to pay those demand response resources, in all hours, the market price of energy for such reductions,'' the Commission posed questions about applying a net benefits test and rules for cost allocation. This article summarizes critical points and poses implications for the issues of net benefit tests and cost allocation. (author)

  6. ACARA - AVAILABILITY, COST AND RESOURCE ALLOCATION

    NASA Technical Reports Server (NTRS)

    Viterna, L. A.

    1994-01-01

    ACARA is a program for analyzing availability, lifecycle cost, and resource scheduling. It uses a statistical Monte Carlo method to simulate a system's capacity states as well as component failure and repair. Component failures are modelled using a combination of exponential and Weibull probability distributions. ACARA schedules component replacement to achieve optimum system performance. The scheduling will comply with any constraints on component production, resupply vehicle capacity, on-site spares, or crew manpower and equipment. ACARA is capable of many types of analyses and trade studies because of its integrated approach. It characterizes the system performance in terms of both state availability and equivalent availability (a weighted average of state availability). It can determine the probability of exceeding a capacity state to assess reliability and loss of load probability. It can also evaluate the effect of resource constraints on system availability and lifecycle cost. ACARA interprets the results of a simulation and displays tables and charts for: (1) performance, i.e., availability and reliability of capacity states, (2) frequency of failure and repair, (3) lifecycle cost, including hardware, transportation, and maintenance, and (4) usage of available resources, including mass, volume, and maintenance man-hours. ACARA incorporates a user-friendly, menu-driven interface with full screen data entry. It provides a file management system to store and retrieve input and output datasets for system simulation scenarios. ACARA is written in APL2 using the APL2 interpreter for IBM PC compatible systems running MS-DOS. Hardware requirements for the APL2 system include 640K of RAM, 2Mb of extended memory, and an 80386 or 80486 processor with an 80x87 math co-processor. A dot matrix printer is required if the user wishes to print a graph from a results table. A sample MS-DOS executable is provided on the distribution medium. The executable contains licensed

  7. Using Excel's Matrix Operations to Facilitate Reciprocal Cost Allocations

    ERIC Educational Resources Information Center

    Leese, Wallace R.; Kizirian, Tim

    2009-01-01

    The reciprocal method of service department cost allocation requires linear equations to be solved simultaneously. These computations are often so complex as to cause the abandonment of the reciprocal method in favor of the less sophisticated direct or step-down methods. Here is a short example demonstrating how Excel's sometimes unknown matrix…

  8. Cognitive cost as dynamic allocation of energetic resources.

    PubMed

    Christie, S Thomas; Schrater, Paul

    2015-01-01

    While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the "cost/benefit" and "limited resource" models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning. PMID:26379482

  9. Cognitive cost as dynamic allocation of energetic resources

    PubMed Central

    Christie, S. Thomas; Schrater, Paul

    2015-01-01

    While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the “cost/benefit” and “limited resource” models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning. PMID:26379482

  10. Cognitive cost as dynamic allocation of energetic resources.

    PubMed

    Christie, S Thomas; Schrater, Paul

    2015-01-01

    While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the "cost/benefit" and "limited resource" models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning.

  11. 45 CFR 95.511 - Approval of the cost allocation plan or plan amendment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.511 Approval of the cost allocation plan or plan... 45 Public Welfare 1 2014-10-01 2014-10-01 false Approval of the cost allocation plan or plan amendment. 95.511 Section 95.511 Public Welfare Department of Health and Human Services...

  12. 45 CFR 95.511 - Approval of the cost allocation plan or plan amendment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.511 Approval of the cost allocation plan or plan... 45 Public Welfare 1 2012-10-01 2012-10-01 false Approval of the cost allocation plan or plan amendment. 95.511 Section 95.511 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  13. 45 CFR 95.511 - Approval of the cost allocation plan or plan amendment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.511 Approval of the cost allocation plan or plan... 45 Public Welfare 1 2010-10-01 2010-10-01 false Approval of the cost allocation plan or plan amendment. 95.511 Section 95.511 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  14. 45 CFR 95.509 - Cost allocation plan amendments and certifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.509 Cost allocation plan amendments and certifications. (a... 45 Public Welfare 1 2013-10-01 2013-10-01 false Cost allocation plan amendments and certifications. 95.509 Section 95.509 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  15. 45 CFR 95.509 - Cost allocation plan amendments and certifications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.509 Cost allocation plan amendments and certifications. (a... 45 Public Welfare 1 2010-10-01 2010-10-01 false Cost allocation plan amendments and certifications. 95.509 Section 95.509 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  16. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.515 Effective date of a cost allocation plan amendment. As a... 45 Public Welfare 1 2010-10-01 2010-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  17. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.515 Effective date of a cost allocation plan amendment. As a... 45 Public Welfare 1 2014-10-01 2014-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare Department of Health and Human Services GENERAL...

  18. 45 CFR 95.509 - Cost allocation plan amendments and certifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.509 Cost allocation plan amendments and certifications. (a... 45 Public Welfare 1 2014-10-01 2014-10-01 false Cost allocation plan amendments and certifications. 95.509 Section 95.509 Public Welfare Department of Health and Human Services GENERAL...

  19. 45 CFR 95.509 - Cost allocation plan amendments and certifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.509 Cost allocation plan amendments and certifications. (a... 45 Public Welfare 1 2012-10-01 2012-10-01 false Cost allocation plan amendments and certifications. 95.509 Section 95.509 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  20. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.515 Effective date of a cost allocation plan amendment. As a... 45 Public Welfare 1 2013-10-01 2013-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  1. 45 CFR 95.511 - Approval of the cost allocation plan or plan amendment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.511 Approval of the cost allocation plan or plan... 45 Public Welfare 1 2011-10-01 2011-10-01 false Approval of the cost allocation plan or plan amendment. 95.511 Section 95.511 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  2. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.515 Effective date of a cost allocation plan amendment. As a... 45 Public Welfare 1 2012-10-01 2012-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  3. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.515 Effective date of a cost allocation plan amendment. As a... 45 Public Welfare 1 2011-10-01 2011-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  4. 45 CFR 95.509 - Cost allocation plan amendments and certifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... INSURANCE PROGRAMS) Cost Allocation Plans § 95.509 Cost allocation plan amendments and certifications. (a... 45 Public Welfare 1 2011-10-01 2011-10-01 false Cost allocation plan amendments and certifications. 95.509 Section 95.509 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL...

  5. 45 CFR 95.511 - Approval of the cost allocation plan or plan amendment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.511 Approval of the cost allocation plan or plan... 45 Public Welfare 1 2013-10-01 2013-10-01 false Approval of the cost allocation plan or plan amendment. 95.511 Section 95.511 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  6. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Apportionment and allocation of administrative and... Apportionment and allocation of administrative and general costs. (a) Costs not directly associated with... administrative and general costs that are not included in paragraph (a) of this section. (2) The allocation...

  7. 26 CFR 1.162-28 - Allocation of costs to lobbying activities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... costs include depreciation, rent, utilities, insurance, maintenance costs, security costs, and other... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Allocation of costs to lobbying activities. 1... Corporations § 1.162-28 Allocation of costs to lobbying activities. (a) Introduction—(1) In general....

  8. An Approach for Transmission Loss and Cost Allocation by Loss Allocation Index and Co-operative Game Theory

    NASA Astrophysics Data System (ADS)

    Khan, Baseem; Agnihotri, Ganga; Mishra, Anuprita S.

    2016-03-01

    In the present work authors proposed a novel method for transmission loss and cost allocation to users (generators and loads). In the developed methodology transmission losses are allocated to users based on their usage of the transmission line. After usage allocation, particular loss allocation indices (PLAI) are evaluated for loads and generators. Also Cooperative game theory approach is applied for comparison of results. The proposed method is simple and easy to implement on the practical power system. Sample 6 bus and IEEE 14 bus system is used for showing the effectiveness of proposed method.

  9. 50 CFR 80.64 - How does an agency allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.64 How does an agency allocate costs... project or facility. The agency must describe the method used to allocate costs in multipurpose...

  10. 50 CFR 80.64 - How does an agency allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.64 How does an agency allocate costs... project or facility. The agency must describe the method used to allocate costs in multipurpose...

  11. 50 CFR 80.64 - How does an agency allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.64 How does an agency allocate costs... project or facility. The agency must describe the method used to allocate costs in multipurpose...

  12. 50 CFR 80.64 - How does an agency allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.64 How does an agency allocate costs... project or facility. The agency must describe the method used to allocate costs in multipurpose...

  13. 48 CFR 9904.413 - Adjustment and allocation of pension cost.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Adjustment and allocation of pension cost. 9904.413 Section 9904.413 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.413 Adjustment and allocation of...

  14. 7 CFR 1737.61 - Cost allocation for rural and nonrural areas.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... TELECOMMUNICATIONS LOANS Project Cost Estimation Procedures § 1737.61 Cost allocation for rural and nonrural areas. (a) Pursuant to the requirements in 7 CFR part 1735, if loan funds are proposed for facilities to... 7 Agriculture 11 2010-01-01 2010-01-01 false Cost allocation for rural and nonrural areas....

  15. Cost Allocation Plan for Interest Expense on Higher Education Facilities Bonds, Fiscal Year 2005

    ERIC Educational Resources Information Center

    Ohio Board of Regents, 2006

    2006-01-01

    This document supports the Cost Allocation Plan for state costs incurred on behalf of, and in benefit to, the public higher education institutions of Ohio. Tables report a summary of recalled/refunded debt and initial adjustment of Fiscal Year 2005 interest payments for refunded debt. Attached schedules calculate the allocable interest for each…

  16. Cost Allocation Plan for Interest Expense on Higher Education Facilities Bonds, Fiscal Year 2006

    ERIC Educational Resources Information Center

    Ohio Board of Regents, 2007

    2007-01-01

    This document supports the Cost Allocation Plan for state costs incurred on behalf of, and in benefit to, the public higher education institutions of Ohio. Tables report a summary of recalled/refunded debt and initial adjustment of Fiscal Year 2006 interest payments fore refunded debt. Attached schedules calculate the allocable interest for each…

  17. 77 FR 73965 - Allocation of Costs Under the Simplified Methods; Hearing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-12

    ...) that was published in the Federal Register on Wednesday, September 5, 2012 (77 FR 54482). The rules of... Internal Revenue Service 26 CFR Part 1 RIN 1545-BG07 Allocation of Costs Under the Simplified Methods... provide guidance on allocating costs to certain property produced by the taxpayer or acquired by...

  18. 48 CFR 9904.418 - Allocation of direct and indirect costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... indirect costs. 9904.418 Section 9904.418 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 ACCOUNTING STANDARDS 9904.418 Allocation of direct and indirect costs....

  19. 48 CFR 9904.418 - Allocation of direct and indirect costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... indirect costs. 9904.418 Section 9904.418 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 ACCOUNTING STANDARDS 9904.418 Allocation of direct and indirect costs....

  20. 48 CFR 9904.418 - Allocation of direct and indirect costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... indirect costs. 9904.418 Section 9904.418 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 ACCOUNTING STANDARDS 9904.418 Allocation of direct and indirect costs....

  1. 48 CFR 9904.418 - Allocation of direct and indirect costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... indirect costs. 9904.418 Section 9904.418 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 ACCOUNTING STANDARDS 9904.418 Allocation of direct and indirect costs....

  2. 47 CFR 64.901 - Allocation of costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... common costs. Common costs shall be grouped into homogeneous cost categories designed to facilitate the... competitive to subsidize services subject to competition. Services included in the definition of...

  3. 47 CFR 64.901 - Allocation of costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... common costs. Common costs shall be grouped into homogeneous cost categories designed to facilitate the... competitive to subsidize services subject to competition. Services included in the definition of...

  4. 47 CFR 64.901 - Allocation of costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... common costs. Common costs shall be grouped into homogeneous cost categories designed to facilitate the... competitive to subsidize services subject to competition. Services included in the definition of...

  5. 47 CFR 64.901 - Allocation of costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... common costs. Common costs shall be grouped into homogeneous cost categories designed to facilitate the... competitive to subsidize services subject to competition. Services included in the definition of...

  6. 48 CFR 9904.413 - Adjustment and allocation of pension cost.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of pension cost. 9904.413 Section 9904.413 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 ACCOUNTING STANDARDS 9904.413 Adjustment and allocation of...

  7. 48 CFR 9904.413 - Adjustment and allocation of pension cost.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of pension cost. 9904.413 Section 9904.413 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 ACCOUNTING STANDARDS 9904.413 Adjustment and allocation of...

  8. 48 CFR 9904.413 - Adjustment and allocation of pension cost.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of pension cost. 9904.413 Section 9904.413 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 ACCOUNTING STANDARDS 9904.413 Adjustment and allocation of...

  9. Allocation of Transaction Cost to Market Participants Using an Analytical Method in Deregulated Market

    NASA Astrophysics Data System (ADS)

    Jeyasankari, S.; Jeslin Drusila Nesamalar, J.; Charles Raja, S.; Venkatesh, P.

    2014-04-01

    Transmission cost allocation is one of the major challenges in transmission open access faced by the electric power sector. The purpose of this work is to provide an analytical method for allocating transmission transaction cost in deregulated market. This research work provides a usage based transaction cost allocation method based on line-flow impact factor (LIF) which relates the power flow in each line with respect to transacted power for the given transaction. This method provides the impact of line flows without running iterative power flow solution and is well suited for real time applications. The proposed method is compared with the Newton-Raphson (NR) method of cost allocation on sample six bus and practical Indian utility 69 bus systems by considering multilateral transaction.

  10. Allocating physicians' overhead costs to services: an econometric/accounting-activity based-approach.

    PubMed

    Peden, Al; Baker, Judith J

    2002-01-01

    Using the optimizing properties of econometric analysis, this study analyzes how physician overhead costs (OC) can be allocated to multiple activities to maximize precision in reimbursing the costs of services. Drawing on work by Leibenstein and Friedman, the analysis also shows that allocating OC to multiple activities unbiased by revenue requires controlling for revenue when making the estimates. Further econometric analysis shows that it is possible to save about 10 percent of OC by paying only for those that are necessary.

  11. 26 CFR 1.460-5 - Cost allocation rules.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... using the simplified cost-to-cost method. As in section 263A, the use of the practical capacity concept... benefits plan; (F) Indirect materials and supplies; (G) Noncapitalized tools and equipment; (H)...

  12. Cost Allocation of Multiagency Water Resource Projects: Game Theoretic Approaches and Case Study

    NASA Astrophysics Data System (ADS)

    Lejano, Raul P.; Davos, Climis A.

    1995-05-01

    Water resource projects are often jointly carried out by a number of communities and agencies. Participation in a joint project depends on how costs are allocated among the participants and how cost shares compare with the cost of independent projects. Cooperative N-person game theory offers approaches which yield cost allocations that satisfy rationality conditions favoring participation. A new solution concept, the normalized nucleolus, is discussed and applied to a water reuse project in southern California. Results obtained with the normalized nucleolus are compared with those derived with more traditional solution concepts, namely, the nucleolus and the Shapley value.

  13. Sex allocation theory reveals a hidden cost of neonicotinoid exposure in a parasitoid wasp

    PubMed Central

    Whitehorn, Penelope R.; Cook, Nicola; Blackburn, Charlotte V.; Gill, Sophie M.; Green, Jade; Shuker, David M.

    2015-01-01

    Sex allocation theory has proved to be one the most successful theories in evolutionary ecology. However, its role in more applied aspects of ecology has been limited. Here we show how sex allocation theory helps uncover an otherwise hidden cost of neonicotinoid exposure in the parasitoid wasp Nasonia vitripennis. Female N. vitripennis allocate the sex of their offspring in line with Local Mate Competition (LMC) theory. Neonicotinoids are an economically important class of insecticides, but their deployment remains controversial, with evidence linking them to the decline of beneficial species. We demonstrate for the first time to our knowledge, that neonicotinoids disrupt the crucial reproductive behaviour of facultative sex allocation at sub-lethal, field-relevant doses in N. vitripennis. The quantitative predictions we can make from LMC theory show that females exposed to neonicotinoids are less able to allocate sex optimally and that this failure imposes a significant fitness cost. Our work highlights that understanding the ecological consequences of neonicotinoid deployment requires not just measures of mortality or even fecundity reduction among non-target species, but also measures that capture broader fitness costs, in this case offspring sex allocation. Our work also highlights new avenues for exploring how females obtain information when allocating sex under LMC. PMID:25925105

  14. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany.

    PubMed

    Vogl, Matthias

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level. PMID:22935314

  15. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany.

    PubMed

    Vogl, Matthias

    2012-08-30

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level.

  16. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany

    PubMed Central

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the “one hospital” approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the “one hospital” model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital’s cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level. PMID:22935314

  17. 20 CFR 633.304 - Section 402 cost allocation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., equipment, office-space costs, and staff training. (i) Also included are salaries and fringe benefits of... project directors. Additionally, all costs of clerical personnel, materials, supplies, equipment, space... (including classroom training in conjunction with Vocational Exploration or Job Readiness or...

  18. 20 CFR 633.304 - Section 402 cost allocation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., equipment, office-space costs, and staff training. (i) Also included are salaries and fringe benefits of... project directors. Additionally, all costs of clerical personnel, materials, supplies, equipment, space... (including classroom training in conjunction with Vocational Exploration or Job Readiness or...

  19. 76 FR 53377 - Cost Accounting Standards; Allocation of Home Office Expenses to Segments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ... FR 8260). C. Public Comments Three respondents submitted comments in response to the SDP. Two... BUDGET Office of Federal Procurement Policy 48 CFR Part 9904 Cost Accounting Standards; Allocation of... Procurement Policy (OFPP), Cost Accounting Standards Board (Board). ACTION: Notice of Discontinuation...

  20. Minimum cost maximum flow algorithm for upstream bandwidth allocation in OFDMA passive optical networks

    NASA Astrophysics Data System (ADS)

    Wu, Yating; Kuang, Bin; Wang, Tao; Zhang, Qianwu; Wang, Min

    2015-12-01

    This paper presents a minimum cost maximum flow (MCMF) based upstream bandwidth allocation algorithm, which supports differentiated QoS for orthogonal frequency division multiple access passive optical networks (OFDMA-PONs). We define a utility function as the metric to characterize the satisfaction degree of an ONU on the obtained bandwidth. The bandwidth allocation problem is then formulated as maximizing the sum of the weighted total utility functions of all ONUs. By constructing a flow network graph, we obtain the optimized bandwidth allocation using the MCMF algorithm. Simulation results show that the proposed scheme improves the performance in terms of mean packet delay, packet loss ratio and throughput.

  1. Strategic costs and preferences revelation in the allocation of resources for health care.

    PubMed

    Levaggi, Laura; Levaggi, Rosella

    2010-09-01

    This article examines the resources allocation process in the internal market for health care in an environment characterised by asymmetry of information. We analyse the strategic behaviour of the provider and show how, by misreporting its cost function and reservation utility, it might shift the allocation of resources away from the purchaser's objectives. Although the fundamental importance of equity, efficiency and risk aversion considerations which have been the traditional focus of the literature on allocation of resources should not be denied, this paper shows that contracts and internal markets are not neutral instruments and more research should be devoted to studying their effects. PMID:20309636

  2. 26 CFR 1.460-5 - Cost allocation rules.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... $10,000,000 gross receipts test described in § 1.460-3(b)(3) or will not be completed within two years... safety, medical treatment, recreational and eating facilities, membership dues, etc.; (K) Cost... date and the taxpayer satisfies the $10,000,000 gross receipts test described in § 1.460-3(b)(3)....

  3. 47 CFR 76.924 - Allocation to service cost categories.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the basic service tier is regulated by local franchising authorities or the Commission, or, with... level their costs of franchise requirements, franchise fees, local taxes and local programming. (d... Expenses (Excluding Franchise Fees) Franchise Fees Interest on Funded Debt Interest on Capital Leases...

  4. A Study on Cost Allocation in Nuclear Power Coupled with Desalination

    SciTech Connect

    Lee, ManKi; Kim, SeungSu; Moon, KeeHwan; Lim, ChaeYoung

    2004-07-01

    As for a single-purpose desalination plant, there is no particular difficulty in computing the unit cost of the water, which is obtained by dividing the annual total costs by the output of fresh water. When it comes to a dual-purpose plant, cost allocation is needed between the two products. No cost allocation is needed in some cases where two alternatives producing the same water and electricity output are to be compared. In these cases, the consideration of the total cost is then sufficient. This study assumes MED (Multi-Effect Distillation) technology is adopted when nuclear power is coupled with desalination. The total production cost of the two commodities in dual-purpose plant can easily be obtained by using costing methods, if the necessary raw data are available. However, it is not easy to calculate a separate cost for each product, because high-pressure steam plant costs cannot be allocated to one or the other without adopting arbitrary methods. Investigation on power credit method is carried out focusing on the cost allocation of combined benefits due to dual production, electricity and water. The illustrative calculation is taken from Preliminary Economic Feasibility Study of Nuclear Desalination in Madura Island, Indonesia. The study is being performed by BATAN (National Nuclear Energy Agency), KAERI (Korean Atomic Energy Research Institute) and under support of the IAEA (International Atomic Energy Agency) started in the year 2002 in order to perform a preliminary economic feasibility in providing the Madurese with sufficient power and potable water for the public and to support industrialization and tourism in Madura Region. The SMART reactor coupled with MED is considered to be an option to produce electricity and potable water. This study indicates that the correct recognition of combined benefits attributable to dual production is important in carrying out economics of desalination coupled with nuclear power. (authors)

  5. Encouraging energy conservation in multifamily housing: RUBS and other methods of allocating energy costs to residents

    SciTech Connect

    McClelland, L

    1980-10-01

    Methods of encouraging energy conservation in multifamily housing by allocating energy costs to residents are discussed; specifically, methods appropriate for use in master metered buildings without equipment to monitor energy consumption in individual apartments are examined. Several devices available for monitoring individual energy consumption are also discussed plus methods of comparing the energy savings and cost effectiveness of monitoring devices with those of other means of promoting conservation. Specific information in Volume I includes a comparison study on energy use in master and individually metered buildings; types of appropriate conservation programs for master metered buildings; a description of the Resident Utility Billing System (RUBS); energy savings associated with RUBS; Resident reactions to RUBS; cost effectiveness of RUBS for property owners; potential abuses, factors limiting widespread use, and legal status of RUBS. Part I of Volume II contains a cost allocation decision guide and Part II in Volume II presents the RUBS Operations Manual. Pertinent appendices to some chapters are attached. (MCW)

  6. 75 FR 37883 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-30

    ...The Federal Energy Regulatory Commission is proposing to amend the transmission planning and cost allocation requirements established in Order No. 890 to ensure that Commission-jurisdictional services are provided on a basis that is just, reasonable and not unduly discriminatory or preferential. With respect to transmission planning, the proposed rule would provide that local and regional......

  7. 18 CFR 366.5 - Allocation of costs for non-power goods and services.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT BOOKS AND RECORDS Definitions and Provisions Under PUHCA 2005, the Federal Power Act and the Natural Gas Act § 366.5 Allocation of costs for non-power... state commission seeking such a determination shall bear the burden of demonstrating that...

  8. 18 CFR 366.5 - Allocation of costs for non-power goods and services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (16 U.S.C. 791 et seq.), the Natural Gas Act (15 U.S.C. 717 et seq.), or other applicable law... ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT BOOKS AND RECORDS Definitions and Provisions Under PUHCA 2005, the Federal Power Act and the Natural Gas Act § 366.5 Allocation of costs for...

  9. 2 CFR Appendix D to Part 225 - Public Assistance Cost Allocation Plans

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... administered by State public assistance agencies include: Temporary Assistance to Needy Families (TANF... approval of public assistance cost allocation plans in Subpart E of 45 CFR part 95. All administrative... in Subpart E of 45 CFR part 95. For the purpose of this appendix, these programs include all...

  10. 2 CFR Appendix Vi to Part 200 - Public Assistance Cost Allocation Plans

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Needy Families (TANF), Medicaid, Food Stamps, Child Support Enforcement, Adoption Assistance and Foster..., submission, negotiation, and approval of public assistance cost allocation plans in Subpart E of 45 CFR Part... by the state as identified in Subpart E of 45 CFR Part 95. For the purpose of this Appendix,...

  11. 2 CFR Appendix D to Part 225 - Public Assistance Cost Allocation Plans

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... administered by State public assistance agencies include: Temporary Assistance to Needy Families (TANF... approval of public assistance cost allocation plans in Subpart E of 45 CFR part 95. All administrative... in Subpart E of 45 CFR part 95. For the purpose of this appendix, these programs include all...

  12. 2 CFR Appendix D to Part 225 - Public Assistance Cost Allocation Plans

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... to Needy Families (TANF), Medicaid, Food Stamps, Child Support Enforcement, Adoption Assistance and..., submission, negotiation, and approval of public assistance cost allocation plans in Subpart E of 45 CFR part... operated by the State as identified in Subpart E of 45 CFR part 95. For the purpose of this appendix,...

  13. 2 CFR Appendix D to Part 225 - Public Assistance Cost Allocation Plans

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... administered by State public assistance agencies include: Temporary Assistance to Needy Families (TANF... approval of public assistance cost allocation plans in Subpart E of 45 CFR part 95. All administrative... in Subpart E of 45 CFR part 95. For the purpose of this appendix, these programs include all...

  14. 30 CFR 1220.014 - Allocation of joint costs and credits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Allocation of joint costs and credits. 1220.014 Section 1220.014 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural Resources Revenue ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR...

  15. 75 FR 51986 - Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-24

    ... INFORMATION: On July 27, 2010, the DOE published an NOI in the Federal Register (75 FR 43945) on the development of regulations under section 934 of the Act, entitled Convention on Supplementary Compensation for... Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation AGENCY: Office of...

  16. 75 FR 64717 - Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-20

    ... Federal Register (75 FR 43945) on the development of regulations under section 934 of the Act, entitled... 24, 2010, DOE published a notice in the Federal Register (75 FR 51986) extending the period for... Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation AGENCY: Office of...

  17. 30 CFR 220.014 - Allocation of joint costs and credits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Allocation of joint costs and credits. 220.014 Section 220.014 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL SHELF OIL...

  18. Studying Costs of Title I Under Achievement and Poverty Allocation Criteria.

    ERIC Educational Resources Information Center

    Huseby, Jane R. O.; Hentschke, Guilbert

    The study presented in this paper is part of the National Institute of Education's effort to study federally sponsored compensatory education programs through demonstration projects. One aspect of the study of demonstration projects concerns the cost associated with the changes in allocation procedures and concentration levels which result from…

  19. 5 CFR 734.503 - Allocation and reimbursement of costs associated with political activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... associated with political activities. 734.503 Section 734.503 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) POLITICAL ACTIVITIES OF FEDERAL EMPLOYEES... Executive Office of the President § 734.503 Allocation and reimbursement of costs associated with...

  20. 5 CFR 734.503 - Allocation and reimbursement of costs associated with political activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... associated with political activities. 734.503 Section 734.503 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) POLITICAL ACTIVITIES OF FEDERAL EMPLOYEES... Executive Office of the President § 734.503 Allocation and reimbursement of costs associated with...

  1. 5 CFR 734.503 - Allocation and reimbursement of costs associated with political activities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... associated with political activities. 734.503 Section 734.503 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) POLITICAL ACTIVITIES OF FEDERAL EMPLOYEES... Executive Office of the President § 734.503 Allocation and reimbursement of costs associated with...

  2. 5 CFR 734.503 - Allocation and reimbursement of costs associated with political activities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... associated with political activities. 734.503 Section 734.503 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) POLITICAL ACTIVITIES OF FEDERAL EMPLOYEES... Executive Office of the President § 734.503 Allocation and reimbursement of costs associated with...

  3. 2 CFR Appendix C to Part 225 - State/Local-Wide Central Service Cost Allocation Plans

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... cost allocations or billings for are allowable in accordance with the requirements of 2 CFR Part 225... cycle to the next. Charges by an internal service activity to provide for the establishment and... allowable. A working capital reserve as part of retained earnings of up to 60 days cash expenses for...

  4. Using Excel's Solver Function to Facilitate Reciprocal Service Department Cost Allocations

    ERIC Educational Resources Information Center

    Leese, Wallace R.

    2013-01-01

    The reciprocal method of service department cost allocation requires linear equations to be solved simultaneously. These computations are often so complex as to cause the abandonment of the reciprocal method in favor of the less sophisticated and theoretically incorrect direct or step-down methods. This article illustrates how Excel's Solver…

  5. [High-cost therapy. Ethical principles of allocation of scarce resources].

    PubMed

    Norheim, O F

    1992-10-10

    This article raises some ethical problems concerning high-cost therapy for malignant haematological diseases. The problem of setting priorities is discussed within the framework of utilitarianism, right-based theories and the contractarian theory of John Rawls. It is argued that utilitarianism can provide precise answers, based on the principle of allocative efficiency. However, this is not the only objective of a public health care system. The right-based approach is discussed, but sufficiently precise definitions seem hard to formulate. The contractarian approach is regarded as interesting, since it tries to address the question of trade-offs between objectives of allocative efficiency and distributive fairness.

  6. Cost of equity in homeland security resource allocation in the face of a strategic attacker.

    PubMed

    Shan, Xiaojun; Zhuang, Jun

    2013-06-01

    Hundreds of billions of dollars have been spent in homeland security since September 11, 2001. Many mathematical models have been developed to study strategic interactions between governments (defenders) and terrorists (attackers). However, few studies have considered the tradeoff between equity and efficiency in homeland security resource allocation. In this article, we fill this gap by developing a novel model in which a government allocates defensive resources among multiple potential targets, while reserving a portion of defensive resources (represented by the equity coefficient) for equal distribution (according to geographical areas, population, density, etc.). Such a way to model equity is one of many alternatives, but was directly inspired by homeland security resource allocation practice. The government is faced with a strategic terrorist (adaptive adversary) whose attack probabilities are endogenously determined in the model. We study the effect of the equity coefficient on the optimal defensive resource allocations and the corresponding expected loss. We find that the cost of equity (in terms of increased expected loss) increases convexly in the equity coefficient. Furthermore, such cost is lower when: (a) government uses per-valuation equity; (b) the cost-effectiveness coefficient of defense increases; and (c) the total defense budget increases. Our model, results, and insights could be used to assist policy making.

  7. Accounting for enforcement costs in the spatial allocation of marine zones.

    PubMed

    Davis, Katrina; Kragt, Marit; Gelcich, Stefan; Schilizzi, Steven; Pannell, David

    2015-02-01

    Marine fish stocks are in many cases extracted above sustainable levels, but they may be protected through restricted-use zoning systems. The effectiveness of these systems typically depends on support from coastal fishing communities. High management costs including those of enforcement may, however, deter fishers from supporting marine management. We incorporated enforcement costs into a spatial optimization model that identified how conservation targets can be met while maximizing fishers' revenue. Our model identified the optimal allocation of the study area among different zones: no-take, territorial user rights for fisheries (TURFs), or open access. The analysis demonstrated that enforcing no-take and TURF zones incurs a cost, but results in higher species abundance by preventing poaching and overfishing. We analyzed how different enforcement scenarios affected fishers' revenue. Fisher revenue was approximately 50% higher when territorial user rights were enforced than when they were not. The model preferentially allocated area to the enforced-TURF zone over other zones, demonstrating that the financial benefits of enforcement (derived from higher species abundance) exceeded the costs. These findings were robust to increases in enforcement costs but sensitive to changes in species' market price. We also found that revenue under the existing zoning regime in the study area was 13-30% lower than under an optimal solution. Our results highlight the importance of accounting for both the benefits and costs of enforcement in marine conservation, particularly when incurred by fishers. PMID:25103090

  8. Prospective Memory Function in Late Adulthood: Affect at Encoding and Resource Allocation Costs

    PubMed Central

    Henry, Julie D.; Joeffry, Sebastian; Terrett, Gill; Ballhausen, Nicola; Kliegel, Matthias; Rendell, Peter G.

    2015-01-01

    Some studies have found that prospective memory (PM) cues which are emotionally valenced influence age effects in prospective remembering, but it remains unclear whether this effect reflects the operation of processes implemented at encoding or retrieval. In addition, none of the prior ageing studies of valence on PM function have examined potential costs of engaging in different valence conditions, or resource allocation trade-offs between the PM and the ongoing task. In the present study, younger, young-old and old-old adults completed a PM task in which the valence of the cues varied systematically (positive, negative or neutral) at encoding, but was kept constant (neutral) at retrieval. The results indicated that PM accuracy did not vary as a function of affect at encoding, and that this effect did not interact with age group. There was also no main or interaction effect of valence on PM reaction time in PM cue trials, indicating that valence costs across the three encoding conditions were equivalent. Old-old adults’ PM accuracy was reduced relative to both young-old and younger adults. Prospective remembering incurred dual-task costs for all three groups. Analyses of reaction time data suggested that for both young-old and old-old, these costs were greater, implying differential resource allocation cost trade-offs. However, when reaction time data were expressed as a proportional change that adjusted for the general slowing of the older adults, costs did not differ as a function of group. PMID:25893540

  9. Accounting for enforcement costs in the spatial allocation of marine zones.

    PubMed

    Davis, Katrina; Kragt, Marit; Gelcich, Stefan; Schilizzi, Steven; Pannell, David

    2015-02-01

    Marine fish stocks are in many cases extracted above sustainable levels, but they may be protected through restricted-use zoning systems. The effectiveness of these systems typically depends on support from coastal fishing communities. High management costs including those of enforcement may, however, deter fishers from supporting marine management. We incorporated enforcement costs into a spatial optimization model that identified how conservation targets can be met while maximizing fishers' revenue. Our model identified the optimal allocation of the study area among different zones: no-take, territorial user rights for fisheries (TURFs), or open access. The analysis demonstrated that enforcing no-take and TURF zones incurs a cost, but results in higher species abundance by preventing poaching and overfishing. We analyzed how different enforcement scenarios affected fishers' revenue. Fisher revenue was approximately 50% higher when territorial user rights were enforced than when they were not. The model preferentially allocated area to the enforced-TURF zone over other zones, demonstrating that the financial benefits of enforcement (derived from higher species abundance) exceeded the costs. These findings were robust to increases in enforcement costs but sensitive to changes in species' market price. We also found that revenue under the existing zoning regime in the study area was 13-30% lower than under an optimal solution. Our results highlight the importance of accounting for both the benefits and costs of enforcement in marine conservation, particularly when incurred by fishers.

  10. Allocation Costs Associated with Induced Defense in Phaeocystis globosa (Prymnesiophyceae): the Effects of Nutrient Availability

    PubMed Central

    Wang, Xiaodong; Wang, Yan; Ou, Linjian; He, Xuejia; Chen, Da

    2015-01-01

    Colony enlargement in Phaeocystis globosa has been considered as an induced defense strategy that reduces its susceptibility to grazers, but allocation costs inflicted by this plastic morphological defense are poorly understood. We conducted experiments in which P. globosa cultures were exposed to chemical cues from copepods, ciliates and heterotrophic dinoflagellates, respectively, under nutrient sufficient and deficient conditions to evaluate allocation costs associated with induced defense. Phaeocystis globosa responded to chemical cues from grazers by increasing colony diameter irrespective of nutrient conditions. We did not find trade-offs between induced defense and growth rate under nutrient sufficient conditions. Instead, induced defensive P. globosa had higher growth rates than non-induced P. globosa. When nutrient became limited, P. globosa exposed to grazing cues from copepods and dinoflagellates had significantly decreased growth rates when compared with non-induced P. globosa. We suggested that the decreased growth revealed allocation costs associated with induced defense that may influence on the trophic interactions between Phaeocystis and consumers. PMID:26040243

  11. Cost allocation methodology applicable to the temporary assistance for needy families program. Final rule.

    PubMed

    2008-07-23

    This final rule applies to the Temporary Assistance for Needy Families (TANF) program and requires States, the District of Columbia and the Territories (hereinafter referred to as the "States") to use the "benefiting program" cost allocation methodology in U.S. Office of Management and Budget (OMB) Circular A-87 (2 CFR part 225). It is the judgment and determination of HHS/ACF that the "benefiting program" cost allocation methodology is the appropriate methodology for the proper use of Federal TANF funds. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave federally-recognized Tribes the opportunity to operate their own Tribal TANF programs. Federally-recognized Indian tribes operating approved Tribal TANF programs have always followed the "benefiting program" cost allocation methodology in accordance with OMB Circular A-87 (2 CFR part 225) and the applicable regulatory provisions at 45 CFR 286.45(c) and (d). This final rule contains no substantive changes to the proposed rule published on September 27, 2006.

