A Survey of Cost Estimating Methodologies for Distributed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Foreman, Veronica; Le Moigne, Jacqueline; de Weck, Oliver

2016-01-01

Satellite constellations present unique capabilities and opportunities to Earth orbiting and near-Earth scientific and communications missions, but also present new challenges to cost estimators. An effective and adaptive cost model is essential to successful mission design and implementation, and as Distributed Spacecraft Missions (DSM) become more common, cost estimating tools must become more representative of these types of designs. Existing cost models often focus on a single spacecraft and require extensive design knowledge to produce high fidelity estimates. Previous research has examined the shortcomings of existing cost practices as they pertain to the early stages of mission formulation, for both individual satellites and small satellite constellations. Recommendations have been made for how to improve the cost models for individual satellites one-at-a-time, but much of the complexity in constellation and DSM cost modeling arises from constellation systems level considerations that have not yet been examined. This paper constitutes a survey of the current state-of-the-art in cost estimating techniques with recommendations for improvements to increase the fidelity of future constellation cost estimates. To enable our investigation, we have developed a cost estimating tool for constellation missions. The development of this tool has revealed three high-priority weaknesses within existing parametric cost estimating capabilities as they pertain to DSM architectures: design iteration, integration and test, and mission operations. Within this paper we offer illustrative examples of these discrepancies and make preliminary recommendations for addressing them. DSM and satellite constellation missions are shifting the paradigm of space-based remote sensing, showing promise in the realms of Earth science, planetary observation, and various heliophysical applications. To fully reap the benefits of DSM technology, accurate and relevant cost estimating capabilities must exist; this paper offers insights critical to the future development and implementation of DSM cost estimating tools.

A Survey of Cost Estimating Methodologies for Distributed Spacecraft Missions

NASA Technical Reports Server (NTRS)

Foreman, Veronica L.; Le Moigne, Jacqueline; de Weck, Oliver

2016-01-01

Satellite constellations present unique capabilities and opportunities to Earth orbiting and near-Earth scientific and communications missions, but also present new challenges to cost estimators. An effective and adaptive cost model is essential to successful mission design and implementation, and as Distributed Spacecraft Missions (DSM) become more common, cost estimating tools must become more representative of these types of designs. Existing cost models often focus on a single spacecraft and require extensive design knowledge to produce high fidelity estimates. Previous research has examined the limitations of existing cost practices as they pertain to the early stages of mission formulation, for both individual satellites and small satellite constellations. Recommendations have been made for how to improve the cost models for individual satellites one-at-a-time, but much of the complexity in constellation and DSM cost modeling arises from constellation systems level considerations that have not yet been examined. This paper constitutes a survey of the current state-of-theart in cost estimating techniques with recommendations for improvements to increase the fidelity of future constellation cost estimates. To enable our investigation, we have developed a cost estimating tool for constellation missions. The development of this tool has revealed three high-priority shortcomings within existing parametric cost estimating capabilities as they pertain to DSM architectures: design iteration, integration and test, and mission operations. Within this paper we offer illustrative examples of these discrepancies and make preliminary recommendations for addressing them. DSM and satellite constellation missions are shifting the paradigm of space-based remote sensing, showing promise in the realms of Earth science, planetary observation, and various heliophysical applications. To fully reap the benefits of DSM technology, accurate and relevant cost estimating capabilities must exist; this paper offers insights critical to the future development and implementation of DSM cost estimating tools.

Rough sets and Laplacian score based cost-sensitive feature selection

PubMed Central

Yu, Shenglong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of “good” features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms. PMID:29912884

Rough sets and Laplacian score based cost-sensitive feature selection.

PubMed

Yu, Shenglong; Zhao, Hong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of "good" features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms.

Solar Power Satellites

NASA Technical Reports Server (NTRS)

Kraft, C. C., Jr.

1977-01-01

A satellite based energy concept is described, including the advantages of the basic concept, system characteristics, cost, and environmental considerations. An outline of a plan for the further evaluation and implementation of the system is given. It is concluded that the satellite concept is competitive with other advanced power generation systems when a variety of factors are considered, including technical feasibility, cost, safety, natural resources, environment, baseload capability, location flexibility, land use, and existing industrial base for implementation.

"Supra-Institutional Research": A Cost-Effective Contribution towards Enhancement

ERIC Educational Resources Information Center

Yorke, Mantz

2010-01-01

Relatively inexpensive studies that go beyond the boundaries of individual institutions have considerable attraction, particularly at a time when resources are under significant constraint. These studies can be viewed as existing under the rather larger umbrella of "supra-institutional research". Three examples illustrate the argument…

THROUGH CABLE TO CLASSROOM, A GUIDE TO ITV DISTRIBUTION SYSTEMS.

ERIC Educational Resources Information Center

LEWIS, WILLIAM C.

THE BENEFITS OF MASTER ANTENNA TELEVISION SYSTEMS (HAVING CENTRAL ANTENNA AND AMPLIFIERS WITH CABLE CONNECTIONS TO CLASSROOM) ARE DISCUSSED WITH RESPECT TO OTHER SYSTEMS OF CLASSROOM TELEVISION. INCLUDED ARE COST CONSIDERATIONS, NEED DETERMINATION, SCHOOL DESIGN, UTILIZATION OF EXISTING EQUIPMENT, AND FUTURE DEVELOPMENTS. AN EXTENSIVE ILLUSTRATED…

Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease--a cost-effectiveness analysis.

PubMed

Wisløff, Torbjørn; Selmer, Randi M; Halvorsen, Sigrun; Fretheim, Atle; Norheim, Ole F; Kristiansen, Ivar Sønbø

2012-04-04

Hypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease. We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources. In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs. Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.

Conestoga 2: A low cost commercial space transport system

NASA Technical Reports Server (NTRS)

Rasmussen, R. O.

1984-01-01

Conestoga 2 is currently under development. It is capable of inserting 500 Kg satellites into 800 Km circular polar orbits. Conestoga 2 makes maximum use of existing (developed) technology and hardware. Its commercial objective is to fill a need for low cost low Earth orbital transport not efficiently served by Shuttle or larger space transport systems. Low Earth orbit markets, foreign participation, and launch site considerations are discussed along with technical and economic trade-offs.

Laser power beaming applications and technology

NASA Astrophysics Data System (ADS)

Burke, Robert J.; Cover, Ralph A.; Curtin, Mark S.; Dinius, R.; Lampel, Michael C.

1994-05-01

Beaming laser energy to spacecraft has important economic potential. It promises significant reduction in the cost of access to space, for commercial and government missions. While the potential payoff is attractive, existing technologies perform the same missions and the keys to market penetration for power beaming are a competitive cost and a schedule consistent with customers' plans. Rocketdyne is considering these questions in the context of a commercial enterprise -- thus, evaluation of the requirements must be done based on market assessments and recognition that significant private funding will be involved. It is in the context of top level business considerations that the technology requirements are being assessed and the program being designed. These considerations result in the essential elements of the development program. Since the free electron laser is regarded as the `long pole in the tent,' this paper summarizes Rocketdyne's approach for a timely, cost-effective program to demonstrate an FEL capable of supporting an initial operating capability.

76 FR 20088 - Amendment To Extend the Term of the Existing Enhanced-Use Lease (EUL) at the Department of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... determines that the implementation of a business plan proposed by the Under Secretary for Health for applying... property as a mixed-use property at no cost to VA. VA plans to use the additional lease consideration from...

Feasibility study of modifications to BQM-34E drone for NASA research applications

NASA Technical Reports Server (NTRS)

James, H. A.

1972-01-01

The feasibility of modifying an existing supersonic drone into a free-flight research vehicle is examined. Appropriate structural and control system modifications, reliability and operational considerations, and ROM costs indicate that the BQM-34E drone is indeed suitable as a NASA research vehicle.

40 CFR 230.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of a bottom surface area and any overlying volume of water. In the case of wetlands on which surface water is not present, the disposal site consists of the wetland surface area. (j) [Reserved] (k) The... available and capable of being done after taking into consideration cost, existing technology, and logistics...

40 CFR 230.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of a bottom surface area and any overlying volume of water. In the case of wetlands on which surface water is not present, the disposal site consists of the wetland surface area. (j) [Reserved] (k) The... available and capable of being done after taking into consideration cost, existing technology, and logistics...

40 CFR 230.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of a bottom surface area and any overlying volume of water. In the case of wetlands on which surface water is not present, the disposal site consists of the wetland surface area. (j) [Reserved] (k) The... available and capable of being done after taking into consideration cost, existing technology, and logistics...

40 CFR 230.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of a bottom surface area and any overlying volume of water. In the case of wetlands on which surface water is not present, the disposal site consists of the wetland surface area. (j) [Reserved] (k) The... available and capable of being done after taking into consideration cost, existing technology, and logistics...

Cost-Effectiveness Analysis for the "War on Poverty."

ERIC Educational Resources Information Center

Besen, Stanley M.; And Others

Two anti-poverty programs--investment in education and in highways and other public facilities--should increase earnings and employment through an increase in production possibilities and a fuller utilization of existing resources. In evaluating training programs, there is considerable evidence that training expenditures have a return at least…

Defining Operational Space Suit Requirements for Commercial Orbital Spaceflight

NASA Technical Reports Server (NTRS)

Alpert, Brian K.

2015-01-01

As the commercial spaceflight industry transitions from suborbital brevity to orbital outposts, spacewalking will become a major consideration for tourists, scientists, and hardware providers. The challenge exists to develop a space suit designed for the orbital commercial spaceflight industry. The unique needs and requirements of this industry will drive space suit designs and costs that are unlike any existing product. Commercial space tourists will pay for the experience of a lifetime, while scientists may not be able to rely on robotics for all operations and external hardware repairs. This study was aimed at defining space suit operational and functional needs across the spectrum of spacewalk elements, identifying technical design drivers and establishing appropriate options. Recommendations from the analysis are offered for consideration

Policy analysis for prenatal genetic diagnosis.

PubMed

Thompson, M; Milunsky, A

1979-01-01

Consideration of the analytic difficulties faced in estimating the benefits and costs of prenatal genetic diagnosis, coupled with a brief review of existing benefit-cost studies, leads to the conclusion that public subsidy of prenatal testing can yield benefits substantially in excess of costs. The practical obstacles to such programs include the attitudes of prospective parents, a lack of knowledge, monetary barriers, inadequately organized medical resources, and the political issue of abortion. Policy analysis can now nevertheless formulate principles and guide immediate actions to improve present utilization of prenatal testing and to facilitate possible future expansion of these diagnostic techniques.

Engine dynamic analysis with general nonlinear finite element codes

NASA Technical Reports Server (NTRS)

Adams, M. L.; Padovan, J.; Fertis, D. G.

1991-01-01

A general engine dynamic analysis as a standard design study computational tool is described for the prediction and understanding of complex engine dynamic behavior. Improved definition of engine dynamic response provides valuable information and insights leading to reduced maintenance and overhaul costs on existing engine configurations. Application of advanced engine dynamic simulation methods provides a considerable cost reduction in the development of new engine designs by eliminating some of the trial and error process done with engine hardware development.

Titanium fasteners. [for aircraft industry

NASA Technical Reports Server (NTRS)

Phillips, J. L.

1972-01-01

Titanium fasteners are used in large quantities throughout the aircraft industry. Most of this usage is in aluminum structure; where titanium structure exists, titanium fasteners are logically used as well. Titanium fasteners offer potential weight savings to the designer at a cost of approximately $30 per pound of weight saved. Proper and least cost usage must take into consideration type of fastener per application, galvanic couples and installation characteristics of protective coatings, cosmetic appearance, paint adhesion, installation forces and methods available and fatigue performance required.

Natural gas treating with molecular sieves. Pt. 2. Regeneration, economics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, T.B.

1972-08-01

Regeneration considerations are often the key to successful and economical application of molecular sieves for natural gas sweetening. In effect, molecular sieves remove the sulfur compounds from the feed stream and concentrate them into a smaller regeneration gas stream. Because a molecular sieve natural gas sweetener concentrates the hydrogen sulfide from the feed stream in a smaller regeneration gas stream, the sulfur-rich gas must be subsequently treated or disposed of. Molecular sieve sweeteners afford a high degree of flexibility in operating rates. They have a very high turndown ratio limited only by the use of product gas for regeneration, whichmore » can be utilized to full advantage with a control system that provides variable cycle times. Tabular data provide a range of designed conditions for existing molecular sieve natural gas sweeteners. Actual operating experience has shown that, in most cases, the following economical advantages can be realized: (1) investment cost is competitive to alternate forms of gas treating; (2) operating cost of molecular sieve units are generally lower (3) the value of carbon dioxide left in natural gas can lead to a considerable operating credit; and (4) the incremental costs of expansion to an existing plant are normally much less. (24 refs.)« less

The NTF as a national facility. [project planning

NASA Technical Reports Server (NTRS)

Nicks, O. W.

1977-01-01

Activities which led to the definition of the National Transonic Facility and the general agreements reached regarding its use and operations are reviewed. Topics discussed include: redefinition of test requirements, development of low cost options, consideration of a single transonic facility using existing hardware if feasible, facility concept recommendations, and acquisition schedule proposals.

Adopting epidemic model to optimize medication and surgical intervention of excess weight

NASA Astrophysics Data System (ADS)

Sun, Ruoyan

2017-01-01

We combined an epidemic model with an objective function to minimize the weighted sum of people with excess weight and the cost of a medication and surgical intervention in the population. The epidemic model is consisted of ordinary differential equations to describe three subpopulation groups based on weight. We introduced an intervention using medication and surgery to deal with excess weight. An objective function is constructed taking into consideration the cost of the intervention as well as the weight distribution of the population. Using empirical data, we show that fixed participation rate reduces the size of obese population but increases the size for overweight. An optimal participation rate exists and decreases with respect to time. Both theoretical analysis and empirical example confirm the existence of an optimal participation rate, u*. Under u*, the weighted sum of overweight (S) and obese (O) population as well as the cost of the program is minimized. This article highlights the existence of an optimal participation rate that minimizes the number of people with excess weight and the cost of the intervention. The time-varying optimal participation rate could contribute to designing future public health interventions of excess weight.

ENGINEERING ECONOMIC ANALYSIS OF A PROGRAM FOR ARTIFICIAL GROUNDWATER RECHARGE.

USGS Publications Warehouse

Reichard, Eric G.; Bredehoeft, John D.

1984-01-01

This study describes and demonstrates two alternate methods for evaluating the relative costs and benefits of artificial groundwater recharge using percolation ponds. The first analysis considers the benefits to be the reduction of pumping lifts and land subsidence; the second considers benefits as the alternative costs of a comparable surface delivery system. Example computations are carried out for an existing artificial recharge program in Santa Clara Valley in California. A computer groundwater model is used to estimate both the average long term and the drought period effects of artificial recharge in the study area. Results indicate that the costs of artificial recharge are considerably smaller than the alternative costs of an equivalent surface system. Refs.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part II: cost comparison of different sanitation systems.

PubMed

Oldenburg, M; Peter-Fröhlich, A; Dlabacs, C; Pawlowski, L; Bonhomme, A

2007-01-01

The experience from the EU demonstration project was used for a cost analysis of different sanitation systems with regard to nutrient recycling. The analysis was made for an existing residential area, for which the different sanitation systems have been applied. The cost calculations were made for a lifetime of 50 years. The multiple sewer systems cause higher investment costs, mainly for the installation of the additional facilities; the investment costs for the treatment are lower. The cost analysis did not prove lower costs for the new sanitation concepts in this special case in comparison with the conventional system. Economic benefits are demonstrated for the operation costs. The result will be reinforced by the consideration of an increase of the energy costs. The revenues for the nutrient related products have only a very small impact on the result.

Economic lot sizing in a production system with random demand

NASA Astrophysics Data System (ADS)

Lee, Shine-Der; Yang, Chin-Ming; Lan, Shu-Chuan

2016-04-01

An extended economic production quantity model that copes with random demand is developed in this paper. A unique feature of the proposed study is the consideration of transient shortage during the production stage, which has not been explicitly analysed in existing literature. The considered costs include set-up cost for the batch production, inventory carrying cost during the production and depletion stages in one replenishment cycle, and shortage cost when demand cannot be satisfied from the shop floor immediately. Based on renewal reward process, a per-unit-time expected cost model is developed and analysed. Under some mild condition, it can be shown that the approximate cost function is convex. Computational experiments have demonstrated that the average reduction in total cost is significant when the proposed lot sizing policy is compared with those with deterministic demand.

Conducting systematic reviews of economic evaluations.

PubMed

Gomersall, Judith Streak; Jadotte, Yuri Tertilus; Xue, Yifan; Lockwood, Suzi; Riddle, Dru; Preda, Alin

2015-09-01

In 2012, a working group was established to review and enhance the Joanna Briggs Institute (JBI) guidance for conducting systematic review of evidence from economic evaluations addressing a question(s) about health intervention cost-effectiveness. The objective is to present the outcomes of the working group. The group conducted three activities to inform the new guidance: review of literature on the utility/futility of systematic reviews of economic evaluations and consideration of its implications for updating the existing methodology; assessment of the critical appraisal tool in the existing guidance against criteria that promotes validity in economic evaluation research and two other commonly used tools; and a workshop. The debate in the literature on the limitations/value of systematic review of economic evidence cautions that systematic reviews of economic evaluation evidence are unlikely to generate one size fits all answers to questions about the cost-effectiveness of interventions and their comparators. Informed by this finding, the working group adjusted the framing of the objectives definition in the existing JBI methodology. The shift is away from defining the objective as to determine one cost-effectiveness measure toward summarizing study estimates of cost-effectiveness and informed by consideration of the included study characteristics (patient, setting, intervention component, etc.), identifying conditions conducive to lowering costs and maximizing health benefits. The existing critical appraisal tool was included in the new guidance. The new guidance includes the recommendation that a tool designed specifically for the purpose of appraising model-based studies be used together with the generic appraisal tool for economic evaluations assessment to evaluate model-based evaluations. The guidance produced by the group offers reviewers guidance for each step of the systematic review process, which are the same steps followed in JBI reviews of other types of evidence. The updated JBI guidance will be useful for researchers wanting to synthesize evidence about economic questions, either as stand-alone reviews or part of comprehensive or mixed method evidence reviews. Although the updated methodology produced by the work of the working group has improved the JBI guidance for systematic reviews of economic evaluations, there are areas where further work is required. These include adjusting the critical appraisal tool to separate out questions addressing intervention cost and effectiveness measurement; providing more explicit guidance for assessing generalizability of findings; and offering a more robust method for evidence synthesis that facilitates achieving the more ambitious review objectives.

Evidence for moxifloxacin in community-acquired pneumonia: the impact of pharmaco-economic considerations on guidelines.

PubMed

Simoens, Steven

2009-10-01

In an era of limited resources, policy makers and health care payers are concerned about the costs of treatment in addition to its effectiveness. However, guidelines do not tend to consider the cost-effectiveness of treatment options. This paper aims to conduct an international literature review with a view to assessing the impact of pharmaco-economic considerations of CAP treatment with moxifloxacin on recent guidelines. The pharmaco-economic state of the art of treating CAP with moxifloxacin is assessed and compared with guidelines issued by the European Respiratory Society and by the Infectious Diseases Society of America/American Thoracic Society. Also, evidence on moxifloxacin consumption and antimicrobial resistance, and the impact of resistance on the cost-effectiveness of moxifloxacin is reviewed. Studies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, and EconLit up to January 2009. The existing pharmaco-economic evidence indicates that moxifloxacin is a cost-effective treatment for CAP. However, data limitations and uncertainty surrounding the evolution of resistance emphasize the need for caution. As recommended by guidelines, the choice of antimicrobial should consider the local frequency of causative pathogens, the local pattern of antimicrobial resistance, and risk factors for resistant bacteria. The pharmaco-economic evidence corroborates the importance of these factors as they have an impact on the cost-effectiveness of treating CAP patients with moxifloxacin. CAP guidelines need to take into account pharmaco-economic considerations by balancing the effectiveness of antimicrobial regimens against their costs. The pharmaco-economic value of moxifloxacin is influenced by the causative pathogens involved and resistance patterns. Therefore, it may be advisable to identify patient subgroups in which treatment with moxifloxacin is cost-effective and should be recommended by guidelines.

Generic Drug Cost Containment in Medicaid: Lessons from Five State MAC Programs

PubMed Central

Abramson, Richard G.; Harrington, Catherine A.; Missmar, Raad; Li, Susan P.; Mendelson, Daniel N.

2004-01-01

In Medicaid, generic drug cost containment revolves around two programs: the Federal upper limit (FUL) program and State maximum allowable cost (MAC) programs. This article analyzes MAC programs in five States and finds considerable variation between these programs and the FUL program in both size and pricing aggressiveness. We conclude that expansion of existing MAC programs and creation of new ones could contribute to cost containment efforts nationwide. Options for States seeking to optimize their efforts include focusing on pricing for drugs with high sales volumes, ensuring that MAC lists include prices for all forms and dosages of listed drug entities, and collaborating with other States or the Federal Government on MAC list operations. PMID:15229994

What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses.

PubMed

Doble, Brett; Wordsworth, Sarah; Rogers, Chris A; Welbourn, Richard; Byrne, James; Blazeby, Jane M

2017-08-01

This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended 'important' cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

Incremental burden of congestive heart failure among elderly with Alzheimer's.

PubMed

Chhatre, Sumedha; Weiner, Mark G; Jayadevappa, Ravishankar; Johnson, Jerry C

2009-07-01

A complex relationship exists between Alzheimer's disease (AD) and other co-existing co-morbidities such as congestive heart failure (CHF) with implications for health resource utilization (HRU) and cost of care. Study objective was to assess HRU and cost of care in elderly with AD and with or without concomitant CHF. All elderly (> or =65 years) from an academic healthcare system diagnosed with AD in 1999 (n = 904) and matched AD-free controls (n = 3616). Each group was subdivided into those with and without a CHF diagnosis. Costs and HRU were obtained from Medicare databases for 1999 and 2000. Costs and HRU were compared using ANOVA and Wilcoxon rank sum tests. Regressions were used to model the effect of AD and CHF on outcomes. Mean annual cost were 20,888 US dollars for AD + CHF group, 5,473 US dollars for only AD group, 17,700 US dollars for only CHF group and 4,578 US dollars for the control group (no-AD and no-CHF). After adjusting for covariates, AD + CHF group had an eight-fold increase in total cost, while only CHF group had five-fold increase in total cost, compared to the control group. Regressions for inpatient costs, outpatient costs and inpatient pharmacy costs exhibited comparable trends. For elderly AD patients, a co-occurring diagnosis of CHF can result in a substantial increase in cost and HRU. This necessitates additional considerations if health care expenditures are to be reduced, particularly inpatient expenditure.

Reciprocal Allocation Method in Service Departments. The Case of a Production Enterprise

NASA Astrophysics Data System (ADS)

Papaj, Ewelina

2017-12-01

The main aim of this article is to indicate the role of reciprocal allocation method in the process of costs calculation. In the environment of nowadays companies, often taking very complex organisational forms, the existence of service departments becomes of great importance. Although, as far as management accounting processes are concerned, which lead to identifying the product cost, the service departments' costs come out to be of minor importance. This article means to prove that the service departments' costs and their reliable settlement are a desirable source of information about the products. This work consists of two parts. First of them features theoretical considerations and a critical analysis of subject literature. In the latter part, the service departments' costs calculation will be presented, basing on reciprocal services in a production enterprise from chemical industry.

Flying Lessons: Learning from Ryanair's Cost Reduction Culture

NASA Technical Reports Server (NTRS)

Lawton, Thomas C.

2000-01-01

Through radically improving the value equation for airline customers, Ryanair has served to shake-up established norms and practices in European aviation. Underpinning its price leadership and market success is a vigorous and relentless cost reduction ethos and resultant low break-even load factor. Ryanair has lowered European airline cost structures considerably, shattering existing cost floors. Few competitors are able to follow, either because they do not know how or they are unable due to social settlement obligations or service commitments. At the same time, the company has maintained high average load factors on its flights. Taken in conjunction with its low break-even load factor, this results in consistently high overall profit margins. On this basis, Ryanair is likely to remain a significant competitor and increase its market presence and success across Europe.

IEA Wind TCP Task 26: Impacts of Wind Turbine Technology on the System Value of Wind in Europe

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lantz, Eric J.; Riva, Alberto D.; Hethey, Janos

This report analyzes the impact of different land-based wind turbine designs on grid integration and related system value and cost. This topic has been studied in a number of previous publications, showing the potential benefits of wind turbine technologies that feature higher capacity factors. Building on the existing literature, this study aims to quantify the effects of different land-based wind turbine designs in the context of a projection of the European power system to 2030. This study contributes with insights on the quantitative effects in a likely European market setup, taking into account the effect of existing infrastructure on bothmore » existing conventional and renewable generation capacities. Furthermore, the market effects are put into perspective by comparing cost estimates for deploying different types of turbine design. Although the study focuses on Europe, similar considerations and results can be applied to other power systems with high wind penetration.« less

Economic benefits of optimizing anchor therapy for rheumatoid arthritis.

PubMed

Fautrel, Bruno

2012-06-01

The total cost of RA is substantial, particularly in patients with high levels of disability. There are considerable differences in cost between countries, driven in part by differences in the use of biologic therapies. Economic evaluations are needed to assess the extra cost of using these treatments and the benefits obtained, to ensure appropriate allocation of limited health care resources. The BeSt trial, evaluating four treatment strategies, found comparable medium-term efficacy but substantially higher costs with early biologic therapy. A systematic review of such cost-effectiveness analyses concluded that biologic therapy should be used after therapy has failed with less costly alternatives such as synthetic DMARDs and glucocorticoids. Optimizing such relatively low-cost therapy to improve outcomes may delay the need for biologic therapy, thereby saving costs. A simple model has confirmed the value of this approach. The addition of modified-release prednisone 5 mg/day to existing synthetic DMARD therapy in patients with active disease resulted in improvement in DAS-28 to below the threshold level for initiation of reimbursed biologic therapy in 28-34% of patients. On a conservative estimate (i.e. assuming no further benefits beyond the 12 weeks of the study and a 12-week wait-and-see approach to starting biologic therapy), cost savings amounted to nearly € 400 per patient. While treatment decisions should never be based only on cost considerations, prolonging disease control by optimizing the use of non-biologic treatments may bring benefits to patients and also economic benefits by delaying the need for biologic treatments.

Cost Considerations in Cloud Computing

DTIC Science & Technology

2014-01-01

investments. 2. Database Options The potential promise that “ big data ” analytics holds for many enterprise mission areas makes relevant the question of the...development of a range of new distributed file systems and data - bases that have better scalability properties than traditional SQL databases. Hadoop ... data . Many systems exist that extend or supplement Hadoop —such as Apache Accumulo, which provides a highly granular mechanism for managing security

Public financing of IVF: a review of policy rationales.

PubMed

Mladovsky, Philipa; Sorenson, Corinna

2010-06-01

There is great diversity in in vitro fertilization (IVF) funding and reimbursement policies and practice throughout Europe and the rest of the world. While many existing reimbursement and regulatory frameworks address safety and legal concerns, economic factors also assume a central role. However, there are several problems with the evidence that is available on the economics of IVF. This suggests there is a need for more robust cost-effectiveness studies. It also indicates the need for alternative rationales to justify the reimbursement of IVF, which might more fully account for the social, political, ethical, and philosophical considerations embedded in notions of infertility and technology-driven reproductive treatments. The merits and limitations of five alternative rationales are discussed. The review suggests that while no existing single rationale provides a complete framework with which to support funding decisions, taken together they provide guideposts which signal important issues for consideration and highlight where further research, action, and debate are needed.

Communications network design and costing model technical manual

NASA Technical Reports Server (NTRS)

Logan, K. P.; Somes, S. S.; Clark, C. A.

1983-01-01

This computer model provides the capability for analyzing long-haul trunking networks comprising a set of user-defined cities, traffic conditions, and tariff rates. Networks may consist of all terrestrial connectivity, all satellite connectivity, or a combination of terrestrial and satellite connectivity. Network solutions provide the least-cost routes between all cities, the least-cost network routing configuration, and terrestrial and satellite service cost totals. The CNDC model allows analyses involving three specific FCC-approved tariffs, which are uniquely structured and representative of most existing service connectivity and pricing philosophies. User-defined tariffs that can be variations of these three tariffs are accepted as input to the model and allow considerable flexibility in network problem specification. The resulting model extends the domain of network analysis from traditional fixed link cost (distance-sensitive) problems to more complex problems involving combinations of distance and traffic-sensitive tariffs.

Preliminary Design Considerations for Access and Operations in Earth-Moon L1/L2 Orbits

NASA Technical Reports Server (NTRS)

Folta, David C.; Pavlak, Thomas A.; Haapala, Amanda F.; Howell, Kathleen C.

2013-01-01

Within the context of manned spaceflight activities, Earth-Moon libration point orbits could support lunar surface operations and serve as staging areas for future missions to near-Earth asteroids and Mars. This investigation examines preliminary design considerations including Earth-Moon L1/L2 libration point orbit selection, transfers, and stationkeeping costs associated with maintaining a spacecraft in the vicinity of L1 or L2 for a specified duration. Existing tools in multi-body trajectory design, dynamical systems theory, and orbit maintenance are leveraged in this analysis to explore end-to-end concepts for manned missions to Earth-Moon libration points.

Quality assurance and reliability in the Japanese electronics industry

NASA Astrophysics Data System (ADS)

Pecht, Michael; Boulton, William R.

1995-02-01

Quality and reliability are two attributes required for all Japanese products, although the JTEC panel found these attributes to be secondary to customer cost requirements. While our Japanese hosts gave presentations on the challenges of technology, cost, and miniaturization, quality and reliability were infrequently the focus of our discussions. Quality and reliability were assumed to be sufficient to meet customer needs. Fujitsu's slogan, 'quality built-in, with cost and performance as prime consideration,' illustrates this point. Sony's definition of a next-generation product is 'one that is going to be half the size and half the price at the same performance of the existing one'. Quality and reliability are so integral to Japan's electronics industry that they need no new emphasis.

Quality assurance and reliability in the Japanese electronics industry

NASA Technical Reports Server (NTRS)

Pecht, Michael; Boulton, William R.

1995-01-01

Quality and reliability are two attributes required for all Japanese products, although the JTEC panel found these attributes to be secondary to customer cost requirements. While our Japanese hosts gave presentations on the challenges of technology, cost, and miniaturization, quality and reliability were infrequently the focus of our discussions. Quality and reliability were assumed to be sufficient to meet customer needs. Fujitsu's slogan, 'quality built-in, with cost and performance as prime consideration,' illustrates this point. Sony's definition of a next-generation product is 'one that is going to be half the size and half the price at the same performance of the existing one'. Quality and reliability are so integral to Japan's electronics industry that they need no new emphasis.