  12. Resource allocation in a patient population exhibiting bimodal and logarithmic cost behavior.

    PubMed

    Patterson, Charles W

    2011-12-01

    Budgeting and forecasting is a part of the resource allocation process. Statistical models used in these processes often use data based on unimodal or normal probability distributions using mean values for analysis. However, health care data are frequently skewed and stratified, demanding careful analyses. In this study, financial data was examined over a 10-month period at an overseas federal health care facility in a patient population of 70 with a primary diagnosis of post-traumatic stress disorder without a concurrent concussive injury. There were 823 direct provider contacts incurring a total cost of $286,917 that included allocated fixed overhead. The data were stratified and highly variable as two distinct groups based on chronicity. Group A (acute) consisted of 62 cases costing $117,612. Group B (chronic) consisted of 8 cases costing $169,755. This data, presented in descending order, fit a logarithmic equation with an r value of 0.95. Using this equation, a decreasing linear budget model is developed that represents an alternative nonparametric approach to allocate resources for this population. The model predicted an expenditure of $284,880, within 0.70% of the amount actually spent, and addresses the subcomponent simplification issue raised by a 2008 Rand study and mitigates problems associated with data stratification or transformations. PMID:22338354

  13. Resource allocation in a patient population exhibiting bimodal and logarithmic cost behavior.

    PubMed

    Patterson, Charles W

    2011-12-01

    Budgeting and forecasting is a part of the resource allocation process. Statistical models used in these processes often use data based on unimodal or normal probability distributions using mean values for analysis. However, health care data are frequently skewed and stratified, demanding careful analyses. In this study, financial data was examined over a 10-month period at an overseas federal health care facility in a patient population of 70 with a primary diagnosis of post-traumatic stress disorder without a concurrent concussive injury. There were 823 direct provider contacts incurring a total cost of $286,917 that included allocated fixed overhead. The data were stratified and highly variable as two distinct groups based on chronicity. Group A (acute) consisted of 62 cases costing $117,612. Group B (chronic) consisted of 8 cases costing $169,755. This data, presented in descending order, fit a logarithmic equation with an r value of 0.95. Using this equation, a decreasing linear budget model is developed that represents an alternative nonparametric approach to allocate resources for this population. The model predicted an expenditure of $284,880, within 0.70% of the amount actually spent, and addresses the subcomponent simplification issue raised by a 2008 Rand study and mitigates problems associated with data stratification or transformations.

  14. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure

    PubMed Central

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D.

    2015-01-01

    Study objective We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. Methods We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient’s characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Results Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP’s being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. Conclusion The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. PMID:25737210

  15. Thermoeconomic analysis of steam turbines: An approach to marginal cost allocation

    SciTech Connect

    Royo, J.; Zaleta, A.; Valero, A.

    1996-12-31

    One of the main problems arising with the thermoeconomic optimization of energy plants, is marginal cost allocation in components containing a flow bifurcation. A typical example is a cogeneration steam turbine. The analysis of the marginal cost allocation of this type of turbine is rigorously studied in this paper. Structural Theory (Valero et al., 1992; 1993) takes under consideration that marginal cost assessment depends on the marginal consumptions of the inlet flow for each outlet energy flow. Supposing that the behavior of the turbine would not be affected by the quantity of mass flowing in the process, these marginal consumptions could easily be calculated (Royo and Valero, 1995). Nevertheless, the calculation of marginal consumptions under this supposition is only an initial approach to the problem. The accurate values of marginal consumptions (and therefore of marginal cost) may be calculated if one knows the actual behavior of the steam turbine. This is the process followed in this paper to obtain the values of the marginal consumptions of several cogeneration steam turbines. The analysis offers a complete knowledge of the marginal consumptions for different steam turbine characteristics that work under on-design and off-design conditions. The results obtained are compared with respect to the above initial approach. It is shown that the errors appearing when assessing marginal costs in this way could be relatively important. Nonetheless, a series of correction terms is proposed, by means of which it is possible to considerably decrease these errors.

  16. Reduction of Baltic Sea nutrient inputs and allocation of abatement costs within the Baltic Sea catchment.

    PubMed

    Wulff, Fredrik; Humborg, Christoph; Andersen, Hans Estrup; Blicher-Mathiesen, Gitte; Czajkowski, Mikołaj; Elofsson, Katarina; Fonnesbech-Wulff, Anders; Hasler, Berit; Hong, Bongghi; Jansons, Viesturs; Mörth, Carl-Magnus; Smart, James C R; Smedberg, Erik; Stålnacke, Per; Swaney, Dennis P; Thodsen, Hans; Was, Adam; Zylicz, Tomasz

    2014-02-01

    The Baltic Sea Action Plan (BSAP) requires tools to simulate effects and costs of various nutrient abatement strategies. Hierarchically connected databases and models of the entire catchment have been created to allow decision makers to view scenarios via the decision support system NEST. Increased intensity in agriculture in transient countries would result in increased nutrient loads to the Baltic Sea, particularly from Poland, the Baltic States, and Russia. Nutrient retentions are high, which means that the nutrient reduction goals of 135 000 tons N and 15 000 tons P, as formulated in the BSAP from 2007, correspond to a reduction in nutrient loadings to watersheds by 675 000 tons N and 158 000 tons P. A cost-minimization model was used to allocate nutrient reductions to measures and countries where the costs for reducing loads are low. The minimum annual cost to meet BSAP basin targets is estimated to 4.7 billion Euro.

  17. Costs and Their Assessment to Users of a Medical Library, Part III: Allocating Fixed Joint Costs.

    ERIC Educational Resources Information Center

    Bres, E.; And Others

    Part III of the study describes a model for completing the cost assessment (justification) process by accounting for the fixed joint costs; a "fair" and equitable mechanism is developed in the context of game-theoretic approach. An n-person game is constructed in which the "players" are the institutions served by the library, but whose…

  18. 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...

  19. Distributed Bees Algorithm Parameters Optimization for a Cost Efficient Target Allocation in Swarms of Robots

    PubMed Central

    Jevtić, Aleksandar; Gutiérrez, Álvaro

    2011-01-01

    Swarms of robots can use their sensing abilities to explore unknown environments and deploy on sites of interest. In this task, a large number of robots is more effective than a single unit because of their ability to quickly cover the area. However, the coordination of large teams of robots is not an easy problem, especially when the resources for the deployment are limited. In this paper, the Distributed Bees Algorithm (DBA), previously proposed by the authors, is optimized and applied to distributed target allocation in swarms of robots. Improved target allocation in terms of deployment cost efficiency is achieved through optimization of the DBA’s control parameters by means of a Genetic Algorithm. Experimental results show that with the optimized set of parameters, the deployment cost measured as the average distance traveled by the robots is reduced. The cost-efficient deployment is in some cases achieved at the expense of increased robots’ distribution error. Nevertheless, the proposed approach allows the swarm to adapt to the operating conditions when available resources are scarce. PMID:22346677

  20. Genotype and environment determine allocation to and costs of resistance in quaking aspen.

    PubMed

    Osier, Tod L; Lindroth, Richard L

    2006-06-01

    Although genetic variability and resource availability both influence plant chemical composition, little is known about how these factors interact to modulate costs of resistance, expressed as negative correlations between growth and defense. We evaluated genotype x environment effects on foliar chemistry and growth of quaking aspen (Populus tremuloides) by growing multiple aspen genotypes under variable conditions of light and soil nutrient availability in a common garden. Foliage was analyzed for levels of nitrogen, phenolic glycosides and condensed tannins. Bioassays of leaf quality were conducted with fourth-stadium gypsy moth (Lymantria dispar) larvae. Results revealed strong effects of plant genotype, light availability and nutrient availability; the importance of each factor depended upon compound type. For example, tannin concentrations differed little among genotypes and across nutrient regimes under low light conditions, but markedly so under high light conditions. Phenolic glycoside concentrations, in contrast, were largely determined by genotype. Variation in phenolic glycoside concentrations among genotypes was the most important factor affecting gypsy moth performance. Gypsy moth biomass and development time were negatively and positively correlated, respectively, with phenolic glycoside levels. Allocation to phenolic glycosides appeared to be costly in terms of growth, but only under resource-limiting conditions. Context-dependent trade-offs help to explain why costs of allocation to resistance are often difficult to demonstrate.

  1. The dynamics of resource allocation and costs of reproduction in a sexually dimorphic, wind-pollinated dioecious plant.

    PubMed

    Teitel, Z; Pickup, M; Field, D L; Barrett, S C H

    2016-01-01

    Sexual dimorphism in resource allocation is expected to change during the life cycle of dioecious plants because of temporal differences between the sexes in reproductive investment. Given the potential for sex-specific differences in reproductive costs, resource availability may contribute to variation in reproductive allocation in females and males. Here, we used Rumex hastatulus, a dioecious, wind-pollinated annual plant, to investigate whether sexual dimorphism varies with life-history stage and nutrient availability, and determine whether allocation patterns differ depending on reproductive commitment. To examine if the costs of reproduction varied between the sexes, reproduction was either allowed or prevented through bud removal, and biomass allocation was measured at maturity. In a second experiment to assess variation in sexual dimorphism across the life cycle, and whether this varied with resource availability, plants were grown in high and low nutrients and allocation to roots, aboveground vegetative growth and reproduction were measured at three developmental stages. Males prevented from reproducing compensated with increased above- and belowground allocation to a much larger degree than females, suggesting that male reproductive costs reduce vegetative growth. The proportional allocation to roots, reproductive structures and aboveground vegetative growth varied between the sexes and among life-cycle stages, but not with nutrient treatment. Females allocated proportionally more resources to roots than males at peak flowering, but this pattern was reversed at reproductive maturity under low-nutrient conditions. Our study illustrates the importance of temporal dynamics in sex-specific resource allocation and provides support for high male reproductive costs in wind-pollinated plants.

  2. Interim report on revising the resource allocation and mine costing model. [By states for 8 sulfur content ranges

    SciTech Connect

    Not Available

    1980-03-07

    The purpose of this contract is to provide the Coal and Electric Power Analysis Division, EIA, with a revised and fully documented Resource Allocation and Mine Costing (RAMC) model to be used in developing coal supply curves for use in the Mid-range Energy Forecasting System and the National Coal Model. The project is structured in three phases, as follows: establish conceptual underpinnings of revised supply curve methodology; revise mine costing methodology; and revise resource allocation methodology. The first three tasks in Phase I were to review and critique the current RAMC approach, review and critique the NUS deep mine and the Fluor Utah surface mine costing methodologies, and to propose revisions to the current approach. This Interim Report documents our findings under these three tasks. Our review of the current RAMC concludes that the resource allocation methodology is reasonable; however, the mine costing methodology has a number of deficiencies. Hence, Section 5 presents a number of alternative approaches for implementing an improved costing methodology in the RAMC model. Although the resource allocation approach is reasonable, the data used to drive the model need to be improved. The Appendices discuss a number of these data issues, affecting both mine costing and resource allocation.

  3. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

    PubMed

    Goold, S D

    1996-01-01

    Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

  4. Reducing Clinical Trial Monitoring Resource Allocation and Costs Through Remote Access to Electronic Medical Records

    PubMed Central

    Uren, Shannon C.; Kirkman, Mitchell B.; Dalton, Brad S.; Zalcberg, John R.

    2013-01-01

    Purpose: With electronic medical records (eMRs), the option now exists for clinical trial monitors to perform source data verification (SDV) remotely. We report on a feasibility study of remote access to eMRs for SDV and the potential advantages of such a process in terms of resource allocation and cost. Methods: The Clinical Trials Unit at the Peter MacCallum Cancer Centre, in collaboration with Novartis Pharmaceuticals Australia, conducted a 6-month feasibility study of remote SDV. A Novartis monitor was granted dedicated software and restricted remote access to the eMR portal of the cancer center, thereby providing an avenue through which perform SDV. Results: Six monitoring visits were conducted during the study period, four of which were performed remotely. The ability to conduct two thirds of the monitoring visits remotely in this complex phase III study resulted in an overall cost saving to Novartis. Similarly, remote monitoring eased the strain on internal resources, particularly monitoring space and hospital computer terminal access, at the cancer center. Conclusion: Remote access to patient eMRs for SDV is feasible and is potentially an avenue through which resources can be more efficiently used. Although this feasibility study involved limited numbers, there is no limit to scaling these processes to any number of patients enrolled onto large clinical trials. PMID:23633977

  5. Scopolamine in Brugmansia suaveolens (Solanaceae): defense, allocation, costs, and induced response.

    PubMed

    Alves, Marcos Nopper; Sartoratto, Adilson; Trigo, José Roberto

    2007-02-01

    Brugmansia suaveolens (Solanaceae) contains tropane alkaloids (TAs), which can act as chemical defenses. Selective pressures might modulate the allocation of alkaloids within the plant, as postulated by optimal-defense theory. By tracing scopolamine, the most abundant TA in this species, we found that scopolamine in an artificial diet, in concentrations similar to those in leaves of B. suaveolens, increased mortality and prolonged developmental time of the larvae of the generalist noctuid moth Spodoptera frugiperda. A diet of undamaged leaves of B. suaveolens also showed a large negative effect on the growth of larvae of S. frugiperda compared to a diet of leaves of Ricinus communis, a species that did not have negative effects on this moth; more valuable plant parts, such as young leaves, flowers, and unripe fruits with seeds, have higher scopolamine concentrations than other tissues; leaves of B. suaveolens increase their content of scopolamine after artificial damage. The highest induction was found 24 hr after the damage, and after that, scopolamine content decreased to constitutive levels. This increase represented a cost, because in another experiment, a treatment with methyl jasmonate, an elicitor hormone, increased scopolamine production 9.5-fold and decreased leaf growth 2.3-fold; a diet of artificially damaged leaves of B. suaveolens showed a negative effect on the growth of larvae of S. furgiperda compared to undamaged leaves, suggesting that damage by herbivores induces resistance. Our data are in line with the optimal-defense theory, but experiments in the field with herbivores that share an evolutionary history with B. suaveolens must be undertaken to understand the dynamics of TA allocation in response to herbivory.

  6. 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.

  7. Energetic cost of breathing, body composition, and pulmonary function in horses with recurrent airway obstruction.

    PubMed

    Mazan, Melissa R; Deveney, Edward F; DeWitt, Shane; Bedenice, Daniela; Hoffman, Andrew

    2004-07-01

    This study was conducted to determine whether horses with naturally occurring, severe chronic recurrent airway obstruction (RAO) 1). have a greater resting energy expenditure (REE) than control horses, 2). suffer body mass depletion, and 3). have significantly decreased REE after bronchodilation and, therefore, also 4). whether increased work of breathing contributes to the cachexia seen in some horses with RAO. Six RAO horses and six control horses underwent indirect calorimetric measures of REE and pulmonary function testing using the esophageal balloon-pneumotachograph method before and after treatment with ipratropium bromide, a parasympatholytic bronchodilator agent, at 4-h intervals for a 24-h period. Body condition scoring was performed, and an estimate of fat mass was determined via B-mode ultrasonography. O(2) and CO(2) fractions, respiratory airflow, respiratory rate, and pleural pressure changes were recorded, and O(2) consumption, CO(2) production, REE, pulmonary resistance, dynamic elastance, and tidal volume were calculated. In addition, we performed lung function testing and calorimetry both before and after sedation in two control horses. RAO horses had significantly lower body condition scores (2.8 +/- 1.0 vs. 6.4 +/- 1.2) and significantly greater O(2) consumption than controls (4.93 +/- 1.30 vs. 2.93 +/- 0.70 ml.kg(-1).min(-1)). After bronchodilation, there was no significant difference in O(2) consumption between RAO horses and controls, although there remained evidence of residual airway obstruction. There was a strong correlation between O(2) consumption and indexes of airway obstruction. Xylazine sedation was not associated with changes in pulmonary function but did result in markedly decreased REE in controls.

  8. Cost-effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea-hypopnea in British Columbia

    PubMed Central

    Tan, MCY; Ayas, NT; Mulgrew, A; Cortes, L; FitzGerald, JM; Fleetham, JA; Schulzer, M; Ryan, CF; Ghaeli, R; Cooperx, P; Marra, CA

    2008-01-01

    BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life. OBJECTIVE: To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers. METHODS: A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society. RESULTS: From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis. CONCLUSION: After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly

  9. Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach

    PubMed Central

    2013-01-01

    Background There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services. Methods The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider’s perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis. Results The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery. Conclusion The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to

  10. Pollution control costs of a transboundary river basin: Empirical tests of the fairness and stability of cost allocation mechanisms using game theory.

    PubMed

    Shi, Guang-Ming; Wang, Jin-Nan; Zhang, Bing; Zhang, Zhe; Zhang, Yong-Liang

    2016-07-15

    With rapid economic growth, transboundary river basin pollution in China has become a very serious problem. Based on practical experience in other countries, cooperation among regions is an economic way to control the emission of pollutants. This study develops a game theoretic simulation model to analyze the cost effectiveness of reducing water pollutant emissions in four regions of the Jialu River basin while considering the stability and fairness of four cost allocation schemes. Different schemes (the nucleolus, the weak nucleolus, the Shapley value and the Separable Cost Remaining Benefit (SCRB) principle) are used to allocate regionally agreed-upon water pollutant abatement costs. The main results show that the fully cooperative coalition yielded the highest incremental gain for regions willing to cooperate if each region agreed to negotiate by transferring part of the incremental gain obtained from the cooperation to cover the losses of other regions. In addition, these allocation schemes produce different outcomes in terms of their fairness to the players and in terms of their derived stability, as measured by the Shapley-Shubik Power Index and the Propensity to Disrupt. Although the Shapley value and the SCRB principle exhibit superior fairness and stabilization to the other methods, only the SCRB principle may maintains full cooperation among regions over the long term. The results provide clear empirical evidence that regional gain allocation may affect the sustainability of cooperation. Therefore, it is implied that not only the cost-effectiveness but also the long-term sustainability should be considered while formulating and implementing environmental policies. PMID:27088211

  11. Pollution control costs of a transboundary river basin: Empirical tests of the fairness and stability of cost allocation mechanisms using game theory.

    PubMed

    Shi, Guang-Ming; Wang, Jin-Nan; Zhang, Bing; Zhang, Zhe; Zhang, Yong-Liang

    2016-07-15

    With rapid economic growth, transboundary river basin pollution in China has become a very serious problem. Based on practical experience in other countries, cooperation among regions is an economic way to control the emission of pollutants. This study develops a game theoretic simulation model to analyze the cost effectiveness of reducing water pollutant emissions in four regions of the Jialu River basin while considering the stability and fairness of four cost allocation schemes. Different schemes (the nucleolus, the weak nucleolus, the Shapley value and the Separable Cost Remaining Benefit (SCRB) principle) are used to allocate regionally agreed-upon water pollutant abatement costs. The main results show that the fully cooperative coalition yielded the highest incremental gain for regions willing to cooperate if each region agreed to negotiate by transferring part of the incremental gain obtained from the cooperation to cover the losses of other regions. In addition, these allocation schemes produce different outcomes in terms of their fairness to the players and in terms of their derived stability, as measured by the Shapley-Shubik Power Index and the Propensity to Disrupt. Although the Shapley value and the SCRB principle exhibit superior fairness and stabilization to the other methods, only the SCRB principle may maintains full cooperation among regions over the long term. The results provide clear empirical evidence that regional gain allocation may affect the sustainability of cooperation. Therefore, it is implied that not only the cost-effectiveness but also the long-term sustainability should be considered while formulating and implementing environmental policies.

  12. 48 CFR 9904.402 - Cost accounting standard-consistency in allocating costs incurred for the same purpose.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402 Cost... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting...

  13. 48 CFR 9904.402 - Cost accounting standard-consistency in allocating costs incurred for the same purpose.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Cost accounting standard... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402...

  14. 48 CFR 9904.402 - Cost accounting standard-consistency in allocating costs incurred for the same purpose.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Cost accounting standard... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402...

  15. 48 CFR 9904.402 - Cost accounting standard-consistency in allocating costs incurred for the same purpose.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Cost accounting standard... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402...

  16. A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

    NASA Astrophysics Data System (ADS)

    Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

    2016-02-01

    Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

  17. 78 FR 15615 - Practice and Procedure; Pole Attachment Complaint Procedures; Allocation of Unusable Space Costs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ... 63 FR 12026, March 12, 1998, has been approved by OMB and is effective March 12, 2013. SUPPLEMENTARY... COMMISSION 47 CFR Part 1 Practice and Procedure; Pole Attachment Complaint Procedures; Allocation of Unusable... policies concerning a methodology for just and reasonable rates for pole attachments, conduits, and...

  18. Estimating Costs of Services and Resource Allocations Using Self Reports of Time Proportions.

    ERIC Educational Resources Information Center

    Newman, Warren B.; Jones, Robert A.

    A method using estimates of individual time allocations was developed to produce a profile of departmental functioning as a whole. Previous research suggested that staff estimates were a reasonably accurate and economical method for obtaining estimates of time. Each staff member estimated the percentage of his or her time spent on different tasks…

  19. A Guide to Cost Allocation Procedures: Implementing Strategies for Universal Pre-Kindergarten.

    ERIC Educational Resources Information Center

    Russell-Browne, Acquenetta; Lederman, Nancy

    This guide is intended to assist community-based providers in New York City who intend to blend universal pre-kindergarten funds with public child care funds, Head Start, preschool special education, or other funds to provide full or extended day early education programs for children. The guide provides information on how to allocate a programs…

  20. 11 CFR 300.33 - Allocation of costs of Federal election activity.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... activity, or generic campaign activities within certain time periods. Subject to the conditions of 11 CFR... identification, get-out-the-vote activity, or generic campaign activities, as defined in 11 CFR 100.24(a)(3) and.... See 11 CFR 106.7(c)(1) and (d)(1). (e) Transfers between accounts to cover allocable expenses....

  1. 48 CFR 9905.502 - Cost accounting standard-consistency in allocating costs incurred for the same purpose by...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Cost accounting standard... 9905.502 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS...

  2. 48 CFR 9905.502 - Cost accounting standard-consistency in allocating costs incurred for the same purpose by...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Cost accounting standard... 9905.502 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS...

  3. 48 CFR 9905.502 - Cost accounting standard-consistency in allocating costs incurred for the same purpose by...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Cost accounting standard... 9905.502 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS...

  4. 48 CFR 9905.502 - Cost accounting standard-consistency in allocating costs incurred for the same purpose by...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard... 9905.502 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS...

  5. Roots, shoots and reproduction: sexual dimorphism in size and costs of reproductive allocation in an annual herb.

    PubMed

    Harris, Mark S; Pannell, John R

    2008-11-22

    Females tend to be smaller than males in woody dioecious plant species, but they tend to be larger in herbs. The smaller size of females in woody species has been attributed to higher reproductive costs, yet no satisfactory explanation has been provided for their larger size in herbs. Because herbs have higher nitrogen concentrations in their tissues than woody plants, and because pollen is particularly rich in nitrogen, we predicted that male growth would be more compromised by reproduction than female growth. To test this hypothesis, we conducted three experiments on the annual dioecious herb Mercurialis annua. First, we compared the timing of reproduction between males and females and found that males started flowering earlier than females; early flowering is expected to compromise growth more than later flowering. Second, we compared plants allowed to flower with those prevented from flowering by experimental debudding and found that males incurred a higher reproductive cost than females in terms of both biomass and, particularly, nitrogen. Third, we grew plants under varying levels of nitrogen availability and found that although sexual size dimorphism was unaffected by nitrogen, females, but not males, decreased their relative allocation to both roots and reproduction under high nitrogen availability. We propose that males deal with the high cost of pollen production in terms of nitrogen by allocating biomass to nitrogen-harvesting roots, whereas females pay for carbon-rich seeds and fruits by investing in photosynthetic organs. Sexual dimorphism would thus seem to be the outcome of allocation to above- versus below-ground sinks that supply resources (carbon versus nitrogen) limiting the female and male reproduction differentially.

  6. Make or buy analysis model based on tolerance allocation to minimize manufacturing cost and fuzzy quality loss

    NASA Astrophysics Data System (ADS)

    Rosyidi, C. N.; Puspitoingrum, W.; Jauhari, W. A.; Suhardi, B.; Hamada, K.

    2016-02-01

    The specification of tolerances has a significant impact on the quality of product and final production cost. The company should carefully pay attention to the component or product tolerance so they can produce a good quality product at the lowest cost. Tolerance allocation has been widely used to solve problem in selecting particular process or supplier. But before merely getting into the selection process, the company must first make a plan to analyse whether the component must be made in house (make), to be purchased from a supplier (buy), or used the combination of both. This paper discusses an optimization model of process and supplier selection in order to minimize the manufacturing costs and the fuzzy quality loss. This model can also be used to determine the allocation of components to the selected processes or suppliers. Tolerance, process capability and production capacity are three important constraints that affect the decision. Fuzzy quality loss function is used in this paper to describe the semantic of the quality, in which the product quality level is divided into several grades. The implementation of the proposed model has been demonstrated by solving a numerical example problem that used a simple assembly product which consists of three components. The metaheuristic approach were implemented to OptQuest software from Oracle Crystal Ball in order to obtain the optimal solution of the numerical example.

  7. Health Aid Is Allocated Efficiently, But Not Optimally: Insights From A Review Of Cost-Effectiveness Studies.

    PubMed

    Bendavid, Eran; Duong, Andrew; Sagan, Charlotte; Raikes, Gillian

    2015-07-01

    Development assistance from high-income countries to the health sectors of low- and middle-income countries (health aid) is an important source of funding for health in low- and middle-income countries. However, the relationship between health aid and the expected health improvements from those expenditures--the cost-effectiveness of targeted interventions--remains unknown. We reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV; malaria; tuberculosis; noncommunicable diseases; and maternal, newborn, and child health. We measured the alignment between health aid and cost-effectiveness, and we examined the possibility of better alignment by simulating health aid reallocation. The relationship between health aid and incremental cost-effectiveness ratios is negative and significant: More health aid is going to disease categories with more cost-effective interventions. Changing the allocation of health aid earmarked funding could lead to greater health gains even without expanding overall disbursements. The greatest improvements in the alignment would be achieved by reallocating some aid from HIV or maternal, newborn, and child health to malaria or TB. We conclude that health aid is generally aligned with cost-effectiveness considerations, but in some countries this alignment could be improved.

  8. Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing.

    PubMed

    Loss, R W; Hall, W J; Speers, D M

    1979-01-01

    We studied 73 young adults who were presently cigarette smokers to evaluate whether the identification of abnormalities in pulmonary function tests had a detectable influence on modification of smoking habits. Utilizing rate schedules for these tests presently applicable in Rochester, New York, we determined the potential cost to these subjects and community relative to the number of subjects who stopped smoking as a result of test findings. Subjects were evaluated by questionnaire and function testing including spirometry, flow-volume curves, body plethysmography and single breath nitrogen washout test (SBN2). Functional abnormalities were present in 75% of subjects screened. The SBN2 test was most sensitive, identifying 97% of subjects with any abnormality. The presence of common respiratory symptoms was found to be highly predictive of test abnormalities. Subjects were informed of results and counseled. At six-month follow-up, 7% of subjects with abnormal test results had stopped smoking. Utilizing even our most cost-effective test, the SBN2, it would cost +1,392 for each "benefit" defined as one subject not smoking for six months. Application of these screening techniques is unlikely to be effective in altering smoking habits in the absence of continued physician support.

  9. Activity-based resource allocation: a system for predicting nursing costs.

    PubMed

    Crockett, M J; DiBlasi, M; Flaherty, P; Sampson, K

    1997-01-01

    As hospital-based managers are being confronted with changing patterns of reimbursement, ranging from revenue generating to cost management, it is imperative that hospitals know the exact nursing costs associated with the actual care delivered to specific patients. Nursing care has traditionally been bundled into the room rate for patients. This approach is extremely limiting when facilities are negotiating per diem rates and capitated rate contracts. At Braintree Hospital Rehabilitation Network, the nursing department has developed and implemented an activity-based management system to determine the actual cost of nursing care provided to each patient. This approach, which differentiates nursing costs accurately by diagnostic group and by intensity of nursing care, has contributed to the hospital's success in negotiating individual patient contracts with insurers in the managed care environment that increasingly focuses on costs and outcomes. Another result has been to enhance the accuracy of the network's cost accounting system. PMID:9416189

  10. Improving resource allocation decisions for health and HIV programmes in South Africa: Bioethical, cost-effectiveness and health diplomacy considerations.

    PubMed

    Kevany, Sebastian; Benatar, Solomon R; Fleischer, Theodore

    2013-01-01

    The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012-2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system. PMID:23651436

  11. Improving resource allocation decisions for health and HIV programmes in South Africa: Bioethical, cost-effectiveness and health diplomacy considerations.

    PubMed

    Kevany, Sebastian; Benatar, Solomon R; Fleischer, Theodore

    2013-01-01

    The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012-2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system.

  12. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... providing medical care. Enrollment, marketing, and other administrative and general costs that benefit the...) Political and lobbying activities. (4) Charity or courtesy allowances. (5) Spousal education....

  13. 5 CFR 734.503 - Allocation and reimbursement of costs associated with political activities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... employee covered under this subpart must apportion the costs of mixed travel based on the time spent on political activities and the time spent performing official duties. Prorating the cost of travel involves..., receptions, rallies, and similar activities. Time spent in actual travel, private study, or rest...

  14. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417... associated with providing medical care. Enrollment, marketing, and other administrative and general costs... medical care must be apportioned on the basis of a ratio of Medicare enrollees to the total HMO or...

  15. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417... associated with providing medical care. Enrollment, marketing, and other administrative and general costs... medical care must be apportioned on the basis of a ratio of Medicare enrollees to the total HMO or...

  16. Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial

    PubMed Central

    Pietzsch, Jan B.; Liu, Shan; Garner, Abigail M.; Kezirian, Eric J.; Strollo, Patrick J.

    2015-01-01

    Study Objectives: Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective. Design: A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year. Setting: U.S. healthcare system; third-party payer perspective. Patients or Participants: 83% male cohort with mean age of 54.5 years. Interventions: UAS vs. no treatment. Measurements and Results: UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY. Conclusions: Relative to the acknowledged willingness-to-pay threshold of $50,000–$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system. Citation: Pietzsch JB, Liu S, Garner AM, Kezirian EJ, Strollo PJ. Long-term cost-effectiveness of upper airway stimulation for the treatment of obstructive sleep apnea: a model-based projection based on the STAR Trial. SLEEP 2015;38(5):735–744. PMID:25348126

  17. Understanding the Uncertainty of an Effectiveness-Cost Ratio in Educational Resource Allocation: A Bayesian Approach

    ERIC Educational Resources Information Center

    Pan, Yilin

    2016-01-01

    Given the necessity to bridge the gap between what happened and what is likely to happen, this paper aims to explore how to apply Bayesian inference to cost-effectiveness analysis so as to capture the uncertainty of a ratio-type efficiency measure. The first part of the paper summarizes the characteristics of the evaluation data that are commonly…

  18. 2 CFR Appendix C to Part 225 - State/Local-Wide Central Service Cost Allocation Plans

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... activities. In addition, for pension and post-retirement health insurance plans, the following information... funds c. Self-insurance funds d. Fringe benefits 4. Required certification F. Negotiation and Approval... Health and Human Services entitled “A Guide for State and Local Government Agencies: Cost Principles...

  19. 2 CFR Appendix C to Part 225 - State/Local-Wide Central Service Cost Allocation Plans

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... activities. In addition, for pension and post-retirement health insurance plans, the following information... funds c. Self-insurance funds d. Fringe benefits 4. Required certification F. Negotiation and Approval... Health and Human Services entitled “A Guide for State and Local Government Agencies: Cost Principles...

  20. 2 CFR Appendix C to Part 225 - State/Local-Wide Central Service Cost Allocation Plans

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... activities. In addition, for pension and post-retirement health insurance plans, the following information... funds c. Self-insurance funds d. Fringe benefits 4. Required certification F. Negotiation and Approval... Health and Human Services entitled “A Guide for State and Local Government Agencies: Cost Principles...

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

    ERIC Educational Resources Information Center

    Wynn, Barbara O.; Kawata, Jennifer

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

  2. ESEA Title I Allocation Policy: Demonstration Study. Cost Analysis; Planning Year 1975-76.

    ERIC Educational Resources Information Center

    Sjogren, Jane Huseby; Ames, Richard

    This report describes resource use and program costs of the Elementary Secondary Education Act Title I programs in thirteen demonstration local education agencies (LEAs) during 1975-76. This analysis provides a baseline for comparing data from later years when waivers were granted for compliance with Title I guidelines. This study is concerned…

  3. 30 CFR 1220.011 - Schedule of allowable direct and allocable joint costs and credits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... engineering design problems related to equipment or facilities required for NPSL operations. (4) The cost of... services calling for feasibility studies not directly related to specific engineering design problems or... prevailing in the vicinity of the NPSL project area less 20 percent. For automotive equipment, the lessee...

  4. 30 CFR 1220.011 - Schedule of allowable direct and allocable joint costs and credits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... engineering design problems related to equipment or facilities required for NPSL operations. (4) The cost of... services calling for feasibility studies not directly related to specific engineering design problems or... prevailing in the vicinity of the NPSL project area less 20 percent. For automotive equipment, the lessee...

  5. Cost optimal allocation of amplifiers and DCMs in WDM ring networks.

    PubMed

    Minagar, Amir; Premaratne, Malin; Tran, An V

    2006-10-30

    Designing metropolitan wavelength division multiplexing (WDM) ring networks with minimum deployment cost is a demanding issue in Telecommunication Network planning . We have already presented amplifier placement methods to minimize the number of amplifiers in WDM rings for the case all amplifiers follow a unique gain model. In this paper, we take into account different types of amplifiers with predefined fixed characteristics and costs. We also formulate fiber dispersion limitations on the ring design, and present two efficient methods for placing amplifiers and Dispersion Compensation Modules (DCMs) in WDM rings to minimize the total deployment cost of the system. The first method deals with both linear and nonlinear equations and uses a mixed integer nonlinear programming (MINLP) solver where the second method applies the linear approximation of nonlinear constraints, and uses a mixed integer linear programming (MILP) solver to minimize the total cost of the system. We carry out Simulation experiments to confirm the applicability of the methods and compare the results for various network configurations.

  6. Allocating the costs of failed or abandoned projects of regulated public utilities

    SciTech Connect

    Urban, R.T.

    1984-05-24

    The author proposes a regulatory and financial management method whereby the holders of a utility company's equity shares in existence during the planning and commencement of a major construction project which is never completed or never becomes productive will bear the losses represented by the '' management error.'' Sure to be controversial, the proposal at least offers regulators a possibility for negating the usual result of penalizing equity holders when and if it is determined that a course of action by the utility's management has been imprudent or otherwise unwarranted; namely, the cost of capital for a utility in that posture rises significantly, thus imposing upon the utility's rate payers the true cost of the attempted penalization of the utility's management and owners. 16 references.

  7. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... universal service support mechanism (See 47 CFR 54.701 of this chapter), the TRS Fund (See 47 CFR 64.604(c)(4)(iii)(H) of this chapter), and the North American Numbering Plan cost recovery (See 47 CFR 52.16... “telecommunications service” shall include “interconnected VoIP service” as that term is defined in 47 CFR 9.3....

  8. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... universal service support mechanism (See 47 CFR 54.701 of this chapter), the TRS Fund (See 47 CFR 64.604(c)(4)(iii)(H) of this chapter), and the North American Numbering Plan cost recovery (See 47 CFR 52.16... “telecommunications service” shall include “interconnected VoIP service” as that term is defined in 47 CFR 9.3....

  9. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... universal service support mechanism (See 47 CFR 54.701 of this chapter), the TRS Fund (See 47 CFR 64.604(c)(4)(iii)(H) of this chapter), and the North American Numbering Plan cost recovery (See 47 CFR 52.16... “telecommunications service” shall include “interconnected VoIP service” as that term is defined in 47 CFR 9.3....

  10. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... universal service support mechanism (See 47 CFR 54.701 of this chapter), the TRS Fund (See 47 CFR 64.604(c)(4)(iii)(H) of this chapter), and the North American Numbering Plan cost recovery (See 47 CFR 52.16... “telecommunications service” shall include “interconnected VoIP service” as that term is defined in 47 CFR 9.3....

  11. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... universal service support mechanism (See 47 CFR 54.701 of this chapter), the TRS Fund (See 47 CFR 64.604(c)(4)(iii)(H) of this chapter), and the North American Numbering Plan cost recovery (See 47 CFR 52.16... “telecommunications service” shall include “interconnected VoIP service” as that term is defined in 47 CFR 9.3....