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

The Blue Emu

NASA Technical Reports Server (NTRS)

Descalzi, Doug; Gillett, John; Gordon, Carlton; Keener, ED; Novak, Ken; Puente, Laura

1993-01-01

The primary goal in designing the Blue Emu was to provide an airline with a cost efficient and profitable means of transporting passengers between the major cities in Aeroworld. The design attacks the market where a demand for inexpensive transportation exists and for this reason the Blue Emu is an attractive investment for any airline. In order to provide a profitable aircraft, special attention was paid to cost and economics. For example, in manufacturing, simplicity was stressed in structural design to reduce construction time and cost. Aerodynamic design employed a tapered wing which reduced the induced drag coefficient while also reducing the weight of the wing. Even the propulsion system was selected with cost effectiveness in mind, yet also to maintain the marketability of the aircraft. Thus, in every aspect of the design, consideration was given to economics and marketability of the final product.

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

PubMed

Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

2015-04-01

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations assessed in the current study are likely to improve the efficiency of the mental health care sector. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Low-Income Community Solar: Utility Return Considerations for Electric Cooperatives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aznar, Alexandra Y; Gagne, Douglas A

The objective of this short report is to identify project structures that make low-income community solar projects more cost-effective, replicable, and scalable, for electric cooperative and municipal utilities. This report explores the tradeoffs between providing energy bill savings for low-income subscribers and utility project returns, as well as some of the key lessons learned from existing successful low-income community solar pilot projects.

Advanced Energy Retrofit Guide (AERG): Practical Ways to Improve Energy Performance; Healthcare Facilities (Book)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hendron, R.; Leach, M.; Bonnema, E.

The Advanced Energy Retrofit Guide for Healthcare Facilities is part of a series of retrofit guides commissioned by the U.S. Department of Energy. By presenting general project planning guidance as well as detailed descriptions and financial payback metrics for the most important and relevant energy efficiency measures (EEMs), the guides provide a practical roadmap for effectively planning and implementing performance improvements in existing buildings. The Advanced Energy Retrofit Guides (AERGs) are intended to address key segments of the U.S. commercial building stock: retail stores, office buildings, K-12 schools, grocery stores, and healthcare facilities. The guides' general project planning considerations aremore » applicable nationwide; the energy and cost savings estimates for recommended EEMs were developed based on energy simulations and cost estimates for an example hospital tailored to five distinct climate regions. These results can be extrapolated to other U.S. climate zones. Analysis is presented for individual EEMs, and for packages of recommended EEMs for two project types: existing building commissioning projects that apply low-cost and no-cost measures, and whole-building retrofits involving more capital-intensive measures.« less

The utilisation of engineered invert traps in the management of near bed solids in sewer networks.

PubMed

Ashley, R M; Tait, S J; Stovin, V R; Burrows, R; Framer, A; Buxton, A P; Blackwood, D J; Saul, A J; Blanksby, J R

2003-01-01

Large existing sewers are considerable assets which wastewater utilities will require to operate for the foreseeable future to maintain health and the quality of life in cities. Despite their existence for more than a century there is surprisingly little guidance available to manage these systems to minimise problems associated with in-sewer solids. A joint study has been undertaken in the UK, to refine and utilise new knowledge gained from field data, laboratory results and Computational Fluid Dynamics (CFD) simulations to devise cost beneficial engineering tools for the application of small invert traps to localise the deposition of sediments in sewers at accessible points for collection. New guidance has been produced for trap siting and this has been linked to a risk-cost-effectiveness assessment procedure to enable system operators to approach in-sewer sediment management pro-actively rather than reactively as currently happens.

Manufacture, distribution, and handling of nitrate salts for solar-thermal applications

NASA Astrophysics Data System (ADS)

Fiorucci, L. C.; Goldstein, S. L.

1982-11-01

The low cost and attractive physical properties of molten sodium/potassium nitrate salts were shown to be one of the most cost effective fluids for heat absorption and thermal energy storage in Solar Central Receiver (SCR) systems. Information related to the availability, transport, handling, and utilization of these salts for commercial size SCR applications is provided. The following items are reviewed: existing manufacturing processes for natural and synthetic nitrates; the upstream availability of raw materials; downstream existing and projected demand for these products in other sectors of the economy; and relevant handling and distribution technologies. Safety considerations and issues more directly related to the SCR facility, such as initial system charging, salt maintenance and regeneration, and disposal are also reviewed. Options for supply, surge storage, and initial charging are discussed for the 1 MWt to 300 MWe range of solar plant sizes.

The costs of future polio risk management policies.

PubMed

Tebbens, Radboud J Duintjer; Sangrujee, Nalinee; Thompson, Kimberly M

2006-12-01

Decisionmakers need information about the anticipated future costs of maintaining polio eradication as a function of the policy options under consideration. Given the large portfolio of options, we reviewed and synthesized the existing cost data relevant to current policies to provide context for future policies. We model the expected future costs of different strategies for continued vaccination, surveillance, and other costs that require significant potential resource commitments. We estimate the costs of different potential policy portfolios for low-, middle-, and high-income countries to demonstrate the variability in these costs. We estimate that a global transition from routine immunization with oral poliovirus vaccine (OPV) to inactivated poliovirus vaccine (IPV) would increase the costs of managing polio globally, although routine IPV use remains less costly than routine OPV use with supplemental immunization activities. The costs of surveillance and a stockpile, while small compared to routine vaccination costs, represent important expenditures to ensure adequate response to potential outbreaks. The uncertainty and sensitivity analyses highlight important uncertainty in the aggregated costs and demonstrates that the discount rate and uncertainty in price and administration cost of IPV drives the expected incremental cost of routine IPV vs. OPV immunization.

The Economic Costs of Type 2 Diabetes: A Global Systematic Review.

PubMed

Seuring, Till; Archangelidi, Olga; Suhrcke, Marc

2015-08-01

There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs.

Economic and financial evaluation of neglected tropical diseases.

PubMed

Lee, Bruce Y; Bartsch, Sarah M; Gorham, Katrin M

2015-03-01

Economic and financing studies are particularly important for decision-making when resources are scarce or considerably limited. This is the case for neglected tropical diseases (NTDs). In fact, the definition of NTDs is an economic one. The shortage of resources for NTD control may be due in large part to the fact that the burden of NTDs and economic value of control measures have not been fully characterized. A number of economic study methodologies are available: cost of illness can quantify the extent, magnitude, and change of a problem; cost of intervention studies can outline the feasibility and guide the design of a policy or intervention; and cost-benefit, cost-effectiveness, and return-on-investment studies can determine the potential value of different interventions and policies. NTDs have unique characteristics that require special consideration in such analyses. Hence, approaches used for other diseases may need modifications to capture the full impact of NTDs. While the existing literature has made important findings, there is a need for substantially more work, as many NTDs and their associated interventions and policies require more evaluation. With increasing work in this area, NTDs may not be as 'neglected' in the future as they are now. Copyright © 2015 Elsevier Ltd. All rights reserved.

Harvesting forest biomass for energy in Minnesota: An assessment of guidelines, costs and logistics

NASA Astrophysics Data System (ADS)

Saleh, Dalia El Sayed Abbas Mohamed

The emerging market for renewable energy in Minnesota has generated a growing interest in utilizing more forest biomass for energy. However, this growing interest is paralleled with limited knowledge of the environmental impacts and cost effectiveness of utilizing this resource. To address environmental and economic viability concerns, this dissertation has addressed three areas related to biomass harvest: First, existing biomass harvesting guidelines and sustainability considerations are examined. Second, the potential contribution of biomass energy production to reduce the costs of hazardous fuel reduction treatments in these trials is assessed. Third, the logistics of biomass production trials are analyzed. Findings show that: (1) Existing forest related guidelines are not sufficient to allow large-scale production of biomass energy from forest residue sustainably. Biomass energy guidelines need to be based on scientific assessments of how repeated and large scale biomass production is going to affect soil, water and habitat values, in an integrated and individual manner over time. Furthermore, such guidelines would need to recommend production logistics (planning, implementation, and coordination of operations) necessary for a potential supply with the least site and environmental impacts. (2) The costs of biomass production trials were assessed and compared with conventional treatment costs. In these trials, conventional mechanical treatment costs were lower than biomass energy production costs less income from biomass sale. However, a sensitivity analysis indicated that costs reductions are possible under certain site, prescriptions and distance conditions. (3) Semi-structured interviews with forest machine operators indicate that existing fuel reduction prescriptions need to be more realistic in making recommendations that can overcome operational barriers (technical and physical) and planning and coordination concerns (guidelines and communications) identified by machine operators, and which are necessary for a viable biomass energy production system. The results of this dissertation suggest that once biomass energy production is intended, incorporating an early understanding of production logistics while developing environmentally sensitive guidelines and site-specific prescriptions can improve biomass energy production, costs, performance and sustainability.

Maglev guideway route alignment and right-of-way requirements

NASA Astrophysics Data System (ADS)

Carlton, S.; Andriola, T.

1992-12-01

The use of existing rights-of-way (ROW) is assessed for maglev systems by estimating trip times and land acquisition requirements for potential maglev corridors while meeting passenger comfort limits. Right-of-way excursions improve trip time but incur a cost for purchasing land. The final report documents findings of the eight tasks in establishing right-of-way feasibility by examining three city-pair corridors in detail and developing an approximation method for estimating route length and travel times in 20 additional city-pair corridor portions and 21 new corridors. The use of routes independent of existing railroad or highway right-of-way have trip time advantages and significantly reduce the need for aggressive guideway geometries on intercity corridors. Selection of the appropriate alignment is determined by many corridor specific issues. Use of existing intercity rights-of-way may be appropriate for parts of routes on a corridor-specific basis and for urban penetration where vehicle speeds are likely to be reduced by policy due to noise and safety considerations, and where land acquisition costs are high. Detailed aspects of available rights-of-way, land acquisition costs, geotechnical issues, land use, and population centers must be examined in more detail on a specific corridor basis before the proper or best maglev alignment can be chosen.

Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative.

PubMed

Obure, Carol Dayo; Guinness, Lorna; Sweeney, Sedona; Initiative, Integra; Vassall, Anna

2016-03-01

Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice. We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope. The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only. The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate. NCT01694862. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative

PubMed Central

Obure, Carol Dayo; Guinness, Lorna; Sweeney, Sedona; Initiative, Integra; Vassall, Anna

2016-01-01

Objective Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice. Methods We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope. Findings The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only. Conclusions The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate. Trial registration number NCT01694862. PMID:26438349

Psoriasis treatment considerations in military patients: unique patients, unique drugs.

PubMed

Evans, Thomas; Davidson, Nathan; Logemann, Nicholas

2016-12-01

Psoriasis is a common dermatologic problem with a chronic and sometimes debilitating course. Psoriasis can impair a service member's ability to perform job-related activities and should certainly be treated; however, use of immunosuppressive treatments can prevent deployment to strategic locations around the world for numerous reasons, such as the need for laboratory monitoring, minimal access to climate-controlled storage, and potential increased risk of exposure to virulent pathogens while on these medications. Similar obstacles can exist for nonmilitary patients who are placed in austere conditions or participate in worldwide travel. Although treatment efficacy, cost, and side-effect profiles are always paramount considerations in deciding on treatment regimens with patients, herein we focus our discussion on a consideration that might be easily overlooked when treating patients in modern society, that being the "logistics" of treatment.

Patient level costing in Ireland: process, challenges and opportunities.

PubMed

Murphy, A; McElroy, B

2015-03-01

In 2013, the Department of Health released their policy paper on hospital financing entitled Money Follows the Patient. A fundamental building block for the proposed financing model is patient level costing. This paper outlines the patient level costing process, identifies the opportunities and considers the challenges associated with the process in the Irish hospital setting. Methods involved a review of the existing literature which was complemented with an interview with health service staff. There are considerable challenges associated with implementing patient level costing including deficits in information and communication technologies and financial expertise as well as timeliness of coding. In addition, greater clinical input into the costing process is needed compared to traditional costing processes. However, there are long-term benefits associated with patient level costing; these include empowerment of clinical staff, improved transparency and price setting and greater fairness, especially in the treatment of outliers. These can help to achieve the Government's Health Strategy. The benefits of patient level costing need to be promoted and a commitment to investment in overcoming the challenges is required.

Antiseptic technology: access, affordability, and acceptance.

PubMed Central

Boyce, J. M.

2001-01-01

Factors other than antimicrobial activity of soaps and antiseptic agents used for hand hygiene by health personnel play a role in compliance with recommendations. Hand hygiene products differ considerably in acceptance by hospital personnel. If switching from a nonmedicated soap to an antiseptic agent or increased use of an existing antiseptic agent for hand hygiene prevented a few more infections per year, additional expenditures for antiseptic agents would be offset by cost savings. PMID:11294713

Pigovian taxes which work in the small-number case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wittman, D.

1985-06-01

An appropriately conceived pollution tax can achieve a Pareto optimal equilibrium which is (1) stable in the presence of myopia, (2) not subject to strategic manipulation even in the small-number case, and (3) resistant to inefficient cost shifting by the participants when transaction costs are low. A considerable amount of confusion in the literature exists because different authors use different tax formulas (often implicitly) and different assumptions regarding conjectural behavior. Some of this confusion is cleared up by formally presenting various Pigovian tax formulas, explicitly considering whether there is Cournot or Stakleberg behavior, and comparing the properties of the variousmore » configurations. The author argues that charging for mitigated marginal cost rather than for actual damage avoids many pitfalls typically associated with Pignovian taxes. 15 references, 1 table.« less

Policy Framework for Covering Preventive Services Without Cost Sharing: Saving Lives and Saving Money?

PubMed

Chen, Stephanie C; Pearson, Steven D

2016-08-01

The US Affordable Care Act mandates that private insurers cover a list of preventive services without cost sharing. The list is determined by 4 expert committees that evaluate the overall health effect of preventive services. We analyzed the process by which the expert committees develop their recommendations. Each committee uses different criteria to evaluate preventive services and none of the committees consider cost systematically. We propose that the existing committees adopt consistent evidence review methodologies and expand the scope of preventive services reviewed and that a separate advisory committee be established to integrate economic considerations into the final selection of free preventive services. The comprehensive framework and associated criteria are intended to help policy makers in the future develop a more evidence-based, consistent, and ethically sound approach.

Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada

PubMed Central

Pataky, Reka; Gulati, Roman; Etzioni, Ruth; Black, Peter; Chi, Kim N.; Coldman, Andrew J.; Pickles, Tom; Tyldesley, Scott; Peacock, Stuart

2015-01-01

Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of overdiagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40 year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from $36,300/LYG, for screening every four years from ages 55-69, to $588,300/LYG, for screening every two years from ages 40-74. The marginal benefits of increasing screening frequency to two years or starting screening at age 40 were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of QALYs; however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration. PMID:24443367

Payer and Pharmaceutical Manufacturer Considerations for Outcomes-Based Agreements in the United States.

PubMed

Brown, Joshua D; Sheer, Rich; Pasquale, Margaret; Sudharshan, Lavanya; Axelsen, Kirsten; Subedi, Prasun; Wiederkehr, Daniel; Brownfield, Fred; Kamal-Bahl, Sachin

2018-01-01

Considerable interest exists among health care payers and pharmaceutical manufacturers in designing outcomes-based agreements (OBAs) for medications for which evidence on real-world effectiveness is limited at product launch. To build hypothetical OBA models in which both payer and manufacturer can benefit. Models were developed for a hypothetical hypercholesterolemia OBA, in which the OBA was assumed to increase market access for a newly marketed medication. Fixed inputs were drug and outcome event costs from the literature over a 1-year OBA period. Model estimates were developed using a range of inputs for medication effectiveness, medical cost offsets, and the treated population size. Positive or negative feedback to the manufacturer was incorporated on the basis of expectations of drug performance through changes in the reimbursement level. Model simulations demonstrated that parameters had the greatest impact on payer cost and manufacturer reimbursement. Models suggested that changes in the size of the population treated and drug effectiveness had the largest influence on reimbursement and costs. Despite sharing risk for potential product underperformance, manufacturer reimbursement increased relative to having no OBA, if the OBA improved market access for the new product. Although reduction in medical costs did not fully offset the cost of the medication, the payer could still save on net costs per patient relative to having no OBA by tying reimbursement to drug effectiveness. Pharmaceutical manufacturers and health care payers have demonstrated interest in OBAs, and under a certain set of assumptions both may benefit. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Operational and support considerations in standardization

NASA Astrophysics Data System (ADS)

Oreilly, W. T.

Military applications in the era of the 1990's and beyond, require capabilities beyond those available in most existing systems. These capabilities must be provided in a manner that will achieve a low logistic support cost and that can be maintained with relatively inexperienced personnel. This paper presents the design considerations that must be addressed in each of the standardized subsystems and modules that will provide the operational and support needs for tomorrow and beyond. Advanced maintenance concepts, such as two and one level maintenance, are described together with the operational and life cycle cost benefits that will be achieved. A new operation concept called deferred maintenance, which provides sustained operation without maintenance support, is presented. The fault tolerant architecture which will permit a standardized modular design to efficiently accommodate a variety of system applications is presented. The concerns discussed include combat damage survivability, fail safe and fail operational needs, as well as high availability for long life applications as is required for systems employed in the Space Defense Initiative (SDI).

Screening, prevention and treatment of cervical cancer -- a global and regional generalized cost-effectiveness analysis.

PubMed

Ginsberg, Gary Michael; Edejer, Tessa Tan-Torres; Lauer, Jeremy A; Sepulveda, Cecilia

2009-10-09

The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Using standardised WHO-CHOICE methodology, a cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. In regions characterized by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost-effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost-effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost-effective. Vaccination is usually the most cost-effective intervention. Penta or tri-annual PAP smears appear to be cost-effective, though when combined with HPV-DNA testing they are not cost-effective. In regions characterized by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. A one off vaccination plus expanding treatment was usually very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. From a cost-effectiveness perspective, consideration should be given to implementing vaccination (depending on cost per dose and longevity of efficacy) and screening programmes on a worldwide basis to reduce the burden of disease from cervical cancer. Treatment should also be increased where coverage is low.

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

PubMed Central

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-01-01

Background: Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. Objectives: The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). Materials and Methods: We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Results: Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. Conclusion: As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs. PMID:26715979

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

PubMed

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-10-01

Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.

Value considerations in the treatment of head and neck cancer: radiation, chemotherapy, and supportive care.

PubMed

Baxi, Shrujal S; Sher, David J; Pfister, David G

2014-01-01

The management of head and neck cancer has advanced in many areas, including but not limited to diagnostic imaging and response assessment, radiation delivery, surgical approaches, combined-modality therapy, as well as new drug discovery. These advances have become widely used, however, the associated improvements in outcomes of interest compared with other options may at times be modest in magnitude or supported by limited data. In addition, the price tag of these advancements is often high. There is a growing mandate to look at existing data to identify insights into how to improve the value of care and to better understand the comparative effectiveness of one intervention versus another with regard to tumor control, quality of life, and other important outcomes; such insights become particularly important when considerable disparities exist in related costs. We review selected issues in radiotherapy, chemotherapy and supportive care applicable to the management of head and neck cancer and relevant to ascertaining the value of care.

Cost of ownership for military cargo aircraft using a common versus disparate display configuration

NASA Astrophysics Data System (ADS)

Desjardins, Daniel D.; Most, Marvin C.

2010-04-01

A 2009 paper considered possibilities for applying a common display suite to various front-line bubble canopy fighters, whereas further research suggests the cost savings, post Milestone C production/deployment, might not be advantageous. The situation for military cargo and tanker aircraft, may offer a different paradigm. The primary objective of Defense acquisition is to acquire quality products that satisfy user needs with measurable improvements to mission capability and operational support, in a timely manner, and at a fair and reasonable price. DODD 5000.01 specifies that all participants in the acquisition system shall recognize the reality of fiscal constraints, viewing cost as an independent variable. DoD Components must therefore plan programs based on realistic projections of the dollars and manpower likely to be available in future years and also identify the total costs of ownership, as well as the major drivers of total ownership costs. In theory, therefore, this has already been done for existing cargo/tanker aircraft programs accommodating independent, disparate display suites. This paper goes beyond that stage by exploring total costs of ownership for a hypothetical common approach to cargo/tanker display avionics, bounded by looking at a limited number of such aircraft, e.g., C-5, C-17, C-130H (variants), and C-130J. It is the purpose of this paper to reveal whether there are total cost of ownership advantages for a common approach over and above the existing disparate approach. Aside from cost issues, other considerations, i.e., availability and supportability, may also be analyzed.

Planning long lasting insecticide treated net campaigns: should households’ existing nets be taken into account?

PubMed Central

2013-01-01

Background Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. Methods A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net ‘decay’ parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Conclusions Where pre-campaign coverage levels established by a household survey are below 40% we recommend that planners do not take such LLINs into account and instead plan a blanket mass distribution. At pre-campaign coverage levels above 40%, campaign planners should make explicit consideration of the cost and feasibility of accounting for existing LLINs before planning blanket mass distributions. Planners should also consider restricting the coverage estimates used for this decision to only include nets under two years of age in order to ensure that old and damaged nets do not compose too large a fraction of existing net coverage. PMID:23763773

Planning long lasting insecticide treated net campaigns: should households' existing nets be taken into account?

PubMed

Yukich, Joshua; Bennett, Adam; Keating, Joseph; Yukich, Rudy K; Lynch, Matt; Eisele, Thomas P; Kolaczinski, Kate

2013-06-14

Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net 'decay' parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Where pre-campaign coverage levels established by a household survey are below 40% we recommend that planners do not take such LLINs into account and instead plan a blanket mass distribution. At pre-campaign coverage levels above 40%, campaign planners should make explicit consideration of the cost and feasibility of accounting for existing LLINs before planning blanket mass distributions. Planners should also consider restricting the coverage estimates used for this decision to only include nets under two years of age in order to ensure that old and damaged nets do not compose too large a fraction of existing net coverage.

48 CFR 915.404-4-72 - Special considerations for cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost-plus-award-fee contracts. 915.404-4-72 Section 915.404-4-72 Federal Acquisition Regulations System....404-4-72 Special considerations for cost-plus-award-fee contracts. (a) When a contract is to be awarded on a cost-plus-award-fee basis several special considerations are appropriate. Fee objectives for...

Thermal energy storage heat exchanger: Molten salt heat exchanger design for utility power plants

NASA Technical Reports Server (NTRS)

Ferarra, A.; Yenetchi, G.; Haslett, R.; Kosson, R.

1977-01-01

The use of thermal energy storage (TES) in the latent heat of molten salts as a means of conserving fossil fuels and lowering the cost of electric power was evaluated. Public utility systems provided electric power on demand. This demand is generally maximum during late weekday afternoons, with considerably lower overnight and weekend loads. Typically, the average demand is only 60% to 80% of peak load. As peak load increases, the present practice is to purchase power from other grid facilities or to bring older less efficient fossil-fuel plants on line which increase the cost of electric power. The widespread use of oil-fired boilers, gas turbine and diesel equipment to meet peaking loads depletes our oil-based energy resources. Heat exchangers utilizing molten salts can be used to level the energy consumption curve. The study begins with a demand analysis and the consideration of several existing modern fossil-fuel and nuclear power plants for use as models. Salts are evaluated for thermodynamic, economic, corrosive, and safety characteristics. Heat exchanger concepts are explored and heat exchanger designs are conceived. Finally, the economics of TES conversions in existing plants and new construction is analyzed. The study concluded that TES is feasible in electric power generation. Substantial data are presented for TES design, and reference material for further investigation of techniques is included.

Vaccine stabilization: research, commercialization, and potential impact.

PubMed

Kristensen, Debra; Chen, Dexiang; Cummings, Ray

2011-09-22

All vaccines are susceptible to damage by elevated temperatures and many are also damaged by freezing. The distribution, storage, and use of vaccines therefore present challenges that could be reduced by enhanced thermostability, with resulting improvements in vaccine effectiveness. Formulation and processing technologies exist that can improve the stability of vaccines at temperature extremes, however, customization is required for individual vaccines and results are variable. Considerations affecting decisions about stabilization approaches include development cost, manufacturing cost, and the ease of use of the final product. Public sector agencies can incentivize vaccine developers to prioritize stabilization efforts through advocacy and by implementing policies that increase demand for thermostable vaccines. Copyright © 2011 Elsevier Ltd. All rights reserved.

Wind energy - A utility perspective

NASA Astrophysics Data System (ADS)

Fung, K. T.; Scheffler, R. L.; Stolpe, J.

1981-03-01

Broad consideration is given to the siting, demand, capital and operating cost and wind turbine design factors involved in a utility company's incorporation of wind powered electrical generation into existing grids. With the requirements of the Southern California Edison service region in mind, it is concluded that although the economic and legal climate for major investments in windpower are favorable, the continued development of large only wind turbine machines (on the scale of NASA's 2.5 MW Mod-2 design) is imperative in order to reduce manpower and maintenance costs. Stress is also put on the use of demonstration projects for both vertical and horizontal axis devices, in order to build up operational experience and confidence.

Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention.

PubMed

Kanuri, Nitya; Taylor, C Barr; Cohen, Jeffrey M; Newman, Michelle G

2015-08-01

Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders on college campuses and often goes unidentified and untreated. We propose a combined prevention and treatment model composed of evidence-based self-help (SH) and guided self-help (GSH) interventions to address this issue. To inform the development of this stepped-care model of intervention delivery, we evaluated results from a population-based anxiety screening of college students. A primary model was developed to illustrate how increasing levels of symptomatology could be linked to prevention/treatment interventions. We used screening data to propose four models of classification for populations at risk for GAD. We then explored the cost considerations of implementing this prevention/treatment stepped-care model. Among 2489 college students (mean age 19.1 years; 67% female), 8.0% (198/2489) met DSM-5 clinical criteria for GAD, in line with expected clinical rates for this population. At-risk Model 1 (subthreshold, but considerable symptoms of anxiety) identified 13.7% of students as potentially at risk for developing GAD. Model 2 (subthreshold, but high GAD symptom severity) identified 13.7%. Model 3 (subthreshold, but symptoms were distressing) identified 12.3%. Model 4 (subthreshold, but considerable worry) identified 17.4%. There was little overlap among these models, with a combined at-risk population of 39.4%. The efficiency of these models in identifying those truly at risk and the cost and efficacy of preventive interventions will determine if prevention is viable. Using Model 1 data and conservative cost estimates, we found that a preventive intervention effect size of even 0.2 could make a prevention/treatment model more cost-effective than existing models of "wait-and-treat." Copyright © 2015 Elsevier Ltd. All rights reserved.

Programme costs in the economic evaluation of health interventions

PubMed Central

Johns, Benjamin; Baltussen, Rob; Hutubessy, Raymond

2003-01-01

Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of their health system performance. Costs can, for example, be used to assess if scarce resources are being used efficiently or whether there is scope to reallocate them in a way that would lead to improvements in population health. As part of its WHO-CHOICE project, WHO has been developing a database on the overall costs of health interventions in different parts of the world as an input to discussions about priority setting. Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered. This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions. PMID:12773220

Estimating the Medical Care Costs of Obesity in the United States: Systematic Review, Meta-Analysis, and Empirical Analysis.

PubMed

Kim, David D; Basu, Anirban

2016-01-01

The prevalence of adult obesity exceeds 30% in the United States, posing a significant public health concern as well as a substantial financial burden. Although the impact of obesity on medical spending is undeniably significant, the estimated magnitude of the cost of obesity has varied considerably, perhaps driven by different study methodologies. To document variations in study design and methodology in existing literature and to understand the impact of those variations on the estimated costs of obesity. We conducted a systematic review of the twelve recently published articles that reported costs of obesity and performed a meta-analysis to generate a pooled estimate across those studies. Also, we performed an original analysis to understand the impact of different age groups, statistical models, and confounder adjustment on the magnitude of estimated costs using the nationally representative Medical Expenditure Panel Surveys from 2008-2010. We found significant variations among cost estimates in the existing literature. The meta-analysis found that the annual medical spending attributable to an obese individual was $1901 ($1239-$2582) in 2014 USD, accounting for $149.4 billion at the national level. The two most significant drivers of variability in the cost estimates were age groups and adjustment for obesity-related comorbid conditions. It would be important to acknowledge variations in the magnitude of the medical cost of obesity driven by different study design and methodology. Researchers and policy-makers need to be cautious on determining appropriate cost estimates according to their scientific and political questions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A method to assess the allocation suitability of recreational activities: An economic approach

NASA Astrophysics Data System (ADS)

Wang, Hsiao-Lin

1996-03-01

Most existing methods of planning focus on development of a recreational area; less consideration is placed on the allocation of recreational activities within a recreational area. Most existing research emphasizes the economic benefits of developing a recreational area; few authors assessed the allocation suitability of recreational activities from an economic point of view. The purpose of this work was to develop a model to assess the allocation suitability of recreational activities according to the application of a concept of analysis of cost and benefit under a premise of ecological concern. The model was verified with a case study of Taiwan. We suggest that the proposed model should form a critical part of recreational planning.

Power Distribution System Planning with GIS Consideration

NASA Astrophysics Data System (ADS)

Wattanasophon, Sirichai; Eua-Arporn, Bundhit

This paper proposes a method for solving radial distribution system planning problems taking into account geographical information. The proposed method can automatically determine appropriate location and size of a substation, routing of feeders, and sizes of conductors while satisfying all constraints, i.e. technical constraints (voltage drop and thermal limit) and geographical constraints (obstacle, existing infrastructure, and high-cost passages). Sequential quadratic programming (SQP) and minimum path algorithm (MPA) are applied to solve the planning problem based on net price value (NPV) consideration. In addition this method integrates planner's experience and optimization process to achieve an appropriate practical solution. The proposed method has been tested with an actual distribution system, from which the results indicate that it can provide satisfactory plans.

Long-range consequences of interplanetary collisions

NASA Technical Reports Server (NTRS)

Sagan, Carl; Ostro, Steven J.

1994-01-01

As Comet Shoemaker-Levy 9 races toward its mid-July collision with the planet Jupiter, considerable public attention is focused on catastrophic impacts with the Earth -- in the past and in the future. In recent years calls have been made to develop technologies that could deflect any asteroid or comet on a collision course. Careful consideration must be given to the nature and time scale of the risk and to the cost-effectiveness and possible problems in the suggested solutions. Risk assessment, threat removal, and resources misuse are examined. The greatest concern is to have a poorly informed public -- exerting pressure for means to mitigate even non-existent threats. The only foreseeable solution is a combination of accurate orbit estimation, realistic threat assessment, and effective public education.

Ultimate disposal of scrubber wastes

NASA Technical Reports Server (NTRS)

Cohenour, B. C.

1978-01-01

Part of the initial concern with using the wet scrubbers on the hypergolic propellants was the subsequential disposal of the liquid wastes. To do this, consideration was given to all possible methods to reduce the volume of the wastes and stay within the guidelines established by the state and federal environmental protection agencies. One method that was proposed was the use of water hyacinths in disposal ponds to reduce the waste concentration in the effluent to less than EPA tolerable levels. This method was under consideration and even in use by private industry, municipal governments, and NASA for upgrading existing wastewater treatment facilities to a tertiary system. The use of water hyacinths in disposal ponds appears to be a very cost-effective method for reduction and disposal of hypergolic propellants.