  12. The impact of proposed changes in liver allocation policy on cold ischemia times and organ transportation costs.

    PubMed

    DuBay, D A; MacLennan, P A; Reed, R D; Fouad, M; Martin, M; Meeks, C B; Taylor, G; Kilgore, M L; Tankersley, M; Gray, S H; White, J A; Eckhoff, D E; Locke, J E

    2015-02-01

    Changes to the liver allocation system have been proposed to decrease regional variation in access to liver transplant. It is unclear what impact these changes will have on cold ischemia times (CITs) and donor transportation costs. Therefore, we performed a retrospective single center study (2008-2012) measuring liver procurement CIT and transportation costs. Four groups were defined: Local-within driving distance (Local-D, n = 262), Local-flight (Local-F, n = 105), Regional-flight <3 h (Regional <3 h, n = 61) and Regional-Flight >3 h (Regional >3 h, n = 53). The median travel distance increased in each group, varying from zero miles (Local-D), 196 miles (Local-F), 384 miles (Regional <3 h), to 1647 miles (Regional >3 h). Increasing travel distances did not significantly increase CIT until the flight time was >3 h. The average CIT ranged from 5.0 to 6.0 h for Local-D, Local-F and Regional <3 h, but increased to 10 h for Regional >3 h (p < 0.0001). Transportation costs increased with greater distance traveled: Local-D $101, Local-F $1993, Regional <3 h $8324 and Regional >3 h $27 810 (p < 0.0001). With proposed redistricting, local financial modeling suggests that the average liver donor procurement transportation variable direct costs will increase from $2415 to $7547/liver donor, an increase of 313%. These findings suggest that further discussion among transplant centers and insurance providers is needed prior to policy implementation.

  13. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  14. 2 CFR Appendix V to Part 200 - State/Local Government and Indian Tribe-Wide Central Service Cost Allocation Plans

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false State/Local Government and Indian Tribe-Wide Central Service Cost Allocation Plans V Appendix V to Part 200 Grants and Agreements Office of Management..., App. V Appendix V to Part 200—State/Local Government and Indian Tribe-Wide Central Service...

  15. 50 CFR 80.63 - Does an agency have to allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.63 Does an agency have to allocate... in multipurpose projects and facilities. A grant-funded project or facility is multipurpose if...

  16. 50 CFR 80.63 - Does an agency have to allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.63 Does an agency have to allocate... in multipurpose projects and facilities. A grant-funded project or facility is multipurpose if...

  17. 50 CFR 80.63 - Does an agency have to allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.63 Does an agency have to allocate... in multipurpose projects and facilities. A grant-funded project or facility is multipurpose if...

  18. 50 CFR 80.63 - Does an agency have to allocate costs in multipurpose projects and facilities?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Allocation of Funds by an Agency § 80.63 Does an agency have to allocate... in multipurpose projects and facilities. A grant-funded project or facility is multipurpose if...

  19. Nurse staff allocation by nurse patient ratio vs. a computerized nurse dependency management system: a comparative cost analysis of Australian and New Zealand hospitals.

    PubMed

    Heslop, Liza; Plummer, Virginia

    2012-01-01

    Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research. Nurse costing for two nurse staffing allocation methods--nurse patient ratios and a computerized nurse dependency management system--were compared. Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand. Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care. The comparison of costs for nursing staff by nurse-patient ratios and by a computerized nurse dependency management system demonstrated differences. The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios. PMID:23346733

  20. Nurse staff allocation by nurse patient ratio vs. a computerized nurse dependency management system: a comparative cost analysis of Australian and New Zealand hospitals.

    PubMed

    Heslop, Liza; Plummer, Virginia

    2012-01-01

    Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research. Nurse costing for two nurse staffing allocation methods--nurse patient ratios and a computerized nurse dependency management system--were compared. Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand. Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care. The comparison of costs for nursing staff by nurse-patient ratios and by a computerized nurse dependency management system demonstrated differences. The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios.

  1. 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...

  2. PPD-QALY-an index for cost-effectiveness in orthopedics: providing essential information to both physicians and health care policy makers for appropriate allocation of medical resources.

    PubMed

    Dougherty, Christopher P; Howard, Timothy

    2013-09-01

    Because of the increasing health care costs and the need for proper allocation of resources, it is important to ensure the best use of health benefits for sick and injured people of the population. An index or indicator is needed to help us quantify what is being spent so that comparisons with other options can be implemented. Cost-effective analysis seems to be well suited to provide this essential information to health care policy makers and those charged with distributing disability funds so that the proper allocation of resources can be achieved. There is currently no such index to show whether the benefits paid out are the most cost-effective. By comparing the quality-adjusted life year (QALY) of a treatment method to the disability an individual would experience, on the basis of lost wages as measure of disability, we provide decision makers more information for the basis of cost allocation in health care. To accomplish this, we describe a new term, the PPD-QALY (permanent partial disability-quality of life year). This term was developed to establish an index to which musculoskeletal care can be compared, to evaluate the cost-effectiveness of a treatment on the basis of the monetary value of the disability. This term serves to standardize the monetary value of an injury. Cost-effective analysis in arthroscopic surgery may prove to be a valuable asset in this role and to provide decision makers the information needed to determine the societal benefit from new arthroscopic procedures as they are developed and implemented. PMID:23924750

  3. PPD-QALY-an index for cost-effectiveness in orthopedics: providing essential information to both physicians and health care policy makers for appropriate allocation of medical resources.

    PubMed

    Dougherty, Christopher P; Howard, Timothy

    2013-09-01

    Because of the increasing health care costs and the need for proper allocation of resources, it is important to ensure the best use of health benefits for sick and injured people of the population. An index or indicator is needed to help us quantify what is being spent so that comparisons with other options can be implemented. Cost-effective analysis seems to be well suited to provide this essential information to health care policy makers and those charged with distributing disability funds so that the proper allocation of resources can be achieved. There is currently no such index to show whether the benefits paid out are the most cost-effective. By comparing the quality-adjusted life year (QALY) of a treatment method to the disability an individual would experience, on the basis of lost wages as measure of disability, we provide decision makers more information for the basis of cost allocation in health care. To accomplish this, we describe a new term, the PPD-QALY (permanent partial disability-quality of life year). This term was developed to establish an index to which musculoskeletal care can be compared, to evaluate the cost-effectiveness of a treatment on the basis of the monetary value of the disability. This term serves to standardize the monetary value of an injury. Cost-effective analysis in arthroscopic surgery may prove to be a valuable asset in this role and to provide decision makers the information needed to determine the societal benefit from new arthroscopic procedures as they are developed and implemented.

  4. Towards an equitable allocation of the cost of a global change adaptation plan at the river basin scale: going beyond the perfect cooperation assumption

    NASA Astrophysics Data System (ADS)

    Girard, Corentin; Rinaudo, Jean-Daniel; Pulido-Velázquez, Manuel

    2015-04-01

    Adaptation to global change is a key issue in the planning of water resource systems in a changing world. Adaptation has to be efficient, but also equitable in the share of the costs of joint adaptation at the river basin scale. Least-cost hydro-economic optimization models have been helpful at defining efficient adaptation strategies. However, they often rely on the assumption of a "perfect cooperation" among the stakeholders, required for reaching the optimal solution. Nowadays, most adaptation decisions have to be agreed among the different actors in charge of their implementation, thus challenging the validity of a perfect command-and-control solution. As a first attempt to over-pass this limitation, our work presents a method to allocate the cost of an efficient adaptation programme of measures among the different stakeholders at the river basin scale. Principles of equity are used to define cost allocation scenarios from different perspectives, combining elements from cooperative game theory and axioms from social justice to bring some "food for thought" in the decision making process of adaptation. To illustrate the type of interactions between stakeholders in a river basin, the method has been applied in a French case study, the Orb river basin. Located on the northern rim of the Mediterranean Sea, this river basin is experiencing changes in demand patterns, and its water resources will be impacted by climate change, calling for the design of an adaptation plan. A least-cost river basin optimization model (LCRBOM) has been developed under GAMS to select the combination of demand- and supply-side adaptation measures that allows meeting quantitative water management targets at the river basin scale in a global change context. The optimal adaptation plan encompasses measures in both agricultural and urban sectors, up-stream and down-stream of the basin, disregarding the individual interests of the stakeholders. In order to ensure equity in the cost allocation

  5. Cost-effectiveness in orthopedics: providing essential information to both physicians and health care policy makers for appropriate allocation of medical resources.

    PubMed

    Dougherty, Christopher P; Howard, Timothy

    2013-09-01

    Cost-effective analysis has become an important tool in helping determine what procedures are both cost-effective and appropriate in today's cost control health care. The quality-adjusted life-year (QALY) is a standard measure for health-related quality-of-life in medical cost-effectiveness research. It can be used to compare different interventions to determine the cost-effectiveness of each procedure. Use of QALY to compare health care interventions has become the new gold standard. The key words arthroscopy, cost-effectiveness analysis, QALY, shoulder, hip, knee, ankle, elbow, wrist, and pubic symphysis were searched utilizing PubMed and an internet search engine. Cost/QALY ratios were determined and compared with other surgical procedures using techniques other than arthroscopy. Cost/QALYs were found for the shoulder, hip, knee, and elbow. The QALY for the shoulder was $13,092, for a simple knee was $5783, for a hip $21,700, and for an elbow $2031. General costs were found for the ankle, wrist, and pubic symphysis, that could be used to estimate QALYs without the complex formal calculation. On the basis of our findings, arthroscopy is an extremely cost-effective allocation of health care resources.

  6. A High-Value, Low-Cost Bubble Continuous Positive Airway Pressure System for Low-Resource Settings: Technical Assessment and Initial Case Reports

    PubMed Central

    Brown, Jocelyn; Machen, Heather; Kawaza, Kondwani; Mwanza, Zondiwe; Iniguez, Suzanne; Lang, Hans; Gest, Alfred; Kennedy, Neil; Miros, Robert; Richards-Kortum, Rebecca; Molyneux, Elizabeth; Oden, Maria

    2013-01-01

    Acute respiratory infections are the leading cause of global child mortality. In the developing world, nasal oxygen therapy is often the only treatment option for babies who are suffering from respiratory distress. Without the added pressure of bubble Continuous Positive Airway Pressure (bCPAP) which helps maintain alveoli open, babies struggle to breathe and can suffer serious complications, and frequently death. A stand-alone bCPAP device can cost $6,000, too expensive for most developing world hospitals. Here, we describe the design and technical evaluation of a new, rugged bCPAP system that can be made in small volume for a cost-of-goods of approximately $350. Moreover, because of its simple design—consumer-grade pumps, medical tubing, and regulators—it requires only the simple replacement of a <$1 diaphragm approximately every 2 years for maintenance. The low-cost bCPAP device delivers pressure and flow equivalent to those of a reference bCPAP system used in the developed world. We describe the initial clinical cases of a child with bronchiolitis and a neonate with respiratory distress who were treated successfully with the new bCPAP device. PMID:23372661

  7. Influence of atmospheric [CO2] on growth, carbon allocation and cost of plant tissues on leaf nitrogen concentration maintenance in nodulated Medicago sativa

    NASA Astrophysics Data System (ADS)

    Pereyra, Gabriela; Hartmann, Henrik; Ziegler, Waldemar; Michalzik, Beate; Gonzalez-Meler, Miquel; Trumbore, Susan

    2015-04-01

    Plant carbon (C) allocation and plant metabolic processes (i.e. photosynthesis and respiration) can be affected by changes in C availability, for example from changing atmospheric [CO2]. In nodulated plants, C availability may also influence nitrogen (N) fixation by bacteriods. But C allocation and N fixation are often studied independently and hence do not allow elucidating interactive effects. We investigated how different atmospheric [CO2] (Pleistocene: 170 ppm, ambient: 400 ppm and projected future: 700 ppm) influence plant growth, allocation to nodules, and the ratio of photosynthesis-to-respiration (R:A) as an indicator of C cost in Medicago sativa inoculated with Ensifer meliloti. M. sativa grew c. 38% more nodules at 400 ppm and 700 ppm than at 170 ppm. However, ratios of above- and belowground plant biomass to nodule biomass were constant over time and independent of atmospheric [CO2]. Total non-structural carbohydrate concentrations were not significantly different between plants grown at 400 and 700 ppm, but were four to five-fold higher than in 170 ppm plants. Leaf level N concentration was similar across treatments, but N-based photosynthetic rates were 82% and 93% higher in leaves of plants grown at 400 and 700 ppm, respectively, than plants grown at 170 ppm. In addition, leaf R:A was greater (48% or 55%) in plants grown at 170 ppm than plants grown at 400 and 700 ppm. Similarly, the greatest proportion of assimilated CO2 released by root respiration occurred in rhizobial plants growing at 170 ppm. Our results suggest that C limitation in nodulated Medicago sativa plants did not influence C allocation to nodule biomass but caused a proportionally greater allocation of C to belowground respiration, most likely to bacteriods. This suggests that N tissue concentration was maintained at low [CO2] by revving up bacteriod metabolism and at the expense of non-structural carbohydrate reserves.

  8. 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...

  9. Approaches to Resource Allocation

    ERIC Educational Resources Information Center

    Dressel, Paul; Simon, Lou Anna Kimsey

    1976-01-01

    Various budgeting patterns and strategies are currently in use, each with its own particular strengths and weaknesses. Neither cost-benefit analysis nor cost-effectiveness analysis offers any better solution to the allocation problem than do the unsupported contentions of departments or the historical unit costs. An operable model that performs…

  10. Laryngeal mask airway: uses in anesthesiology.

    PubMed

    Pinosky, M

    1996-06-01

    The laryngeal mask airway (LMA), developed in 1983, is a new device to assist in the management of the pediatric and adult airway. In 1991, the Food and Drug Administration gave its approval for use of the LMA in the United States. The LMA is reusable and appears to provide cost-effective airway management in numerous situations. The LMA is simple to use, atraumatic to insert, and helpful in overcoming an obstructed airway. Its role in management of the difficult airway and the traumatic airway is still evolving. This review will introduce the LMA to the nonanesthesiologist and review for the anesthesiologist the origins of the LMA, its physical structure, the technical aspects of insertion, problems with aspiration, its role in the difficult airway, and experience with the pediatric population.

  11. 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.

  12. Summary of the technical report on estimating the impact of key programmatic risk allocation decisions on Phase 1 bids and U.S. Department of Energy costs

    SciTech Connect

    Keisler, J.M.; Buehring, W.A.

    1996-05-01

    The US Department of Energy (DOE) is privatizing the processing of hazardous and radioactive tank waste at the Hanford Site in Washington State. As part of the privatization process, a request for proposals describing the conditions and DOE`s expectations for contractor performance and responsibilities was issued. Argonne National Laboratory and Pacific Northwest National Laboratory collaborated to analyze programmatic risks and costs associated with privatization. They examined nine major risks to determine financial impacts on the prospective vendors and DOE for three alternative risk allocations: (1) DOE bears the risk, (2) the vendor bears the risk, or (3) the risk is shared. With the help of a subject-matter expert, each risk was characterized by estimating potential consequences and likelihood of occurrence. A financial risk model was developed to estimate the total cost to DOE for a given risk allocation strategy covering all nine risks. Results showed that it is financially advantageous to DOE to bear some risks, share some others, and assign some to the vendor.

  13. 77 FR 43184 - Allocation of Capacity on New Merchant Transmission Projects and New Cost-Based, Participant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... Utilities; Recovery of Stranded Costs by Public Utilities and Transmitting Utilities, Order No. 888, 61 FR 21540 (May 10, 1996), FERC Stats. & Regs. ] 31,036 (1996), order on reh'g, Order No. 888-A, 62 FR 12274...,838 (2000) (TransEnergie). \\3\\ Id. at 61,836. \\4\\ Id.; Neptune Regional Transmission System, LLC,...

  14. Resource Allocation.

    ERIC Educational Resources Information Center

    Stennett, R. G.

    A research allocation formula employed in London, Ontario elementary schools, as well as supporting data on the method, are provided in this report. Attempts to improve on the traditional methods of resource allocation in London's schools were based on two principles: (1) that need for a particular service could and should be determined…

  15. Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

    PubMed Central

    Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

    2015-01-01

    or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which more than 200 providers were trained. Conclusions DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care. PMID:26086513

  16. Triggers of airway inflammation.

    PubMed

    Kerrebijn, K F

    1986-01-01

    Most asthmatics have hyperresponsive airways. This makes them more sensitive than non-asthmatics to bronchoconstricting environmental exposures which, in their turn, may enhance responsiveness. Airway inflammation is considered to be a key determinant of airway hyperresponsiveness: the fact that chronic airway inflammation in cystic fibrosis does not lead to airway hyperresponsiveness of any importance indicates, however, that the role of airway inflammation is complex and incompletely elucidated. The main inducers of airway inflammation are viral infections, antigens, occupational stimuli and pollutants. Although exercise, airway cooling and hyper- or hypotonic aerosols are potent stimuli of bronchoconstriction, it is questionable if airway inflammation is involved in their mode of action. Each of the above-mentioned stimuli is discussed, with emphasis laid on the relation of symptoms to mechanisms. PMID:3533597

  17. Emergency airway puncture

    MedlinePlus

    Emergency airway puncture is the placement of a hollow needle through the throat into the airway. It ... efforts to assist with breathing have failed. A hollow needle or tube can be inserted into the ...

  18. A Systems Approach for Allocating Educational Space.

    ERIC Educational Resources Information Center

    Florida Univ., Gainesville. Center for Community Needs Assessment.

    A computer simulation model for allocating facilities and physical space is presented as a means of optimally allocating available educational resources. The model allows the decisionmaker to change specific program allocations, system parameters, and other controllable variables in order to determine the effects, both cost and utility, of these…

  19. 39 CFR 3060.12 - Asset allocation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Asset allocation. 3060.12 Section 3060.12 Postal... COMPETITIVE PRODUCTS ENTERPRISE § 3060.12 Asset allocation. Within 6 months of January 23, 2009, and for each... competitive products enterprise using a method of allocation based on appropriate revenue or cost...

  20. Careers in Airway Science.

    ERIC Educational Resources Information Center

    Federal Aviation Administration (DOT), Washington, DC.

    The Federal Aviation Administration (FAA) has initiated the Airway Science curriculum as a method of preparing the next generation of aviation technicians and managers. This document: (1) discusses the FAA's role in the Airway Science program; (2) describes some of the career fields that FAA offers to Airway Science graduates (air traffic control…

  1. Integrated care pathways for airway diseases (AIRWAYS-ICPs).

    PubMed

    Bousquet, J; Addis, A; Adcock, I; Agache, I; Agusti, A; Alonso, A; Annesi-Maesano, I; Anto, J M; Bachert, C; Baena-Cagnani, C E; Bai, C; Baigenzhin, A; Barbara, C; Barnes, P J; Bateman, E D; Beck, L; Bedbrook, A; Bel, E H; Benezet, O; Bennoor, K S; Benson, M; Bernabeu-Wittel, M; Bewick, M; Bindslev-Jensen, C; Blain, H; Blasi, F; Bonini, M; Bonini, S; Boulet, L P; Bourdin, A; Bourret, R; Bousquet, P J; Brightling, C E; Briggs, A; Brozek, J; Buhl, R; Bush, A; Caimmi, D; Calderon, M; Calverley, P; Camargos, P A; Camuzat, T; Canonica, G W; Carlsen, K H; Casale, T B; Cazzola, M; Cepeda Sarabia, A M; Cesario, A; Chen, Y Z; Chkhartishvili, E; Chavannes, N H; Chiron, R; Chuchalin, A; Chung, K F; Cox, L; Crooks, G; Crooks, M G; Cruz, A A; Custovic, A; Dahl, R; Dahlen, S E; De Blay, F; Dedeu, T; Deleanu, D; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dubakiene, R; Eglin, S; Elliot, F; Emuzyte, R; Fabbri, L; Fink Wagner, A; Fletcher, M; Fokkens, W J; Fonseca, J; Franco, A; Frith, P; Furber, A; Gaga, M; Garcés, J; Garcia-Aymerich, J; Gamkrelidze, A; Gonzales-Diaz, S; Gouzi, F; Guzmán, M A; Haahtela, T; Harrison, D; Hayot, M; Heaney, L G; Heinrich, J; Hellings, P W; Hooper, J; Humbert, M; Hyland, M; Iaccarino, G; Jakovenko, D; Jardim, J R; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Joos, G; Jung, K S; Kalayci, O; Karunanithi, S; Keil, T; Khaltaev, N; Kolek, V; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Le, L T; Lodrup Carlsen, K C; Louis, R; MacNee, W; Mair, A; Majer, I; Manning, P; de Manuel Keenoy, E; Masjedi, M R; Melen, E; Melo-Gomes, E; Menzies-Gow, A; Mercier, G; Mercier, J; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; N'Diaye, M; Nafti, S; Nekam, K; Neou, A; Nicod, L; O'Hehir, R; Ohta, K; Paggiaro, P; Palkonen, S; Palmer, S; Papadopoulos, N G; Papi, A; Passalacqua, G; Pavord, I; Pigearias, B; Plavec, D; Postma, D S; Price, D; Rabe, K F; Radier Pontal, F; Redon, J; Rennard, S; Roberts, J; Robine, J M; Roca, J; Roche, N; Rodenas, F; Roggeri, A; Rolland, C; Rosado-Pinto, J; Ryan, D; Samolinski, B; Sanchez-Borges, M; Schünemann, H J; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Small, I; Sola-Morales, O; Sooronbaev, T; Stelmach, R; Sterk, P J; Stiris, T; Sud, P; Tellier, V; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valiulis, A; Valovirta, E; Van Ganse, E; Vandenplas, O; Vasankari, T; Vestbo, J; Vezzani, G; Viegi, G; Visier, L; Vogelmeier, C; Vontetsianos, T; Wagstaff, R; Wahn, U; Wallaert, B; Whalley, B; Wickman, M; Williams, D M; Wilson, N; Yawn, B P; Yiallouros, P K; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zhong, N; Zidarn, M; Zuberbier, T

    2014-08-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers). PMID:24925919

  2. Integrated care pathways for airway diseases (AIRWAYS-ICPs).

    PubMed

    Bousquet, J; Addis, A; Adcock, I; Agache, I; Agusti, A; Alonso, A; Annesi-Maesano, I; Anto, J M; Bachert, C; Baena-Cagnani, C E; Bai, C; Baigenzhin, A; Barbara, C; Barnes, P J; Bateman, E D; Beck, L; Bedbrook, A; Bel, E H; Benezet, O; Bennoor, K S; Benson, M; Bernabeu-Wittel, M; Bewick, M; Bindslev-Jensen, C; Blain, H; Blasi, F; Bonini, M; Bonini, S; Boulet, L P; Bourdin, A; Bourret, R; Bousquet, P J; Brightling, C E; Briggs, A; Brozek, J; Buhl, R; Bush, A; Caimmi, D; Calderon, M; Calverley, P; Camargos, P A; Camuzat, T; Canonica, G W; Carlsen, K H; Casale, T B; Cazzola, M; Cepeda Sarabia, A M; Cesario, A; Chen, Y Z; Chkhartishvili, E; Chavannes, N H; Chiron, R; Chuchalin, A; Chung, K F; Cox, L; Crooks, G; Crooks, M G; Cruz, A A; Custovic, A; Dahl, R; Dahlen, S E; De Blay, F; Dedeu, T; Deleanu, D; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dubakiene, R; Eglin, S; Elliot, F; Emuzyte, R; Fabbri, L; Fink Wagner, A; Fletcher, M; Fokkens, W J; Fonseca, J; Franco, A; Frith, P; Furber, A; Gaga, M; Garcés, J; Garcia-Aymerich, J; Gamkrelidze, A; Gonzales-Diaz, S; Gouzi, F; Guzmán, M A; Haahtela, T; Harrison, D; Hayot, M; Heaney, L G; Heinrich, J; Hellings, P W; Hooper, J; Humbert, M; Hyland, M; Iaccarino, G; Jakovenko, D; Jardim, J R; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Joos, G; Jung, K S; Kalayci, O; Karunanithi, S; Keil, T; Khaltaev, N; Kolek, V; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Le, L T; Lodrup Carlsen, K C; Louis, R; MacNee, W; Mair, A; Majer, I; Manning, P; de Manuel Keenoy, E; Masjedi, M R; Melen, E; Melo-Gomes, E; Menzies-Gow, A; Mercier, G; Mercier, J; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; N'Diaye, M; Nafti, S; Nekam, K; Neou, A; Nicod, L; O'Hehir, R; Ohta, K; Paggiaro, P; Palkonen, S; Palmer, S; Papadopoulos, N G; Papi, A; Passalacqua, G; Pavord, I; Pigearias, B; Plavec, D; Postma, D S; Price, D; Rabe, K F; Radier Pontal, F; Redon, J; Rennard, S; Roberts, J; Robine, J M; Roca, J; Roche, N; Rodenas, F; Roggeri, A; Rolland, C; Rosado-Pinto, J; Ryan, D; Samolinski, B; Sanchez-Borges, M; Schünemann, H J; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Small, I; Sola-Morales, O; Sooronbaev, T; Stelmach, R; Sterk, P J; Stiris, T; Sud, P; Tellier, V; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valiulis, A; Valovirta, E; Van Ganse, E; Vandenplas, O; Vasankari, T; Vestbo, J; Vezzani, G; Viegi, G; Visier, L; Vogelmeier, C; Vontetsianos, T; Wagstaff, R; Wahn, U; Wallaert, B; Whalley, B; Wickman, M; Williams, D M; Wilson, N; Yawn, B P; Yiallouros, P K; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zhong, N; Zidarn, M; Zuberbier, T

    2014-08-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

  3. The emergency airway.

    PubMed

    Goon, Serena S H; Stephens, Robert C M; Smith, Helen

    2009-12-01

    The 'can't intubate, can't ventilate' scenario is a nightmare for all clinicians who manage airways. Cricothyroidotomy is one of several emergency airway management techniques. Cricothyroidotomy is a short-term solution which provides oxygenation, not ventilation, and is not a definitive airway. Although there are tests which can help predict whether an intubation will be difficult, they are not always good predictors. As the can't intubate, can't ventilate scenario is rare, cricothyroidotomy is an unfamiliar procedure to many. In this situation, expert help must be called for early on. In the meantime, it is vital that all other simple airway manoeuvres have been attempted, such as good positioning of the patient with head tilt and chin lift, and use of airway adjuncts like the oral (Guedel) airway or nasopharyngeal airway, and the laryngeal mask airway. However, if attempts to secure the airway are unsuccessful, there may be no other option than to perform a cricothyroidotomy. It is a difficult decision to make, but with increasing hypoxia, it is essential that one oxygenates the patient. Cricothyroidotomy provides an opening in the pace between the anterior inferior border of the thyroid cartilage and the anterior superior border of the cricoid cartilage, allowing access to the airway below the glottis. The anatomical considerations are important when performing this procedure (Ellis, 2009), and there are other scenarios when it is used. It is not without consequence, as with any procedure.

  4. Engineering Airway Epithelium

    PubMed Central

    Soleas, John P.; Paz, Ana; Marcus, Paula; McGuigan, Alison; Waddell, Thomas K.

    2012-01-01

    Airway epithelium is constantly presented with injurious signals, yet under healthy circumstances, the epithelium maintains its innate immune barrier and mucociliary elevator function. This suggests that airway epithelium has regenerative potential (I. R. Telford and C. F. Bridgman, 1990). In practice, however, airway regeneration is problematic because of slow turnover and dedifferentiation of epithelium thereby hindering regeneration and increasing time necessary for full maturation and function. Based on the anatomy and biology of the airway epithelium, a variety of tissue engineering tools available could be utilized to overcome the barriers currently seen in airway epithelial generation. This paper describes the structure, function, and repair mechanisms in native epithelium and highlights specific and manipulatable tissue engineering signals that could be of great use in the creation of artificial airway epithelium. PMID:22523471

  5. Medicaid program; allocation of enhanced federal matching funds for increased administrative costs resulting from welfare reform--HCFA. Notice with comment period.

    PubMed

    1997-05-14

    This notice with comment period announces the methodology used to determine the allocation, among the States and certain Territories, of a $500 million fund to assist them with the additional expenses attributable to eligibility determinations incurred as a result of the provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which decouples Medicaid eligibility from receipt of cash assistance for families and children. Also, it announces the actual allocation amount for each State and Territory. The special fund is available for matching a State's or Territory's allowable administrative expenditures incurred only during Federal fiscal years 1997 through 2000, and only during the first 12 calendar quarters in which the State's Temporary Assistance to Needy Families program, which replaced the Aid to Families with Dependent Children program, is in effect after August 21, 1996. PMID:10167530

  6. Attribution of Library Costs

    ERIC Educational Resources Information Center

    Drake, Miriam A.

    1977-01-01

    Universities conduct a variety of cost-allocation studies that require the collection and analysis of the library cost-data. Cost accounting methods are used in most studies; however, costs are attributed to library user groups in a variety of ways. Cost accounting studies are reviewed and allocation methods are discussed. (Author)

  7. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  8. Cost Accounting for Decision Makers.

    ERIC Educational Resources Information Center

    Kaneklides, Ann L.

    1985-01-01

    Underscores the importance of informed decision making through accurate anticipation of cost incurrence in light of changing economic and environmental conditions. Explains the concepts of cost accounting, full allocation of costs, the selection of an allocation base, the allocation of indirect costs, depreciation, and implications for community…

  9. Management of the difficult airway.

    PubMed

    Strauss, Robert A; Noordhoek, Roseanna

    2010-03-01

    The oral and maxillofacial surgeon frequently encounters and manages difficult airways. Knowledge of and calm progression by practitioner and staff through different means to ventilate and manage a difficult airway are crucial. Practitioners should become comfortable with different types of alternative or rescue airways in order to intervene quickly in case of emergent or unanticipated airway compromise.

  10. Airway management in trauma.

    PubMed

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration. PMID:19412149

  11. The Place of a Pharmacy School Library on a Large University Campus with Special Emphasis on Use, Materials Costs, and Fund Allocation

    ERIC Educational Resources Information Center

    Andrews, Theodora

    1977-01-01

    The areas discussed relate to materials costs, collection development, circulation trends and patterns, comparisons of use in various department and/or school libraries, and identification of user groups within the Purdue University Libraries. (LBH)

  12. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

    PubMed Central

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy

    2014-01-01

    BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1

  13. Role of upper airway ultrasound in airway management.

    PubMed

    Osman, Adi; Sum, Kok Meng

    2016-01-01

    Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future. PMID:27529028

  14. Role of upper airway ultrasound in airway management.

    PubMed

    Osman, Adi; Sum, Kok Meng

    2016-01-01

    Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.

  15. 17 CFR 256.01-11 - Methods of allocation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Methods of allocation. 256.01... HOLDING COMPANY ACT OF 1935 General Instructions § 256.01-11 Methods of allocation. Indirect costs and... applicable and currently effective methods of allocation filed with the Commission. Both direct and...

  16. 18 CFR 367.28 - Methods of allocation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Methods of allocation... Instructions § 367.28 Methods of allocation. Indirect costs and compensation for use of capital must be allocated to projects in accordance with the service company's applicable and currently effective methods...

  17. Indirect airway challenges.

    PubMed

    Joos, G F; O'Connor, B; Anderson, S D; Chung, F; Cockcroft, D W; Dahlén, B; DiMaria, G; Foresi, A; Hargreave, F E; Holgate, S T; Inman, M; Lötvall, J; Magnussen, H; Polosa, R; Postma, D S; Riedler, J

    2003-06-01

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving. Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.

  18. Cost-Effectiveness of Coronary Artery Calcium Testing for Coronary Heart and Cardiovascular Disease Risk Prediction to Guide Statin Allocation: The Multi-Ethnic Study of Atherosclerosis (MESA)

    PubMed Central

    Roberts, Eric T.; Horne, Aaron; Martin, Seth S.; Blaha, Michael J.; Blankstein, Ron; Budoff, Matthew J.; Sibley, Christopher; Polak, Joseph F.; Frick, Kevin D.; Blumenthal, Roger S.; Nasir, Khurram

    2015-01-01

    Background The Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels <160 mg/dL. However, the cost-effectiveness of incorporating CAC into treatment decision rules has yet to be clearly delineated. Objective To model the cost-effectiveness of CAC for cardiovascular risk stratification in asymptomatic, intermediate risk patients not taking a statin. Treatment based on CAC was compared to (1) treatment of all intermediate-risk patients, and (2) treatment on the basis of United States guidelines. Methods We developed a Markov model of first coronary heart disease (CHD) and cardiovascular disease (CVD) events. We modeled statin treatment in intermediate risk patients with CAC≥1 and CAC≥100, with different intensities of statins based on the CAC score. We compared these CAC-based treatment strategies to a “treat all” strategy and to treatment according to the Adult Treatment Panel III (ATP III) guidelines. Clinical and economic outcomes were modeled over both five- and ten-year time horizons. Outcomes consisted of CHD and CVD events and Quality-Adjusted Life Years (QALYs). Sensitivity analyses considered the effect of higher event rates, different CAC and statin costs, indirect costs, and re-scanning patients with incidentalomas. Results We project that it is both cost-saving and more effective to scan intermediate-risk patients for CAC and to treat those with CAC≥1, compared to treatment based on established risk-assessment guidelines. Treating patients with CAC≥100 is also preferred to existing guidelines when we account for statin side effects and the disutility of statin use. Conclusion Compared to the alternatives we assessed, CAC testing is both effective and cost saving as a risk-stratification tool, particularly if there are adverse effects of long-term statin

  19. Airway statuses and nasopharyngeal airway use for airway obstruction in syndromic craniosynostosis.

    PubMed

    Kouga, Takeshi; Tanoue, Koji; Matsui, Kiyoshi

    2014-05-01

    Syndromic craniosynostosis is associated with a high rate of respiratory difficulty, due mainly to midfacial hypoplasia. Nasopharyngeal airway establishment has been reported as the first-line approach to airway obstruction and may obviate the need for a highly invasive tracheotomy. No previous studies have compared airway obstruction status in syndromic craniosynostosis between cases requiring and not requiring airway managements. We focus on nasopharyngeal airway use and airway status outcomes to assess respiratory difficulty in patients with syndromic craniosynostosis. A retrospective data analysis of 51 cases with syndromic craniosynostosis was carried out. We divided 30 of the 51 cases with lateral pharyngeal x-rays taken before operations affecting airway diameters into 2 groups, one with neither nasopharyngeal airway insertion nor tracheotomy and the other with one or both of these interventions, and the mean diameters for 8 indices related to the pharyngeal space were compared. Cases with respiratory difficulty due to nasopharyngeal stenosis and requiring airway managements comprised a significantly higher proportion of those with Pfeiffer syndrome than patients with Crouzon or Apert syndrome. Comparative examination of lateral x-ray cephalometry between cases with neither nasopharyngeal airway insertion nor tracheotomy and cases with one or both revealed oropharyngeal diameters tended to be smaller in those with interventions. Cases requiring nasopharyngeal airway insertion were able to continue nasopharyngeal airway use for more than 1 year and a considerable number avoided tracheotomy. It may be worth considering an oropharyngeal-bypass nasopharyngeal airway before performing a tracheotomy. PMID:24820706

  20. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

    PubMed Central

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy

    2014-01-01

    BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1

  1. Vascular Anomalies and Airway Concerns

    PubMed Central

    Clarke, Caroline; Lee, Edward I.; Edmonds, Joseph

    2014-01-01

    Vascular anomalies, both tumors and malformations, can occur anywhere in the body, including the airway, often without any external manifestations. However, vascular anomalies involving the airway deserve special consideration as proper recognition and management can be lifesaving. In this article, the authors discuss vascular anomalies as they pertains to the airway, focusing on proper diagnosis, diagnostic modalities, and therapeutic options. PMID:25045336

  2. Computer Processor Allocator

    2004-03-01

    The Compute Processor Allocator (CPA) provides an efficient and reliable mechanism for managing and allotting processors in a massively parallel (MP) computer. It maintains information in a database on the health. configuration and allocation of each processor. This persistent information is factored in to each allocation decision. The CPA runs in a distributed fashion to avoid a single point of failure.