Non-woody weed control in pine plantations

Treesearch

Phillip M. Dougherty; Bob Lowery

1986-01-01

The cost and benefits derived from controlling non-woody competitors in pine planations were reviewed. Cost considerations included both the capital cost and biological cost that may be incurred when weed control treatments are applied. Several methods for reducing the cost of herbicide treatments were explored. Cost reduction considerations included adjustments in...

Critical operations capabilities in a high cost environment: a multiple case study

NASA Astrophysics Data System (ADS)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Cost-Effectiveness of Orthogeriatric and Fracture Liaison Service Models of Care for Hip Fracture Patients: A Population-Based Study.

PubMed

Leal, Jose; Gray, Alastair M; Hawley, Samuel; Prieto-Alhambra, Daniel; Delmestri, Antonella; Arden, Nigel K; Cooper, Cyrus; Javaid, M Kassim; Judge, Andrew

2017-02-01

Fracture liaison services are recommended as a model of best practice for organizing patient care and secondary fracture prevention for hip fracture patients, although variation exists in how such services are structured. There is considerable uncertainty as to which model is most cost-effective and should therefore be mandated. This study evaluated the cost- effectiveness of orthogeriatric (OG)- and nurse-led fracture liaison service (FLS) models of post-hip fracture care compared with usual care. Analyses were conducted from a health care and personal social services payer perspective, using a Markov model to estimate the lifetime impact of the models of care. The base-case population consisted of men and women aged 83 years with a hip fracture. The risk and costs of hip and non-hip fractures were derived from large primary and hospital care data sets in the UK. Utilities were informed by a meta-regression of 32 studies. In the base-case analysis, the orthogeriatric-led service was the most effective and cost-effective model of care at a threshold of £30,000 per quality-adjusted life years gained (QALY). For women aged 83 years, the OG-led service was the most cost-effective at £22,709/QALY. If only health care costs are considered, OG-led service was cost-effective at £12,860/QALY and £14,525/QALY for women and men aged 83 years, respectively. Irrespective of how patients were stratified in terms of their age, sex, and Charlson comorbidity score at index hip fracture, our results suggest that introducing an orthogeriatrician-led or a nurse-led FLS is cost-effective when compared with usual care. Although considerable uncertainty remains concerning which of the models of care should be preferred, introducing an orthogeriatrician-led service seems to be the most cost-effective service to pursue. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

Note: An inexpensive square waveform ion funnel driver

NASA Astrophysics Data System (ADS)

Hoffman, Nathan M.; Opačić, Bojana; Reilly, Peter T. A.

2017-01-01

An inexpensive frequency variable square waveform generator (WFG) was developed to use with existing sinusoidal waveform driven ion funnels. The developed WFG was constructed using readily available low voltage DC power supplies and discrete components placed in printed circuit boards. As applied to ion funnels, this WFG represents considerable cost savings over commercially available products without sacrificing performance. Operation of the constructed pulse generator has been demonstrated for a 1 nF ion funnel at an operating frequency of 1 MHz while switching 48 Vp-p.

Note: An inexpensive square waveform ion funnel driver.

PubMed

Hoffman, Nathan M; Opačić, Bojana; Reilly, Peter T A

2017-01-01

An inexpensive frequency variable square waveform generator (WFG) was developed to use with existing sinusoidal waveform driven ion funnels. The developed WFG was constructed using readily available low voltage DC power supplies and discrete components placed in printed circuit boards. As applied to ion funnels, this WFG represents considerable cost savings over commercially available products without sacrificing performance. Operation of the constructed pulse generator has been demonstrated for a 1 nF ion funnel at an operating frequency of 1 MHz while switching 48 V p-p .

Considerations with respect to the design of solar photovoltaic power systems for terrestrial applications

NASA Technical Reports Server (NTRS)

Berman, P. A.

1972-01-01

The various factors involved in the development of solar photovoltaic power systems for terrestrial application are discussed. The discussion covers the tradeoffs, compromises, and optimization studies which must be performed in order to develop a viable terrestrial solar array system. It is concluded that the technology now exists for the fabrication of terrestrial solar arrays but that the economics are prohibitive. Various approaches to cost reduction are presented, and the general requirements for materials and processes to be used are delineated.

Primary lithium batteries, some consumer considerations

NASA Technical Reports Server (NTRS)

Bro, P.

1983-01-01

In order to determine whether larger size lithium batteries would be commercially marketable, the performance of several D size lithium batteries was compared with that of an equivalent alkaline manganese battery, and the relative costs of the different systems were compared. It is concluded that opportunities exist in the consumer market for the larger sizes of the low rate and moderate rate lithium batteries, and that the high rate lithium batteries need further improvements before they can be recommended for consumer applications.

A model to estimate the cost effectiveness of the indoorenvironment improvements in office work

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seppanen, Olli; Fisk, William J.

2004-06-01

Deteriorated indoor climate is commonly related to increases in sick building syndrome symptoms, respiratory illnesses, sick leave, reduced comfort and losses in productivity. The cost of deteriorated indoor climate for the society is high. Some calculations show that the cost is higher than the heating energy costs of the same buildings. Also building-level calculations have shown that many measures taken to improve indoor air quality and climate are cost-effective when the potential monetary savings resulting from an improved indoor climate are included as benefits gained. As an initial step towards systemizing these building level calculations we have developed a conceptualmore » model to estimate the cost-effectiveness of various measures. The model shows the links between the improvements in the indoor environment and the following potential financial benefits: reduced medical care cost, reduced sick leave, better performance of work, lower turn over of employees, and lower cost of building maintenance due to fewer complaints about indoor air quality and climate. The pathways to these potential benefits from changes in building technology and practices go via several human responses to the indoor environment such as infectious diseases, allergies and asthma, sick building syndrome symptoms, perceived air quality, and thermal environment. The model also includes the annual cost of investments, operation costs, and cost savings of improved indoor climate. The conceptual model illustrates how various factors are linked to each other. SBS symptoms are probably the most commonly assessed health responses in IEQ studies and have been linked to several characteristics of buildings and IEQ. While the available evidence indicates that SBS symptoms can affect these outcomes and suspects that such a linkage exists, at present we can not quantify the relationships sufficiently for cost-benefit modeling. New research and analyses of existing data to quantify the financial importance of SBS symptoms would enable more widespread consideration of the effects of IEQ in cost benefit calculations.« less

Role of prospective registries in defining the value and effectiveness of spine care.

PubMed

McGirt, Matthew J; Parker, Scott L; Asher, Anthony L; Norvell, Dan; Sherry, Ned; Devin, Clinton J

2014-10-15

Literature review and case example. Describe methodological considerations of spine surgery registries. Review existing spine surgery registries. Describe the Vanderbilt Prospective Spine Registry (VPSR) as a case example and demonstrate its impact on comparative effectiveness research, value analysis, quality improvement, and practice-based learning. To bend the cost curve and ultimately achieve sustainability in health care, medical providers and surgical treatments of the highest quality and effectiveness must be preferentially used and purchased. As the current US health care environment continues to evolve, it will be essential for all spine clinicians to understand and be facile with the principles of evidence-based health care reform. We describe the methodological considerations of spine surgery registries, review the literature to describe existing spine surgery registries, and discuss the VPSR as a case example. We were able to obtain detailed information on 13 existing spine surgery registries through various internet-based resources. Of the 13, 2 registries had start dates before 2000, 3 between 2001 and 2005, 5 starting in 2006, and 3 were indeterminate. Follow-up rates were in the range from 22% to 79%, with longer follow-up times consistently producing lower follow-up rates. Prospective, longitudinal, patient-reported outcomes registries are powerful tools that allow measurement of cost, safety, effectiveness, and health care value across clinically meaningful episodes of care. Registries entirely based on claims or billing data, safety measures alone, process measures, or other proxies of outcome offer valuable insights, but do not provide comprehensive data to drive patient-centered value-based reform. As more spine-focused registries emerge and their integration into the US health care delivery evolve, the evidence to power value-based reform will be enabled.

Sustainable business models: systematic approach toward successful ambulatory care pharmacy practice.

PubMed

Sachdev, Gloria

2014-08-15

This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The cost effectiveness of radon mitigation in existing German dwellings--a decision theoretic analysis.

PubMed

Haucke, Florian

2010-11-01

Radon is a naturally occurring inert radioactive gas found in soils and rocks that can accumulate in dwellings, and is associated with an increased risk of lung cancer. This study aims to analyze the cost effectiveness of different intervention strategies to reduce radon concentrations in existing German dwellings. The cost effectiveness analysis (CEA) was conducted as a scenario analysis, where each scenario represents a specific regulatory regime. A decision theoretic model was developed, which reflects accepted recommendations for radon screening and mitigation and uses most up-to-date data on radon distribution and relative risks. The model was programmed to account for compliance with respect to the single steps of radon intervention, as well as data on the sensitivity/specificity of radon tests. A societal perspective was adopted to calculate costs and effects. All scenarios were calculated for different action levels. Cost effectiveness was measured in costs per averted case of lung cancer, costs per life year gained and costs per quality adjusted life year (QALY) gained. Univariate and multivariate deterministic and probabilistic sensitivity analyses (SA) were performed. Probabilistic sensitivity analyses were based on Monte Carlo simulations with 5000 model runs. The results show that legal regulations with mandatory screening and mitigation for indoor radon levels >100 Bq/m(3) are most cost effective. Incremental cost effectiveness compared to the no mitigation base case is 25,181 euro (95% CI: 7371 euro-90,593 euro) per QALY gained. Other intervention strategies focussing primarily on the personal responsibility for screening and/or mitigative actions show considerably worse cost effectiveness ratios. However, targeting radon intervention to radon-prone areas is significantly more cost effective. Most of the uncertainty that surrounds the results can be ascribed to the relative risk of radon exposure. It can be concluded that in the light of international experience a legal regulation requiring radon screening and, if necessary, mitigation is justifiable under the terms of CEA. Copyright 2010 Elsevier Ltd. All rights reserved.

Is Financial Literacy a Determinant of Health?

PubMed

Meyer, Melanie

2017-08-01

Changes in economic conditions and healthcare delivery models have shifted more healthcare costs to patients, resulting in greater patient financial responsibilities. As a result, it is important to understand the potential impact of financial literacy on patients' healthcare behavior. With the focus on delivering better health outcomes at lower costs, factors that influence patient behavior are important considerations for healthcare providers. Although researchers have proposed a variety of conceptual models that identify influential factors, those models do not fully address financial literacy and its potential impact patients' healthcare decisions. This article examines existing models of patient healthcare decision-making and current research on factors affecting patient decision-making and behavior and then presents recommendations for closing the identified gap in our current knowledge.

Cost analysis of school-based intermittent screening and treatment of malaria in Kenya

PubMed Central

2011-01-01

Background The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. This paper analyses the costs of intermittent screening and treatment (IST) of malaria in schools, implemented as part of a cluster-randomized controlled trial on the Kenyan coast. Methods Financial and economic costs were estimated using an ingredients approach whereby all resources required in the delivery of IST are quantified and valued. Sensitivity analysis was conducted to investigate how programme variation affects costs and to identify potential cost savings in the future implementation of IST. Results The estimated financial cost of IST per child screened is US$ 6.61 (economic cost US$ 6.24). Key contributors to cost were salary costs (36%) and malaria rapid diagnostic tests (RDT) (22%). Almost half (47%) of the intervention cost comprises redeployment of existing resources including health worker time and use of hospital vehicles. Sensitivity analysis identified changes to intervention delivery that can reduce programme costs by 40%, including use of alternative RDTs and removal of supervised treatment. Cost-effectiveness is also likely to be highly sensitive to the proportion of children found to be RDT-positive. Conclusion In the current context, school-based IST is a relatively expensive malaria intervention, but reducing the complexity of delivery can result in considerable savings in the cost of intervention. (Costs are reported in US$ 2010). PMID:21933376

[Direct and indirect costs of fractures due to osteoporosis in Austria].

PubMed

Dimai, H-P; Redlich, K; Schneider, H; Siebert, U; Viernstein, H; Mahlich, J

2012-10-01

We examined the financial burden of osteoporosis in Austria. We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers. © Georg Thieme Verlag KG Stuttgart · New York.

Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs.

PubMed

Cole, Evan S; Campbell, Claudia; Diana, Mark L; Webber, Larry; Culbertson, Richard

2015-01-01

The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. Project HOPE—The People-to-People Health Foundation, Inc.

Investigation and appreciation of optimal output feedback. Volume 1: A convergent algorithm for the stochastic infinite-time discrete optimal output feedback problem

NASA Technical Reports Server (NTRS)

Halyo, N.; Broussard, J. R.

1984-01-01

The stochastic, infinite time, discrete output feedback problem for time invariant linear systems is examined. Two sets of sufficient conditions for the existence of a stable, globally optimal solution are presented. An expression for the total change in the cost function due to a change in the feedback gain is obtained. This expression is used to show that a sequence of gains can be obtained by an algorithm, so that the corresponding cost sequence is monotonically decreasing and the corresponding sequence of the cost gradient converges to zero. The algorithm is guaranteed to obtain a critical point of the cost function. The computational steps necessary to implement the algorithm on a computer are presented. The results are applied to a digital outer loop flight control problem. The numerical results for this 13th order problem indicate a rate of convergence considerably faster than two other algorithms used for comparison.

The high intensity solar cell - Key to low cost photovoltaic power

NASA Technical Reports Server (NTRS)

Sater, B. L.; Goradia, C.

1975-01-01

This paper discusses the problems associated with conventional solar cells at high intensities and presents the design considerations and performance characteristics of the 'high intensity' (HI) solar cell which appears to eliminate the major problems. Test data obtained at greater than 250 AM1 suns gave a peak output power density of 2 W per sq cm at an efficiency exceeding 6% with an unoptimized cell operating at over 100 C. It appears that operation at 1000 AM1 suns at efficiencies greater than 10% is possible. At 1000 AM1 suns and 10% efficiency, the HI cell manufacturing cost is estimated to be $0.25/watt, with multi-megawatt annual production capability already existing within the industrial sector. A high intensity solar system was also analyzed to determine its cost effectiveness and to assess the benefits of further improving HI cell efficiency.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marnay, Chris; Siddiqui, Afzal; Marnay, Chris

This paper examines a California-based microgrid?s decision to invest in a distributed generation (DG) unit fuelled by natural gas. While the long-term natural gas generation cost is stochastic, we initially assume that the microgrid may purchase electricity at a fixed retail rate from its utility. Using the real options approach, we find a natural gas generation cost threshold that triggers DG investment. Furthermore, the consideration of operational flexibility by the microgrid increases DG investment, while the option to disconnect from the utility is not attractive. By allowing the electricity price to be stochastic, we next determine an investment threshold boundarymore » and find that high electricity price volatility relative to that of natural gas generation cost delays investment while simultaneously increasing the value of the investment. We conclude by using this result to find the implicit option value of the DG unit when two sources of uncertainty exist.« less

Regulatory and clinical considerations for biosimilar oncology drugs

PubMed Central

Bennett, Charles L; Chen, Brian; Hermanson, Terhi; Wyatt, Michael D; Schulz, Richard M; Georgantopoulos, Peter; Kessler, Samuel; Raisch, Dennis W; Qureshi, Zaina P; Lu, Z Kevin; Love, Bryan L; Noxon, Virginia; Bobolts, Laura; Armitage, Melissa; Bian, John; Ray, Paul; Ablin, Richard J; Hrushesky, William J; Macdougall, Iain C; Sartor, Oliver; Armitage, James O

2015-01-01

Biological oncology products are integral to cancer treatment, but their high costs pose challenges to patients, families, providers, and insurers. The introduction of biosimilar agents—molecules that are similar in structure, function, activity, immunogenicity, and safety to the original biological drugs—provide opportunities both to improve healthcare access and outcomes, and to reduce costs. Several international regulatory pathways have been developed to expedite entry of biosimilars into global marketplaces. The first wave of oncology biosimilar use was in Europe and India in 2007. Oncology biosimilars are now widely marketed in several countries in Europe, and in Australia, Japan, China, Russia, India, and South Korea. Their use is emerging worldwide, with the notable exception of the USA, where several regulatory and cost barriers to biosimilar approval exist. In this Review, we discuss oncology biosimilars and summarise their regulatory frameworks, clinical experiences, and safety concerns. PMID:25456378

Economic considerations in the care of patients with head and neck malignancies.

PubMed

Pfister, D G; Ruchlin, H S; Elkin, E B

1997-05-01

In an era of cost-consciousness and managed care, quality concerns practice variability attributed to nonmedical factors, and growing attention to outcomes research, there is increasing interest in the economics of malignant disease. This review explores economic issues pertinent to the management of patients with head and neck malignancies. Using economic principles to evaluate medical practice does not uniformly mean that less money should be spent; rather, the intention is to optimize efficiency in the use of limited resources. Accordingly costs are best evaluated in the context of other outcomes of interest. The available economic literature for head and neck tumors is limited; it is often compromised by the use of facility charges as a proxy for true costs and the adoption of a truncated economic perspective. Given the potential health policy implications of such studies, their methodologies and results warrant careful scrutiny. Many opportunities exist for further research.

New approach for optimal electricity planning and dispatching with hourly time-scale air quality and health considerations.

PubMed

Kerl, Paul Y; Zhang, Wenxian; Moreno-Cruz, Juan B; Nenes, Athanasios; Realff, Matthew J; Russell, Armistead G; Sokol, Joel; Thomas, Valerie M

2015-09-01

Integrating accurate air quality modeling with decision making is hampered by complex atmospheric physics and chemistry and its coupling with atmospheric transport. Existing approaches to model the physics and chemistry accurately lead to significant computational burdens in computing the response of atmospheric concentrations to changes in emissions profiles. By integrating a reduced form of a fully coupled atmospheric model within a unit commitment optimization model, we allow, for the first time to our knowledge, a fully dynamical approach toward electricity planning that accurately and rapidly minimizes both cost and health impacts. The reduced-form model captures the response of spatially resolved air pollutant concentrations to changes in electricity-generating plant emissions on an hourly basis with accuracy comparable to a comprehensive air quality model. The integrated model allows for the inclusion of human health impacts into cost-based decisions for power plant operation. We use the new capability in a case study of the state of Georgia over the years of 2004-2011, and show that a shift in utilization among existing power plants during selected hourly periods could have provided a health cost savings of $175.9 million dollars for an additional electricity generation cost of $83.6 million in 2007 US dollars (USD2007). The case study illustrates how air pollutant health impacts can be cost-effectively minimized by intelligently modulating power plant operations over multihour periods, without implementing additional emissions control technologies.

New approach for optimal electricity planning and dispatching with hourly time-scale air quality and health considerations

PubMed Central

Kerl, Paul Y.; Zhang, Wenxian; Moreno-Cruz, Juan B.; Nenes, Athanasios; Realff, Matthew J.; Russell, Armistead G.; Sokol, Joel; Thomas, Valerie M.

2015-01-01

Integrating accurate air quality modeling with decision making is hampered by complex atmospheric physics and chemistry and its coupling with atmospheric transport. Existing approaches to model the physics and chemistry accurately lead to significant computational burdens in computing the response of atmospheric concentrations to changes in emissions profiles. By integrating a reduced form of a fully coupled atmospheric model within a unit commitment optimization model, we allow, for the first time to our knowledge, a fully dynamical approach toward electricity planning that accurately and rapidly minimizes both cost and health impacts. The reduced-form model captures the response of spatially resolved air pollutant concentrations to changes in electricity-generating plant emissions on an hourly basis with accuracy comparable to a comprehensive air quality model. The integrated model allows for the inclusion of human health impacts into cost-based decisions for power plant operation. We use the new capability in a case study of the state of Georgia over the years of 2004–2011, and show that a shift in utilization among existing power plants during selected hourly periods could have provided a health cost savings of $175.9 million dollars for an additional electricity generation cost of $83.6 million in 2007 US dollars (USD2007). The case study illustrates how air pollutant health impacts can be cost-effectively minimized by intelligently modulating power plant operations over multihour periods, without implementing additional emissions control technologies. PMID:26283358

Explanation of Change (EoC) Study: Considerations and Implementation Challenges

NASA Technical Reports Server (NTRS)

Bitten, Robert E.; Emmons, Debra L.; Hart, Matthew J.; Bordi, Francesco; Scolese, Christopher; Hinners, Noel

2013-01-01

This paper discusses the implementation of considerations resulting from a study investigating the cost change experienced by historical NASA science missions. The study investigated historical milestone and monthly status report documentation followed by interviews with key project personnel. The reasons for cost change were binned as being external to NASA, external to the project and internal to the project relative to the project's planning and execution. Based on the results of the binning process and the synthesis of project meetings and interviews, ten considerations were made with the objective to decrease the potential for cost change in future missions. Although no one magic bullet consideration was discovered, the considerations taken as a whole should help reduce cost and schedule change in future NASA missions.

Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave

PubMed Central

2010-01-01

Background Estimating the economic impact of influenza is complicated because the disease may have non-specific symptoms, and many patients with influenza are registered with other diagnoses. Furthermore, in some countries like Norway, employees can be on paid sick leave for a specified number of days without a doctor's certificate ("self-reported sick leave") and these sick leaves are not registered. Both problems result in gaps in the existing literature: costs associated with influenza-related illness and self-reported sick leave are rarely included. The aim of this study was to improve estimates of total influenza-related health-care costs and productivity losses by estimating these missing costs. Methods Using Norwegian data, the weekly numbers of influenza-attributable hospital admissions and certified sick leaves registered with other diagnoses were estimated from influenza-like illness surveillance data using quasi-Poisson regression. The number of self-reported sick leaves was estimated using a Monte-Carlo simulation model of illness recovery curves based on the number of certified sick leaves. A probabilistic sensitivity analysis was conducted on the economic outcomes. Results During the 1998/99 through 2005/06 influenza seasons, the models estimated an annual average of 2700 excess influenza-associated hospitalizations in Norway, of which 16% were registered as influenza, 51% as pneumonia and 33% were registered with other diagnoses. The direct cost of seasonal influenza totaled US$22 million annually, including costs of pharmaceuticals and outpatient services. The annual average number of working days lost was predicted at 793 000, resulting in an estimated productivity loss of US$231 million. Self-reported sick leave accounted for approximately one-third of the total indirect cost. During a pandemic, the total cost could rise to over US$800 million. Conclusions Influenza places a considerable burden on patients and society with indirect costs greatly exceeding direct costs. The cost of influenza-attributable complications and the cost of self-reported sick leave represent a considerable part of the economic burden of influenza. PMID:21106057

Cost consideration in the clinical guidance documents of physician specialty societies in the United States.

PubMed

Schwartz, Jennifer A T; Pearson, Steven D

2013-06-24

Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

Power Systems Life Cycle Analysis Tool (Power L-CAT).

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andruski, Joel; Drennen, Thomas E.

2011-01-01

The Power Systems L-CAT is a high-level dynamic model that calculates levelized production costs and tracks environmental performance for a range of electricity generation technologies: natural gas combined cycle (using either imported (LNGCC) or domestic natural gas (NGCC)), integrated gasification combined cycle (IGCC), supercritical pulverized coal (SCPC), existing pulverized coal (EXPC), nuclear, and wind. All of the fossil fuel technologies also include an option for including carbon capture and sequestration technologies (CCS). The model allows for quick sensitivity analysis on key technical and financial assumptions, such as: capital, O&M, and fuel costs; interest rates; construction time; heat rates; taxes; depreciation;more » and capacity factors. The fossil fuel options are based on detailed life cycle analysis reports conducted by the National Energy Technology Laboratory (NETL). For each of these technologies, NETL's detailed LCAs include consideration of five stages associated with energy production: raw material acquisition (RMA), raw material transport (RMT), energy conversion facility (ECF), product transportation and distribution (PT&D), and end user electricity consumption. The goal of the NETL studies is to compare existing and future fossil fuel technology options using a cradle-to-grave analysis. The NETL reports consider constant dollar levelized cost of delivered electricity, total plant costs, greenhouse gas emissions, criteria air pollutants, mercury (Hg) and ammonia (NH3) emissions, water withdrawal and consumption, and land use (acreage).« less

Application of an Original Wildfire Smoke Health Cost Benefits Transfer Protocol to the Western US, 2005-2015

NASA Astrophysics Data System (ADS)

Jones, Benjamin A.; Berrens, Robert P.

2017-11-01

Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates 165 million in annual morbidity and mortality health costs.

Application of an Original Wildfire Smoke Health Cost Benefits Transfer Protocol to the Western US, 2005-2015.

PubMed

Jones, Benjamin A; Berrens, Robert P

2017-11-01

Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates $165 million in annual morbidity and mortality health costs.

Potential Nationwide Improvements in Productivity and Health from Better Indoor Environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisk, W.J.; Rosenfeld, A.H.

1998-05-01

Theoretical considerations and empirical data suggest that existing technologies and procedures can improve indoor environments in a manner that significantly increases productivity and health. Existing literature contains moderate to strong evidence that characteristics of buildings and indoor environments significantly influence rates of respiratory disease, allergy and asthma symptoms, sick building symptoms, and worker performance. While there is considerable uncertainty in our estimates of the magnitudes of productivity gains that may be obtained by providing better indoor environments, the projected gains are very large. For the U.S., we estimate potential annual savings and productivity gains of $6 to $19 billion frommore » reduced respiratory disease, $1 to $4 billion from reduced allergies and asthma, $10 to $20 billion from reduced sick building syndrome symptoms, and $12 to $125 billion from direct improvements in worker performance that are unrelated to health. In two example calculations, the potential financial benefits of improving indoor environments exceed costs by a factor of 8 and 14. Productivity gains that are quantified and demonstrated could serve as a strong stimulus for energy efficiency measures that simultaneously improve the indoor environment.« less

Potential nationwide improvements in productivity and health from better indoor environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisk, W.J.; Rosenfeld, A.H.

1998-07-01

Theoretical considerations and empirical data suggest that existing technologies and procedures can improve indoor environments in a manner that significantly increases productivity and health. Existing literature contains moderate to strong evidence that characteristics of buildings and indoor environments significantly influence rates of respiratory disease, allergy and asthma symptoms, sick building symptoms, and worker performance. While there is considerable uncertainty in their estimates of the magnitudes of productivity gains that may be obtained by providing better indoor environments, the projected gains are very large. For the US, the authors estimate potential annual savings and productivity gains of $6 to $19 billionmore » from reduced respiratory disease, $1 to $4 billion from reduced allergies and asthma, $10 to $20 billion from reduced sick building syndrome symptoms, and $12 to $125 billion from direct improvements in worker performance that are unrelated to health. In two example calculations, the potential financial benefits of improving indoor environments exceed costs by a factor of 8 and 14. Productivity gains that are quantified and demonstrated could serve as a strong stimulus for energy efficiency measures that simultaneously improve the indoor environment.« less

Satellite sound broadcasting system study: Mobile considerations

NASA Technical Reports Server (NTRS)

Golshan, Nasser

1990-01-01

Discussed here is the mobile reception part of a study to investigate a satellite sound broadcast system in the UHF or L bands. Existing propagation and reception measurements are used with proper interpretation to evaluate the signaling, coding, and diversity alternatives suitable for the system. Signal attenuation in streets shadowed by buildings appear to be around 29 db, considerably higher than the 10 db adopted by CCIR. With the marriage of proper technologies, an LMSS class satellite can provide substantial direct satellite audio broadcast capability in UHF or L bands for high quality mobile and portable indoor reception by low cost radio receivers. This scheme requires terrestrial repeaters for satisfactory mobile reception in urban areas. A specialized bandwidth efficient spread spectrum signalling technique is particularly suitable for the terrestrial repeaters.

A Shuttle Derived Vehicle launch system

NASA Technical Reports Server (NTRS)

Tewell, J. R.; Buell, D. N.; Ewing, E. S.

1982-01-01

This paper describes a Shuttle Derived Vehicle (SDV) launch system presently being studied for the NASA by Martin Marietta Aerospace which capitalizes on existing Shuttle hardware elements to provide increased accommodations for payload weight, payload volume, or both. The SDV configuration utilizes the existing solid rocket boosters, external tank and the Space Shuttle main engines but replaces the manned orbiter with an unmanned, remotely controlled cargo carrier. This cargo carrier substitution more than doubles the performance capability of the orbiter system and is realistically achievable for minimal cost. The advantages of the SDV are presented in terms of performance and economics. Based on these considerations, it is concluded that an unmanned SDV offers a most attractive complement to the present Space Transportation System.

Spinal surgery: variations in health care costs and implications for episode-based bundled payments.

PubMed

Ugiliweneza, Beatrice; Kong, Maiying; Nosova, Kristin; Huang, Kevin T; Babu, Ranjith; Lad, Shivanand P; Boakye, Maxwell

2014-07-01

Retrospective, observational. To simulate what episodes of care in spinal surgery might look like in a bundled payment system and to evaluate the associated costs and characteristics. Episode-based payment bundling has received considerable attention as a potential method to help curb the rise in health care spending and is being investigated as a new payment model as part of the Affordable Care Act. Although earlier studies investigated bundled payments in a number of surgical settings, very few focused on spine surgery, specifically. We analyzed data from MarketScan. Patients were included in the study if they underwent cervical or lumbar spinal surgery during 2000-2009, had at least 2-year preoperative and 90-day postoperative follow-up data. Patients were grouped on the basis of their diagnosis-related group (DRG) and then tracked in simulated episodes-of-care/payment bundles that lasted for the duration of 30, 60, and 90 days after the discharge from the index-surgical hospitalization. The total cost associated with each episode-of-care duration was measured and characterized. A total of 196,918 patients met our inclusion criteria. Significant variation existed between DRGs, ranging from $11,180 (30-day bundle, DRG 491) to $107,642 (30-day bundle, DRG 456). There were significant cost variations within each individual DRG. Postdischarge care accounted for a relatively small portion of overall bundle costs (range, 4%-8% in 90-day bundles). Total bundle costs remained relatively flat as bundle-length increased (total average cost of 30-day bundle: $33,522 vs. $35,165 for 90-day bundle). Payments to hospitals accounted for the largest portion of bundle costs (76%). There exists significant variation in total health care costs for patients who undergo spinal surgery, even within a given DRG. Better characterization of impacts of a bundled payment system in spine surgery is important for understanding the costs of index procedure hospital, physician services, and postoperative care on potential future health care policy decision making. N/A.

An overview of autonomous rendezvous and docking system technology development

NASA Astrophysics Data System (ADS)

Nelson, Kurt D.

The Centaur upper stage was selected for an airborne avionics modernization program. The parts used in the existing avionics units were obsolete. Continued use of existing hardware would require substantial redesign, yet would result in the use of outdated hardware. Out of date processes, with very expensive and labor intensive technologies, were being used for manufacturing. The Atlas/Centaur avionics were to be procured at a fairly high rate that demanded the use of modern components. The new avionics also reduce size, weight, power, and parts count with a dramatic improvement in reliability. Finally, the cost leverage derived from upgrading the avionics as opposed to any other subsystem for the existing Atlas/Centaur was a very large consideration in the upgrade decision. The upgrade program is a multiyear effort that began in 1989. It includes telemetry, guidance and navigation, control electronics, thrust vector control, and redundancy levels.