  3. Quantitative analysis of airway abnormalities in CT

    NASA Astrophysics Data System (ADS)

    Petersen, Jens; Lo, Pechin; Nielsen, Mads; Edula, Goutham; Ashraf, Haseem; Dirksen, Asger; de Bruijne, Marleen

    2010-03-01

    A coupled surface graph cut algorithm for airway wall segmentation from Computed Tomography (CT) images is presented. Using cost functions that highlight both inner and outer wall borders, the method combines the search for both borders into one graph cut. The proposed method is evaluated on 173 manually segmented images extracted from 15 different subjects and shown to give accurate results, with 37% less errors than the Full Width at Half Maximum (FWHM) algorithm and 62% less than a similar graph cut method without coupled surfaces. Common measures of airway wall thickness such as the Interior Area (IA) and Wall Area percentage (WA%) was measured by the proposed method on a total of 723 CT scans from a lung cancer screening study. These measures were significantly different for participants with Chronic Obstructive Pulmonary Disease (COPD) compared to asymptomatic participants. Furthermore, reproducibility was good as confirmed by repeat scans and the measures correlated well with the outcomes of pulmonary function tests, demonstrating the use of the algorithm as a COPD diagnostic tool. Additionally, a new measure of airway wall thickness is proposed, Normalized Wall Intensity Sum (NWIS). NWIS is shown to correlate better with lung function test values and to be more reproducible than previous measures IA, WA% and airway wall thickness at a lumen perimeter of 10 mm (PI10).

  4. Total airway reconstruction.

    PubMed

    Connor, Matthew P; Barrera, Jose E; Eller, Robert; McCusker, Scott; O'Connor, Peter

    2013-02-01

    We present a case of obstructive sleep apnea (OSA) that required multilevel surgical correction of the airway and literature review and discuss the role supraglottic laryngeal collapse can have in OSA. A 34-year-old man presented to a tertiary otolaryngology clinic for treatment of OSA. He previously had nasal and palate surgeries and a Repose tongue suspension. His residual apnea hypopnea index (AHI) was 67. He had a dysphonia associated with a true vocal cord paralysis following resection of a benign neck mass in childhood. He also complained of inspiratory stridor with exercise and intolerance to continuous positive airway pressure. Physical examination revealed craniofacial hypoplasia, full base of tongue, and residual nasal airway obstruction. On laryngoscopy, the paretic aryepiglottic fold arytenoid complex prolapsed into the laryngeal inlet with each breath. This was more pronounced with greater respiratory effort. Surgical correction required a series of operations including awake tracheostomy, supraglottoplasty, midline glossectomy, genial tubercle advancement, maxillomandibular advancement, and reconstructive rhinoplasty. His final AHI was 1.9. Our patient's supraglottic laryngeal collapse constituted an area of obstruction not typically evaluated in OSA surgery. In conjunction with treating nasal, palatal, and hypopharyngeal subsites, our patient's supraglottoplasty represented a key component of his success. This case illustrates the need to evaluate the entire upper airway in a complicated case of OSA. PMID:22965285

  5. Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

    PubMed

    2013-12-01

    This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes. PMID:24294635

  6. Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

    PubMed

    2013-12-01

    This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes.

  7. Methods of airway resistance assessment.

    PubMed

    Urbankowski, Tomasz; Przybyłowski, Tadeusz

    2016-01-01

    Airway resistance is the ratio of driving pressure to the rate of the airflow in the airways. The most frequent methods used to measure airway resistance are whole-body plethysmography, the interrupter technique and the forced oscillation technique. All these methods allow to measure resistance during respiration at the level close to tidal volume, they do not require forced breathing manoeuvres or deep breathing during measurement. The most popular method for measuring airway resistance is whole-body plethysmography. The results of plethysmography include among others the following parameters: airway resistance (Raw), airway conductance (Gaw), specific airway resistance (sRaw) and specific airway conductance (sGaw). The interrupter technique is based on the assumption that at the moment of airway occlusion, air pressure in the mouth is equal to the alveolar pressure . In the forced oscillation technique (FOT), airway resistance is calculated basing on the changes in pressure and flow caused by air vibration. The methods for measurement of airway resistance that are described in the present paper seem to be a useful alternative to the most common lung function test - spirometry. The target group in which these methods may be widely used are particularly the patients who are unable to perform spirometry.

  8. CT based computerized identification and analysis of human airways: A review

    SciTech Connect

    Pu Jiantao; Gu Suicheng; Liu Shusen; Zhu Shaocheng; Wilson, David; Siegfried, Jill M.; Gur, David

    2012-05-15

    As one of the most prevalent chronic disorders, airway disease is a major cause of morbidity and mortality worldwide. In order to understand its underlying mechanisms and to enable assessment of therapeutic efficacy of a variety of possible interventions, noninvasive investigation of the airways in a large number of subjects is of great research interest. Due to its high resolution in temporal and spatial domains, computed tomography (CT) has been widely used in clinical practices for studying the normal and abnormal manifestations of lung diseases, albeit there is a need to clearly demonstrate the benefits in light of the cost and radiation dose associated with CT examinations performed for the purpose of airway analysis. Whereas a single CT examination consists of a large number of images, manually identifying airway morphological characteristics and computing features to enable thorough investigations of airway and other lung diseases is very time-consuming and susceptible to errors. Hence, automated and semiautomated computerized analysis of human airways is becoming an important research area in medical imaging. A number of computerized techniques have been developed to date for the analysis of lung airways. In this review, we present a summary of the primary methods developed for computerized analysis of human airways, including airway segmentation, airway labeling, and airway morphometry, as well as a number of computer-aided clinical applications, such as virtual bronchoscopy. Both successes and underlying limitations of these approaches are discussed, while highlighting areas that may require additional work.

  9. Patterns of recruitment and injury in a heterogeneous airway network model.

    PubMed

    Stewart, Peter S; Jensen, Oliver E

    2015-10-01

    In respiratory distress, lung airways become flooded with liquid and may collapse due to surface-tension forces acting on air-liquid interfaces, inhibiting gas exchange. This paper proposes a mathematical multiscale model for the mechanical ventilation of a network of occluded airways, where air is forced into the network at a fixed tidal volume, allowing investigation of optimal recruitment strategies. The temporal response is derived from mechanistic models of individual airway reopening, incorporating feedback on the airway pressure due to recruitment. The model accounts for stochastic variability in airway diameter and stiffness across and between generations. For weak heterogeneity, the network is completely ventilated via one or more avalanches of recruitment (with airways recruited in quick succession), each characterized by a transient decrease in the airway pressure; avalanches become more erratic for airways that are initially more flooded. However, the time taken for complete ventilation of the network increases significantly as the network becomes more heterogeneous, leading to increased stresses on airway walls. The model predicts that the most peripheral airways are most at risk of ventilation-induced damage. A positive-end-expiratory pressure reduces the total recruitment time but at the cost of larger stresses exerted on airway walls. PMID:26423440

  10. Neural-Network Processor Would Allocate Resources

    NASA Technical Reports Server (NTRS)

    Eberhardt, Silvio P.; Moopenn, Alexander W.

    1990-01-01

    Global optimization problems solved quickly. Neural-network processor optimizes allocation of M resources among N expenditures according to cost of pairing each resource with each expenditure and subject to limit on number of resources feeding into each expenditure and/or limit on number of expenditures to which each resource allocated. One cell performs several analog and digital functions. Potential applications include assignment of jobs, scheduling, dispatching, and planning of military maneuvers.

  11. Managing upper airway obstruction.

    PubMed

    Innes, M H

    A complete respiratory obstruction can lead to death in 3 minutes. The first and constant duty of the nurse aider is to check that the person is breathing by looking, listening and feeling. Partial obstruction is no less serious than complete obstruction. The nurse aider, in any situation, should assess the problem and attempt to overcome the airway obstruction using the measures described. PMID:1490067

  12. Airway gene therapy.

    PubMed

    Davies, Jane C; Alton, Eric W F W

    2005-01-01

    Given both the accessibility and the genetic basis of several pulmonary diseases, the lungs and airways initially seemed ideal candidates for gene therapy. Several routes of access are available, many of which have been refined and optimized for nongene drug delivery. Two respiratory diseases, cystic fibrosis (CF) and alpha1-antitrypsin (alpha1-AT) deficiency, are relatively common; the single gene responsible has been identified and current treatment strategies are not curative. This type of inherited disease was the obvious initial target for gene therapy, but it has become clear that nongenetic and acquired diseases, including cancer, may also be amenable to this approach. The majority of preclinical and clinical studies in the airway have involved viral vectors, although for diseases such as CF, likely to require repeated application, non-viral delivery systems have clear advantages. However, with both approaches a range of barriers to gene expression have been identified that are limiting success in the airway and alveolar region. This chapter reviews these issues, strategies aimed at overcoming them, and progress into clinical trials with non-viral vectors in a variety of pulmonary diseases.

  13. Causes of the difficult airway.

    PubMed

    Orfanos, John G; Quereshy, Faisal A

    2010-03-01

    Recognizing a potentially difficult airway is important in avoiding a life-threatening emergency. There are 2 separate scenarios for considering the difficult airway: difficult mask ventilation (DMV) and difficult tracheal intubation (DTI). DMV can be described as lacking the ability to maintain oxygen saturation or lacking the ability to reverse signs of inadequate ventilation with positive-pressure mask ventilation under general anesthesia. DTI remains constant among anesthesia-related patient injuries, and is the third most common respiratory-related episode leading to death and possible brain damage. It is important to preoperatively assess every patient by completing a full history and physical. A thorough history can provide clues in detecting a possible difficult airway. Airway impairment has been further subdivided into the anatomic regions that affect the airway, namely above the larynx, supraglottic, glottic, subglottic, and tracheobronchial. This article discusses the factors that can result in a difficult airway.

  14. 19 CFR 351.407 - Calculation of constructed value and cost of production.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... input. (c) Allocation of costs. In determining the appropriate method for allocating costs among... quantitative and qualitative factors associated with the manufacture and sale of the subject merchandise...

  15. Allocation Games: Addressing the Ill-Posed Nature of Allocation in Life-Cycle Inventories.

    PubMed

    Hanes, Rebecca J; Cruze, Nathan B; Goel, Prem K; Bakshi, Bhavik R

    2015-07-01

    Allocation is required when a life cycle contains multi-functional processes. One approach to allocation is to partition the embodied resources in proportion to a criterion, such as product mass or cost. Many practitioners apply multiple partitioning criteria to avoid choosing one arbitrarily. However, life cycle results from different allocation methods frequently contradict each other, making it difficult or impossible for the practitioner to draw any meaningful conclusions from the study. Using the matrix notation for life-cycle inventory data, we show that an inventory that requires allocation leads to an ill-posed problem: an inventory based on allocation is one of an infinite number of inventories that are highly dependent upon allocation methods. This insight is applied to comparative life-cycle assessment (LCA), in which products with the same function but different life cycles are compared. Recently, there have been several studies that applied multiple allocation methods and found that different products were preferred under different methods. We develop the Comprehensive Allocation Investigation Strategy (CAIS) to examine any given inventory under all possible allocation decisions, enabling us to detect comparisons that are not robust to allocation, even when the comparison appears robust under conventional partitioning methods. While CAIS does not solve the ill-posed problem, it provides a systematic way to parametrize and examine the effects of partitioning allocation. The practical usefulness of this approach is demonstrated with two case studies. The first compares ethanol produced from corn stover hydrolysis, corn stover gasification, and corn grain fermentation. This comparison was not robust to allocation. The second case study compares 1,3-propanediol (PDO) produced from fossil fuels and from biomass, which was found to be a robust comparison. PMID:26061700

  16. Allocation Games: Addressing the Ill-Posed Nature of Allocation in Life-Cycle Inventories.

    PubMed

    Hanes, Rebecca J; Cruze, Nathan B; Goel, Prem K; Bakshi, Bhavik R

    2015-07-01

    Allocation is required when a life cycle contains multi-functional processes. One approach to allocation is to partition the embodied resources in proportion to a criterion, such as product mass or cost. Many practitioners apply multiple partitioning criteria to avoid choosing one arbitrarily. However, life cycle results from different allocation methods frequently contradict each other, making it difficult or impossible for the practitioner to draw any meaningful conclusions from the study. Using the matrix notation for life-cycle inventory data, we show that an inventory that requires allocation leads to an ill-posed problem: an inventory based on allocation is one of an infinite number of inventories that are highly dependent upon allocation methods. This insight is applied to comparative life-cycle assessment (LCA), in which products with the same function but different life cycles are compared. Recently, there have been several studies that applied multiple allocation methods and found that different products were preferred under different methods. We develop the Comprehensive Allocation Investigation Strategy (CAIS) to examine any given inventory under all possible allocation decisions, enabling us to detect comparisons that are not robust to allocation, even when the comparison appears robust under conventional partitioning methods. While CAIS does not solve the ill-posed problem, it provides a systematic way to parametrize and examine the effects of partitioning allocation. The practical usefulness of this approach is demonstrated with two case studies. The first compares ethanol produced from corn stover hydrolysis, corn stover gasification, and corn grain fermentation. This comparison was not robust to allocation. The second case study compares 1,3-propanediol (PDO) produced from fossil fuels and from biomass, which was found to be a robust comparison.

  17. 42 CFR 417.566 - Other methods of allocation and apportionment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Other methods of allocation and apportionment. 417..., AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.566 Other methods of allocation and apportionment. (a) Justification. A method of apportionment or allocation of costs, other than...

  18. 45 CFR 1355.57 - Cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... information retrieval system described in § 1355.53 of this part shall be treated as necessary for the proper..., information collection and management, equipment or services that are not directly related to...

  19. 45 CFR 1355.57 - Cost allocation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE... system may be used with respect to foster or adoptive children other than those on behalf of whom foster care maintenance payments or adoption assistance payments may be made under the title IV-E plan....

  20. 45 CFR 1355.57 - Cost allocation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE... system may be used with respect to foster or adoptive children other than those on behalf of whom foster care maintenance payments or adoption assistance payments may be made under the title IV-E plan....

  1. 45 CFR 1355.57 - Cost allocation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE... system may be used with respect to foster or adoptive children other than those on behalf of whom foster care maintenance payments or adoption assistance payments may be made under the title IV-E plan....

  2. Simplifying rules for optimal allocation of preventive care resources.

    PubMed

    Gandjour, Afschin

    2012-04-01

    Given the limited resources for preventive care, policy-makers need to consider the efficiency/cost-effectiveness of preventive measures, such as drugs and vaccines, when allocating preventive care resources. However, in many settings only limited information on lifetime costs and effects of preventive measures exists. Therefore, it seems useful to provide policy-makers with some simplifying rules when allocating preventive care resources. The purpose of this article is to investigate the relevance of risk and severity of the disease to be prevented for the optimal allocation of preventive care resources. The report shows - based on a constrained optimization model - that optimal allocation of preventive care resources does, in fact, depend on both factors. Resources should be allocated to the prevention of diseases with a higher probability of occurrence or larger severity. This article also identifies situations where preventive care resources should be allocated to the prevention of less severe disease.

  3. Global airway disease beyond allergy.

    PubMed

    Hellings, Peter W; Prokopakis, Emmanuel P

    2010-03-01

    Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

  4. The mechanics of airway closure.

    PubMed

    Heil, Matthias; Hazel, Andrew L; Smith, Jaclyn A

    2008-11-30

    We describe how surface-tension-driven instabilities of the lung's liquid lining may lead to pulmonary airway closure via the formation of liquid bridges that occlude the airway lumen. Using simple theoretical models, we demonstrate that this process may occur via a purely fluid-mechanical "film collapse" or through a coupled, fluid-elastic "compliant collapse" mechanism. Both mechanisms can lead to airway closure in times comparable with the breathing cycle, suggesting that surface tension is the primary mechanical effect responsible for the closure observed in peripheral regions of the human lungs. We conclude by discussing the influence of additional effects not included in the simple models, such as gravity, the presence of pulmonary surfactant, respiratory flow and wall motion, the airways' geometry, and the mechanical structure of the airway walls. PMID:18595784

  5. Operative endoscopy of the airway

    PubMed Central

    Walters, Dustin M.

    2016-01-01

    Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies. PMID:26981263

  6. 48 CFR 1631.203-70 - Allocation techniques.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... base varies in proportion to the services performed. (4) Other method. Some cost groupings cannot.... Overall management costs should be grouped in relation to the activities managed. The base selected to measure the allocation of these indirect costs to cost objectives should be a base representative of...

  7. Constrained Allocation Flux Balance Analysis.

    PubMed

    Mori, Matteo; Hwa, Terence; Martin, Olivier C; De Martino, Andrea; Marinari, Enzo

    2016-06-01

    New experimental results on bacterial growth inspire a novel top-down approach to study cell metabolism, combining mass balance and proteomic constraints to extend and complement Flux Balance Analysis. We introduce here Constrained Allocation Flux Balance Analysis, CAFBA, in which the biosynthetic costs associated to growth are accounted for in an effective way through a single additional genome-wide constraint. Its roots lie in the experimentally observed pattern of proteome allocation for metabolic functions, allowing to bridge regulation and metabolism in a transparent way under the principle of growth-rate maximization. We provide a simple method to solve CAFBA efficiently and propose an "ensemble averaging" procedure to account for unknown protein costs. Applying this approach to modeling E. coli metabolism, we find that, as the growth rate increases, CAFBA solutions cross over from respiratory, growth-yield maximizing states (preferred at slow growth) to fermentative states with carbon overflow (preferred at fast growth). In addition, CAFBA allows for quantitatively accurate predictions on the rate of acetate excretion and growth yield based on only 3 parameters determined by empirical growth laws.

  8. Constrained Allocation Flux Balance Analysis.

    PubMed

    Mori, Matteo; Hwa, Terence; Martin, Olivier C; De Martino, Andrea; Marinari, Enzo

    2016-06-01

    New experimental results on bacterial growth inspire a novel top-down approach to study cell metabolism, combining mass balance and proteomic constraints to extend and complement Flux Balance Analysis. We introduce here Constrained Allocation Flux Balance Analysis, CAFBA, in which the biosynthetic costs associated to growth are accounted for in an effective way through a single additional genome-wide constraint. Its roots lie in the experimentally observed pattern of proteome allocation for metabolic functions, allowing to bridge regulation and metabolism in a transparent way under the principle of growth-rate maximization. We provide a simple method to solve CAFBA efficiently and propose an "ensemble averaging" procedure to account for unknown protein costs. Applying this approach to modeling E. coli metabolism, we find that, as the growth rate increases, CAFBA solutions cross over from respiratory, growth-yield maximizing states (preferred at slow growth) to fermentative states with carbon overflow (preferred at fast growth). In addition, CAFBA allows for quantitatively accurate predictions on the rate of acetate excretion and growth yield based on only 3 parameters determined by empirical growth laws. PMID:27355325

  9. Constrained Allocation Flux Balance Analysis

    PubMed Central

    Mori, Matteo; Hwa, Terence; Martin, Olivier C.

    2016-01-01

    New experimental results on bacterial growth inspire a novel top-down approach to study cell metabolism, combining mass balance and proteomic constraints to extend and complement Flux Balance Analysis. We introduce here Constrained Allocation Flux Balance Analysis, CAFBA, in which the biosynthetic costs associated to growth are accounted for in an effective way through a single additional genome-wide constraint. Its roots lie in the experimentally observed pattern of proteome allocation for metabolic functions, allowing to bridge regulation and metabolism in a transparent way under the principle of growth-rate maximization. We provide a simple method to solve CAFBA efficiently and propose an “ensemble averaging” procedure to account for unknown protein costs. Applying this approach to modeling E. coli metabolism, we find that, as the growth rate increases, CAFBA solutions cross over from respiratory, growth-yield maximizing states (preferred at slow growth) to fermentative states with carbon overflow (preferred at fast growth). In addition, CAFBA allows for quantitatively accurate predictions on the rate of acetate excretion and growth yield based on only 3 parameters determined by empirical growth laws. PMID:27355325

  10. The Unobtrusive Memory Allocator

    2003-03-31

    This library implements a memory allocator/manager which ask its host program or library for memory refions to manage rather than requesting them from the operating system. This allocator supports multiple distinct heaps within a single executable, each of which may grow either upward or downward in memory. The GNU mmalloc library has been modified in such a way that its allocation algorithms have been preserved, but the manner in which it obtains regions to managemore » has been changed to request memory from the host program or library. Additional modifications allow the allocator to manage each heap as either upward or downward-growing. By allowing the hosting program or library to determine what memory is managed, this package allows a greater degree of control than other memory allocation/management libraries. Additional distinguishing features include the ability to manage multiple distinct heaps with in a single executable, each of which may grow either upward or downward in memory. The most common use of this library is in conjunction with the Berkeley Unified Parallel C (UPC) Runtime Library. This package is a modified version of the LGPL-licensed "mmalloc" allocator from release 5.2 of the "gdb" debugger's source code.« less

  11. Increased airway glucose increases airway bacterial load in hyperglycaemia.

    PubMed

    Gill, Simren K; Hui, Kailyn; Farne, Hugo; Garnett, James P; Baines, Deborah L; Moore, Luke S P; Holmes, Alison H; Filloux, Alain; Tregoning, John S

    2016-01-01

    Diabetes is associated with increased frequency of hospitalization due to bacterial lung infection. We hypothesize that increased airway glucose caused by hyperglycaemia leads to increased bacterial loads. In critical care patients, we observed that respiratory tract bacterial colonisation is significantly more likely when blood glucose is high. We engineered mutants in genes affecting glucose uptake and metabolism (oprB, gltK, gtrS and glk) in Pseudomonas aeruginosa, strain PAO1. These mutants displayed attenuated growth in minimal medium supplemented with glucose as the sole carbon source. The effect of glucose on growth in vivo was tested using streptozocin-induced, hyperglycaemic mice, which have significantly greater airway glucose. Bacterial burden in hyperglycaemic animals was greater than control animals when infected with wild type but not mutant PAO1. Metformin pre-treatment of hyperglycaemic animals reduced both airway glucose and bacterial load. These data support airway glucose as a critical determinant of increased bacterial load during diabetes. PMID:27273266

  12. Increased airway glucose increases airway bacterial load in hyperglycaemia

    PubMed Central

    Gill, Simren K.; Hui, Kailyn; Farne, Hugo; Garnett, James P.; Baines, Deborah L.; Moore, Luke S.P.; Holmes, Alison H.; Filloux, Alain; Tregoning, John S.

    2016-01-01

    Diabetes is associated with increased frequency of hospitalization due to bacterial lung infection. We hypothesize that increased airway glucose caused by hyperglycaemia leads to increased bacterial loads. In critical care patients, we observed that respiratory tract bacterial colonisation is significantly more likely when blood glucose is high. We engineered mutants in genes affecting glucose uptake and metabolism (oprB, gltK, gtrS and glk) in Pseudomonas aeruginosa, strain PAO1. These mutants displayed attenuated growth in minimal medium supplemented with glucose as the sole carbon source. The effect of glucose on growth in vivo was tested using streptozocin-induced, hyperglycaemic mice, which have significantly greater airway glucose. Bacterial burden in hyperglycaemic animals was greater than control animals when infected with wild type but not mutant PAO1. Metformin pre-treatment of hyperglycaemic animals reduced both airway glucose and bacterial load. These data support airway glucose as a critical determinant of increased bacterial load during diabetes. PMID:27273266

  13. Apoptosis and the Airway Epithelium

    PubMed Central

    White, Steven R.

    2011-01-01

    The airway epithelium functions as a barrier and front line of host defense in the lung. Apoptosis or programmed cell death can be elicited in the epithelium as a response to viral infection, exposure to allergen or to environmental toxins, or to drugs. While apoptosis can be induced via activation of death receptors on the cell surface or by disruption of mitochondrial polarity, epithelial cells compared to inflammatory cells are more resistant to apoptotic stimuli. This paper focuses on the response of airway epithelium to apoptosis in the normal state, apoptosis as a potential regulator of the number and types of epithelial cells in the airway, and the contribution of epithelial cell apoptosis in important airways diseases. PMID:22203854

  14. Extraglottic airway devices: A review

    PubMed Central

    Ramaiah, Ramesh; Das, Debasmita; Bhananker, Sanjay M; Joffe, Aaron M

    2014-01-01

    Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted. PMID:24741502

  15. United airway disease: current perspectives

    PubMed Central

    Giavina-Bianchi, Pedro; Aun, Marcelo Vivolo; Takejima, Priscila; Kalil, Jorge; Agondi, Rosana Câmara

    2016-01-01

    Upper and lower airways are considered a unified morphological and functional unit, and the connection existing between them has been observed for many years, both in health and in disease. There is strong epidemiologic, pathophysiologic, and clinical evidence supporting an integrated view of rhinitis and asthma: united airway disease in the present review. The term “united airway disease” is opportune, because rhinitis and asthma are chronic inflammatory diseases of the upper and lower airways, which can be induced by allergic or nonallergic reproducible mechanisms, and present several phenotypes. Management of rhinitis and asthma must be jointly carried out, leading to better control of both diseases, and the lessons of the Allergic Rhinitis and Its Impact on Asthma initiative cannot be forgotten. PMID:27257389

  16. Airway Surface Mycosis in Chronic Th2-Associated Airway Disease

    PubMed Central

    Porter, Paul; Lim, Dae Jun; Maskatia, Zahida Khan; Mak, Garbo; Tsai, Chu-Lin; Citardi, Martin J; Fakhri, Samer; Shaw, Joanne L.; Fothergil, Annette; Kheradmand, Farrah; Corry, David B; Luong, Amber

    2014-01-01

    Background Environmental fungi have been linked to T helper type 2 (Th2) cell-related airway inflammation and the Th2-associated chronic airway diseases asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown. Objective To determine the frequency of fungus isolation and fungus-specific immunity in Th2-associated and non-associated airway disease patients. Methods Sinus lavage fluid and blood were collected from sinus surgery patients (n=118) including CRS patients with and without nasal polyps and AFRS and non-CRS/non-asthmatic control patients. Asthma status was deteremined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. Peripheral blood mononuclear cells were restimulated with fungal antigens in an enzyme linked immunocell spot (ELISpot) assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared to fungus-specific IgE levels measured from plasma by ELISA. Results Filamentous fungi were significantly more commonly cultured from Th2-associated airway disease subjects (asthma, CRSwNP, or AFRS: n=68) compared to non-Th2-associated control patients (n=31); 74% vs 16% respectively, p<0.001. Both fungus-specific IL-4 ELISpot (n=48) and specific IgE (n=70) data correlated with Th2-associated diseases (sensitivity 73% and specificity 100% vs. 50% and 77%, respectively). Conclusions The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with Th2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients. Clinical Implications Airway fungi may contribute to the expression of sinusitis with nasal polyps and

  17. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction.

  18. A new removable airway stent

    PubMed Central

    Amundsen, Tore; Sørhaug, Sveinung; Leira, Håkon Olav; Tyvold, Stig Sverre; Langø, Thomas; Hammer, Tommy; Manstad-Hulaas, Frode; Mattsson, Erney

    2016-01-01

    Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use. PMID:27608269

  19. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction. PMID:10671836

  20. 48 CFR 9904.403 - Allocation of home office expenses to segments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Allocation of home office expenses to segments. 9904.403 Section 9904.403 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403 Allocation of home office expenses...

  1. 48 CFR 9904.403 - Allocation of home office expenses to segments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Allocation of home office expenses to segments. 9904.403 Section 9904.403 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403 Allocation of home office expenses...

  2. 48 CFR 9904.403 - Allocation of home office expenses to segments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Allocation of home office expenses to segments. 9904.403 Section 9904.403 Federal Acquisition Regulations System COST ACCOUNTING... AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403 Allocation of home office expenses...

  3. Human airway ciliary dynamics

    PubMed Central

    Thompson, Kristin; Knowles, Michael R.; Davis, C. William

    2013-01-01

    Airway cilia depend on precise changes in shape to transport the mucus gel overlying mucosal surfaces. The ciliary motion can be recorded in several planes using video microscopy. However, cilia are densely packed, and automated computerized systems are not available to convert these ciliary shape changes into forms that are useful for testing theoretical models of ciliary function. We developed a system for converting planar ciliary motions recorded by video microscopy into an empirical quantitative model, which is easy to use in validating mathematical models, or in examining ciliary function, e.g., in primary ciliary dyskinesia (PCD). The system we developed allows the manipulation of a model cilium superimposed over a video of beating cilia. Data were analyzed to determine shear angles and velocity vectors of points along the cilium. Extracted waveforms were used to construct a composite waveform, which could be used as a standard. Variability was measured as the mean difference in position of points on individual waveforms and the standard. The shapes analyzed were the end-recovery, end-effective, and fastest moving effective and recovery with mean (± SE) differences of 0.31(0.04), 0.25(0.06), 0.50(0.12), 0.50(0.10), μm, respectively. In contrast, the same measures for three different PCD waveforms had values far outside this range. PMID:23144323

  4. Airway Hydration and COPD

    PubMed Central

    Ghosh, Arunava; Boucher, R.C.; Tarran, Robert

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the prevalent causes of worldwide mortality and encompasses two major clinical phenotypes, i.e., chronic bronchitis (CB) and emphysema. The most common cause of COPD is chronic tobacco inhalation. Research focused on the chronic bronchitic phenotype of COPD has identified several pathological processes that drive disease initiation and progression. For example, the lung’s mucociliary clearance (MCC) system performs the critical task of clearing inhaled pathogens and toxic materials from the lung. MCC efficiency is dependent on: (i) the ability of apical plasma membrane ion channels such as the cystic fibrosis transmembrane conductance regulator (CFTR) and the epithelial Na+ channel (ENaC) to maintain airway hydration; (ii) ciliary beating; and, (iii) appropriate rates of mucin secretion. Each of these components is impaired in CB and likely contributes to the mucus stasis/accumulation seen in CB patients. This review highlights the cellular components responsible for maintaining MCC and how this process is disrupted following tobacco exposure and with CB. We shall also discuss existing therapeutic strategies for the treatment of chronic bronchitis and how components of the MCC can be used as biomarkers for the evaluation of tobacco or tobacco-like-product exposure. PMID:26068443

  5. Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

    PubMed Central

    Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

    2015-01-01

    Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh–Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty. PMID:26567879

  6. 42 CFR 413.24 - Adequate cost data and cost finding.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... percentages of cost in relation to total costs will be allocated this way. The combined total costs of... Reimbursement Questionnaire. Additionally, a cost report for a teaching hospital is rejected for lack...

  7. 42 CFR 413.24 - Adequate cost data and cost finding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... percentages of cost in relation to total costs will be allocated this way. The combined total costs of... Reimbursement Questionnaire. Additionally, a cost report for a teaching hospital is rejected for lack...

  8. Allergen-induced airway responses.

    PubMed

    Gauvreau, Gail M; El-Gammal, Amani I; O'Byrne, Paul M

    2015-09-01

    Environmental allergens are an important cause of asthma and can contribute to loss of asthma control and exacerbations. Allergen inhalation challenge has been a useful clinical model to examine the mechanisms of allergen-induced airway responses and inflammation. Allergen bronchoconstrictor responses are the early response, which reaches a maximum within 30 min and resolves by 1-3 h, and late responses, when bronchoconstriction recurs after 3-4 h and reaches a maximum over 6-12 h. Late responses are followed by an increase in airway hyperresponsiveness. These responses occur when IgE on mast cells is cross-linked by an allergen, causing degranulation and the release of histamine, neutral proteases and chemotactic factors, and the production of newly formed mediators, such as cysteinyl leukotrienes and prostaglandin D2. Allergen-induced airway inflammation consists of an increase in airway eosinophils, basophils and, less consistently, neutrophils. These responses are mediated by the trafficking and activation of myeloid dendritic cells into the airways, probably as a result of the release of epithelial cell-derived thymic stromal lymphopoietin, and the release of pro-inflammatory cytokines from type 2 helper T-cells. Allergen inhalation challenge has also been a widely used model to study potential new therapies for asthma and has an excellent negative predictive value for this purpose. PMID:26206871

  9. The Airway Microbiome at Birth

    PubMed Central

    Lal, Charitharth Vivek; Travers, Colm; Aghai, Zubair H.; Eipers, Peter; Jilling, Tamas; Halloran, Brian; Carlo, Waldemar A.; Keeley, Jordan; Rezonzew, Gabriel; Kumar, Ranjit; Morrow, Casey; Bhandari, Vineet; Ambalavanan, Namasivayam

    2016-01-01

    Alterations of pulmonary microbiome have been recognized in multiple respiratory disorders. It is critically important to ascertain if an airway microbiome exists at birth and if so, whether it is associated with subsequent lung disease. We found an established diverse and similar airway microbiome at birth in both preterm and term infants, which was more diverse and different from that of older preterm infants with established chronic lung disease (bronchopulmonary dysplasia). Consistent temporal dysbiotic changes in the airway microbiome were seen from birth to the development of bronchopulmonary dysplasia in extremely preterm infants. Genus Lactobacillus was decreased at birth in infants with chorioamnionitis and in preterm infants who subsequently went on to develop lung disease. Our results, taken together with previous literature indicating a placental and amniotic fluid microbiome, suggest fetal acquisition of an airway microbiome. We speculate that the early airway microbiome may prime the developing pulmonary immune system, and dysbiosis in its development may set the stage for subsequent lung disease. PMID:27488092

  10. Postnatal Exposure History and Airways

    PubMed Central

    Murphy, Shannon R.; Schelegle, Edward S.; Edwards, Patricia C.; Miller, Lisa A.; Hyde, Dallas M.

    2012-01-01

    Postnatally, the lung continues to grow and differentiate while interacting with the environment. Exposure to ozone (O3) and allergens during postnatal lung development alters structural elements of conducting airways, including innervation and neurokinin abundance. These changes have been linked with development of asthma in a rhesus monkey model. We hypothesized that O3 exposure resets the ability of the airways to respond to oxidant stress and that this is mediated by changes in the neurokinin-1 receptor (NK-1R). Infant rhesus monkeys received episodic exposure to O3 biweekly with or without house dust mite antigen (HDMA) from 6 to 12 months of age. Age-matched monkeys were exposed to filtered air (FA). Microdissected airway explants from midlevel airways (intrapulmonary generations 5–8) for four to six animals in each of four groups (FA, O3, HDMA, and HDMA+O3) were tested for NK-1R gene responses to acute oxidant stress using exposure to hydrogen peroxide (1.2 mM), a lipid ozonide (10 μM), or sham treatment for 4 hours in vitro. Airway responses were measured using real-time quantitative RT-PCR of NK-1R and IL-8 gene expression. Basal NK-1R gene expression levels were not different between the exposure groups. Treatment with ozonide or hydrogen peroxide did not change NK-1R gene expression in animals exposed to FA, HDMA, or HDMA+O3. However, treatment in vitro with lipid ozonide significantly increased NK-1R gene expression in explants from O3–exposed animals. We conclude that a history of prior O3 exposure resets the steady state of the airways to increase the NK-1R response to subsequent acute oxidant stresses. PMID:22962062

  11. Airway Assessment for Office Sedation/Anesthesia.

    PubMed

    Rosenberg, Morton B; Phero, James C

    2015-01-01

    Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques.

  12. Myrmics Memory Allocator

    SciTech Connect

    Lymperis, S.

    2011-09-23

    MMA is a stand-alone memory management system for MPI clusters. It implements a shared Partitioned Global Address Space, where multiple MPI processes request objects from the allocator and the latter provides them with system-wide unique memory addresses for each object. It provides applications with an intuitive way of managing the memory system in a unified way, thus enabling easier writing of irregular application code.

  13. Comparison of I-gel with Classic Laryngeal Mask Airway Regarding the Ease of Use and Clinical Performance

    PubMed Central

    Arı, Dilek Erdoğan; Ar, Arzu Yıldırım; Karip, Ceren Şanlı; Siyahkoç, İncifer; Arslan, Ahmet Hakan; Akgün, Fatma Nur

    2015-01-01

    Objective I-gel is a new supraglottic airway device without an inflatable cuff. We aimed to compare I-gel and the classic laryngeal mask airway (LMA) regarding the ease of use and clinical performance in Turkish population. Methods Fifty American Society of Anesthesiologists (ASA) I–II patients were randomly allocated into two groups: Group I-gel and Group LMA. Insertion time and success in first attempt were recorded. Peak, plato and mean airway pressures, EtCO2, airway compliance and leak volume were periodically recorded during the operation. The presence of blood on device removal and postoperative sore throat were also assessed. Results The device insertion time in Group I-gel was shorter than that in Group LMA (21.00±4.15 vs. 30.40±12.17 s, p=0.001). The success rate in first attempt, peak, plato and mean airway pressures, EtCO2 and airway compliance did not differ between the groups. The leak volume was lower in Group I-gel 5 and 45 min after insertion (p=0.041 and p=0.027). The presence of blood on device removal and postoperative sore throat were similar in both groups. Conclusion I-gel may be a more advantageous supraglottic airway device compared with LMA. PMID:27366518

  14. Synaptic Tagging During Memory Allocation

    PubMed Central

    Rogerson, Thomas; Cai, Denise; Frank, Adam; Sano, Yoshitake; Shobe, Justin; Aranda, Manuel L.; Silva, Alcino J.

    2014-01-01

    There is now compelling evidence that the allocation of memory to specific neurons (neuronal allocation) and synapses (synaptic allocation) in a neurocircuit is not random and that instead specific mechanisms, such as increases in neuronal excitability and synaptic tagging and capture, determine the exact sites where memories are stored. We propose an integrated view of these processes, such that neuronal allocation, synaptic tagging and capture, spine clustering and metaplasticity reflect related aspects of memory allocation mechanisms. Importantly, the properties of these mechanisms suggest a set of rules that profoundly affect how memories are stored and recalled. PMID:24496410

  15. [Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)].

    PubMed

    Francon, D; Estèbe, J P; Ecoffey, C

    2003-08-01

    The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management.

  16. 50 CFR 660.323 - Pacific whiting allocations, allocation attainment, and inseason allocation reapportionment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Pacific whiting allocations, allocation attainment, and inseason allocation reapportionment. 660.323 Section 660.323 Wildlife and Fisheries FISHERY...) FISHERIES OFF WEST COAST STATES West Coast Groundfish Fisheries § 660.323 Pacific whiting...

  17. Inflammatory bowel disease and airway diseases

    PubMed Central

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact. PMID:27678355

  18. Inflammatory bowel disease and airway diseases

    PubMed Central

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact.

  19. Lung function and airway diseases.

    PubMed

    Weiss, Scott T

    2010-01-01

    Two studies report genome-wide association studies for lung function, using cross-sectional spirometric measurements in healthy individuals. They identify six genetic loci newly associated to natural variation in lung function, which may have implications for the related airway diseases of asthma and chronic obstructive pulmonary disease. PMID:20037613

  20. Management of the difficult airway.

    PubMed

    Schwartz, D E; Wiener-Kronish, J P

    1991-09-01

    For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. The intubation should be attempted in the awake state, preferably using the fiberoptic bronchoscope. The more challenging situation is when the difficult airway is confronted unexpectedly. After the first failed attempt at laryngoscopy, head position should be checked and the patient ventilated with oxygen by mask. A smaller styletted tube and possibly a different laryngoscope blade should be selected for a second attempt at intubation. The fiberoptic bronchoscope and other equipment for difficult intubation should be obtained. A second attempt should then be made. If this is unsuccessful, the patient should be reoxygenated, and assistance including a skilled anesthesiologist and surgeon should be summoned. On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed. PMID:1934950

  1. [Supraglottic airways in infants and children].

    PubMed

    Goldmann, Kai

    2013-04-01

    The development of the LMA-Classic™ revolutionized anaesthesia practice as its wide-spread use led to the establishment of a unique form of airway management, the "supraglottic airway management", besides the existing classical airway management with the face mask or endotracheal tube. Today, 25 years later, along with the original prototype of supraglottic airways quite a few numbers of different devices exist that can be used to secure the airway "above the glottis". After initially primarily marketing adult sizes many suppliers offer paediatric sizes nowadays. However, the scientific evidence in terms of superiority or at a least equality to the original LMA-Classic( of any of these airway devices must be considered insufficient except for the LMA-ProSeal™. Consequently, the routine use of these devices outside controlled clinical studies must be considered questionable. The following article aims at providing a critical appraisal of currently available supraglottic airway devices for neonates and infants. PMID:23633256

  2. Sarcoidosis of the upper and lower airways.

    PubMed

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed. PMID:22082167

  3. A Persistent and Diverse Airway Microbiota Present during Chronic Obstructive Pulmonary Disease Exacerbations

    PubMed Central

    Huang, Yvonne J.; Kim, Eugenia; Cox, Michael J.; Brodie, Eoin L.; Brown, Ron; Wiener-Kronish, Jeanine P.

    2010-01-01

    Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major source of morbidity and contribute significantly to healthcare costs. Although bacterial infections are implicated in nearly 50% of exacerbations, only a handful of pathogens have been consistently identified in COPD airways, primarily by culture-based methods, and the bacterial microbiota in acute exacerbations remains largely uncharacterized. The aim of this study was to comprehensively profile airway bacterial communities using a culture-independent microarray, the 16S rRNA PhyloChip, of a cohort of COPD patients requiring ventilatory support and antibiotic therapy for exacerbation-related respiratory failure. PhyloChip analysis revealed the presence of over 1,200 bacterial taxa representing 140 distinct families, many previously undetected in airway diseases; bacterial community composition was strongly influenced by the duration of intubation. A core community of 75 taxa was detected in all patients, many of which are known pathogens. Bacterial community diversity in COPD airways is substantially greater than previously recognized and includes a number of potential pathogens detected in the setting of antibiotic exposure. Comprehensive assessment of the COPD airway microbiota using high-throughput, culture-independent methods may prove key to understanding the relationships between airway bacterial colonization, acute exacerbation, and clinical outcomes in this and other chronic inflammatory airway diseases. PMID:20141328

  4. A model for analysis of TDA budget allocation

    NASA Technical Reports Server (NTRS)

    Remer, D. S.; Buchanan, H. R.

    1994-01-01

    There is an ever-increasing need to achieve greater efficiency in the operation of the Deep Space Network (DSN), i.e., increased productivity at reduced cost. One of the tools used in the course of a planning workshop on this subject was a methodology for budget allocation applicable to long-range planning. This article presents a model for analysis of the TDA budget allocation. For the 1994 through 1999 period, the percentage of the total TDA budget allocated to capacity and capability is being cut in half, whereas the percentage spent on efficiency of delivery will be increasing.

  5. A Costing Methodology for Schools of Nursing.

    ERIC Educational Resources Information Center

    Brown, Billye J.; And Others

    1979-01-01

    Describes a cost allocation procedure developed at the University of Texas at Austin for its School of Nursing to project costs for long-range budget planning. Eleven tables illustrate the use of this costing/budgeting/resource allocation methodology, a potentially effective way to justify funding increases. (MF)

  6. [Organ allocation. Ethical issues].

    PubMed

    Cattorini, P

    2010-01-01

    The criteria for allocating organs are one of the most debated ethical issue in the transplantation programs. The article examines some rules and principles followed by "Nord Italia Transplant program", summarized in its Principles' Charter and explained in a recent interdisciplinary book. General theories of justice and their application to individual clinical cases are commented and evaluated, in order to foster a public, democratic, transparent debate among professionals and citizens, scientific associations and customers' organizations. Some specific moral dilemmas are focused regarding the concepts of proportionate treatment, unselfish donation by living persons, promotion of local institutions efficiency. PMID:20677677

  7. 20 CFR 627.435 - Cost principles and allowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... OMB Circulars identified in DOL's regulations at 29 CFR 97.22(b). (c) Costs allocable to another...) Entertainment costs; (4) Bad debts expense; (5) Insurance policies offering protection against debts established... unforeseen events; (7) Costs prohibited by 29 CFR part 93 (Lobbying Restrictions) or costs of any salaries...

  8. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    PubMed Central

    Nirupa, R; Gombar, Satinder; Ahuja, Vanita; Sharma, Preeti

    2016-01-01

    Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar. PMID:27761035

  9. Computationally efficient control allocation

    NASA Technical Reports Server (NTRS)

    Durham, Wayne (Inventor)

    2001-01-01

    A computationally efficient method for calculating near-optimal solutions to the three-objective, linear control allocation problem is disclosed. The control allocation problem is that of distributing the effort of redundant control effectors to achieve some desired set of objectives. The problem is deemed linear if control effectiveness is affine with respect to the individual control effectors. The optimal solution is that which exploits the collective maximum capability of the effectors within their individual physical limits. Computational efficiency is measured by the number of floating-point operations required for solution. The method presented returned optimal solutions in more than 90% of the cases examined; non-optimal solutions returned by the method were typically much less than 1% different from optimal and the errors tended to become smaller than 0.01% as the number of controls was increased. The magnitude of the errors returned by the present method was much smaller than those that resulted from either pseudo inverse or cascaded generalized inverse solutions. The computational complexity of the method presented varied linearly with increasing numbers of controls; the number of required floating point operations increased from 5.5 i, to seven times faster than did the minimum-norm solution (the pseudoinverse), and at about the same rate as did the cascaded generalized inverse solution. The computational requirements of the method presented were much better than that of previously described facet-searching methods which increase in proportion to the square of the number of controls.

  10. UPPER AIRWAY BLOCKS FOR AWAKE DIFFICULT AIRWAY MANAGEMENT.

    PubMed

    Pintaric, Tatjana Stopar

    2016-03-01

    Airway anesthesia is pivotal for successful awake intubation provided either topically or by blocks. Airway blocks are considered technically more difficult to perform and carry a higher risk of complications. However, in experienced hands, they can be useful as they provide excellent intubating conditions. For complete upper airway anesthesia, bilateral glossopharyngeal and superior laryngeal nerve blocks with translaryngeal injection are required. Superior laryngeal nerve block and translaryngeal injection can be performed easily, safely and with a high success rate in patients with normal anatomy. In those with difficult landmarks, ultrasound can be of assistance. For the superior laryngeal nerve block, other targets than the nerve itself must be established to make the technique consistently successful, easy to teach, learn and perform. The same applies to the translaryngeal injection, where the use of ultrasound is necessary for correct midline identification. Intraoral glossopharyngeal nerve block is also safe and easy to perform, but associated with long lasting discomfort. Bilateral extraoral peristyloid approach should be discouraged since inadvertent blocks of the closely adjacent vagus nerve cannot be prevented in this location. A safe and easy method of blocking the distal portions of the glossopharyngeal nerve for awake intubation is therefore required. PMID:27276778

  11. Generalized multidimensional dynamic allocation method.

    PubMed

    Lebowitsch, Jonathan; Ge, Yan; Young, Benjamin; Hu, Feifang

    2012-12-10

    Dynamic allocation has received considerable attention since it was first proposed in the 1970s as an alternative means of allocating treatments in clinical trials which helps to secure the balance of prognostic factors across treatment groups. The purpose of this paper is to present a generalized multidimensional dynamic allocation method that simultaneously balances treatment assignments at three key levels: within the overall study, within each level of each prognostic factor, and within each stratum, that is, combination of levels of different factors Further it offers capabilities for unbalanced and adaptive designs for trials. The treatment balancing performance of the proposed method is investigated through simulations which compare multidimensional dynamic allocation with traditional stratified block randomization and the Pocock-Simon method. On the basis of these results, we conclude that this generalized multidimensional dynamic allocation method is an improvement over conventional dynamic allocation methods and is flexible enough to be applied for most trial settings including Phases I, II and III trials.

  12. Optimal Sensor Allocation for Fault Detection and Isolation

    NASA Technical Reports Server (NTRS)

    Azam, Mohammad; Pattipati, Krishna; Patterson-Hine, Ann

    2004-01-01

    Automatic fault diagnostic schemes rely on various types of sensors (e.g., temperature, pressure, vibration, etc) to measure the system parameters. Efficacy of a diagnostic scheme is largely dependent on the amount and quality of information available from these sensors. The reliability of sensors, as well as the weight, volume, power, and cost constraints, often makes it impractical to monitor a large number of system parameters. An optimized sensor allocation that maximizes the fault diagnosibility, subject to specified weight, volume, power, and cost constraints is required. Use of optimal sensor allocation strategies during the design phase can ensure better diagnostics at a reduced cost for a system incorporating a high degree of built-in testing. In this paper, we propose an approach that employs multiple fault diagnosis (MFD) and optimization techniques for optimal sensor placement for fault detection and isolation (FDI) in complex systems. Keywords: sensor allocation, multiple fault diagnosis, Lagrangian relaxation, approximate belief revision, multidimensional knapsack problem.

  13. Activity-Based Costing Systems for Higher Education.

    ERIC Educational Resources Information Center

    Day, Dennis H.

    1993-01-01

    Examines traditional costing models utilized in higher education and pinpoints shortcomings related to proper identification of costs. Describes activity-based costing systems as a superior alternative for cost identification, measurement, and allocation. (MLF)

  14. Research on allocation efficiency of the daisy chain allocation algorithm

    NASA Astrophysics Data System (ADS)

    Shi, Jingping; Zhang, Weiguo

    2013-03-01

    With the improvement of the aircraft performance in reliability, maneuverability and survivability, the number of the control effectors increases a lot. How to distribute the three-axis moments into the control surfaces reasonably becomes an important problem. Daisy chain method is simple and easy to be carried out in the design of the allocation system. But it can not solve the allocation problem for entire attainable moment subset. For the lateral-directional allocation problem, the allocation efficiency of the daisy chain can be directly measured by the area of its subset of attainable moments. Because of the non-linear allocation characteristic, the subset of attainable moments of daisy-chain method is a complex non-convex polygon, and it is difficult to solve directly. By analyzing the two-dimensional allocation problems with a "micro-element" idea, a numerical calculation algorithm is proposed to compute the area of the non-convex polygon. In order to improve the allocation efficiency of the algorithm, a genetic algorithm with the allocation efficiency chosen as the fitness function is proposed to find the best pseudo-inverse matrix.

  15. Clinical review: Biphasic positive airway pressure and airway pressure release ventilation

    PubMed Central

    Putensen, Christian; Wrigge, Hermann

    2004-01-01

    This review focuses on mechanical ventilation strategies that allow unsupported spontaneous breathing activity in any phase of the ventilatory cycle. By allowing patients with the acute respiratory distress syndrome to breathe spontaneously, one can expect improvements in gas exchange and systemic blood flow, based on findings from both experimental and clinical trials. In addition, by increasing end-expiratory lung volume, as occurs when using biphasic positive airway pressure or airway pressure release ventilation, recruitment of collapsed or consolidated lung is likely to occur, especially in juxtadiaphragmatic lung legions. Traditional approaches to mechanical ventilatory support of patients with acute respiratory distress syndrome require adaptation of the patient to the mechanical ventilator using heavy sedation and even muscle relaxation. Recent investigations have questioned the utility of sedation, muscle paralysis and mechanical control of ventilation. Furthermore, evidence exists that lowering sedation levels will decrease the duration of mechanical ventilatory support, length of stay in the intensive care unit, and overall costs of hospitalization. Based on currently available data, we suggest considering the use of techniques of mechanical ventilatory support that maintain, rather than suppress, spontaneous ventilatory effort, especially in patients with severe pulmonary dysfunction. PMID:15566621

  16. Obesity and upper airway control during sleep

    PubMed Central

    Patil, Susheel P.; Squier, Samuel; Schneider, Hartmut; Kirkness, Jason P.; Smith, Philip L.

    2010-01-01

    Mechanisms linking obesity with upper airway dysfunction in obstructive sleep apnea are reviewed. Obstructive sleep apnea is due to alterations in upper airway anatomy and neuromuscular control. Upper airway structural alterations in obesity are related to adipose deposition around the pharynx, which can increase its collapsibility or critical pressure (Pcrit). In addition, obesity and, particularly, central adiposity lead to reductions in resting lung volume, resulting in loss of caudal traction on upper airway structures and parallel increases in pharyngeal collapsibility. Metabolic and humoral factors that promote central adiposity may contribute to these alterations in upper airway mechanical function and increase sleep apnea susceptibility. In contrast, neural responses to upper airway obstruction can mitigate these mechanical loads and restore pharyngeal patency during sleep. Current evidence suggests that these responses can improve with weight loss. Improvements in these neural responses with weight loss may be related to a decline in systemic and local pharyngeal concentrations of specific inflammatory mediators with somnogenic effects. PMID:19875707

  17. Airway management in cervical spine injury

    PubMed Central

    Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

    2014-01-01

    To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury. PMID:24741498

  18. Airway obstruction in congenital central hypoventilation syndrome.

    PubMed

    Reverdin, Alexandra K; Mosquera, Ricardo; Colasurdo, Giuseppe N; Jon, Cindy K; Clements, Roya M

    2014-01-01

    Congenital central hypoventilation syndrome (CCHS) is the failure of the autonomic system to control adequate ventilation while asleep with preserved ventilatory response while awake. We report a case of a patient with CCHS who presented with intrathoracic and extrathoracic airway obstruction after tracheostomy tube decannulation and phrenic nerve pacer placement. Nocturnal polysomnography (NPSG) revealed hypoxia, hypercapnia and obstructive sleep apnoea, which required bilevel positive airway pressure titration. Airway endoscopy demonstrated tracheomalacia and paretic true vocal cords in the paramedian position during diaphragmatic pacing. Laryngeal electromyography demonstrated muscular electrical impulses that correlated with diaphragmatic pacer settings. Thus, we surmise that the patient's upper and lower airway obstruction was secondary to diaphragmatic pacer activity. Thorough airway evaluation, including NPSG and endoscopy, may help identify the side effects of diaphragmatic pacing, such as airway obstruction, in patients with CCHS.

  19. 48 CFR 31.202 - Direct costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Direct costs. 31.202... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 31.202 Direct costs. (a) No final cost objective shall have allocated to it as a direct cost any cost, if other...

  20. 48 CFR 31.202 - Direct costs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Direct costs. 31.202... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 31.202 Direct costs. (a) No final cost objective shall have allocated to it as a direct cost any cost, if other...

  1. Anatomic Optical Coherence Tomography of Upper Airways

    NASA Astrophysics Data System (ADS)

    Chin Loy, Anthony; Jing, Joseph; Zhang, Jun; Wang, Yong; Elghobashi, Said; Chen, Zhongping; Wong, Brian J. F.

    The upper airway is a complex and intricate system responsible for respiration, phonation, and deglutition. Obstruction of the upper airways afflicts an estimated 12-18 million Americans. Pharyngeal size and shape are important factors in the pathogenesis of airway obstructions. In addition, nocturnal loss in pharyngeal muscular tone combined with high pharyngeal resistance can lead to collapse of the airway and periodic partial or complete upper airway obstruction. Anatomical optical coherence tomography (OCT) has the potential to provide high-speed three-dimensional tomographic images of the airway lumen without the use of ionizing radiation. In this chapter we describe the methods behind endoscopic OCT imaging and processing to generate full three dimensional anatomical models of the human airway which can be used in conjunction with numerical simulation methods to assess areas of airway obstruction. Combining this structural information with flow dynamic simulations, we can better estimate the site and causes of airway obstruction and better select and design surgery for patients with obstructive sleep apnea.

  2. AIRWAY VISUALIZATION: EYES SEE WHAT MIND KNOWS.

    PubMed

    Sorbello, Massimiliano; Frova, Giulio; Zdravković, Ivana

    2016-03-01

    Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation. Nevertheless, each new technology needs time to be tested and considered reliable, and pitfalls and limitations may come out with careful and long lasting analysis, so it is probably not the right time yet to promote video assisted approach as a new gold standard for airway visualization, despite the fact that it certainly offers some new prospects. In any case, whatever the visualization approach, no patient dies because of missed airway visualization or failed intubation, but due to failed ventilation, which remains without doubt the gold standard of any patient safety goal and airway management technique.

  3. Method for 3D Airway Topology Extraction

    PubMed Central

    Grothausmann, Roman; Kellner, Manuela; Heidrich, Marko; Lorbeer, Raoul-Amadeus; Ripken, Tammo; Meyer, Heiko; Kuehnel, Mark P.; Ochs, Matthias; Rosenhahn, Bodo

    2015-01-01

    In lungs the number of conducting airway generations as well as bifurcation patterns varies across species and shows specific characteristics relating to illnesses or gene variations. A method to characterize the topology of the mouse airway tree using scanning laser optical tomography (SLOT) tomograms is presented in this paper. It is used to test discrimination between two types of mice based on detected differences in their conducting airway pattern. Based on segmentations of the airways in these tomograms, the main spanning tree of the volume skeleton is computed. The resulting graph structure is used to distinguish between wild type and surfactant protein (SP-D) deficient knock-out mice. PMID:25767561

  4. Sequential Stenting for Extensive Malignant Airway Stenosis

    PubMed Central

    Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Tei, Keiko; Yamamoto, Ryoji

    2014-01-01

    Purpose: Malignant airway stenosis extending from the bronchial bifurcation to the lower lobar orifice was treated with airway stenting. We herein examine the effectiveness of airway stenting for extensive malignant airway stenosis. Methods: Twelve patients with extensive malignant airway stenosis underwent placement of a silicone Dumon Y stent (Novatech, La Ciotat, France) at the tracheal bifurcation and a metallic Spiral Z-stent (Medico’s Hirata, Osaka, Japan) at either distal side of the Y stent. We retrospectively analyzed the therapeutic efficacy of the sequential placement of these silicone and metallic stents in these 12 patients. Results: The primary disease was lung cancer in eight patients, breast cancer in two patients, tracheal cancer in one patient, and thyroid cancer in one patient. The median survival period after airway stent placement was 46 days. The Hugh–Jones classification and performance status improved in nine patients after airway stenting. One patient had prolonged hemoptysis and died of respiratory tract hemorrhage 15 days after the treatment. Conclusion: Because the initial disease was advanced and aggressive, the prognosis after sequential airway stent placement was significantly poor. However, because respiratory distress decreased after the treatment in most patients, this treatment may be acceptable for selected patients with extensive malignant airway stenosis. PMID:25273272

  5. An improved approach of register allocation via graph coloring

    NASA Astrophysics Data System (ADS)

    Gao, Lei; Shi, Ce

    2005-03-01

    Register allocation is an important part of optimizing compiler. The algorithm of register allocation via graph coloring is implemented by Chaitin and his colleagues firstly and improved by Briggs and others. By abstracting register allocation to graph coloring, the allocation process is simplified. As the physical register number is limited, coloring of the interference graph can"t succeed for every node. The uncolored nodes must be spilled. There is an assumption that almost all the allocation method obeys: when a register is allocated to a variable v, it can"t be used by others before v quit even if v is not used for a long time. This may causes a waste of register resource. The authors relax this restriction under certain conditions and make some improvement. In this method, one register can be mapped to two or more interfered "living" live ranges at the same time if they satisfy some requirements. An operation named merge is defined which can arrange two interfered nodes occupy the same register with some cost. Thus, the resource of register can be used more effectively and the cost of memory access can be reduced greatly.

  6. The Principal as Resource Allocator.

    ERIC Educational Resources Information Center

    Peterson, Kent D.

    The effect of political influences on the allocation of personnel, money, facilities, and equipment by elementary school principals is discussed in this paper. The use of Zald's political economy framework as a tool for understanding the principal's role in allocating resources is described by the author. He suggests that the principal occupies a…

  7. Physical principle of airway design in human lungs

    NASA Astrophysics Data System (ADS)

    Park, Keunhwan; Son, Taeho; Kim, Wonjung; Kim, Ho-Young

    2014-11-01

    From an engineering perspective, lungs are natural microfluidic devices that extract oxygen from air. In the bronchial tree, airways branch by dichotomy with a systematic reduction of their diameters. It is generally accepted that in conducting airways, which air passes on the way to the acinar airways from the atmosphere, the reduction ratio of diameter is closely related to the minimization of viscous dissipation. Such a principle is formulated as the Hess-Murray law. However, in acinar airways, where oxygen transfer to alveolae occurs, the diameter reduction with progressive generations is more moderate than in conducting airways. Noting that the dominant transfer mechanism in acinar airways is diffusion rather than advection, unlike conducting airways, we construct a mathematical model for oxygen transfer through a series of acinar airways. Our model allows us to predict the optimal airway reduction ratio that maximizes the oxygen transfer in a finite airway volume, thereby rationalizing the observed airway reduction ratio in acinar airways.

  8. Equitable fund allocation, an economical approach for sustainable waste load allocation.

    PubMed

    Ashtiani, Elham Feizi; Niksokhan, Mohammad Hossein; Jamshidi, Shervin

    2015-08-01

    This research aims to study a novel approach for waste load allocation (WLA) to meet environmental, economical, and equity objectives, simultaneously. For this purpose, based on a simulation-optimization model developed for Haraz River in north of Iran, the waste loads are allocated according to discharge permit market. The non-dominated solutions are initially achieved through multiobjective particle swarm optimization (MOPSO). Here, the violation of environmental standards based on dissolved oxygen (DO) versus biochemical oxidation demand (BOD) removal costs is minimized to find economical total maximum daily loads (TMDLs). This can save 41% in total abatement costs in comparison with the conventional command and control policy. The BOD discharge permit market then increases the revenues to 45%. This framework ensures that the environmental limits are fulfilled but the inequity index is rather high (about 4.65). For instance, the discharge permit buyer may not be satisfied about the equity of WLA. Consequently, it is recommended that a third party or institution should be in charge of reallocating the funds. It means that the polluters which gain benefits by unfair discharges should pay taxes (or funds) to compensate the losses of other polluters. This intends to reduce the costs below the required values of the lowest inequity index condition. These compensations of equitable fund allocation (EFA) may help to reduce the dissatisfactions and develop WLA policies. It is concluded that EFA in integration with water quality trading (WQT) is a promising approach to meet the objectives.

  9. 24 CFR 92.50 - Formula allocation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Formula allocation. 92.50 Section... Development HOME INVESTMENT PARTNERSHIPS PROGRAM Allocation Formula § 92.50 Formula allocation. (a) Jurisdictions eligible for a formula allocation. HUD will provide allocations of funds in amounts determined...

  10. 23 CFR 1240.15 - Allocations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Allocations. 1240.15 Section 1240.15 Highways NATIONAL... GUIDELINES SAFETY INCENTIVE GRANTS FOR USE OF SEAT BELTS-ALLOCATIONS BASED ON SEAT BELT USE RATES Determination of Allocations § 1240.15 Allocations. (a) Funds allocated under this part shall be available...

  11. Emergency airway management by paramedics: comparison between standard endotracheal intubation, laryngeal mask airway, and I-gel.

    PubMed

    Leventis, Charalampos; Chalkias, Athanasios; Sampanis, Michail A; Foulidou, Xanthipi; Xanthos, Theodoros

    2014-10-01

    The aim of this study was to investigate whether briefly trained paramedics would be able to successfully intubate by endotracheal intubation (ETI) and using the laryngeal mask airway (LMA) and the I-gel in a manikin model. After the completion of a questionnaire, a brief educational session, and presentation of ETI, LMA, and I-gel, 72 paramedics were randomly allocated to intubate an adult manikin. The success rate for I-gel was higher than that for LMA (P<0.001) and ETI (P<0.001), and the insertion time for I-gel was significantly shorter than that for LMA (P<0.001) or during ETI (P<0.001). There was a statistically significant association between the experience level of paramedics and insertion time only for the LMA (P=0.012). In addition, the mean insertion time values were significantly affected by the accuracy of the answers to the theoretical questions (P<0.05 for all questions). Paramedics should lay greater emphasis on airway management using supraglottic devices, especially I-gel because of its shorter time of insertion. PMID:24300244

  12. Allocations for HANDI 2000 business management system

    SciTech Connect

    Wilson, D.

    1998-08-24

    The Data Integration 2000 Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract. It is based on the Commercial-Off-The-Shelf product solution with commercially proven business processes. The COTS product solution set, of PassPort and People Soft software, supports finance, supply and chemical management/Material Safety Data Sheet, human resources. Allocations at Fluor Daniel Hanford are burdens added to base costs using a predetermined rate.

  13. Optimal load allocation of multiple fuel boilers.

    PubMed

    Dunn, Alex C; Du, Yan Yi

    2009-04-01

    This paper presents a new methodology for optimally allocating a set of multiple industrial boilers that each simultaneously consumes multiple fuel types. Unlike recent similar approaches in the utility industry that use soft computing techniques, this approach is based on a second-order gradient search method that is easy to implement without any specialized optimization software. The algorithm converges rapidly and the application yields significant savings benefits, up to 3% of the overall operating cost of industrial boiler systems in the examples given and potentially higher in other cases, depending on the plant circumstances. Given today's energy prices, this can yield significant savings benefits to manufacturers that raise steam for plant operations.

  14. Vitamin D attenuates cytokine-induced remodeling in human fetal airway smooth muscle cells.

    PubMed

    Britt, Rodney D; Faksh, Arij; Vogel, Elizabeth R; Thompson, Michael A; Chu, Vivian; Pandya, Hitesh C; Amrani, Yassine; Martin, Richard J; Pabelick, Christina M; Prakash, Y S

    2015-06-01

    Asthma in the pediatric population remains a significant contributor to morbidity and increasing healthcare costs. Vitamin D3 insufficiency and deficiency have been associated with development of asthma. Recent studies in models of adult airway diseases suggest that the bioactive Vitamin D3 metabolite, calcitriol (1,25-dihydroxyvitamin D3 ; 1,25(OH)2 D3 ), modulates responses to inflammation; however, this concept has not been explored in developing airways in the context of pediatric asthma. We used human fetal airway smooth muscle (ASM) cells as a model of the early postnatal airway to explore how calcitriol modulates remodeling induced by pro-inflammatory cytokines. Cells were pre-treated with calcitriol and then exposed to TNFα or TGFβ for up to 72 h. Matrix metalloproteinase (MMP) activity, production of extracellular matrix (ECM), and cell proliferation were assessed. Calcitriol attenuated TNFα enhancement of MMP-9 expression and activity. Additionally, calcitriol attenuated TNFα and TGFβ-induced collagen III expression and deposition, and separately, inhibited proliferation of fetal ASM cells induced by either inflammatory mediator. Analysis of signaling pathways suggested that calcitriol effects in fetal ASM involve ERK signaling, but not other major inflammatory pathways. Overall, our data demonstrate that calcitriol can blunt multiple effects of TNFα and TGFβ in developing airway, and point to a potentially novel approach to alleviating structural changes in inflammatory airway diseases of childhood. PMID:25204635

  15. Resource Balancing Control Allocation

    NASA Technical Reports Server (NTRS)

    Frost, Susan A.; Bodson, Marc

    2010-01-01

    Next generation aircraft with a large number of actuators will require advanced control allocation methods to compute the actuator commands needed to follow desired trajectories while respecting system constraints. Previously, algorithms were proposed to minimize the l1 or l2 norms of the tracking error and of the control effort. The paper discusses the alternative choice of using the l1 norm for minimization of the tracking error and a normalized l(infinity) norm, or sup norm, for minimization of the control effort. The algorithm computes the norm of the actuator deflections scaled by the actuator limits. Minimization of the control effort then translates into the minimization of the maximum actuator deflection as a percentage of its range of motion. The paper shows how the problem can be solved effectively by converting it into a linear program and solving it using a simplex algorithm. Properties of the algorithm are investigated through examples. In particular, the min-max criterion results in a type of resource balancing, where the resources are the control surfaces and the algorithm balances these resources to achieve the desired command. A study of the sensitivity of the algorithms to the data is presented, which shows that the normalized l(infinity) algorithm has the lowest sensitivity, although high sensitivities are observed whenever the limits of performance are reached.

  16. Airway hyperresponsiveness in elite athletes.

    PubMed

    Langdeau, J B; Turcotte, H; Bowie, D M; Jobin, J; Desgagné, P; Boulet, L P

    2000-05-01

    It has been suggested that high-level training could contribute to the development of airway hyperresponsiveness (AHR), but the comparative effects of different sports on airway function remains to be determined. We evaluated 150 nonsmoking volunteers 18 to 55 yr of age; 100 athletes divided into four subgroups of 25 subjects each according to the predominant estimated hydrocaloric characteristic of ambient air inhaled during training: dry air (DA), cold air (CA), humid air (HA) and a mixture of dry and humid air (MA), and 50 sedentary subjects. Each subject had a respiratory questionnaire, a methacholine challenge, allergy skin-prick tests, and heart rate variability recording for evaluation of parasympathetic tone. The athletes had a 49% prevalence of AHR (PC(20) < 16 mg/ml), with a mean PC(20) of 16.9 mg/ml, compared with 28% (PC(20): 35.4) in sedentary subjects (p = 0.009). The prevalence (%) of AHR and mean PC(20) (mg/ml) varied as followed in the four subgroups of athletes: DA: 32% and 30.9; CA: 52% and 15.8; HA: 76% and 7.3; and MA: 32% and 21.5 (p = 0.002). The estimated parasympathetic tone was higher in athletes (p < 0.001), but this parameter showed only a weak correlation with PC(20) (r = -0.17, p = 0.04). This study has shown a significantly higher prevalence of AHR in athletes than in the control group because of the higher prevalence in the CA and HA groups. Parasympathetic activity may act as modulator of airway responsiveness, but the increased prevalence of AHR in our athlete population may be related to the type and possibly the content of inhaled air during training.

  17. 20 CFR 627.435 - Cost principles and allowable costs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... organizational management studies conducted by outside individuals or firms; and (16) Taxes. ... OMB Circulars identified in DOL's regulations at 29 CFR 97.22(b). (c) Costs allocable to another... unforeseen events; (7) Costs prohibited by 29 CFR part 93 (Lobbying Restrictions) or costs of any salaries...

  18. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma

    PubMed Central

    An, S.S.; Bai, T.R.; Bates, J.H.T.; Black, J.L.; Brown, R.H.; Brusasco, V.; Chitano, P.; Deng, L.; Dowell, M.; Eidelman, D.H.; Fabry, B.; Fairbank, N.J.; Ford, L.E.; Fredberg, J.J.; Gerthoffer, W.T.; Gilbert, S.H.; Gosens, R.; Gunst, S.J.; Halayko, A.J.; Ingram, R.H.; Irvin, C.G.; James, A.L.; Janssen, L.J.; King, G.G.; Knight, D.A.; Lauzon, A.M.; Lakser, O.J.; Ludwig, M.S.; Lutchen, K.R.; Maksym, G.N.; Martin, J.G.; Mauad, T.; McParland, B.E.; Mijailovich, S.M.; Mitchell, H.W.; Mitchell, R.W.; Mitzner, W.; Murphy, T.M.; Paré, P.D.; Pellegrino, R.; Sanderson, M.J.; Schellenberg, R.R.; Seow, C.Y.; Silveira, P.S.P.; Smith, P.G.; Solway, J.; Stephens, N.L.; Sterk, P.J.; Stewart, A.G.; Tang, D.D.; Tepper, R.S.; Tran, T.; Wang, L.

    2008-01-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not “cure” asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored. PMID:17470619

  19. Airway Clearance Devices for Cystic Fibrosis

    PubMed Central

    2009-01-01

    , confidence interval; HFCC, high frequency chest compression; MP, mechanical percussion; N/A: not applicable; PEP, positive expiratory pressure Economic Analysis Devices ranged in cost from around $60 for PEP and handheld AODs to upwards of $18,000 for a HFCC vest device. Although the majority of device costs are paid out-of-pocket by the patients themselves, their parents, or covered by third-party medical insurance, Ontario did provide funding assistance through the Assistive Devices Program (ADP) for postural drainage boards and MP devices. These technologies, however, are either obsolete or their clinical efficacy is not supported by evidence. ADP provided roughly $16,000 in funding for the 2008/09 fiscal year. Using device costs and prevalent and incident cases of CF in Ontario, budget impact projections were generated for Ontario. Prevalence of CF in Ontario for patients from ages 6 to 71 was cited as 1,047 cases in 2002 while incidence was estimated at 46 new cases of CF diagnosed per year in 2002. Budget impact projections indicated that PEP and handheld AODs were highly economically feasible costing around $90,000 for the entire prevalent population and less than $3,000 per year to cover new incident cases. HFCC vest devices were by far the most expensive, costing in excess of $19 million to cover the prevalent population alone. Conclusions There is currently a lack of sufficiently powered, long-term, parallel randomized controlled trials investigating the use of ACDs in comparison to other airway clearance techniques. While much of the current evidence suggests no significant difference between various ACDs and alternative therapies/technologies, at least according to outcomes of pulmonary function, there is a strong possibility that past trials were not sufficiently powered to identify a difference. Unfortunately, it is unlikely that there will be any future trials comparing ACDs to CCPT as withholding therapy using an ACD may be seen as unethical at present

  20. SUBCHRONIC ENDOTOXIN INHALATION CAUSES PERSISTENT AIRWAY DISEASE

    EPA Science Inventory

    ABSTRACT

    The endotoxin component of organic dusts causes acute reversible airflow obstruction and airway inflammation. To test the hypothesis that endotoxin alone causes airway remodeling, we have compared the response of two inbred mouse strains to subchronic endotoxin ...

  1. Airway and Extracellular Matrix Mechanics in COPD.

    PubMed

    Bidan, Cécile M; Veldsink, Annemiek C; Meurs, Herman; Gosens, Reinoud

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases worldwide, and is characterized by airflow obstruction that is not fully reversible with treatment. Even though airflow obstruction is caused by airway smooth muscle contraction, the extent of airway narrowing depends on a range of other structural and functional determinants that impact on active and passive tissue mechanics. Cells and extracellular matrix in the airway and parenchymal compartments respond both passively and actively to the mechanical stimulation induced by smooth muscle contraction. In this review, we summarize the factors that regulate airway narrowing and provide insight into the relative contributions of different constituents of the extracellular matrix and their biomechanical impact on airway obstruction. We then review the changes in extracellular matrix composition in the airway and parenchymal compartments at different stages of COPD, and finally discuss how these changes impact airway narrowing and the development of airway hyperresponsiveness. Finally, we position these data in the context of therapeutic research focused on defective tissue repair. As a conclusion, we propose that future works should primarily target mild or early COPD, prior to the widespread structural changes in the alveolar compartment that are more characteristic of severe COPD.

  2. Athletic Trainers' Knowledge Regarding Airway Adjuncts

    ERIC Educational Resources Information Center

    Edler, Jessica R.; Eberman, Lindsey E.; Kahanov, Leamor; Roman, Christopher; Mata, Heather Lynne

    2015-01-01

    Context: Research suggests that knowledge gaps regarding the appropriate use of airway adjuncts exist among various health care practitioners, and that knowledge is especially limited within athletic training. Objective: To determine the relationship between perceived knowledge (PK) and actual knowledge (AK) of airway adjunct use and the…

  3. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  4. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  5. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  6. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  7. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  8. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  9. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  10. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  11. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  12. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  13. Airway and Extracellular Matrix Mechanics in COPD

    PubMed Central

    Bidan, Cécile M.; Veldsink, Annemiek C.; Meurs, Herman; Gosens, Reinoud

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases worldwide, and is characterized by airflow obstruction that is not fully reversible with treatment. Even though airflow obstruction is caused by airway smooth muscle contraction, the extent of airway narrowing depends on a range of other structural and functional determinants that impact on active and passive tissue mechanics. Cells and extracellular matrix in the airway and parenchymal compartments respond both passively and actively to the mechanical stimulation induced by smooth muscle contraction. In this review, we summarize the factors that regulate airway narrowing and provide insight into the relative contributions of different constituents of the extracellular matrix and their biomechanical impact on airway obstruction. We then review the changes in extracellular matrix composition in the airway and parenchymal compartments at different stages of COPD, and finally discuss how these changes impact airway narrowing and the development of airway hyperresponsiveness. Finally, we position these data in the context of therapeutic research focused on defective tissue repair. As a conclusion, we propose that future works should primarily target mild or early COPD, prior to the widespread structural changes in the alveolar compartment that are more characteristic of severe COPD. PMID:26696894

  14. Cost Analysis: Methods and Realities.

    ERIC Educational Resources Information Center

    Cummings, Martin M.

    1989-01-01

    Argues that librarians need to be concerned with cost analysis of library functions and services because, in the allocation of resources, decision makers will favor library managers who demonstrate understanding of the relationships between costs and productive outputs. Factors that should be included in a reliable scheme for cost accounting are…

  15. Collaborative Resource Allocation

    NASA Technical Reports Server (NTRS)

    Wang, Yeou-Fang; Wax, Allan; Lam, Raymond; Baldwin, John; Borden, Chester

    2007-01-01

    Collaborative Resource Allocation Networking Environment (CRANE) Version 0.5 is a prototype created to prove the newest concept of using a distributed environment to schedule Deep Space Network (DSN) antenna times in a collaborative fashion. This program is for all space-flight and terrestrial science project users and DSN schedulers to perform scheduling activities and conflict resolution, both synchronously and asynchronously. Project schedulers can, for the first time, participate directly in scheduling their tracking times into the official DSN schedule, and negotiate directly with other projects in an integrated scheduling system. A master schedule covers long-range, mid-range, near-real-time, and real-time scheduling time frames all in one, rather than the current method of separate functions that are supported by different processes and tools. CRANE also provides private workspaces (both dynamic and static), data sharing, scenario management, user control, rapid messaging (based on Java Message Service), data/time synchronization, workflow management, notification (including emails), conflict checking, and a linkage to a schedule generation engine. The data structure with corresponding database design combines object trees with multiple associated mortal instances and relational database to provide unprecedented traceability and simplify the existing DSN XML schedule representation. These technologies are used to provide traceability, schedule negotiation, conflict resolution, and load forecasting from real-time operations to long-range loading analysis up to 20 years in the future. CRANE includes a database, a stored procedure layer, an agent-based middle tier, a Web service wrapper, a Windows Integrated Analysis Environment (IAE), a Java application, and a Web page interface.

  16. Airway fires during surgery: Management and prevention

    PubMed Central

    Akhtar, Navaid; Ansar, Farrukh; Baig, Mirza Shahzad; Abbas, Akbar

    2016-01-01

    Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires. PMID:27006554

  17. Airway fires during surgery: Management and prevention.

    PubMed

    Akhtar, Navaid; Ansar, Farrukh; Baig, Mirza Shahzad; Abbas, Akbar

    2016-01-01

    Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires. PMID:27006554

  18. Awake Craniotomy: A New Airway Approach.

    PubMed

    Sivasankar, Chitra; Schlichter, Rolf A; Baranov, Dimitry; Kofke, W Andrew

    2016-02-01

    Awake craniotomies have been performed regularly at the University of Pennsylvania since 2004. Varying approaches to airway management are described for this procedure, including intubation with an endotracheal tube and use of a laryngeal mask airway, simple facemask, or nasal cannula. In this case series, we describe the successful use (i.e., no need for endotracheal intubation related to inadequate gas exchange) of bilateral nasopharyngeal airways in 90 patients undergoing awake craniotomies. The use of nasopharyngeal airways can ease the transition between the asleep and awake phases of the craniotomy without the need to stimulate the airway. Our purpose was to describe our experience and report adverse events related to this technique. PMID:26579845

  19. Anaesthetic management of acute airway obstruction

    PubMed Central

    Wong, Patrick; Wong, Jolin; Mok, May Un Sam

    2016-01-01

    The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom’s 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists’ difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan. PMID:26996162

  20. Investigating the geometry of pig airways using computed tomography

    NASA Astrophysics Data System (ADS)

    Mansy, Hansen A.; Azad, Md Khurshidul; McMurray, Brandon; Henry, Brian; Royston, Thomas J.; Sandler, Richard H.

    2015-03-01

    Numerical modeling of sound propagation in the airways requires accurate knowledge of the airway geometry. These models are often validated using human and animal experiments. While many studies documented the geometric details of the human airways, information about the geometry of pig airways is scarcer. In addition, the morphology of animal airways can be significantly different from that of humans. The objective of this study is to measure the airway diameter, length and bifurcation angles in domestic pigs using computed tomography. After imaging the lungs of 3 pigs, segmentation software tools were used to extract the geometry of the airway lumen. The airway dimensions were then measured from the resulting 3 D models for the first 10 airway generations. Results showed that the size and morphology of the airways of different animals were similar. The measured airway dimensions were compared with those of the human airways. While the trachea diameter was found to be comparable to the adult human, the diameter, length and branching angles of other airways were noticeably different from that of humans. For example, pigs consistently had an early airway branching from the trachea that feeds the superior (top) right lung lobe proximal to the carina. This branch is absent in the human airways. These results suggested that the human geometry may not be a good approximation of the pig airways and may contribute to increasing the errors when the human airway geometric values are used in computational models of the pig chest.

  1. Nucleotide release by airway epithelia.

    PubMed

    Lazarowski, Eduardo R; Sesma, Juliana I; Seminario, Lucia; Esther, Charles R; Kreda, Silvia M

    2011-01-01

    The purinergic events regulating the airways' innate defenses are initiated by the release of purines from the epithelium, which occurs constitutively and is enhanced by chemical or mechanical stimulation. While the external triggers have been reviewed exhaustively, this chapter focuses on current knowledge of the receptors and signaling cascades mediating nucleotide release. The list of secreted purines now includes ATP, ADP, AMP and nucleotide sugars, and involves at least three distinct mechanisms reflecting the complexity of airway epithelia. First, the constitutive mechanism involves ATP translocation to the ER/Golgi complex as energy source for protein folding, and fusion of Golgi-derived vesicles with the plasma membrane. Second, goblet cells package ATP with mucins into granules, which are discharged in response to P2Y(2)R activation and Ca(2+)-dependent signaling pathways. Finally, non-mucous cells support a regulated mechanism of ATP release involving protease activated receptor (PAR)-elicited G(12/13) activation, leading to the RhoGEF-mediated exchange of GDP for GTP on RhoA, and cytoskeleton rearrangement. Together, these pathways provide fine tuning of epithelial responses regulated by purinergic signaling events. PMID:21560042

  2. Puberty and Upper Airway Dynamics During Sleep

    PubMed Central

    Bandla, Preetam; Huang, Jingtao; Karamessinis, Laurie; Kelly, Andrea; Pepe, Michelle; Samuel, John; Brooks, Lee; Mason, Thornton. A.; Gallagher, Paul R.; Marcus, Carole L.

    2008-01-01

    Study Objectives: The upper airway compensatory response to subatmospheric pressure loading declines with age. The epidemiology of obstructive sleep apnea suggests that sex hormones play a role in modulating upper airway function. Sex hormones increase gradually during puberty, from minimally detectable to adult levels. We hypothesized that the upper airway response to subatmospheric pressure loading decreased with increasing pubertal Tanner stage in males but remained stable during puberty in females. Design: Upper airway dynamic function during sleep was measured over the course of puberty. Participants: Normal subjects of Tanner stages 1 to 5. Measurements: During sleep, maximal inspiratory airflow was measured while varying the level of nasal pressure. The slope of the upstream pressure-flow relationship (SPF) was measured. Results: The SPF correlated with age and Tanner stage. However, the relationship with Tanner stage became nonsignificant when the correlation due to the mutual association with age was removed. Females had a lower SPF than males. Conclusions: In both sexes, the upper airway compensatory response to subatmospheric pressure loading decreased with age rather than degree of pubertal development. Thus, changes in sex hormones are unlikely to be a primary modulator of upper airway function during the transition from childhood to adulthood. Although further studies of upper airway structural changes during puberty are needed, we speculate that the changes in upper airway function with age are due to the depressant effect of age on ventilatory drive, leading to a decrease in upper airway neuromotor tone. Citation: Bandla P; Huang J; Karamessinis L; Kelly A; Pepe M; Samuel J; Brooks L; Mason TA; Gallagher PR; Marcus CL. Puberty and Upper Airway Dynamics During Sleep. SLEEP 2008;31(4):534-541. PMID:18457241

  3. Cost analysis helps evaluate contract profitability.

    PubMed

    Sides, R W

    2000-02-01

    A cost-accounting analysis can help group practices assess their costs of doing business and determine the profitability of managed care contracts. Group practices also can use cost accounting to develop budgets and financial benchmarks. To begin a cost analysis, group practices need to determine their revenue and cost centers. Then they can allocate their costs to each center, using an appropriate allocation basis. The next step is to calculate costs per procedure. The results can be used to evaluate operational cost efficiency as well as help negotiate managed care contracts.

  4. 49 CFR 266.11 - Allowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Allowable costs. 266.11 Section 266.11... TRANSPORTATION ACT § 266.11 Allowable costs. Allowable costs include only the following costs which are properly allocable to the work performed: Planning and program operation costs which are allowed under...

  5. 26 CFR 1.42-17 - Qualified allocation plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... schedule of project costs for projects with fewer than 11 units). The CPA's audit must be conducted in... allocated to a project is not to exceed the amount the Agency determines is necessary for the financial feasibility of the project and its viability as a qualified low-income housing project throughout the...

  6. Quadratic Programming for Allocating Control Effort

    NASA Technical Reports Server (NTRS)

    Singh, Gurkirpal

    2005-01-01

    A computer program calculates an optimal allocation of control effort in a system that includes redundant control actuators. The program implements an iterative (but otherwise single-stage) algorithm of the quadratic-programming type. In general, in the quadratic-programming problem, one seeks the values of a set of variables that minimize a quadratic cost function, subject to a set of linear equality and inequality constraints. In this program, the cost function combines control effort (typically quantified in terms of energy or fuel consumed) and control residuals (differences between commanded and sensed values of variables to be controlled). In comparison with prior control-allocation software, this program offers approximately equal accuracy but much greater computational efficiency. In addition, this program offers flexibility, robustness to actuation failures, and a capability for selective enforcement of control requirements. The computational efficiency of this program makes it suitable for such complex, real-time applications as controlling redundant aircraft actuators or redundant spacecraft thrusters. The program is written in the C language for execution in a UNIX operating system.

  7. Genetic association between male attractiveness and female differential allocation

    PubMed Central

    Head, Megan L; Hunt, John; Brooks, Robert

    2006-01-01

    Differential allocation of reproductive effort towards offspring of attractive mates is a form of post-copulatory mate choice. Although differential allocation has been demonstrated in many taxa, its evolutionary implications have received little attention. Theory predicts that mate choice will lead to a positive genetic correlation between female preference and male attractiveness. This prediction has been upheld for pre-copulatory mate choice, but whether such a relationship between male attractiveness and female differential allocation exists has never been tested. Here, we show that both female pre-copulatory mate choice and post-copulatory differential allocation are genetically associated with male attractiveness in house crickets, Acheta domesticus. Daughters of attractive males mated sooner and laid more eggs when paired with larger males. These forms of mate choice are strongest in large females, suggesting that costs decrease with increasing female size. The genetic association between attractiveness and differential allocation suggests potential for differential allocation to become exaggerated by coevolutionary runaway processes in an analogous manner to pre-copulatory choice. Sexual selection is thus likely to be stronger than predicted by pre-copulatory choice alone. PMID:17148398

  8. 42 CFR 417.566 - Other methods of allocation and apportionment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.566 Other methods of allocation... 42 Public Health 3 2011-10-01 2011-10-01 false Other methods of allocation and apportionment. 417.566 Section 417.566 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH...

  9. Educating the Educator: Teaching Airway Adjunct Techniques in Athletic Training

    ERIC Educational Resources Information Center

    Berry, David C.; Seitz, S. Robert

    2011-01-01

    The 5th edition of the "Athletic Training Education Competencies" ("Competencies") now requires athletic training educators (ATEs) to introduce into the curriculum various types of airway adjuncts including: (1) oropharyngeal airways (OPA), (2) nasopharyngeal airways (NPA), (3) supraglottic airways (SGA), and (4) suction. The addition of these…

  10. Small particles disrupt postnatal airway development

    PubMed Central

    Lee, DongYoub; Wallis, Chris; Schelegle, Edward S.; Van Winkle, Laura S.; Plopper, Charles G.; Fanucchi, Michelle V.; Kumfer, Ben; Kennedy, Ian M.; Chan, Jackie K. W.

    2010-01-01

    Increasing numbers of epidemiologic studies associate air pollution exposure in children with decreased lung function development. The objective of this study was to examine the effects of exposure to combustion-generated fine [230 and 212 nm number mean aerodynamic particle diameter (NMAD)] to ultrafine (73 nm NMAD) particles differing in elemental (EC) and organic (OC) carbon content on postnatal airway development in rats. Neonatal Sprague-Dawley rats were exposed from postnatal day 7 through 25, and lung function and airway architecture were evaluated 81 days of age. In a separate group of rats, cell proliferation was examined after a single particle exposure at 7 days of age. Early life exposure to 73 nm high OC/EC particles altered distal airway architecture and resulted in subtle changes in lung mechanics. Early life exposure to 212 nm high OC/EC particles did not alter lung architecture but did alter lung mechanics in a manner suggestive of central airway changes. In contrast, early life exposure to 230 nm low OC/EC particles did not alter lung architecture or mechanics. A single 6-h exposure to 73 nm high OC/EC particle decreased airway cell proliferation, whereas 212 nm high OC/EC particles increased it and 230 nm low OC/EC particles did not. The early life exposure to ultrafine, high OC/EC particles results in persistent alterations in distal airway architecture that is characterized by an initial decrease in airway cell proliferation. PMID:20634362

  11. Comparison of analysis methods for airway quantification

    NASA Astrophysics Data System (ADS)

    Odry, Benjamin L.; Kiraly, Atilla P.; Novak, Carol L.; Naidich, David P.

    2012-03-01

    Diseased airways have been known for several years as a possible contributing factor to airflow limitation in Chronic Obstructive Pulmonary Diseases (COPD). Quantification of disease severity through the evaluation of airway dimensions - wall thickness and lumen diameter - has gained increased attention, thanks to the availability of multi-slice computed tomography (CT). Novel approaches have focused on automated methods of measurement as a faster and more objective means that the visual assessment routinely employed in the clinic. Since the Full-Width Half-Maximum (FWHM) method of airway measurement was introduced two decades ago [1], several new techniques for quantifying airways have been detailed in the literature, but no approach has truly become a standard for such analysis. Our own research group has presented two alternative approaches for determining airway dimensions, one involving a minimum path and the other active contours [2, 3]. With an increasing number of techniques dedicated to the same goal, we decided to take a step back and analyze the differences of these methods. We consequently put to the test our two methods of analysis and the FWHM approach. We first measured a set of 5 airways from a phantom of known dimensions. Then we compared measurements from the three methods to those of two independent readers, performed on 35 airways in 5 patients. We elaborate on the differences of each approach and suggest conclusions on which could be defined as the best one.

  12. 42 CFR 413.50 - Apportionment of allowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... be determined in accordance with principles relating to apportionment of cost. (b) In the study and... “cost-finding” techniques under which indirect costs and nonrevenue activities are allocated to...

  13. School District Program Cost Accounting: An Alternative Approach

    ERIC Educational Resources Information Center

    Hentschke, Guilbert C.

    1975-01-01

    Discusses the value for school districts of a program cost accounting system and examines different approaches to generating program cost data, with particular emphasis on the "cost allocation to program system" (CAPS) and the traditional "transaction-based system." (JG)

  14. 15 CFR 335.4 - Allocation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Allocation. 335.4 Section 335.4... § 335.4 Allocation. (a) For HTS 9902.51.11 and HTS 9902.51.15 each Tariff Rate Quota will be allocated separately. Allocation will be based on an applicant's Worsted Wool Suit production, on a weighted...

  15. Firefighting acutely increases airway responsiveness.

    PubMed

    Sherman, C B; Barnhart, S; Miller, M F; Segal, M R; Aitken, M; Schoene, R; Daniell, W; Rosenstock, L

    1989-07-01

    The acute effects of the products of combustion and pyrolysis on airway responsiveness among firefighters are poorly documented. To study this relationship, spirometry and methacholine challenge testing (MCT) were performed on 18 active Seattle firefighters before and 5 to 24 h after firefighting. Body plethysmography was used to measure changes in specific airway conductance (SGaw), and results of MCT were analyzed using PD35-SGaw, the cumulative dose causing a 35% decrease in SGaw. Subjects who did not react by the end of the protocol were assigned a value of 640 inhalational units, the largest cumulative dose. Fire exposure was defined as the total time (hours) spent without a self-contained breathing apparatus at the firesite and was categorized as mild (less than 1 h, n = 7), moderate (1 to 2 h, n = 5), or severe (greater than 2 h, n = 6). Mean age of the 18 firefighters was 36.7 +/- 6.7 yr (range, 25 to 51), with a mean of 9.1 +/- 7.9 active years in the trade (range, zero to 22). None was known to be asthmatic. After firefighting, FEV1 % predicted (%pred) and FEF25-75 %pred significantly decreased by means of 3.4 +/- 1.1% and 5.6 +/- 2.6%, respectively. The mean decline in PD35-SGaw after firefighting was 184.5 +/- 53.2 units (p = 0.003). This observed decline in PD35-SGaw could not be explained by decrements in prechallenge SGaw, FEV1, or FVC.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Preserving the allocation ratio at every allocation with biased coin randomization and minimization in studies with unequal allocation.

    PubMed

    Kuznetsova, Olga M; Tymofyeyev, Yevgen

    2012-04-13

    The demand for unequal allocation in clinical trials is growing. Most commonly, the unequal allocation is achieved through permuted block randomization. However, other allocation procedures might be required to better approximate the allocation ratio in small samples, reduce the selection bias in open-label studies, or balance on baseline covariates. When these allocation procedures are generalized to unequal allocation, special care is to be taken to preserve the allocation ratio at every allocation step. This paper offers a way to expand the biased coin randomization to unequal allocation that preserves the allocation ratio at every allocation. The suggested expansion works with biased coin randomization that balances only on treatment group totals and with covariate-adaptive procedures that use a random biased coin element at every allocation. Balancing properties of the allocation ratio preserving biased coin randomization and minimization are described through simulations. It is demonstrated that these procedures are asymptotically protected against the shift in the rerandomization distribution identified for some examples of minimization with 1:2 allocation. The asymptotic shift in the rerandomization distribution of the difference in treatment means for an arbitrary unequal allocation procedure is explicitly derived in the paper.

  17. Mechanisms Linking Advanced Airway Management and Cardiac Arrest Outcomes

    PubMed Central

    Benoit, Justin L.; Prince, David K.; Wang, Henry E.

    2015-01-01

    Advanced airway management – such as endotracheal intubation (ETI) or supraglottic airway (SGA) insertion – is one of the most prominent interventions in out-of-hospital cardiac arrest (OHCA) resuscitation. While randomized controlled trials are currently in progress to identify the best advanced airway technique in OHCA, the mechanisms by which airway management may influence OHCA outcomes remain unknown. We provide a conceptual model describing potential mechanisms linking advanced airway management with OHCA outcomes. PMID:26073275

  18. Integration and Task Allocation: Evidence from Patient Care*

    PubMed Central

    David, Guy; Rawley, Evan; Polsky, Daniel

    2013-01-01

    Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower-cost organizations by discharging patients earlier (and in poorer health) and increasing post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings. PMID:24415893

  19. Collective credit allocation in science

    PubMed Central

    Shen, Hua-Wei; Barabási, Albert-László

    2014-01-01

    Collaboration among researchers is an essential component of the modern scientific enterprise, playing a particularly important role in multidisciplinary research. However, we continue to wrestle with allocating credit to the coauthors of publications with multiple authors, because the relative contribution of each author is difficult to determine. At the same time, the scientific community runs an informal field-dependent credit allocation process that assigns credit in a collective fashion to each work. Here we develop a credit allocation algorithm that captures the coauthors’ contribution to a publication as perceived by the scientific community, reproducing the informal collective credit allocation of science. We validate the method by identifying the authors of Nobel-winning papers that are credited for the discovery, independent of their positions in the author list. The method can also compare the relative impact of researchers working in the same field, even if they did not publish together. The ability to accurately measure the relative credit of researchers could affect many aspects of credit allocation in science, potentially impacting hiring, funding, and promotion decisions. PMID:25114238

  20. Collective credit allocation in science.

    PubMed

    Shen, Hua-Wei; Barabási, Albert-László

    2014-08-26

    Collaboration among researchers is an essential component of the modern scientific enterprise, playing a particularly important role in multidisciplinary research. However, we continue to wrestle with allocating credit to the coauthors of publications with multiple authors, because the relative contribution of each author is difficult to determine. At the same time, the scientific community runs an informal field-dependent credit allocation process that assigns credit in a collective fashion to each work. Here we develop a credit allocation algorithm that captures the coauthors' contribution to a publication as perceived by the scientific community, reproducing the informal collective credit allocation of science. We validate the method by identifying the authors of Nobel-winning papers that are credited for the discovery, independent of their positions in the author list. The method can also compare the relative impact of researchers working in the same field, even if they did not publish together. The ability to accurately measure the relative credit of researchers could affect many aspects of credit allocation in science, potentially impacting hiring, funding, and promotion decisions. PMID:25114238

  1. Nasal airway responses to nasal continuous positive airway pressure breathing: An in-vivo pilot study.

    PubMed

    White, David E; Bartley, Jim; Shakeel, Muhammad; Nates, Roy J; Hankin, Robin K S

    2016-06-14

    The nasal cycle, through variation in nasal airflow partitioning, allows the upper airway to accommodate the contrasting demands of air conditioning and removal of entrapped air contaminants. The purpose of this study was to investigate the influence of nasal continuous positive airway pressure (nCPAP) breathing has on both nasal airflow partitioning and nasal geometry. Using a custom-made nasal mask, twenty healthy participants had the airflow in each naris measured during normal nasal breathing followed by nCPAP breathing. Eight participants also underwent magnetic resonance imaging (MRI) of the nasal region during spontaneous nasal breathing, and then nCPAP breathing over a range of air pressures. During nCPAP breathing, a simultaneous reduction in airflow through the patent airway together with a corresponding increase in airway flow within the congested nasal airway were observed in sixteen of the twenty participants. Nasal airflow resistance is inversely proportional to airway cross-sectional area. MRI data analysis during nCPAP breathing confirmed airway cross-sectional area reduced along the patent airway while the congested airway experienced an increase in this parameter. During awake breathing, nCPAP disturbs the normal inter-nasal airflow partitioning. This could partially explain the adverse nasal drying symptoms frequently reported by many users of this therapy. PMID:27173595

  2. Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

    PubMed Central

    Huang, Ren-Chih; Hung, Nan-Kai; Lu, Chueng-He; Wu, Zhi-Fu

    2016-01-01

    Abstract After emergence from anesthesia, the incidence and severity of adverse airway effects caused by the laryngeal mask airway (LMA) can vary, depending on when the device was removed; nonetheless, reports differ regarding the exact optimal timing of LMA removal. The purpose of this study was to compare the rate of adverse events between 2 groups: those whose LMA was removed under general anesthesia (“deep” group) or under target-controlled infusion (TCI) of propofol (“awake” group). Institutional Review Board approval and written informed consent were obtained; 124 patients were then randomly allocated into either the “awake” group or the “deep” group. Anesthesia was induced and maintained using TCI of propofol, as well as intravenous fentanyl. In the “deep” group, the LMA was removed after surgery while the patients were deeply anesthetized using a target effect-site propofol concentration of 2 μg/mL, whereas in the “awake” group, the device was removed while the patients followed verbal instructions. The incidence of the following adverse events was recorded: coughing, straining, bronchospasm, laryngospasm, clenching, breath holding, gross purposeful movement, airway obstruction, retching, vomiting, and oxygen desaturation. If any such event occurred, the LMA removal was considered a failure. Airway hyperreactivity was recorded and graded – based on the severity of cough, breath holding, and oxygen desaturation. The failure rate was higher in the “awake” group (15/61; 24.6%) than in the “deep” group (5/60; 8.3%). Airway hyperreactivity was mild (score, <3) in both groups. Removal of the LMA under deep anesthesia using a target-controlled, effect-site propofol concentration of 2 μg/mL may be safer and more successful than removal when patients are fully awake after surgery. PMID:27124034

  3. Extravascular fibrin, plasminogen activator, plasminogen activator inhibitors, and airway hyperresponsiveness

    PubMed Central

    Wagers, Scott S.; Norton, Ryan J.; Rinaldi, Lisa M.; Bates, Jason H.T.; Sobel, Burton E.; Irvin, Charles G.

    2004-01-01

    Mechanisms underlying airway hyperresponsiveness are not yet fully elucidated. One of the manifestations of airway inflammation is leakage of diverse plasma proteins into the airway lumen. They include fibrinogen and thrombin. Thrombin cleaves fibrinogen to form fibrin, a major component of thrombi. Fibrin inactivates surfactant. Surfactant on the airway surface maintains airway patency by lowering surface tension. In this study, immunohistochemically detected fibrin was seen along the luminal surface of distal airways in a patient who died of status asthmaticus and in mice with induced allergic airway inflammation. In addition, we observed altered airway fibrinolytic system protein balance consistent with promotion of fibrin deposition in mice with allergic airway inflammation. The airways of mice were exposed to aerosolized fibrinogen, thrombin, or to fibrinogen followed by thrombin. Only fibrinogen followed by thrombin resulted in airway hyperresponsiveness compared with controls. An aerosolized fibrinolytic agent, tissue-type plasminogen activator, significantly diminished airway hyperresponsiveness in mice with allergic airway inflammation. These results are consistent with the hypothesis that leakage of fibrinogen and thrombin and their accumulation on the airway surface can contribute to the pathogenesis of airway hyperresponsiveness. PMID:15232617

  4. Therapeutic bronchoscopic interventions for malignant airway obstruction

    PubMed Central

    Dalar, Levent; Özdemir, Cengiz; Abul, Yasin; Karasulu, Levent; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altın, Sedat

    2016-01-01

    Abstract There is no definitive consensus about the factors affecting the choice of interventional bronchoscopy in the management of malignant airway obstruction. The present study defines the choice of the interventional bronchoscopic modality and analyzes the factors influencing survival in patients with malignant central airway obstruction. Totally, over 7 years, 802 interventional rigid bronchoscopic procedures were applied in 547 patients having malignant airway obstruction. There was a significant association between the type of stent and the site of the lesion in the present study. Patients with tracheal involvement and/or involvement of the main bronchi had the worst prognosis. The sites of the lesion and endobronchial treatment modality were independent predictors of survival in the present study. The selection of different types of airway stents can be considered on the base of site of the lesion. Survival can be estimated based on the site of the lesion and endobronchial brochoscopic modality used. PMID:27281104

  5. 21 CFR 868.5810 - Airway connector.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... airway connector is a device intended to connect a breathing gas source to a tracheal tube, tracheostomy tube, or mask. (b) Classification. Class I (general controls). The device is exempt from the...

  6. 21 CFR 868.5810 - Airway connector.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... airway connector is a device intended to connect a breathing gas source to a tracheal tube, tracheostomy tube, or mask. (b) Classification. Class I (general controls). The device is exempt from the...

  7. 21 CFR 868.5810 - Airway connector.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... airway connector is a device intended to connect a breathing gas source to a tracheal tube, tracheostomy tube, or mask. (b) Classification. Class I (general controls). The device is exempt from the...

  8. Virtual Airway Skills Trainer (VAST) Simulator

    PubMed Central

    DEMIREL, Doga; YU, Alexander; HALIC, Tansel; SANKARANARAYANAN, Ganesh; RYASON, Adam; SPINDLER, David; BUTLER, Kathryn L.; CAO, Caroline; PETRUSA, Emil; MOLINA, Marcos; JONES, Dan; DE, Suvranu; DEMOYA, Marc; JONES, Stephanie

    2016-01-01

    This paper presents a simulation of Virtual Airway Skill Trainer (VAST) tasks. The simulated tasks are a part of two main airway management techniques; Endotracheal Intubation (ETI) and Cricothyroidotomy (CCT). ETI is a simple nonsurgical airway management technique, while CCT is the extreme surgical alternative to secure the airway of a patient. We developed identification of Mallampati class, finding the optimal angle for positioning pharyngeal/mouth axes tasks for ETI and identification of anatomical landmarks and incision tasks for CCT. Both ETI and CCT simulators were used to get physicians’ feedback at Society for Education in Anesthesiology and Association for Surgical Education spring meetings. In this preliminary validation study, total 38 participants for ETI and 48 for CCT performed each simulation task and completed pre and post questionnaires. In this work, we present the details of the simulation for the tasks and also the analysis of the collected data from the validation study. PMID:27046559

  9. 21 CFR 868.5810 - Airway connector.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... airway connector is a device intended to connect a breathing gas source to a tracheal tube, tracheostomy tube, or mask. (b) Classification. Class I (general controls). The device is exempt from the...

  10. Diesel exhaust particles and airway inflammation

    EPA Science Inventory

    Purpose of review. Epidemiologic investigation has associated traffic-related air pollution with adverse human health outcomes. The capacity ofdiesel exhaust particles (DEP), a major emission source air pollution particle, to initiate an airway inflammation has subsequently been ...

  11. Airway clearance therapy: finding the evidence.

    PubMed

    Volsko, Teresa A

    2013-10-01

    Disease processes can impair ciliary function, alter secretion production and mucus rheology, and interfere with the cough reflex. Airway clearance therapy has been a cornerstone of therapy aimed at minimizing the devastating effects of airway obstruction, infection, and inflammation due to mucus stasis on the conducting airways and lung parenchyma. Although challenges to performing clinical studies evaluating the effectiveness of airway clearance therapeutic modalities exist, resources are available in the literature. In addition to device evaluations and original clinical research, the expert opinion, systematic reviews, and evidence-based practice guidelines can be found. These tools can be used to develop protocols and pathways to guide our practice. Monitoring and reporting patient, process, and financial outcomes are essential steps germane to the implementation of evidence-based care.

  12. A cuckoo search algorithm by Lévy flights for solving reliability redundancy allocation problems

    NASA Astrophysics Data System (ADS)

    Valian, Ehsan; Valian, Elham

    2013-11-01

    A new metaheuristic optimization algorithm, called cuckoo search (CS), was recently developed by Yang and Deb (2009, 2010). This article uses CS and Lévy flights to solve the reliability redundancy allocation problem. The redundancy allocation problem involves setting reliability objectives for components or subsystems in order to meet the resource consumption constraint, e.g. the total cost. The difficulties facing the redundancy allocation problem are to maintain feasibility with respect to three nonlinear constraints, namely, cost, weight and volume-related constraints. The redundancy allocation problems have been studied in the literature for decades, usually using mathematical programming or metaheuristic optimization algorithms. The performance of the algorithm is tested on five well-known reliability redundancy allocation problems and is compared with several well-known methods. Simulation results demonstrate that the optimal solutions obtained by CS are better than the best solutions obtained by other methods.

  13. 48 CFR 9904.403 - Allocation of home office expenses to segments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... expenses to segments. 9904.403 Section 9904.403 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 ACCOUNTING STANDARDS 9904.403 Allocation of home office expenses...

  14. The Role of Capital Productivity in British Airways' Financial Recovery

    NASA Technical Reports Server (NTRS)

    Morrell, Peter

    1999-01-01

    British Airways (BA) was privatised in 1987, but its financial recovery occurred a number of years earlier. This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKS) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance. However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

  15. The Role of Capital Productivity in British Airways' Financial Recovery

    NASA Technical Reports Server (NTRS)

    Morrell, Peter

    1999-01-01

    British Airways (BA) was privatized in 1987, but its financial recovery occurred a number of years earlier, This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKs) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance, However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

  16. Airway obstruction secondary to rhinoscleroma during pregnancy.

    PubMed

    Armstrong, W B; Peskind, S P; Bressler, K L; Crockett, D M

    1995-11-01

    Dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy infants vaginally. Postpartum, two of the three were successfully decannulated, while the third became pregnant again before decannulation was accomplished. Treatment options and a review of the literature are presented.

  17. Cost Accounting in Higher Education. Simplified Macro- and Micro-Costing Techniques.

    ERIC Educational Resources Information Center

    Jenny, Hans H.

    This manual covers cost accounting applications and techniques as they apply to institutions of higher education, focusing mainly on the different methods of allocating costs. The manual covers four major costing topics: aggregate institution and systemwide costs; major academic and administrative program costs; academic and administrative…

  18. Software For Allocation Of Tolerances

    NASA Technical Reports Server (NTRS)

    Fernandez, Ken; Raman, Shivakumar; Pulat, Simin

    1992-01-01

    Collection of computer programs being developed to assist engineers in allocating tolerances to dimensions of components and assemblies. System reflects tolerancing expertise of design and manufacturing engineers; helps engineers maintain comprehensive tolerancing policy and overview that might otherwise get lost when attending to details of design and manufacturing processes. Necessary to allocate tolerances for three main reasons: tolerances allow for variations in dimensions of components as manufactured; assembly of two or more components, dimensions lie between specified limits; and part replaced must fit in place.

  19. Small Airway Dysfunction and Abnormal Exercise Responses

    PubMed Central

    Petsonk, Edward L.; Stansbury, Robert C.; Beeckman-Wagner, Lu-Ann; Long, Joshua L.; Wang, Mei Lin

    2016-01-01

    Rationale Coal mine dust exposure can cause symptoms and loss of lung function from multiple mechanisms, but the roles of each disease process are not fully understood. Objectives We investigated the implications of small airway dysfunction for exercise physiology among a group of workers exposed to coal mine dust. Methods Twenty coal miners performed spirometry, first breathing air and then helium-oxygen, single-breath diffusing capacity, and computerized chest tomography, and then completed cardiopulmonary exercise testing. Measurements and Main Results Six participants meeting criteria for small airway dysfunction were compared with 14 coal miners who did not. At submaximal workload, miners with small airway dysfunction used a higher proportion of their maximum voluntary ventilation and had higher ventilatory equivalents for both O2 and CO2. Regression modeling indicated that inefficient ventilation was significantly related to small airway dysfunction but not to FEV1 or diffusing capacity. At the end of exercise, miners with small airway dysfunction had 27% lower O2 consumption. Conclusions Small airway abnormalities may be associated with important inefficiency of exercise ventilation. In dust-exposed individuals with only mild abnormalities on resting lung function tests or chest radiographs, cardiopulmonary exercise testing may be important in defining causes of exercise intolerance. PMID:27073987

  20. Migration of Airway Smooth Muscle Cells

    PubMed Central

    Gerthoffer, William T.

    2008-01-01

    Migration of smooth muscle cells is a process fundamental to development of hollow organs, including blood vessels and the airways. Migration is also thought to be part of the response to tissue injury. It has also been suggested to contribute to airways remodeling triggered by chronic inflammation. In both nonmuscle and smooth muscle cells numerous external signaling molecules and internal signal transduction pathways contribute to cell migration. The review includes evidence for the functional significance of airway smooth muscle migration, a summary of promigratory and antimigratory agents, and summaries of important signaling pathways mediating migration. Important signaling pathways and effector proteins described include small G proteins, phosphatidylinositol 3-kinases (PI3-K), Rho activated protein kinase (ROCK), p21-activated protein kinases (PAK), Src family tyrosine kinases, and mitogen-activated protein kinases (MAPK). These signaling modules control multiple critical effector proteins including actin nucleating, capping and severing proteins, myosin motors, and proteins that remodel microtubules. Actin filament remodeling, focal contact remodeling and propulsive force of molecular motors are all coordinated to move cells along gradients of chemical cues, matrix adhesiveness, or matrix stiffness. Airway smooth muscle cell migration can be modulated in vitro by drugs commonly used in pulmonary medicine including β-adrenergic agonists and corticosteroids. Future studies of airway smooth muscle cell migration may uncover novel targets for drugs aimed at modifying airway remodeling. PMID:18094091

  1. Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy

    PubMed Central

    Kao, Erica Y.; Scalzitti, Nicholas J.; Dion, Gregory R.; Bowe, Sarah N.

    2015-01-01

    Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations. PMID:26457086

  2. Taste Receptors in Upper Airway Immunity.

    PubMed

    Carey, Ryan M; Lee, Robert J; Cohen, Noam A

    2016-01-01

    Taste receptors are well known for their role in communicating information from the tongue to the brain about nutritional value or potential toxicity of ingested substances. More recently, it has been shown that taste receptors are expressed in other locations throughout the body, including the airway, gastrointestinal tract, brain and pancreas. The roles of some 'extraoral' taste receptors are largely unknown, but emerging research suggests that bitter and sweet taste receptors in the airway are capable of sensing bacteria and modulating innate immunity. This chapter focuses on the role of bitter and sweet taste receptors in human airway innate immunity and their clinical relevance to rhinosinusitis. The bitter taste receptor T2R38 expressed in sinonasal cilia detects bitter bacterial quorum-sensing molecules and activates a nitric oxide-dependent innate immune response; moreover, there are polymorphisms in T2R38 that underlie susceptibility to chronic rhinosinusitis (CRS). Bitter and sweet receptors in sinonasal solitary chemosensory cells control secretion of antimicrobial peptides in the upper airway and may have a profound impact on airway infections in patients with CRS and diabetes. Future research on taste receptors in the airway has enormous potential to expand our understanding of host-pathogen immune interactions and provide novel therapeutic targets. PMID:27466851

  3. Mechanical Properties of the Upper Airway

    PubMed Central

    Strohl, Kingman P.; Butler, James P.; Malhotra, Atul

    2013-01-01

    The importance of the upper airway (nose, pharynx, and larynx) in health and in the pathogenesis of sleep apnea, asthma, and other airway diseases, discussed elsewhere in the Comprehensive Physiology series, prompts this review of the biomechanical properties and functional aspects of the upper airway. There is a literature based on anatomic or structural descriptions in static circumstances, albeit studied in limited numbers of individuals in both health and disease. As for dynamic features, the literature is limited to studies of pressure and flow through all or parts of the upper airway and to the effects of muscle activation on such features; however, the links between structure and function through airway size, shape, and compliance remain a topic that is completely open for investigation, particularly through analyses using concepts of fluid and structural mechanics. Throughout are included both historically seminal references, as well as those serving as signposts or updated reviews. This article should be considered a resource for concepts needed for the application of biomechanical models of upper airway physiology, applicable to understanding the pathophysiology of disease and anticipated results of treatment interventions. PMID:23723026

  4. Optimal Allocation of Node Capacity in Cascade-Robustness Networks.

    PubMed

    Chen, Zhen; Zhang, Jun; Du, Wen-Bo; Lordan, Oriol; Tang, Jiangjun

    2015-01-01

    The robustness of large scale critical infrastructures, which can be modeled as complex networks, is of great significance. One of the most important means to enhance robustness is to optimize the allocation of resources. Traditional allocation of resources is mainly based on the topology information, which is neither realistic nor systematic. In this paper, we try to build a framework for searching for the most favorable pattern of node capacity allocation to reduce the vulnerability to cascading failures at a low cost. A nonlinear and multi-objective optimization model is proposed and tackled using a particle swarm optimization algorithm (PSO). It is found that the network becomes more robust and economical when less capacity is left on the heavily loaded nodes and the optimized network performs better resisting noise. Our work is helpful in designing a robust economical network. PMID:26496705

  5. Optimal Allocation of Node Capacity in Cascade-Robustness Networks

    PubMed Central

    Chen, Zhen; Zhang, Jun; Du, Wen-Bo; Lordan, Oriol; Tang, Jiangjun

    2015-01-01

    The robustness of large scale critical infrastructures, which can be modeled as complex networks, is of great significance. One of the most important means to enhance robustness is to optimize the allocation of resources. Traditional allocation of resources is mainly based on the topology information, which is neither realistic nor systematic. In this paper, we try to build a framework for searching for the most favorable pattern of node capacity allocation to reduce the vulnerability to cascading failures at a low cost. A nonlinear and multi-objective optimization model is proposed and tackled using a particle swarm optimization algorithm (PSO). It is found that the network becomes more robust and economical when less capacity is left on the heavily loaded nodes and the optimized network performs better resisting noise. Our work is helpful in designing a robust economical network. PMID:26496705

  6. Monetizing Benefits Under Alternative River Recreation Use Allocation Systems

    NASA Astrophysics Data System (ADS)

    Loomis, John B.

    1980-02-01

    An optimal capacity, when the binding use constraint is ecological damage, and monetization of recreational benefits, under alternative means of rationing that capacity, were conceptually and empirically developed. The model was developed by first estimating the demand to float Westwater Canyon, derived from a modified travel cost model. Recreational benefits of 6,500 under a hypothetical capacity of 50 trips, when pricing was used to allocate the permits, and a range of benefits from as low as 880 to an expected value of $3,690, if a lottery system is used, were estimated using this model. The monetization of the efficiency losses associated with more equitable allocation systems allows managers to be more objective in making the equity-efficiency trade-offs involved in picking a recreation use allocation system.

  7. Modelling C allocation in response to nutrient availability

    NASA Astrophysics Data System (ADS)

    Stocker, Benjamin; Prentice, Colin

    2015-04-01

    Carbon (C) allocation in ecosystems is a key variable of the global terrestrial C cycle. While photosynthesis governs the amount of C that enters ecosystems, its subsequent allocation to compartments with different life times determines its over-all residence time and variations in allocation patterns drive changes in ecosystem C balance and its response to environmental change. A better understanding of the controls on allocation is thus key to improving global vegetation models that commonly rely on using fixed partitioning factors. Observational data suggests variations of ecosystem structure and functioning along large-scale gradients of resource availability. Below-ground C allocation, inferred as gross primary production minus above-ground biomass production increases along gradients of decreasing nutrient availability. This is not only due to more root growth, but also due to enhanced production of exudates and stimulation of root symbionts and has been interpreted to reflect optimal plant allocation decisions under a varying soil fertility status. Here, we propose a model that accounts for trade-offs between (i) growth in above-ground and (ii) below-ground plant compartments, (iii) exudation to the rhizosphere and root symbionts and (iv) temporary storage in non-structural pools. By postulating the maximization of long-term growth under a given (seasonal regime) of soil nitrogen (N) availability, we attempt to reproduce observed large-scale gradients. The model is formulated based on a C cost for different N uptake decisions, where the cost is a function of N availability, root mass, and soil temperature (for biological N fixation). On a daily time scale, ecosystem N uptake may be realized by C exudation to the rhizosphere and/or symbiotic fixation of atmospheric N2. On an annual time scale, allocation to roots versus leaves is adjusted to soil inorganic N availability and modeled to yield maximum total growth. Exudation versus temporary storage of C is

  8. Task allocation among multiple intelligent robots

    NASA Technical Reports Server (NTRS)

    Gasser, L.; Bekey, G.

    1987-01-01

    Researchers describe the design of a decentralized mechanism for allocating assembly tasks in a multiple robot assembly workstation. Currently, the approach focuses on distributed allocation to explore its feasibility and its potential for adaptability to changing circumstances, rather than for optimizing throughput. Individual greedy robots make their own local allocation decisions using both dynamic allocation policies which propagate through a network of allocation goals, and local static and dynamic constraints describing which robots are elibible for which assembly tasks. Global coherence is achieved by proper weighting of allocation pressures propagating through the assembly plan. Deadlock avoidance and synchronization is achieved using periodic reassessments of local allocation decisions, ageing of allocation goals, and short-term allocation locks on goals.

  9. Implementing a trustworthy cost-accounting model.

    PubMed

    Spence, Jay; Seargeant, Dan

    2015-03-01

    Hospitals and health systems can develop an effective cost-accounting model and maximize the effectiveness of their cost-accounting teams by focusing on six key areas: Implementing an enhanced data model. Reconciling data efficiently. Accommodating multiple cost-modeling techniques. Improving transparency of cost allocations. Securing department manager participation. Providing essential education and training to staff members and stakeholders.

  10. Regulating nutrient allocation in plants

    SciTech Connect

    Udvardi, Michael; Yang, Jiading; Worley, Eric

    2014-12-09

    The invention provides coding and promoter sequences for a VS-1 and AP-2 gene, which affects the developmental process of senescence in plants. Vectors, transgenic plants, seeds, and host cells comprising heterologous VS-1 and AP-2 genes are also provided. Additionally provided are methods of altering nutrient allocation and composition in a plant using the VS-1 and AP-2 genes.

  11. Administrators' Decisions about Resource Allocation

    ERIC Educational Resources Information Center

    Knight, William E.; Folkins, John W.; Hakel, Milton D.; Kennell, Richard P.

    2011-01-01

    Do academic administrators make decisions about resource allocation differently depending on the discipline receiving the funding? Does an administrator's academic identity influence these decisions? This study explored those questions with a sample of 1,690 academic administrators at doctoral-research universities. Participants used fictional…

  12. Report on Tribal Priority Allocations.

    ERIC Educational Resources Information Center

    Bureau of Indian Affairs (Dept. of Interior), Washington, DC.

    As part of Bureau of Indian Affairs (BIA) funding, Tribal Priority Allocations (TPA) are the principal source of funds for tribal governments and agency offices at the reservation level. According to their unique needs and circumstances, tribes may prioritize funding among eight general categories: government, human services, education, public…

  13. The Discipline of Asset Allocation.

    ERIC Educational Resources Information Center

    Petzel, Todd E.

    2000-01-01

    Discussion of asset allocation for college/university endowment funds focuses on three levels of risk: (1) the absolute risk of the portfolio (usually leading to asset diversification); (2) the benchmark risk (usually comparison with peer institutions; and (3) personal career risk (which may incline managers toward maximizing short-term returns,…

  14. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

    PubMed

    Zhao, Xue Hong; Zhang, Yun; Liang, Zhong Yan; Zhang, Shao Yang; Yu, Wen Qiao; Huang, Fang-Fang

    2015-12-01

    The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis. PMID:27011511

  15. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

    PubMed

    Zhao, Xue Hong; Zhang, Yun; Liang, Zhong Yan; Zhang, Shao Yang; Yu, Wen Qiao; Huang, Fang-Fang

    2015-12-01

    The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.

  16. The relation of airway size to lung function

    NASA Astrophysics Data System (ADS)

    Leader, J. Ken; Zheng, Bin; Sciurba, Frank C.; Fuhrman, Carl R.; Bon, Jessica M.; Park, Sang C.; Pu, Jiantao; Gur, David

    2008-03-01

    Chronic obstructive pulmonary disease may cause airway remodeling, and small airways are the mostly likely site of associated airway flow obstruction. Detecting and quantifying airways depicted on a typical computed tomography (CT) images is limited by spatial resolution. In this study, we examined the association between lung function and airway size. CT examinations and spirometry measurement of forced expiratory volume in one second as a percent predicted (FEV I%) from 240 subjects were used in this study. Airway sections depicted in axial CT section were automatically detected and quantified. Pearson correlation coefficients (PCC) were computed to compare lung function across three size categories: (1) all detected airways, (2) the smallest 50% of detected airways, and (3) the largest 50% of detected airways using the CORANOVA test. The mean number of all airways detected per subject was 117.4 (+/- 40.1) with mean size ranging from 20.2 to 50.0 mm2. The correlation between lung function (i.e., FEV I) and airway morphometry associated with airway remodeling and airflow obstruction (i.e., lumen perimeter and wall area as a percent of total airway area) was significantly stronger for smaller compared to larger airways (p < 0.05). The PCCs between FEV I and all airways, the smallest 50%, and the largest 50% were 0.583, 0.617, 0.523, respectively, for lumen perimeter and -0.560, -0.584, and -0.514, respectively, for wall area percent. In conclusion, analyzing a set of smaller airways compared to larger airways may improve detection of an association between lung function and airway morphology change.

  17. Optimal load allocation of multiple fuel boilers.

    PubMed

    Dunn, Alex C; Du, Yan Yi

    2009-04-01

    This paper presents a new methodology for optimally allocating a set of multiple industrial boilers that each simultaneously consumes multiple fuel types. Unlike recent similar approaches in the utility industry that use soft computing techniques, this approach is based on a second-order gradient search method that is easy to implement without any specialized optimization software. The algorithm converges rapidly and the application yields significant savings benefits, up to 3% of the overall operating cost of industrial boiler systems in the examples given and potentially higher in other cases, depending on the plant circumstances. Given today's energy prices, this can yield significant savings benefits to manufacturers that raise steam for plant operations. PMID:19046585

  18. Vaccines: from valuation to resource allocation.

    PubMed

    Bloom, David E; Madhavan, Guruprasad

    2015-06-01

    This review focuses on selected challenges and opportunities concerning broader valuation of vaccines and immunization. The challenges involve conceptualizing and measuring the value of vaccines, while the opportunities relate to the strategic and systematic use of that information in health policy decisions that range from the adoption of particular vaccines in national immunization plans to the allocation of resources to vaccine research, development, and delivery. Clarifying the demonstrable individual, family, and community-level benefits of vaccines will allow the public health community to make better-informed and more meaningful comparisons of the costs of vaccines in relation to their full benefits. Taking advantage of this opportunity will require enhanced data collection and the development of strategic planning tools for transparently assessing trade-offs among the myriad attributes of different vaccines in various social and economic contexts.

  19. Vaccines: from valuation to resource allocation.

    PubMed

    Bloom, David E; Madhavan, Guruprasad

    2015-06-01

    This review focuses on selected challenges and opportunities concerning broader valuation of vaccines and immunization. The challenges involve conceptualizing and measuring the value of vaccines, while the opportunities relate to the strategic and systematic use of that information in health policy decisions that range from the adoption of particular vaccines in national immunization plans to the allocation of resources to vaccine research, development, and delivery. Clarifying the demonstrable individual, family, and community-level benefits of vaccines will allow the public health community to make better-informed and more meaningful comparisons of the costs of vaccines in relation to their full benefits. Taking advantage of this opportunity will require enhanced data collection and the development of strategic planning tools for transparently assessing trade-offs among the myriad attributes of different vaccines in various social and economic contexts. PMID:26022569

  20. The organ allocation controversy: how did we arrive here?

    PubMed

    Van Meter, C H

    1999-01-01

    The Department of Health and Human Services (HHS) recently issued a final regulation governing the Organ Procurement and Transplantation Network (OPTN) that directs the allocation of organs to the sickest patients first without regard to a host of medical, geographic, and social factors that members of the transplant community view as an essential part of a sound organ allocation policy.Current organ allocation mechanisms are based on policies that reflect a broad consensus of medical experts and provide equal consideration for both the needs of the sickest patients and the efficient use of organs. This system also reduces potential waste of organs by minimizing cold ischemic time, increases access to transplantation for patients in local communities, provides positive incentives for local citizens and medical professionals to support organ donation initiatives, and decreases the cost of organ transplantation.Representatives of the American Society of Transplant Surgeons have testified before Congress that "giving priority to the sickest patients first over broad geographic areas would be wasteful and dangerous, resulting in fewer patients transplanted, increased death rates, increased retransplantation due to poor organ function, and increased overall cost of transplantation." In response, Congress enacted a 1-year moratorium on the implementation of the HHS rule and provided for a study of the current organ allocation policy and HHS regulation by The Institute of Medicine. PMID:21845113

  1. Complex Genetic Effects on Early Vegetative Development Shape Resource Allocation Differences Between Arabidopsis lyrata Populations

    PubMed Central

    Remington, David L.; Leinonen, Päivi H.; Leppälä, Johanna; Savolainen, Outi

    2013-01-01

    Costs of reproduction due to resource allocation trade-offs have long been recognized as key forces in life history evolution, but little is known about their functional or genetic basis. Arabidopsis lyrata, a perennial relative of the annual model plant A. thaliana with a wide climatic distribution, has populations that are strongly diverged in resource allocation. In this study, we evaluated the genetic and functional basis for variation in resource allocation in a reciprocal transplant experiment, using four A. lyrata populations and F2 progeny from a cross between North Carolina (NC) and Norway parents, which had the most divergent resource allocation patterns. Local alleles at quantitative trait loci (QTL) at a North Carolina field site increased reproductive output while reducing vegetative growth. These QTL had little overlap with flowering date QTL. Structural equation models incorporating QTL genotypes and traits indicated that resource allocation differences result primarily from QTL effects on early vegetative growth patterns, with cascading effects on later vegetative and reproductive development. At a Norway field site, North Carolina alleles at some of the same QTL regions reduced survival and reproductive output components, but these effects were not associated with resource allocation trade-offs in the Norway environment. Our results indicate that resource allocation in perennial plants may involve important adaptive mechanisms largely independent of flowering time. Moreover, the contributions of resource allocation QTL to local adaptation appear to result from their effects on developmental timing and its interaction with environmental constraints, and not from simple models of reproductive costs. PMID:23979581

  2. Optimal sample size allocation for Welch's test in one-way heteroscedastic ANOVA.

    PubMed

    Shieh, Gwowen; Jan, Show-Li

    2015-06-01

    The determination of an adequate sample size is a vital aspect in the planning stage of research studies. A prudent strategy should incorporate all of the critical factors and cost considerations into sample size calculations. This study concerns the allocation schemes of group sizes for Welch's test in a one-way heteroscedastic ANOVA. Optimal allocation approaches are presented for minimizing the total cost while maintaining adequate power and for maximizing power performance for a fixed cost. The commonly recommended ratio of sample sizes is proportional to the ratio of the population standard deviations or the ratio of the population standard deviations divided by the square root of the ratio of the unit sampling costs. Detailed numerical investigations have shown that these usual allocation methods generally do not give the optimal solution. The suggested procedures are illustrated using an example of the cost-efficiency evaluation in multidisciplinary pain centers.

  3. Acoustic simulation of a patient's obstructed airway.

    PubMed

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound.

  4. Silibinin attenuates allergic airway inflammation in mice

    SciTech Connect

    Choi, Yun Ho; Jin, Guang Yu; Guo, Hui Shu; Piao, Hong Mei; Li, Liang chang; Li, Guang Zhao; Lin, Zhen Hua; Yan, Guang Hai

    2012-10-26

    Highlights: Black-Right-Pointing-Pointer Silibinin diminishes ovalbumin-induced inflammatory reactions in the mouse lung. Black-Right-Pointing-Pointer Silibinin reduces the levels of various cytokines into the lung of allergic mice. Black-Right-Pointing-Pointer Silibinin prevents the development of airway hyperresponsiveness in allergic mice. Black-Right-Pointing-Pointer Silibinin suppresses NF-{kappa}B transcriptional activity. -- Abstract: Allergic asthma is a chronic inflammatory disease regulated by coordination of T-helper2 (Th2) type cytokines and inflammatory signal molecules. Silibinin is one of the main flavonoids produced by milk thistle, which is reported to inhibit the inflammatory response by suppressing the nuclear factor-kappa B (NF-{kappa}B) pathway. Because NF-{kappa}B activation plays a pivotal role in the pathogenesis of allergic inflammation, we have investigated the effect of silibinin on a mouse ovalbumin (OVA)-induced asthma model. Airway hyperresponsiveness, cytokines levels, and eosinophilic infiltration were analyzed in bronchoalveolar lavage fluid and lung tissue. Pretreatment of silibinin significantly inhibited airway inflammatory cell recruitment and peribronchiolar inflammation and reduced the production of various cytokines in bronchoalveolar fluid. In addition, silibinin prevented the development of airway hyperresponsiveness and attenuated the OVA challenge-induced NF-{kappa}B activation. These findings indicate that silibinin protects against OVA-induced airway inflammation, at least in part via downregulation of NF-{kappa}B activity. Our data support the utility of silibinin as a potential medicine for the treatment of asthma.

  5. Measles: an epidemic of upper airway obstruction.

    PubMed

    Manning, S C; Ridenour, B; Brown, O E; Squires, J

    1991-09-01

    Between October 1989 and August 1990, Dallas County experienced an 11-month epidemic of measles. Of 995 cases of pediatric measles diagnosed in the outpatient department of Children's Medical Center, 108 patients were admitted and 34 of these demonstrated significant upper airway obstruction at the time of admission. Airway problems ranged from mild inspiratory stridor with nasal flaring to frank obstruction and arrest in the emergency room, requiring intubation. Eight of the 34 airway patients were eventually diagnosed with bacterial tracheitis on the basis of endoscopic findings and culture results. The remaining patients had pictures more consistent with viral laryngotracheitis, but all patients were treated with broad-spectrum antibiotics to prevent possible progression to bacterial tracheitis. A total of nine patients overall required intubation for airway obstruction and all were successfully extubated. Large outbreaks of measles are becoming common again in populations of urban poor--largely unvaccinated children. The disease in these populations tends to occur at a younger age and may be more aggressive with more associated complications. Physicians must keep in mind the possibility of upper airway obstruction in a significant proportion of these patients. Early diagnosis on the basis of clinical signs and symptoms, endoscopy, and radiographs is the key to timely appropriate management.

  6. Acoustic simulation of a patient's obstructed airway.

    PubMed

    van der Velden, W C P; van Zuijlen, A H; de Jong, A T; Lynch, C T; Hoeve, L J; Bijl, H

    2016-01-01

    This research focuses on the numerical simulation of stridor; a high pitched, abnormal noise, resulting from turbulent airflow and vibrating tissue through a partially obstructed airway. Characteristics of stridor noise are used by medical doctors as indication for location and size of the obstruction. The relation between type of stridor and the various diseases associated with airway obstruction is unclear; therefore, simply listening to stridor is an unreliable diagnostic tool. The overall aim of the study is to better understand the relationship between characteristics of stridor noise and localization and size of the obstruction. Acoustic analysis of stridor may then in future simplify the diagnostic process, and reduce the need for more invasive procedures such as laryngoscopy under general anesthesia. In this paper, the feasibility of a coupled flow, acoustic and structural model is investigated to predict the noise generated by the obstruction as well as the propagation of the noise through the airways, taking into account a one-way coupled fluid, structure, and acoustic interaction components. The flow and acoustic solver are validated on a diaphragm and a simplified airway model. A realistic airway model of a patient suffering from a subglottic stenosis, derived from a real computed tomography scan, is further analyzed. Near the mouth, the broadband noise levels at higher frequencies increased with approximately 15-20 dB comparing the stridorous model with the healthy model, indicating stridorous sound. PMID:25567545

  7. Kinins, airway obstruction, and anaphylaxis.

    PubMed

    Kaplan, Allen P

    2010-01-01

    Anaphylaxis is a term that implies symptoms that are present in many organs, some of which are potentially fatal. The pathogenic process can either be IgE-dependent or non-IgE-dependent; the latter circumstance may be referred to as anaphylactoid. Bradykinin is frequently responsible for the manifestations of IgE-independent reactions. Blood levels may increase because of overproduction; diseases such as the various forms of C1 inhibitor deficiency (hereditary or acquired) or hereditary angioedema with normal C1 inhibitor are examples in this category. Blood levels may also increase because of an abnormality in bradykinin metabolism; the angioedema due to ACE inhibitors is a commonly encountered example. Angioedema due to bradykinin has the potential to cause airway obstruction and asphyxia as well as severe gastrointestinal symptoms simulating an acute abdomen. Formation of bradykinin in plasma is a result of a complex interaction among proteins such as factor XII, prekallikrein, and high molecular weight kininogen (HK) resulting in HK cleavage and liberation of bradykinin. These proteins also assemble along the surface of endothelial cells via zinc-dependent interactions with gC1qR, cytokeratin 1, and u-PAR. Endothelial cell expression (or secretion) of heat-shock protein 90 or prolylcarboxypeptidase can activate the prekallikrein-HK complex to generate bradykinin in the absence of factor XII, however factor XII is then secondarily activated by the kallikrein that results. Bradykinin is destroyed by carboxypeptidase N and angiotensin-converting enzyme. The hypotension associated with IgE-dependent anaphylaxis maybe mediated, in part, by massive proteolytic digestion of HK by kallikreins (tissue or plasma-derived) or other cell-derived kininogenases. PMID:20519882

  8. 40 CFR 74.26 - Allocation formula.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) SULFUR DIOXIDE OPT-INS Allowance Calculations for Combustion Sources § 74.26 Allocation formula. (a) The Administrator will calculate the annual allowance allocation for a combustion source based on the data... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Allocation formula. 74.26 Section...

  9. 49 CFR 262.5 - Allocation requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Allocation requirements. 262.5 Section 262.5... IMPROVEMENT PROJECTS § 262.5 Allocation requirements. At least fifty percent of all grant funds awarded under... than $20,000,000 each. Designated, high-priority projects will be excluded from this allocation...

  10. 15 CFR 923.110 - Allocation formula.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Allocation formula. 923.110 Section... MANAGEMENT COASTAL ZONE MANAGEMENT PROGRAM REGULATIONS Allocation of Section 306 Program Administration Grants § 923.110 Allocation formula. (a) As required by subsection 306(a), the Secretary may make...

  11. 25 CFR 39.902 - Allocation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Allocation. 39.902 Section 39.902 Indians BUREAU OF... Maintenance and Minor Repair Fund § 39.902 Allocation. (a) Interim Maintenance and Minor Repair funds shall be... determining school allocations shall be taken from the facilities inventory maintained by the Division...

  12. 24 CFR 945.203 - Allocation plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Allocation plan. 945.203 Section... FAMILIES Application and Approval Procedures § 945.203 Allocation plan. (a) Applicable terminology. (1) As used in this section, the terms “initial allocation plan” refers to the PHA's first submission of...

  13. 24 CFR 594.15 - Allocation amounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Allocation amounts. 594.15 Section... DEVELOPMENT COMMUNITY FACILITIES JOHN HEINZ NEIGHBORHOOD DEVELOPMENT PROGRAM Funding Allocation and Criteria § 594.15 Allocation amounts. (a) Amounts and match requirement. HUD will make grants, in the form...

  14. SPONTANEOUS AIRWAY HYPERRESPONSIVENESS IN ESTROGEN RECEPTOR-A DEFICIENT MICE

    EPA Science Inventory

    Rationale: Airway hyperresponsiveness is a critical feature of asthma. Substantial epidemiologic evidence supports a role for female sex hormones in modulating lung function and airway hyperresponsiveness in humans. Objectives: To examine the role of estrogen receptors in modulat...

  15. Efficient Allocation of Reserve Costs in RTO Markets

    SciTech Connect

    Kirsch, Laurence D.; Morey, Mathew J.

    2006-10-15

    RTOs' make-whole payments for generation commitment are needed partly because of flaws in the design of reserve markets. Markets might be made more efficient with greater locational differentiation in reserve prices and incorporation of make-whole payments into reserve prices. (author)

  16. 20 CFR 633.304 - Section 402 cost allocation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of personnel engaged in executive, fiscal, data collection, personnel, legal, audit, procurement... development; tuition fees, books and other teaching aids; equipment and materials used in providing...

  17. Communication patterns and allocation strategies.

    SciTech Connect

    Leung, Vitus Joseph; Mache, Jens Wolfgang; Bunde, David P.

    2004-01-01

    Motivated by observations about job runtimes on the CPlant system, we use a trace-driven microsimulator to begin characterizing the performance of different classes of allocation algorithms on jobs with different communication patterns in space-shared parallel systems with mesh topology. We show that relative performance varies considerably with communication pattern. The Paging strategy using the Hilbert space-filling curve and the Best Fit heuristic performed best across several communication patterns.

  18. Minority Transportation Expenditure Allocation Model

    SciTech Connect

    Vyas, Anant D.; Santini, Danilo J.; Marik, Sheri K.

    1993-04-12

    MITRAM (Minority TRansportation expenditure Allocation Model) can project various transportation related attributes of minority (Black and Hispanic) and majority (white) populations. The model projects vehicle ownership, vehicle miles of travel, workers, new car and on-road fleet fuel economy, amount and share of household income spent on gasoline, and household expenditures on public transportation and taxis. MITRAM predicts reactions to sustained fuel price changes for up to 10 years after the change.

  19. Laser applications in pediatric airway surgery

    NASA Astrophysics Data System (ADS)

    Karamzadeh, Amir M.; Ahuja, Gurpreet S.; Nguyen, John D.; Crumley, Roger

    2003-06-01

    The smaller anatomy and limited access to instrumentation pose a challenge to the pediatric airway surgeon. The enhanced precision and ability to photocoagulate tissue while operating with the laser enhances the surgeon"s ability to successfully treat unique pediatric conditions such subglottic hemangiomas, congenital cysts, respiratory papillomatosis, and laryngeal or tracheal stenosis. Due to its shallow tissue penetration and thermal effect, the carbon dioxide (CO2) laser is generally considered the laser of choice for pediatric airway applications. The potential for increased scarring and damage to underlying tissue caused by the greater penetration depth and thermal effect of the Nd:YAG and KTP lasers preclude their use in this population. In this review, we will describe the specific advantages of using lasers in airway surgery, the current technology and where the current technology is deficient.

  20. Airway Management in Croup and Epiglottitis

    PubMed Central

    Crumley, Roger L.

    1977-01-01

    Treatment techniques for airway obstruction in croup and epiglottitis are reviewed in the medical literature. Series totaling 295 nasotracheal intubations, and 591 tracheostomies were reviewed. There were two deaths attributable to airway complications in 126 patients in whom nasotracheal intubation was carried out. In three patients subglottic granulation tissue and subglottic stenoses developed from short-term nasotracheal intubation. There were no subglottic stenoses or tracheal stenoses reported in the 591 tracheostomies. From this review, it would seem feasible to use nasotracheal intubation for short-term airway treatment in croup and epiglottitis. The increasing occurrence of laryngeal and tracheal complications with long-term intubation suggests that tracheostomy be considered in such cases. PMID:349884

  1. MicroRNA in United Airway Diseases

    PubMed Central

    Liu, Zheng; Zhang, Xin-Hao; Callejas-Díaz, Borja; Mullol, Joaquim

    2016-01-01

    The concept of united airway diseases (UAD) has received increasing attention in recent years. Sustained and increased inflammation is a common feature of UAD, which is inevitably accompanied with marked gene modification and tight gene regulation. However, gene regulation in the common inflammatory processes in UAD remains unclear. MicroRNA (miRNA), a novel regulator of gene expression, has been considered to be involved in many inflammatory diseases. Although there are an increasing number of studies of miRNAs in inflammatory upper and lower airway diseases, few miRNAs have been identified that directly link the upper and lower airways. In this article, therefore, we reviewed the relevant studies available in order to improve the understanding of the roles of miRNAs in the interaction and pathogenesis of UAD. PMID:27187364

  2. Klebsiella pneumoniae triggers a cytotoxic effect on airway epithelial cells

    PubMed Central

    2009-01-01

    Background Klebsiella pneumoniae is a capsulated Gram negative bacterial pathogen and a frequent cause of nosocomial infections. Despite its clinical relevance, little is known about the features of the interaction between K. pneumoniae and lung epithelial cells on a cellular level, neither about the role of capsule polysaccharide, one of its best characterised virulence factors, in this interaction. Results The interaction between Klebsiella pneumoniae and cultured airway epithelial cells was analysed. K. pneumoniae infection triggered cytotoxicity, evident by cell rounding and detachment from the substrate. This effect required the presence of live bacteria and of capsule polysaccharide, since it was observed with isolates expressing different amounts of capsule and/or different serotypes but not with non-capsulated bacteria. Cytotoxicity was analysed by lactate dehydrogenase and formazan measurements, ethidium bromide uptake and analysis of DNA integrity, obtaining consistent and complementary results. Moreover, cytotoxicity of non-capsulated strains was restored by addition of purified capsule during infection. While a non-capsulated strain was avirulent in a mouse infection model, capsulated K. pneumoniae isolates displayed different degrees of virulence. Conclusion Our observations allocate a novel role to K. pneumoniae capsule in promotion of cytotoxicity. Although this effect is likely to be associated with virulence, strains expressing different capsule levels were not equally virulent. This fact suggests the existence of other bacterial requirements for virulence, together with capsule polysaccharide. PMID:19650888

  3. Quantifying the Amount of Bleeding and Associated Changes in Intra-Abdominal Pressure and Mean Airway Pressure in Patients Undergoing Lumbar Fixation Surgeries: A Comparison of Three Positioning Systems

    PubMed Central

    Gupta, Vikas; Abraham, Mary; Punetha, Pankaj; Bundela, Yashpal

    2016-01-01

    Study Design Prospective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position. Purpose To compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems. Overview of Literature Studies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear. Methods This prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored. Results IAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups. Conclusions Positioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure. PMID:27114757

  4. Multiple Leader Candidate and Competitive Position Allocation for Robust Formation against Member Robot Faults

    PubMed Central

    Kwon, Ji-Wook; Kim, Jin Hyo; Seo, Jiwon

    2015-01-01

    This paper proposes a Multiple Leader Candidate (MLC) structure and a Competitive Position Allocation (CPA) algorithm which can be applicable for various applications including environmental sensing. Unlike previous formation structures such as virtual-leader and actual-leader structures with position allocation including a rigid allocation and an optimization based allocation, the formation employing the proposed MLC structure and CPA algorithm is robust against the fault (or disappearance) of the member robots and reduces the entire cost. In the MLC structure, a leader of the entire system is chosen among leader candidate robots. The CPA algorithm is the decentralized position allocation algorithm that assigns the robots to the vertex of the formation via the competition of the adjacent robots. The numerical simulations and experimental results are included to show the feasibility and the performance of the multiple robot system employing the proposed MLC structure and the CPA algorithm. PMID:25954956

  5. Multiple Leader Candidate and Competitive Position Allocation for Robust Formation against Member Robot Faults.

    PubMed

    Kwon, Ji-Wook; Kim, Jin Hyo; Seo, Jiwon

    2015-05-06

    This paper proposes a Multiple Leader Candidate (MLC) structure and a Competitive Position Allocation (CPA) algorithm which can be applicable for various applications including environmental sensing. Unlike previous formation structures such as virtual-leader and actual-leader structures with position allocation including a rigid allocation and an optimization based allocation, the formation employing the proposed MLC structure and CPA algorithm is robust against the fault (or disappearance) of the member robots and reduces the entire cost. In the MLC structure, a leader of the entire system is chosen among leader candidate robots. The CPA algorithm is the decentralized position allocation algorithm that assigns the robots to the vertex of the formation via the competition of the adjacent robots. The numerical simulations and experimental results are included to show the feasibility and the performance of the multiple robot system employing the proposed MLC structure and the CPA algorithm.

  6. Preclinical evaluation of epinephrine nebulization to reduce airway hyperemia and improve oxygenation after smoke inhalation injury

    PubMed Central

    Lange, Matthias; Hamahata, Atsumori; Traber, Daniel L.; Cox, Robert A.; Kulp, Gabriela A.; Nakano, Yoshimitsu; Traber, Lillian D.; Herndon, David N.; Enkhbaatar, Perenlei

    2013-01-01

    Objective Acute lung injury secondary to smoke inhalation is a major source of morbidity and mortality in burn patients. We tested the hypothesis that nebulized epinephrine would ameliorate pulmonary dysfunction secondary to acute lung injury by reducing airway hyperemia and edema formation and mediating bronchodilatation in an established, large animal model of inhalation injury. Design Prospective, controlled, randomized trial. Setting University research laboratory. Subjects Twenty-four chronically instrumented, adult, female sheep. Interventions Following baseline measurements, the animals were allocated to a sham-injured group (n = 5), an injured and saline-treated group (n = 6), or an injured group treated with 4 mg of nebulized epinephrine every 4 hrs (n = 6). Inhalation injury was induced by 48 breaths of cotton smoke. The dose of epinephrine was derived from dose finding experiments (n = 7 sheep). Measurements and Main Results The injury induced significant increases in airway blood flows, bronchial wet/dry weight ratio, airway obstruction scores, ventilatory pressures, and lung malondialdehyde content, and contributed to severe pulmonary dysfunction as evidenced by a significant decline in Pao2/Fio2 ratio and increase in pulmonary shunt fraction. Nebulization of epinephrine significantly reduced tracheal and main bronchial blood flows, ventilatory pressures, and lung malondialdehyde content. The treatment was further associated with significant improvements of Pao2/Fio2 ratio and pulmonary shunting. Conclusions Nebulization of epinephrine reduces airway blood flow and attenuates pulmonary dysfunction in sheep subjected to severe smoke inhalation injury. Future studies will have to improve the understanding of the underlying pathomechanisms and identify the optimal dosing for the treatment of patients with this injury. PMID:21263320

  7. [Modern airway management--current concepts for more patient safety].

    PubMed

    Timmermann, Arnd

    2009-04-01

    Effective and safe airway management is one of the core skills among anaesthesiologists and all physicians involved in acute care medicine. However, failure in airway management is still the most frequent single incidence with the highest impact on patient's morbidity and mortality known from closed claims analyses. The anaesthesiologist has to manage the airway in elective patients providing a high level of safety with as little airway injury and interference with the cardio-vascular system as possible. Clinical competence also includes the management of the expected and unexpected difficult airway in different clinical environments. Therefore, it is the anaesthesiologist's responsibility not only to educate and train younger residents, but also all kinds of medical personnel involved in airway management, e.g. emergency physicians, intensive care therapists or paramedics. Modern airway devices, strategies and educational considerations must fulfill these sometimes diverse and large range requirements. Supraglottic airway devices will be used more often in the daily clinical routine. This is not only due the multiple advantages of these devices compared to the tracheal tube, but also because of the new features of some supraglottic airways, which separate the airway from the gastric track and give information of the pharyngeal position. For the event of a difficult airway, new airway devices and concepts should be trained and applied in daily practice.

  8. 21 CFR 868.2600 - Airway pressure monitor.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Airway pressure monitor. 868.2600 Section 868.2600...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2600 Airway pressure monitor. (a) Identification. An airway pressure monitor is a device used to measure the pressure in a patient's upper...

  9. 21 CFR 868.1780 - Inspiratory airway pressure meter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Inspiratory airway pressure meter. 868.1780... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1780 Inspiratory airway pressure meter. (a) Identification. An inspiratory airway pressure meter is a device used to measure the...

  10. 21 CFR 868.1780 - Inspiratory airway pressure meter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Inspiratory airway pressure meter. 868.1780... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1780 Inspiratory airway pressure meter. (a) Identification. An inspiratory airway pressure meter is a device used to measure the...

  11. 21 CFR 868.2600 - Airway pressure monitor.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Airway pressure monitor. 868.2600 Section 868.2600...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2600 Airway pressure monitor. (a) Identification. An airway pressure monitor is a device used to measure the pressure in a patient's upper...

  12. 21 CFR 868.1780 - Inspiratory airway pressure meter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Inspiratory airway pressure meter. 868.1780... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1780 Inspiratory airway pressure meter. (a) Identification. An inspiratory airway pressure meter is a device used to measure the...

  13. 21 CFR 868.2600 - Airway pressure monitor.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Airway pressure monitor. 868.2600 Section 868.2600...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2600 Airway pressure monitor. (a) Identification. An airway pressure monitor is a device used to measure the pressure in a patient's upper...

  14. 21 CFR 868.2600 - Airway pressure monitor.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Airway pressure monitor. 868.2600 Section 868.2600...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2600 Airway pressure monitor. (a) Identification. An airway pressure monitor is a device used to measure the pressure in a patient's upper...

  15. 21 CFR 868.2600 - Airway pressure monitor.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Airway pressure monitor. 868.2600 Section 868.2600...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Monitoring Devices § 868.2600 Airway pressure monitor. (a) Identification. An airway pressure monitor is a device used to measure the pressure in a patient's upper...

  16. 21 CFR 868.1780 - Inspiratory airway pressure meter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Inspiratory airway pressure meter. 868.1780... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1780 Inspiratory airway pressure meter. (a) Identification. An inspiratory airway pressure meter is a device used to measure the...

  17. 21 CFR 868.1780 - Inspiratory airway pressure meter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Inspiratory airway pressure meter. 868.1780... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1780 Inspiratory airway pressure meter. (a) Identification. An inspiratory airway pressure meter is a device used to measure the...

  18. Allocating Variability and Reserve Requirements (Presentation)

    SciTech Connect

    Kirby, B.; King, J.; Milligan, M.

    2011-10-01

    This presentation describes how you could conceivably allocate variability and reserve requirements, including how to allocate aggregation benefits. Conclusions of this presentation are: (1) Aggregation provides benefits because individual requirements are not 100% correlated; (2) Method needed to allocate reduced requirement among participants; (3) Differences between allocation results are subtle - (a) Not immediately obvious which method is 'better'; (b) Many are numerically 'correct', they sum to the physical requirement; (c) Many are not 'fair', Results depend on sub-aggregation and/or the order individuals are included; and (4) Vector allocation method is simple and fair.

  19. Cost-Effectiveness and Educational Policy.

    ERIC Educational Resources Information Center

    Levin, Henry M.

    1988-01-01

    Techniques of cost-effectiveness analysis and their applications to educational policy are discussed. Recommendations are made to increase the capacity of evaluators, policy analysts, and decision makers to use these tools appropriately for resource allocation. (SLD)

  20. 40 CFR 96.53 - Recordation of NOX allowance allocations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... PROGRAMS (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE... allocated to an allocation set-aside. (c) Serial numbers for allocated NO X allowances. When allocating...

  1. 40 CFR 96.53 - Recordation of NOX allowance allocations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PROGRAMS (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO 2 TRADING PROGRAMS FOR STATE... allocated to an allocation set-aside. (c) Serial numbers for allocated NO X allowances. When allocating...

  2. 45 CFR 402.31 - Determination of allocations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... ASSISTANCE GRANTS State Allocations § 402.31 Determination of allocations. (a) Allocation formula. Allocations will be computed according to a formula using the following factors and weights: (1) 50...

  3. 45 CFR 402.31 - Determination of allocations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... State Allocations § 402.31 Determination of allocations. (a) Allocation formula. Allocations will be computed according to a formula using the following factors and weights: (1) 50 percent based on the...

  4. Time Allocation in Primary Care Office Visits

    PubMed Central

    Tai-Seale, Ming; McGuire, Thomas G; Zhang, Weimin

    2007-01-01

    Objectives To use an innovative videotape analysis method to examine how clinic time was spent during elderly patients' visits to primary care physicians. Secondary objectives were to identify the factors that influence time allocations. Data Sources A convenience sample of 392 videotapes of routine office visits conducted between 1998 and 2000 from multiple primary care practices in the United States, supplemented by patient and physician surveys. Research Design Videotaped visits were examined for visit length and time devoted to specific topics—a novel approach to study time allocation. A survival analysis model analyzed the effects of patient, physician, and physician practice setting on how clinic time was spent. Principal Findings Very limited amount of time was dedicated to specific topics in office visits. The median visit length was 15.7 minutes covering a median of six topics. About 5 minutes were spent on the longest topic whereas the remaining topics each received 1.1 minutes. While time spent by patient and physician on a topic responded to many factors, length of the visit overall varied little even when contents of visits varied widely. Macro factors associated with each site had more influence on visit and topic length than the nature of the problem patients presented. Conclusions Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient–physician interactions. PMID:17850524

  5. From Theory to Practice: Implementation of a Resource Allocation Model in Health Departments

    PubMed Central

    Yaylali, Emine; Farnham, Paul G.; Schneider, Karen L.; Landers, Stewart J.; Kouzouian, Oskian; Lasry, Arielle; Purcell, David W.; Green, Timothy A.; Sansom, Stephanie L.

    2016-01-01

    Objective To develop a resource allocation model to optimize health departments’ Centers for Disease Control and Prevention (CDC)–funded HIV prevention budgets to prevent the most new cases of HIV infection and to evaluate the model’s implementation in 4 health departments. Design, Settings, and Participants We developed a linear programming model combined with a Bernoulli process model that allocated a fixed budget among HIV prevention interventions and risk subpopulations to maximize the number of new infections prevented. The model, which required epidemiologic, behavioral, budgetary, and programmatic data, was implemented in health departments in Philadelphia, Chicago, Alabama, and Nebraska. Main Outcome Measures The optimal allocation of funds, the site-specific cost per case of HIV infection prevented rankings by intervention, and the expected number of HIV cases prevented. Results The model suggested allocating funds to HIV testing and continuum-of-care interventions in all 4 health departments. The most cost-effective intervention for all sites was HIV testing in nonclinical settings for men who have sex with men, and the least cost-effective interventions were behavioral interventions for HIV-negative persons. The pilot sites required 3 to 4 months of technical assistance to develop data inputs and generate and interpret the results. Although the sites found the model easy to use in providing quantitative evidence for allocating HIV prevention resources, they criticized the exclusion of structural interventions and the use of the model to allocate only CDC funds. Conclusions Resource allocation models have the potential to improve the allocation of limited HIV prevention resources and can be used as a decision-making guide for state and local health departments. Using such models may require substantial staff time and technical assistance. These model results emphasize the allocation of CDC funds toward testing and continuum-of-care interventions and

  6. 24 CFR 92.212 - Pre-award costs.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... the time the costs are charged to the HOME allocation. (b) Administrative and planning costs. Eligible... consolidated program year (see 24 CFR 91.10) or the date the consolidated plan describing the HOME allocation...) and, if applicable, 24 CFR 91.320(g)(2) (States). The mini-action plan must state that HOME...

  7. 24 CFR 92.212 - Pre-award costs.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... the time the costs are charged to the HOME allocation. (b) Administrative and planning costs. Eligible... consolidated program year (see 24 CFR 91.10) or the date the consolidated plan describing the HOME allocation...) and, if applicable, 24 CFR 91.320(g)(2) (States). The mini-action plan must state that HOME...

  8. 24 CFR 92.212 - Pre-award costs.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... the time the costs are charged to the HOME allocation. (b) Administrative and planning costs. Eligible... consolidated program year (see 24 CFR 91.10) or the date the consolidated plan describing the HOME allocation...) and, if applicable, 24 CFR 91.320(g)(2) (States). The mini-action plan must state that HOME...

  9. Resource allocation to kin, friends, and strangers by 3- to 6-year-old children.

    PubMed

    Lu, Hui Jing; Chang, Lei

    2016-10-01

    Kin altruism has been widely observed across species, including humans. However, few studies have discussed the development of kin altruism or its relationship with theory of mind. In this study, 3- to 6-year-old children allocated resources between themselves and kin, a friend, or a stranger in three allocation tasks where the allocation either incurred a cost, incurred no cost, or conferred a disadvantage. The results showed that, compared with 3- and 4-year-olds, 5- and 6-year-olds acted more altruistically toward kin and that kin altruism was uncorrelated with theory of mind. These findings suggest that, within the context of resource allocation, kin altruism emerges toward the end of early childhood and probably differs from other prosocial behavior that relies solely on the understanding of others' perspectives.

  10. Resource allocation to kin, friends, and strangers by 3- to 6-year-old children.

    PubMed

    Lu, Hui Jing; Chang, Lei

    2016-10-01

    Kin altruism has been widely observed across species, including humans. However, few studies have discussed the development of kin altruism or its relationship with theory of mind. In this study, 3- to 6-year-old children allocated resources between themselves and kin, a friend, or a stranger in three allocation tasks where the allocation either incurred a cost, incurred no cost, or conferred a disadvantage. The results showed that, compared with 3- and 4-year-olds, 5- and 6-year-olds acted more altruistically toward kin and that kin altruism was uncorrelated with theory of mind. These findings suggest that, within the context of resource allocation, kin altruism emerges toward the end of early childhood and probably differs from other prosocial behavior that relies solely on the understanding of others' perspectives. PMID:27336694

  11. Reactive airways dysfunction syndrome. Case reports of persistent airways hyperreactivity following high-level irritant exposures.

    PubMed

    Brooks, S M; Weiss, M A; Bernstein, I L

    1985-07-01

    Two individuals developed an asthma-like illness after a single exposure to high levels of an irritating aerosol, vapor, fume, or smoke. Symptoms developed within a few hours. A consistent physiologic accompaniment was airways hyperreactivity, with the two subjects showing positive methacholine challenge tests. No documented preexisting respiratory illness was identified, nor did subjects relate past respiratory complaints. Respiratory symptoms and airways hyperreactivity persisted for at least four years after the incident. The incriminated etiologic agents all shared a common characteristic of being irritant in nature. Bronchial biopsy specimens showed an airways inflammatory response. This report suggests that acute high-level irritant exposures may produce an asthma-like syndrome in some individuals, with long-term sequelae and chronic airways disease. Nonimmunologic mechanisms seems to be operative in the pathogenesis of this syndrome.

  12. Wind Integration Cost and Cost-Causation: Preprint

    SciTech Connect

    Milligan, M.; Kirby, B.; Holttinen, H.; Kiviluoma, J.; Estanqueiro, A.; Martin-Martinez, S.; Gomez-Lazaro, E.; Peneda, I.; Smith, C.

    2013-10-01

    The question of wind integration cost has received much attention in the past several years. The methodological challenges to calculating integration costs are discussed in this paper. There are other sources of integration cost unrelated to wind energy. A performance-based approach would be technology neutral, and would provide price signals for all technology types. However, it is difficult to correctly formulate such an approach. Determining what is and is not an integration cost is challenging. Another problem is the allocation of system costs to one source. Because of significant nonlinearities, this can prove to be impossible to determine in an accurate and objective way.

  13. Optimization of reliability allocation strategies through use of genetic algorithms

    SciTech Connect

    Campbell, J.E.; Painton, L.A.

    1996-08-01

    This paper examines a novel optimization technique called genetic algorithms and its application to the optimization of reliability allocation strategies. Reliability allocation should occur in the initial stages of design, when the objective is to determine an optimal breakdown or allocation of reliability to certain components or subassemblies in order to meet system specifications. The reliability allocation optimization is applied to the design of a cluster tool, a highly complex piece of equipment used in semiconductor manufacturing. The problem formulation is presented, including decision variables, performance measures and constraints, and genetic algorithm parameters. Piecewise ``effort curves`` specifying the amount of effort required to achieve a certain level of reliability for each component of subassembly are defined. The genetic algorithm evolves or picks those combinations of ``effort`` or reliability levels for each component which optimize the objective of maximizing Mean Time Between Failures while staying within a budget. The results show that the genetic algorithm is very efficient at finding a set of robust solutions. A time history of the optimization is presented, along with histograms or the solution space fitness, MTBF, and cost for comparative purposes.

  14. Efficient Resource Allocation for Multiclass Services in Multiuser OFDM Systems

    NASA Astrophysics Data System (ADS)

    Lee, Jae Soong; Lee, Jae Young; Lee, Soobin; Lee, Hwang Soo

    Although each application has its own quality of service (QoS) requirements, the resource allocation for multiclass services has not been studied adequately in multiuser orthogonal frequency division multiplexing (OFDM) systems. In this paper, a total transmit power minimization problem for downlink transmission is examined while satisfying multiclass services consisting of different data rates and target bit-error rates (BER). Lagrangian relaxation is used to find an optimal subcarrier allocation criterion in the context of subcarrier time-sharing by all users. We suggest an iterative algorithm using this criterion to find the upper and lower bounds of optimal power consumption. We also propose a prioritized subcarrier allocation (PSA) algorithm that provides low computation cost and performance very close to that of the iterative algorithm. The PSA algorithm employs subcarrier selection order (SSO) in order to decide which user takes its best subcarrier first over other users. The SSO is determined by the data rates, channel gain, and target BER of each user. The proposed algorithms are simulated in various QoS parameters and the fading channel model. Furthermore, resource allocation is performed not only subcarrier by subcarrier but also frequency block by frequency block (comprises several subcarriers). These extensive simulation environments provide a more complete assessment of the proposed algorithms. Simulation results show that the proposed algorithms significantly outperform existing algorithms in terms of total transmit power consumption.

  15. 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

  16. Complications of upper airway surgery in companion animals.

    PubMed

    Mercurio, Andrew

    2011-09-01

    Surgery of the upper airway is performed in dogs for the correction of brachycephalic airway syndrome and laryngeal paralysis and for temporary or permanent tracheostomy. Although technically simple to perform, upper airway surgeries can lead to the development of significant postoperative complications. This article reviews complications associated with common surgical conditions of the upper airway. It involves a discussion of brachycephalic airway syndrome and associated respiratory and gastrointestinal complications. It also covers laryngeal paralysis with a focus on unilateral arytenoid lateralization and the complication of aspiration pneumonia. The condition of acquired laryngeal webbing/stenosis and potential treatment options is also discussed. Finally, tracheostomies and associated complications in dogs and cats are reviewed.

  17. Anaesthesia and airway management in mucopolysaccharidosis.

    PubMed

    Walker, Robert; Belani, Kumar G; Braunlin, Elizabeth A; Bruce, Iain A; Hack, Henrik; Harmatz, Paul R; Jones, Simon; Rowe, Richard; Solanki, Guirish A; Valdemarsson, Barbara

    2013-03-01

    This paper provides a detailed overview and discussion of anaesthesia in patients with mucopolysaccharidosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical manifestations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardiovascular manifestations poses a high anaesthetic risk to these patients. Typical anaesthetic problems include airway obstruction after induction or extubation, intubation difficulties or failure [can't intubate, can't ventilate (CICV)], possible emergency tracheostomy and cardiovascular and cervical spine issues. Because of the high anaesthetic risk, the benefits of a procedure in patients with MPS should always be balanced against the associated risks. Therefore, careful evaluation of anaesthetic risk factors should be made before the procedure, involving evaluation of airways and cardiorespiratory and cervical spine problems. In addition, information on the specific type of MPS, prior history of anaesthesia, presence of cervical instability and range of motion of the temporomandibular joint are important and may be pivotal to prevent complications during anaesthesia. Knowledge of these risk factors allows the anaesthetist to anticipate potential problems that may arise during or after the procedure. Anaesthesia in MPS patients should be preferably done by an experienced (paediatric) anaesthetist, supported by a multidisciplinary team (ear, nose, throat surgeon and intensive care team), with access to all necessary equipment and support.

  18. Nasal Airway Resistance: Its Measurement and Regulation.

    ERIC Educational Resources Information Center

    Hamilton, Lyle H.

    1979-01-01

    Reviews studies of regulation of nasal airway resistance (Rn). Describes methods of calculating Rn by measuring pressure-flow relationship. Data are presented on improved methods for measuring Rn and effects for expiratory and inspiratory Rn after topical application of phenylephrine nasal decongestant spray. (Author/SA)

  19. 21 CFR 868.5810 - Airway connector.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5810 Airway connector. (a) Identification. An... tube, or mask. (b) Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 868.9....

  20. Severe upper airway obstruction during sleep.

    PubMed

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  1. Reproducibility of airway wall thickness measurements

    NASA Astrophysics Data System (ADS)

    Schmidt, Michael; Kuhnigk, Jan-Martin; Krass, Stefan; Owsijewitsch, Michael; de Hoop, Bartjan; Peitgen, Heinz-Otto

    2010-03-01

    Airway remodeling and accompanying changes in wall thickness are known to be a major symptom of chronic obstructive pulmonary disease (COPD), associated with reduced lung function in diseased individuals. Further investigation of this disease as well as monitoring of disease progression and treatment effect demand for accurate and reproducible assessment of airway wall thickness in CT datasets. With wall thicknesses in the sub-millimeter range, this task remains challenging even with today's high resolution CT datasets. To provide accurate measurements, taking partial volume effects into account is mandatory. The Full-Width-at-Half-Maximum (FWHM) method has been shown to be inappropriate for small airways1,2 and several improved algorithms for objective quantification of airway wall thickness have been proposed.1-8 In this paper, we describe an algorithm based on a closed form solution proposed by Weinheimer et al.7 We locally estimate the lung density parameter required for the closed form solution to account for possible variations of parenchyma density between different lung regions, inspiration states and contrast agent concentrations. The general accuracy of the algorithm is evaluated using basic tubular software and hardware phantoms. Furthermore, we present results on the reproducibility of the algorithm with respect to clinical CT scans, varying reconstruction kernels, and repeated acquisitions, which is crucial for longitudinal observations.

  2. Airway epithelial cell responses to ozone injury

    SciTech Connect

    Leikauf, G.D.; Simpson, L.G.; Zhao, Qiyu

    1995-03-01

    The airway epithelial cell is an important target in ozone injury. Once activated, the airway epithelium responds in three phases. The initial, or immediate phase, involves activation of constitutive cells, often through direct covalent interactions including the formation of secondary ozonolysis products-hydroxyhydroperoxides, aldehydes, and hydrogen peroxide. Recently, we found hydroxyhydroperoxides to be potent agonists; of bioactive eicosanoid formation by human airway epithelial cells in culture. Other probable immediate events include activation and inactivation of enzymes present on the epithelial surface (e.g., neutral endopeptidase). During the next 2 to 24 hr, or early phase, epithelial cells respond by synthesis and release of chemotactic factors, including chemokines-macrophage inflammatory protein-2, RANTES, and interleukin-8. Infiltrating leukocytes during this period also release elastase, an important agonist of epithelial cell mucus secretion and additional chemokine formation. The third (late) phase of ozone injury is characterized by eosinophil or monocyte infiltration. Cytokine expression leads to alteration of structural protein synthesis, with increases in fibronectin evident by in situ hybridization. Synthesis of epithelial antiproteases, e.g., secretary leukocyte protease inhibitor, may also increase locally 24 to 48 hr after elastase concentrations become excessive. Thus, the epithelium is not merely a passive barrier to ozone injury but has a dynamic role in directing the migration, activating, and then counteracting inflammatory cells. Through these complex interactions, epithelial cells can be viewed as the initiators (alpha) and the receptors (omega) of ozone-induced airway disease. 51 refs., 2 figs., 3 tabs.

  3. COLCHICINE DECREASES AIRWAY HYPERACTIVITY AFTER PHOSGENE EXPOSURE

    EPA Science Inventory

    Phosgene (COCl(2)) exposure affects an influx of inflammatory cells into the lung, which can be reduced in an animal model by pretreatment with colchicine. Inflammation in the respiratory tract can be associated with an increase in airway hyperreactivity. We tested the hypotheses...

  4. Difficult airway in Mowat-Wilson syndrome.

    PubMed

    Packiasabapathy, Senthil; Chandiran, Ravindran; Batra, Ravinder K; Agarwala, Sandeep

    2016-11-01

    Mowat-Wilson syndrome is a rare congenital syndrome involving multiple system abnormalities. The most consistently present components include facial deformity, mental retardation, and Hirschsprung disease. We report the anesthetic management of a case of Mowat-Wilson syndrome, with a difficult airway, who underwent Duhamel's procedure and colostomy closure. PMID:27687363

  5. Volatile Organic Compounds Contribute to Airway Hyperresponsiveness

    PubMed Central

    Jang, An-Soo; Choi, Inseon-S; Koh, Young-Il

    2007-01-01

    Background Volatile organic compounds (VOCs) in concentrations found in both the work and home environments may influence lung function. We investigated the prevalence of airway responsiveness in workers exposed to VOCs. Methods We used allergic skin tests, nonspecific airway hyperresponsiveness testing and questionnaires to study twenty exposed workers and twenty-seven control subjects. Atopy was defined as a reactor who showed >3+ response to one or more allergens on the skin prick tests. Airway hyperresponsiveness (BRindex) was defined as log [% fall of FEV1/ log (last concentration of methacholine) +10]. Results The VOC exposed workers, in comparison with the control subjects, tended to have a higher BRindex (1.19±0.07 vs. 1.15±0.08, respectively). Workers exposed to VOCs with atopy or smoker, as compared with the workers exposed to VOCs with non-atopy and who were non-smokers and the control subjects with non-atopy and who were non-smokers, had a significantly higher BRindex (1.20±0.05 vs. 1.14±0.06 vs. 1.10±0.03, respectively p<0.05). The BRindex was not correlated with atopy, the smoking status or the duration of VOC exposure. Conclusions These findings suggest that VOCs may act as a contributing factor of airway hyperresponsiveness in workers exposed to VOCs. PMID:17427638

  6. Cell Jamming in the Airway Epithelium.

    PubMed

    Park, Jin-Ah; Fredberg, Jeffrey J

    2016-03-01

    Hallmarks of asthma include chronic airway inflammation, progressive airway remodeling, and airway hyperresponsiveness. The initiation and perpetuation of these processes are attributable at least in part to critical events within the airway epithelium, but the underlying mechanisms remain poorly understood. New evidence now suggests that epithelial cells derived from donors without asthma versus donors with asthma, even in the absence of inflammatory cells or mediators, express modes of collective migration that innately differ not only in the amount of migration but also in the kind of migration. The maturing cell layer tends to undergo a transition from a hypermobile, fluid-like, unjammed phase in which cells readily rearrange, exchange places, and flow, to a quiescent, solid-like, jammed phase in which cells become virtually frozen in place. Moreover, the unjammed phase defines a phenotype that can be perpetuated by the compressive stresses caused by bronchospasm. Importantly, in cells derived from donors with asthma versus donors without asthma, this jamming transition becomes substantially delayed, thus suggesting an immature or dysmature epithelial phenotype in asthma. PMID:27027955

  7. 10 CFR 217.53 - Types of allocation orders.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Types of allocation orders. 217.53 Section 217.53 Energy DEPARTMENT OF ENERGY OIL ENERGY PRIORITIES AND ALLOCATIONS SYSTEM Allocation Actions § 217.53 Types of allocation orders. There are three types of allocation orders available for communicating allocation...

  8. Resource allocation using constraint propagation

    NASA Technical Reports Server (NTRS)

    Rogers, John S.

    1990-01-01

    The concept of constraint propagation was discussed. Performance increases are possible with careful application of these constraint mechanisms. The degree of performance increase is related to the interdependence of the different activities resource usage. Although this method of applying constraints to activities and resources is often beneficial, it is obvious that this is no panacea cure for the computational woes that are experienced by dynamic resource allocation and scheduling problems. A combined effort for execution optimization in all areas of the system during development and the selection of the appropriate development environment is still the best method of producing an efficient system.

  9. [Quality assurance in airway management: education and training for difficult airway management].

    PubMed

    Kaminoh, Yoshiroh

    2006-01-01

    Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently. PMID:16440705

  10. 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.

  11. Estimation of airway obstruction using oximeter plethysmograph waveform data

    PubMed Central

    Arnold, Donald H; Spiro, David M; Desmond, Renee' A; Hagood, James S

    2005-01-01

    Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases. PMID:15985171

  12. Postnatal growth of tracheobronchial airways of Sprague–Dawley rats

    PubMed Central

    Lee, DongYoub; Srirama, Praveen K; Wallis, Christopher; Wexler, Anthony S

    2011-01-01

    Rats are widely used for the studies of pulmonary toxicology in both juveniles and adults. To facilitate such studies, investigators have developed models of lung architecture based on manual or computerized airway measurements. However, postnatal growth of conducting airways of rat lungs has never been reported. In this paper, we present conducting airway architecture statistics for male Sprague–Dawley rat lungs at ages 15, 28, 40, and 81 days by analyzing CT images from airway silicon casts. Detailed branching characteristics and intersubject variance are presented. This study shows that (i) airway growth in diameter and length is not linear with age, (ii) growth of airway length is faster than that of diameter during the 15–81-day postnatal period, and (iii) asymmetry in airway diameter (ratio of major to minor daughter diameter) increases with age. PMID:21534951

  13. [Clinical basics of supraglottic airway management in paediatric anaesthesia].

    PubMed

    Goldmann, Kai

    2013-04-01

    The low invasiveness and simplicity of use of the LMA-Classic™ contributed substantially to the supraglottic airway management acquiring a special role in the anaesthesia care of neonates and children. Due to the introduction of new supraglottic airway devices and the expansion of indications, this form of airway management has a predominant role in paediatric anaesthesia in many institutions nowadays. As securing the airway "above the glottis" differs substantially in some aspects from securing the airway using the endotracheal tube it is mandatory to acknowledge special aspects in routine clinical practice in order to avoid complications. The following article describes basic aspects of supraglottic airway management in paediatric anaesthesia and illustrates, where possible, the available scientific evidence in the use of different supraglottic airway devices in this regard. PMID:23633257

  14. [Airway Management in a Patient with Forestier's Disease].

    PubMed

    Kondo, Yuriko; Echigo, Noriyuki; Akata, Mariko; Yokoyama, Kaori; Takasugi, Naoya; Goto, Takahisa

    2016-04-01

    Airway management in a patient with Forestier's disease can be challenging clinically because this disease may cause not only dysphagia but also airway obstruction due to the compression of the pharynx and esophagus caused by the ossification of anterior longitudinal ligament. We report our anesthetic management in a patient with Forestier's disease. Meanwhile, we studied the causes of difficult airway and the most suitable airway device for a patient with this disease from a standpoint of anatomy of upper airway. Our study indicated the possibility that the most suitable airway device differed depending on the actual location of the ossification of anterior longitudinal ligament in the cervical spine and that more prudent airway management would be required if its lesion location extended to upper cervical spine. PMID:27188118

  15. BLUNTING AIRWAYS EOSINOPHILIC INFLAMMATION RESULTS IN A DECREASED AIRWAY NEUTROPHIL RESPONSE TO INHALED LPS IN ATOPIC ASTHMATICS A ROLE FOR CD-14

    EPA Science Inventory

    Recent data demonstrate that atopic inflammation might enhance airway responses to inhaled LPS in individuals with atopic asthma by increasing CD14 expression on airway macrophages. We sought to determine whether blunting airway eosinophilic inflammation decreases CD14 expressio...

  16. Optimal Resource Allocation in Electrical Network Defense

    SciTech Connect

    Yao, Y; Edmunds, T; Papageorgiou, D; Alvarez, R

    2004-01-15

    Infrastructure networks supplying electricity, natural gas, water, and other commodities are at risk of disruption due to well-engineered and coordinated terrorist attacks. Countermeasures such as hardening targets, acquisition of spare critical components, and surveillance can be undertaken to detect and deter these attacks. Allocation of available countermeasures resources to sites or activities in a manner that maximizes their effectiveness is a challenging problem. This allocation must take into account the adversary's response after the countermeasure assets are in place and consequence mitigation measures the infrastructure operation can undertake after the attack. The adversary may simply switch strategies to avoid countermeasures when executing the attack. Stockpiling spares of critical energy infrastructure components has been identified as a key element of a grid infrastructure defense strategy in a recent National Academy of Sciences report [1]. Consider a scenario where an attacker attempts to interrupt the service of an electrical network by disabling some of its facilities while a defender wants to prevent or minimize the effectiveness of any attack. The interaction between the attacker and the defender can be described in three stages: (1) The defender deploys countermeasures, (2) The attacker disrupts the network, and (3) The defender responds to the attack by rerouting power to maintain service while trying to repair damage. In the first stage, the defender considers all possible attack scenarios and deploys countermeasures to defend against the worst scenarios. Countermeasures can include hardening targets, acquiring spare critical components, and installing surveillance devices. In the second stage, the attacker, with full knowledge of the deployed countermeasures, attempts to disable some nodes or links in the network to inflict the greatest loss on the defender. In the third stage, the defender re-dispatches power and restores disabled nodes or

  17. Latent IBP Compound Dirichlet Allocation.

    PubMed

    Archambeau, Cedric; Lakshminarayanan, Balaji; Bouchard, Guillaume

    2015-02-01

    We introduce the four-parameter IBP compound Dirichlet process (ICDP), a stochastic process that generates sparse non-negative vectors with potentially an unbounded number of entries. If we repeatedly sample from the ICDP we can generate sparse matrices with an infinite number of columns and power-law characteristics. We apply the four-parameter ICDP to sparse nonparametric topic modelling to account for the very large number of topics present in large text corpora and the power-law distribution of the vocabulary of natural languages. The model, which we call latent IBP compound Dirichlet allocation (LIDA), allows for power-law distributions, both, in the number of topics summarising the documents and in the number of words defining each topic. It can be interpreted as a sparse variant of the hierarchical Pitman-Yor process when applied to topic modelling. We derive an efficient and simple collapsed Gibbs sampler closely related to the collapsed Gibbs sampler of latent Dirichlet allocation (LDA), making the model applicable in a wide range of domains. Our nonparametric Bayesian topic model compares favourably to the widely used hierarchical Dirichlet process and its heavy tailed version, the hierarchical Pitman-Yor process, on benchmark corpora. Experiments demonstrate that accounting for the power-distribution of real data is beneficial and that sparsity provides more interpretable results. PMID:26353244

  18. 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...

  19. A clinical pilot study: high frequency chest wall oscillation airway clearance in patients with amyotrophic lateral sclerosis.

    PubMed

    Chaisson, Kathleen Marya; Walsh, Susan; Simmons, Zachary; Vender, Robert L

    2006-06-01

    Respiratory complications are common in patients with amyotrophic lateral sclerosis (ALS) with respiratory failure representing the most common cause of death. Ineffective airway clearance resultant from deficient cough frequently contributes to these abnormalities. We sought to evaluate the effectiveness of high frequency chest wall oscillation (HFCWO) administered through the Vest Airway Clearance System when added to standard care in preventing pulmonary complications and prolonging the time to death in patients with ALS. This is a single center study performed at the Penn State Milton S. Hershey Medical Center (HMC). Nine patients with a diagnosis of ALS and concurrently receiving non-invasive ventilatory support with bi-level positive airway pressure (BiPAP) were recruited from the outpatient clinic at HMC. Four patients were randomized to receive standard care and five patients to receive standard care plus the addition of HFCWO administered twice-daily for 15 min duration. Longitudinal assessments of oxyhemoglobin saturation, forced vital capacity (FVC), and adverse events were obtained until time of death. Pulmonary complications of atelectasis, pneumonia, hospitalization for a respiratory-related abnormality, and tracheostomy with mechanical ventilation were monitored throughout the study duration. No differences were observed between treatment groups in relation to the rate of decline in FVC. The addition of HFCWO airway clearance failed to improve time to death compared to standard treatment alone (340 days +/- 247 vs. 470 days +/- 241; p = 0.26). The random allocation of HFCWO airway clearance to patients with ALS concomitantly receiving BiPAP failed to attain any significant clinical benefits in relation to either loss of lung function or mortality. This study does not exclude the potential benefit of HFCWO in select patients with ALS who have coexistent pulmonary diseases, pre-existent mucus-related pulmonary complications, or less severe levels of

  20. Pim1 kinase protects airway epithelial cells from cigarette smoke-induced damage and airway inflammation.

    PubMed

    de Vries, M; Heijink, I H; Gras, R; den Boef, L E; Reinders-Luinge, M; Pouwels, S D; Hylkema, M N; van der Toorn, M; Brouwer, U; van Oosterhout, A J M; Nawijn, M C

    2014-08-01

    Exposure to cigarette smoke (CS) is the main risk factor for developing chronic obstructive pulmonary disease and can induce airway epithelial cell damage, innate immune responses, and airway inflammation. We hypothesized that cell survival factors might decrease the sensitivity of airway epithelial cells to CS-induced damage, thereby protecting the airways against inflammation upon CS exposure. Here, we tested whether Pim survival kinases could protect from CS-induced inflammation. We determined expression of Pim kinases in lung tissue, airway inflammation, and levels of keratinocyte-derived cytokine (KC) and several damage-associated molecular patterns in bronchoalveolar lavage in mice exposed to CS or air. Human bronchial epithelial BEAS-2B cells were treated with CS extract (CSE) in the presence or absence of Pim1 inhibitor and assessed for loss of mitochondrial membrane potential, induction of cell death, and release of heat shock protein 70 (HSP70). We observed increased expression of Pim1, but not of Pim2 and Pim3, in lung tissue after exposure to CS. Pim1-deficient mice displayed a strongly enhanced neutrophilic airway inflammation upon CS exposure compared with wild-type controls. Inhibition of Pim1 activity in BEAS-2B cells increased the loss of mitochondrial membrane potential and reduced cell viability upon CSE treatment, whereas release of HSP70 was enhanced. Interestingly, we observed release of S100A8 but not of double-strand DNA or HSP70 in Pim1-deficient mice compared with wild-type controls upon CS exposure. In conclusion, we show that expression of Pim1 protects against CS-induced cell death in vitro and neutrophilic airway inflammation in vivo. Our data suggest that the underlying mechanism involves CS-induced release of S100A8 and KC. PMID:24816488