40 CFR 35.937-6 - Cost and price considerations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Cost and price considerations. 35.937-6...) shall apply. (1) The candidate(s) selected for negotiation shall submit to the grantee for review...) Cost review. (1) The grantee shall review proposed subagreement costs. (2) As a minimum, proposed...

40 CFR 35.937-6 - Cost and price considerations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Cost and price considerations. 35.937-6...) shall apply. (1) The candidate(s) selected for negotiation shall submit to the grantee for review...) Cost review. (1) The grantee shall review proposed subagreement costs. (2) As a minimum, proposed...

Workshop Report on Deep Mars: Accessing the Subsurface of Mars on Near Term Missions

NASA Technical Reports Server (NTRS)

Langhoff, Stephanie R. (Editor)

2008-01-01

The workshop encompassed three major themes. The first theme was the scientific objectives of drilling, which center on the search for clues to the existence of past life and to the geological and climate history of Mars. Key questions are where and how deep to drill? Planetary protection issues were stressed as an important consideration in the design of any drilling mission. Secondly, architectures for drilling missions were discussed, including an overview of most of the current drills in operation that would be applicable to drilling on Mars. Considerable emphasis was placed on remote operation and drilling automation technologies. Finally, alternatives to conventional drilling were discussed. These included underground moles, penetrometers, horizontal drilling, impactors, and access to the subsurface from subsurface cavities. Considerable discussion centered on the possible Mars drilling missions that could be performed in both the near and longer term. The workshop participants concluded that useful science could be obtained today using low-cost impactors, with or without a sheperding spacecraft.

Health care cost containment in Denmark and Norway: a question of relative professional status?

PubMed

Andersen, Lotte B

2014-04-01

The demand for publicly subsidized health care services is insatiable, but the costs can be contained in different ways: formal rules can limit access to and the number of subsidized services, demand and supply can be regulated through the price mechanism, the relevant profession can contain the costs through state-sanctioned self-regulation, and other professions can contain the costs (e.g. through referrals). The use of these cost containment measures varies between countries, depending on demand and supply factors, but the relative professional status of the health professions may help explain why different countries use cost containment measures differently for different services. This article compares cost containment measures in Denmark and Norway because these countries vary with regard to the professional status of the medical profession relative to other health care providers, while other relevant variables are approximately similar. The investigation is based on formal agreements and rules, historical documents, existing analyses and an analysis of 360 newspaper articles. It shows that high relative professional status seems to help professions to avoid user fees, steer clear of regulation from other professions and regulate the services produced by others. This implies that relative professional status should be taken into consideration in analyses of health care cost containment.

Forecasting the impact of virtual environment technology on maintenance training

NASA Technical Reports Server (NTRS)

Schlager, Mark S.; Boman, Duane; Piantanida, Tom; Stephenson, Robert

1993-01-01

To assist NASA and the Air Force in determining how and when to invest in virtual environment (VE) technology for maintenance training, we identified possible roles for VE technology in such training, assessed its cost-effectiveness relative to existing technologies, and formulated recommendations for a research agenda that would address instructional and system development issues involved in fielding a VE training system. In the first phase of the study, we surveyed VE developers to forecast capabilities, maturity, and estimated costs for VE component technologies. We then identified maintenance tasks and their training costs through interviews with maintenance technicians, instructors, and training developers. Ten candidate tasks were selected from two classes of maintenance tasks (seven aircraft maintenance and three space maintenance) using five criteria developed to identify types of tasks most likely to benefit from VE training. Three tasks were used as specific cases for cost-benefit analysis. In formulating research recommendations, we considered three aspects of feasibility: technological considerations, cost-effectiveness, and anticipated R&D efforts. In this paper, we describe the major findings in each of these areas and suggest research efforts that we believe will help achieve the goal of a cost-effective VE maintenance training system by the next decade.

A Novel Location-Centric IoT-Cloud Based On-Street Car Parking Violation Management System in Smart Cities.

PubMed

Dinh, Thanh; Kim, Younghan

2016-06-02

Nowadays, in big cities, parking management is a critical issue from both the driver's side and the city government's side. From the driver's side, how to find an available parking lot in a city is a considerable concern. As a result, smart parking systems recently have received great interest, both in academia and industry. From the city government's side, how to manage and distribute such a limited public parking resource efficiently to give every visitor a fair chance of finding an on-street parking lot is also a considerable concern. However, existing studies of smart parking management focus only on assisting the driver's side to find available parking spaces. This study aims to raise a new perspective on such smart parking management and to propose a novel location-centric IoT-cloud-based parking violation management system. The system is designed to assist authoritative officers in finding parking violations easily and recommends the least cost path for officers so that officers can achieve their highest productivity in finding parking violations and issuing parking tickets. Experimental results show that the system not only improves the productivity of officers in finding parking violations and issuing tickets, but also helps reduce the traveling cost of officers and to reduce the average violation period of violating cars considerably.

A Novel Location-Centric IoT-Cloud Based On-Street Car Parking Violation Management System in Smart Cities

PubMed Central

Dinh, Thanh; Kim, Younghan

2016-01-01

Nowadays, in big cities, parking management is a critical issue from both the driver’s side and the city government’s side. From the driver’s side, how to find an available parking lot in a city is a considerable concern. As a result, smart parking systems recently have received great interest, both in academia and industry. From the city government’s side, how to manage and distribute such a limited public parking resource efficiently to give every visitor a fair chance of finding an on-street parking lot is also a considerable concern. However, existing studies of smart parking management focus only on assisting the driver’s side to find available parking spaces. This study aims to raise a new perspective on such smart parking management and to propose a novel location-centric IoT-cloud-based parking violation management system. The system is designed to assist authoritative officers in finding parking violations easily and recommends the least cost path for officers so that officers can achieve their highest productivity in finding parking violations and issuing parking tickets. Experimental results show that the system not only improves the productivity of officers in finding parking violations and issuing tickets, but also helps reduce the traveling cost of officers and to reduce the average violation period of violating cars considerably. PMID:27271620

Cultural Differences in Opportunity Cost Consideration.

PubMed

Zhang, Ning; Ji, Li-Jun; Li, Ye

2017-01-01

Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed.

A Lightweight Loudspeaker for Aircraft Communications and Active Noise Control

NASA Technical Reports Server (NTRS)

Warnaka, Glenn E.; Kleinle, Mark; Tsangaris, Parry; Oslac, Michael J.; Moskow, Harry J.

1992-01-01

A series of new, lightweight loudspeakers for use on commercial aircraft has been developed. The loudspeakers use NdFeB magnets and aluminum alloy frames to reduce the weight. The NdFeB magnet is virtually encapsulated by steel in the new speaker designs. Active noise reduction using internal loudspeakers was demonstrated to be effective in 1983. A weight, space, and cost efficient method for creating the active sound attenuating fields is to use the existing cabin loudspeakers for both communication and sound attenuation. This will require some additional loudspeaker design considerations.

From Earth to Orbit: An assessment of transportation options

NASA Technical Reports Server (NTRS)

Gavin, Joseph G., Jr.; Blond, Edmund; Brill, Yvonne C.; Budiansky, Bernard; Cooper, Robert S.; Demisch, Wolfgang H.; Hawk, Clark W.; Kerrebrock, Jack L.; Lichtenberg, Byron K.; Mager, Artur

1992-01-01

The report assesses the requirements, benefits, technological feasibility, and roles of Earth-to-Orbit transportation systems and options that could be developed in support of future national space programs. Transportation requirements, including those for Mission-to-Planet Earth, Space Station Freedom assembly and operation, human exploration of space, space science missions, and other major civil space missions are examined. These requirements are compared with existing, planned, and potential launch capabilities, including expendable launch vehicles (ELV's), the Space Shuttle, the National Launch System (NLS), and new launch options. In addition, the report examines propulsion systems in the context of various launch vehicles. These include the Advanced Solid Rocket Motor (ASRM), the Redesigned Solid Rocket Motor (RSRM), the Solid Rocket Motor Upgrade (SRMU), the Space Shuttle Main Engine (SSME), the Space Transportation Main Engine (STME), existing expendable launch vehicle engines, and liquid-oxygen/hydrocarbon engines. Consideration is given to systems that have been proposed to accomplish the national interests in relatively cost effective ways, with the recognition that safety and reliability contribute to cost-effectiveness. Related resources, including technology, propulsion test facilities, and manufacturing capabilities are also discussed.

Assessing the Accuracy of Ortho-image using Photogrammetric Unmanned Aerial System

NASA Astrophysics Data System (ADS)

Jeong, H. H.; Park, J. W.; Kim, J. S.; Choi, C. U.

2016-06-01

Smart-camera can not only be operated under network environment anytime and any place but also cost less than the existing photogrammetric UAV since it provides high-resolution image, 3D location and attitude data on a real-time basis from a variety of built-in sensors. This study's proposed UAV photogrammetric method, low-cost UAV and smart camera were used. The elements of interior orientation were acquired through camera calibration. The image triangulation was conducted in accordance with presence or absence of consideration of the interior orientation (IO) parameters determined by camera calibration, The Digital Elevation Model (DEM) was constructed using the image data photographed at the target area and the results of the ground control point survey. This study also analyzes the proposed method's application possibility by comparing a Ortho-image the results of the ground control point survey. Considering these study findings, it is suggested that smartphone is very feasible as a payload for UAV system. It is also expected that smartphone may be loaded onto existing UAV playing direct or indirect roles significantly.

Econutrition and utilization of food-based approaches for nutritional health.

PubMed

Blasbalg, Tanya L; Wispelwey, Bram; Deckelbaum, Richard J

2011-03-01

Macronutrient and micronutrient deficiencies continue to have a detrimental impact in lower-income countries, with significant costs in morbidity, mortality, and productivity. Food is the primary source of the nutrients needed to sustain life, and it is the essential component that links nutrition, agriculture, and ecology in the econutrition framework. To present evidence and analysis of food-based approaches for improving nutritional and health outcomes in lower-income countries. Review of existing literature. The benefits of food-based approaches may include nutritional improvement, food security, cost-effectiveness, sustainability, and human productivity. Food-based approaches require additional inputs, including nutrition education, gender considerations, and agricultural planning. Although some forms of malnutrition can be addressed via supplements, food-based approaches are optimal to achieve sustainable solutions to multiple nutrient deficiencies.

Explicating an Evidence-Based, Theoretically Informed, Mobile Technology-Based System to Improve Outcomes for People in Recovery for Alcohol Dependence

PubMed Central

Gustafson, David H.; Isham, Andrew; Baker, Timothy; Boyle, Michael G.; Levy, Michael

2011-01-01

Post treatment relapse to uncontrolled alcohol use is common. More cost-effective approaches are needed. We believe currently available communication technology can use existing models for relapse prevention to cost-effectively improve long-term relapse prevention. This paper describes: 1) research-based elements of alcohol related relapse prevention and how they can be encompassed in Self Determination Theory (SDT) and Marlatt’s Cognitive Behavioral Relapse Prevention Model, 2) how technology could help address the needs of people seeking recovery, 3) a technology-based prototype, organized around Self Determination Theory and Marlatt’s model and 4) how we are testing a system based on the ideas in this article and related ethical and operational considerations. PMID:21190410

A topological proof of chaos for two nonlinear heterogeneous triopoly game models

NASA Astrophysics Data System (ADS)

Pireddu, Marina

2016-08-01

We rigorously prove the existence of chaotic dynamics for two nonlinear Cournot triopoly game models with heterogeneous players, for which in the existing literature the presence of complex phenomena and strange attractors has been shown via numerical simulations. In the first model that we analyze, costs are linear but the demand function is isoelastic, while, in the second model, the demand function is linear and production costs are quadratic. As concerns the decisional mechanisms adopted by the firms, in both models one firm adopts a myopic adjustment mechanism, considering the marginal profit of the last period; the second firm maximizes its own expected profit under the assumption that the competitors' production levels will not vary with respect to the previous period; the third firm acts adaptively, changing its output proportionally to the difference between its own output in the previous period and the naive expectation value. The topological method we employ in our analysis is the so-called "Stretching Along the Paths" technique, based on the Poincaré-Miranda Theorem and the properties of the cutting surfaces, which allows to prove the existence of a semi-conjugacy between the system under consideration and the Bernoulli shift, so that the former inherits from the latter several crucial chaotic features, among which a positive topological entropy.

A topological proof of chaos for two nonlinear heterogeneous triopoly game models.

PubMed

Pireddu, Marina

2016-08-01

We rigorously prove the existence of chaotic dynamics for two nonlinear Cournot triopoly game models with heterogeneous players, for which in the existing literature the presence of complex phenomena and strange attractors has been shown via numerical simulations. In the first model that we analyze, costs are linear but the demand function is isoelastic, while, in the second model, the demand function is linear and production costs are quadratic. As concerns the decisional mechanisms adopted by the firms, in both models one firm adopts a myopic adjustment mechanism, considering the marginal profit of the last period; the second firm maximizes its own expected profit under the assumption that the competitors' production levels will not vary with respect to the previous period; the third firm acts adaptively, changing its output proportionally to the difference between its own output in the previous period and the naive expectation value. The topological method we employ in our analysis is the so-called "Stretching Along the Paths" technique, based on the Poincaré-Miranda Theorem and the properties of the cutting surfaces, which allows to prove the existence of a semi-conjugacy between the system under consideration and the Bernoulli shift, so that the former inherits from the latter several crucial chaotic features, among which a positive topological entropy.

Social and economic influences on human behavioural response in an emerging epidemic

NASA Astrophysics Data System (ADS)

Phang, P.; Wiwatanapataphee, B.; Wu, Y. H.

2017-10-01

The human behavioural changes have been recognized as an important key in shaping the disease spreading and determining the success of control measures in the course of epidemic outbreaks. However, apart from cost-benefit considerations, in reality, people are heterogeneous in their preferences towards adopting certain protective actions to reduce their risk of infection, and social norms have a function in individuals’ decision making. Here, we studied the interplay between the epidemic dynamics, imitation dynamics and the heterogeneity of individual protective behavioural response under the considerations of both economic and social factors, with a simple mathematical compartmental model and multi-population game dynamical replicator equations. We assume that susceptibles in different subpopulations have different preferences in adopting either normal or altered behaviour. By incorporating both intra- and inter-group social pressure, the outcome of the strategy distribution depends on the initial proportion of susceptible with normal and altered strategies in both subpopulations. The increase of additional cost to susceptible with altered behaviour will discourage people to take up protective actions and hence results in higher epidemic final size. For a specific cost of altered behaviour, the social group pressure could be a “double edge sword”, though. We conclude that the interplays between individual protective behaviour adoption, imitation and epidemic dynamics are necessarily complex if both economic and social factors act on populations with existing preferences.

NASA's Space Launch Initiative Targets Toxic Propellants

NASA Technical Reports Server (NTRS)

Hurlbert, Eric; McNeal, Curtis; Davis, Daniel J. (Technical Monitor)

2001-01-01

When manned and unmanned space flight first began, the clear and overriding design consideration was performance. Consequently, propellant combinations of all kinds were considered, tested, and, when they lifted the payload a kilometer higher, or an extra kilogram to the same altitude, they became part of our operational inventory. Cost was not considered. And with virtually all of the early work being performed by the military, safety was hardly a consideration. After all, fighting wars has always been dangerous. Those days are past now. With space flight, and the products of space flight, a regular part of our lives today, safety and cost are being reexamined. NASA's focus turns naturally to its Shuttle Space Transportation System. Designed, built, and flown for the first time in the 1970s, this system remains today America's workhorse for manned space flight. Without its tremendous lift capability and mission flexibility, the International Space Station would not exist. And the Hubble telescope would be a monument to shortsighted management, rather than the clear penetrating eye on the stars it is today. But the Shuttle system fully represents the design philosophy of its period: it is too costly to operate, and not safe enough for regular long term access to space. And one of the key reasons is the utilization of toxic propellants. This paper will present an overview of the utilization of toxic propellants on the current Shuttle system.

Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

PubMed

Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

2016-01-01

Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

[Status of the discussion regarding cost-effectiveness of community psychiatry and inpatient psychiatry].

PubMed

Brenner, H D

1995-01-01

In the current climate of escalating health care costs and shrinking resources, higher priority is also being given to the relation between costs and benefits of reform efforts and further developments of existing service delivery systems in the field of mental health. Some proponents of community psychiatry have predicted in a pointed manner that a change in the allocation of resources in favor of community-based care would dramatically decrease the need for hospital beds, cost half as much and be clinically at least as efficacious as inpatient treatment. The author gives careful consideration to these postulates based on today's available literature and on his own experiences in Mannheim and in Bern. He presents an array of newer findings which places them in perspective and to some extent contradicts them as well. Recent studies on the effects of an expansion of outpatient treatment programs on the overall mental health delivery system suggest that in areas with already reasonably developed community services its further enhancement rarely has an effect on the number of admissions to and length of hospital stays. In addition, the postulate that community care is considerably less costly only holds if in- and outpatient facilities are not considered to be integral parts of a comprehensive system of mental health care which both serve different purposes. Accordingly, the question of the effectiveness of treatment must also be discussed very distinctively. Although a network of well-functioning community-based services is (not yet) a veritable alternative, it can by all means, however, serve as a useful counterpart to the intensive treatment offered in modern mental institutions.(ABSTRACT TRUNCATED AT 250 WORDS)

A literature review of economic evaluations for a neglected tropical disease: human African trypanosomiasis ("sleeping sickness").

PubMed

Sutherland, C Simone; Yukich, Joshua; Goeree, Ron; Tediosi, Fabrizio

2015-02-01

Human African trypanosomiasis (HAT) is a disease caused by infection with the parasite Trypanosoma brucei gambiense or T. b. rhodesiense. It is transmitted to humans via the tsetse fly. Approximately 70 million people worldwide were at risk of infection in 1995, and approximately 20,000 people across Africa are infected with HAT. The objective of this review was to identify existing economic evaluations in order to summarise cost-effective interventions to reduce, control, or eliminate the burden of HAT. The studies included in the review were compared and critically appraised in order to determine if there were existing standardised methods that could be used for economic evaluation of HAT interventions or if innovative methodological approaches are warranted. A search strategy was developed using keywords and was implemented in January 2014 in several databases. The search returned a total of 2,283 articles. After two levels of screening, a total of seven economic evaluations were included and underwent critical appraisal using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist 6: Economic Evaluations. Results from the existing studies focused on the cost-effectiveness of interventions for the control and reduction of disease transmission. Modelling was a common method to forecast long-term results, and publications focused on interventions by category, such as case detection, diagnostics, drug treatments, and vector control. Most interventions were considered cost-effective based on the thresholds described; however, the current treatment, nifurtomix-eflornithine combination therapy (NECT), has not been evaluated for cost-effectiveness, and considerations for cost-effective strategies for elimination have yet to be completed. Overall, the current evidence highlights the main components that play a role in control; however, economic evaluations of HAT elimination strategies are needed to assist national decision makers, stakeholders, and key funders. These analyses would be of use, as HAT is currently being prioritized as a neglected tropical disease (NTD) to reach elimination by 2020.

Economic considerations in coverting from oil/gas firing to coal

NASA Technical Reports Server (NTRS)

Rau, J. G.

1978-01-01

Economic considerations involved in fuel conversion such as from oil and/or gas firing to coal are discussed including investments costs for new facilities and equipment (including air pollution control equipment), operation and maintenance costs, and purchased fuel costs. An analytical approach to assessing the cost effectiveness of fuel conversion in terms of the annual net cost of conversion, the equivalent annual number of barrels of oil saved, and the integral rate of return of the conversion investment is presented. Illustrative numerical examples are presented for typical utility boilers and industrial boiler facilities. A further consideration addressed deals with the impacts of these costs on the overall financial structure of the firm and the ability of the firm to raise the necessary investment captial.

Health care costs: saving in the private sector.

PubMed

Robeson, F E

1979-01-01

Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.

Enabling fast charging - Infrastructure and economic considerations

NASA Astrophysics Data System (ADS)

Burnham, Andrew; Dufek, Eric J.; Stephens, Thomas; Francfort, James; Michelbacher, Christopher; Carlson, Richard B.; Zhang, Jiucai; Vijayagopal, Ram; Dias, Fernando; Mohanpurkar, Manish; Scoffield, Don; Hardy, Keith; Shirk, Matthew; Hovsapian, Rob; Ahmed, Shabbir; Bloom, Ira; Jansen, Andrew N.; Keyser, Matthew; Kreuzer, Cory; Markel, Anthony; Meintz, Andrew; Pesaran, Ahmad; Tanim, Tanvir R.

2017-11-01

The ability to charge battery electric vehicles (BEVs) on a time scale that is on par with the time to fuel an internal combustion engine vehicle (ICEV) would remove a significant barrier to the adoption of BEVs. However, for viability, fast charging at this time scale needs to also occur at a price that is acceptable to consumers. Therefore, the cost drivers for both BEV owners and charging station providers are analyzed. In addition, key infrastructure considerations are examined, including grid stability and delivery of power, the design of fast charging stations and the design and use of electric vehicle service equipment. Each of these aspects have technical barriers that need to be addressed, and are directly linked to economic impacts to use and implementation. This discussion focuses on both the economic and infrastructure issues which exist and need to be addressed for the effective implementation of fast charging at 400 kW and above. In so doing, it has been found that there is a distinct need to effectively manage the intermittent, high power demand of fast charging, strategically plan infrastructure corridors, and to further understand the cost of operation of charging infrastructure and BEVs.

Enabling fast charging – Infrastructure and economic considerations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burnham, Andrew; Dufek, Eric J.; Stephens, Thomas

The ability to charge battery electric vehicles (BEVs) on a time scale that is on par with the time to fuel an internal combustion engine vehicle (ICEV) would remove a significant barrier to the adoption of BEVs. However, for viability, fast charging at this time scale needs to also occur at a price that is acceptable to consumers. Therefore, the cost drivers for both BEV owners and charging station providers are analyzed. In addition, key infrastructure considerations are examined, including grid stability and delivery of power, the design of fast charging stations and the design and use of electric vehiclemore » service equipment. Each of these aspects have technical barriers that need to be addressed, and are directly linked to economic impacts to use and implementation. This discussion focuses on both the economic and infrastructure issues which exist and need to be addressed for the effective implementation of fast charging at 400 kW and above. In so doing, it has been found that there is a distinct need to effectively manage the intermittent, high power demand of fast charging, strategically plan infrastructure corridors, and to further understand the cost of operation of charging infrastructure and BEVs.« less

Enabling fast charging – Infrastructure and economic considerations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burnham, Andrew; Dufek, Eric J.; Stephens, Thomas

The ability to charge battery electric vehicles (BEVs) on a time scale that is on par with the time to fuel an internal combustion engine vehicle (ICEV) would remove a significant barrier to the adoption of BEVs. However, for viability, fast charging at this time scale needs to also occur at a price that is acceptable to consumers. Therefore, the cost drivers for both BEV owners and charging station providers are analyzed. In addition, key infrastructure considerations are examined, including grid stability and delivery of power, the design of fast charging stations and the design and use of electric vehiclemore » service equipment. Each of these aspects have technical barriers that need to be addressed, and are directly linked to economic impacts to use and implementation. Here, this discussion focuses on both the economic and infrastructure issues which exist and need to be addressed for the effective implementation of fast charging up to 350 kW. In doing so, it has been found that there is a distinct need to effectively manage the intermittent, high power demand of fast charging, strategically plan infrastructure corridors, and to further understand the cost of operation of charging infrastructure and BEVs.« less

Enabling fast charging – Infrastructure and economic considerations

DOE PAGES

Burnham, Andrew; Dufek, Eric J.; Stephens, Thomas; ...

2017-10-23

The ability to charge battery electric vehicles (BEVs) on a time scale that is on par with the time to fuel an internal combustion engine vehicle (ICEV) would remove a significant barrier to the adoption of BEVs. However, for viability, fast charging at this time scale needs to also occur at a price that is acceptable to consumers. Therefore, the cost drivers for both BEV owners and charging station providers are analyzed. In addition, key infrastructure considerations are examined, including grid stability and delivery of power, the design of fast charging stations and the design and use of electric vehiclemore » service equipment. Each of these aspects have technical barriers that need to be addressed, and are directly linked to economic impacts to use and implementation. Here, this discussion focuses on both the economic and infrastructure issues which exist and need to be addressed for the effective implementation of fast charging up to 350 kW. In doing so, it has been found that there is a distinct need to effectively manage the intermittent, high power demand of fast charging, strategically plan infrastructure corridors, and to further understand the cost of operation of charging infrastructure and BEVs.« less

Towards canine rabies elimination: Economic comparisons of three project sites.

PubMed

Elser, J L; Hatch, B G; Taylor, L H; Nel, L H; Shwiff, S A

2018-02-01

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house-to-house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre-existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large-scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Cultural Differences in Opportunity Cost Consideration

PubMed Central

Zhang, Ning; Ji, Li-Jun; Li, Ye

2017-01-01

Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed. PMID:28184202

The influence of targeted education on medication persistence and generic substitution among consumer-directed health care enrollees.

PubMed

Sedjo, Rebecca L; Cox, Emily R

2009-12-01

To evaluate an educational outreach among consumer-directed health plan (CDHP) enrollees on medication persistence and lower-cost generic substitution within four chronic medication therapies. A cross-sectional analysis using pharmacy claims data from a national employer group that began offering a CDHP in 2006 and implemented an educational outreach to some CDHP enrollees in 2007 was used. The intervention group was comprised of CDHP enrollees who received education outreach and was compared with CDHP enrollees without the educational outreach. Adjusted and unadjusted medication persistence and lower-cost generic substitutions were compared between groups. There was no difference in medication persistence between groups. CDHP enrollees with the educational outreach were more likely to have converted to lower-cost generic alternative antihypertensive medication compared with CDHP enrollees without the educational outreach (OR(adj)=29.82, 95 percent CI=4.41-201.93). Educational outreach directed to CDHP enrollees was associated with increases in lower-cost generic alternatives with no change in patients' chronic medication use. However, considerable opportunity exists to assist CDHP enrollees in making sound health care decisions.

Epigenetics and Future Generations.

PubMed

Del Savio, Lorenzo; Loi, Michele; Stupka, Elia

2015-10-01

Recent evidence of intergenerational epigenetic programming of disease risk broadens the scope of public health preventive interventions to future generations, i.e. non existing people. Due to the transmission of epigenetic predispositions, lifestyles such as smoking or unhealthy diet might affect the health of populations across several generations. While public policy for the health of future generations can be justified through impersonal considerations, such as maximizing aggregate well-being, in this article we explore whether there are rights-based obligations supervening on intergenerational epigenetic programming despite the non-identity argument, which challenges this rationale in case of policies that affect the number and identity of future people. We propose that rights based obligations grounded in the interests of non-existing people might fall upon existing people when generations overlap. In particular, if environmental exposure in F0 (i.e. existing people) will affect the health of F2 (i.e. non-existing people) through epigenetic programming, then F1 (i.e. existing and overlapping with both F0 and F2) might face increased costs to address F2's condition in the future: this might generate obligations upon F0 from various distributive principles, such as the principle of equal opportunity for well being. © 2015 John Wiley & Sons Ltd.

Alternative synthetic aperture radar (SAR) modalities using a 1D dynamic metasurface antenna

NASA Astrophysics Data System (ADS)

Boyarsky, Michael; Sleasman, Timothy; Pulido-Mancera, Laura; Imani, Mohammadreza F.; Reynolds, Matthew S.; Smith, David R.

2017-05-01

Synthetic aperture radar (SAR) systems conventionally rely on mechanically-actuated reflector dishes or large phased arrays for generating steerable directive beams. While these systems have yielded high-resolution images, the hardware suffers from considerable weight, high cost, substantial power consumption, and moving parts. Since these disadvantages are particularly relevant in airborne and spaceborne systems, a flat, lightweight, and low-cost solution is a sought-after goal. Dynamic metasurface antennas have emerged as a recent technology for generating waveforms with desired characteristics. Metasurface antennas consist of an electrically-large waveguide loaded with numerous subwavelength radiators which selectively leak energy from a guided wave into free space to form various radiation patterns. By tuning each radiating element, we can modulate the aperture's overall radiation pattern to generate steered directive beams, without moving parts or phase shifters. Furthermore, by using established manufacturing methods, these apertures can be made to be lightweight, low-cost, and planar, while maintaining high performance. In addition to their hardware benefits, dynamic metasurfaces can leverage their dexterity and high switching speeds to enable alternative SAR modalities for improved performance. In this work, we briefly discuss how dynamic metasurfaces can conduct existing SAR modalities with similar performance as conventional systems from a significantly simpler hardware platform. We will also describe two additional modalities which may achieve improved performance as compared to traditional modalities. These modalities, enhanced resolution stripmap and diverse pattern stripmap, offer the ability to circumvent the trade-off between resolution and region-of-interest size that exists within stripmap and spotlight. Imaging results with a simulated dynamic metasurface verify the benefits of these modalities and a discussion of implementation considerations and noise effects is also included. Ultimately, the hardware gains coupled with the additional modalities well-suited to dynamic metasurface antennas has poised them to propel the SAR field forward and open the door to exciting opportunities.

Bantam System Technology Project

NASA Technical Reports Server (NTRS)

Moon, J. M.; Beveridge, J. R.

1998-01-01

This report focuses on determining a best value, low risk, low cost and highly reliable Data and Command System for support of the launch of low cost vehicles which are to carry small payloads into low earth orbit. The ground-based DCS is considered as a component of the overall ground and flight support system which includes the DCS, flight computer, mission planning system and simulator. Interfaces between the DCS and these other component systems are considered. Consideration is also given to the operational aspects of the mission and of the DCS selected. This project involved: defining requirements, defining an efficient operations concept, defining a DCS architecture which satisfies the requirements and concept, conducting a market survey of commercial and government off-the-shelf DCS candidate systems and rating the candidate systems against the requirements/concept. The primary conclusions are that several low cost, off-the-shelf DCS solutions exist and these can be employed to provide for very low cost operations and low recurring maintenance cost. The primary recommendation is that the DCS design/specification should be integrated within the ground and flight support system design as early as possible to ensure ease of interoperability and efficient allocation of automation functions among the component systems.

Enhanced Condensation Heat Transfer On Patterned Surfaces

NASA Astrophysics Data System (ADS)

Alizadeh-Birjandi, Elaheh; Kavehpour, H. Pirouz

2017-11-01

Transition from film to drop wise condensation can improve the efficiency of thermal management applications and result in considerable savings in investments and operating costs by millions of dollars every year. The current methods available are either hydrophobic coating or nanostructured surfaces. The former has little adhesion to the structure which tends to detach easily under working conditions, the fabrication techniques of the latter are neither cost-effective nor scalable, and both are made with low thermal conductivity materials that would negate the heat transfer enhancement by drop wise condensation. Therefore, the existing technologies have limitations in enhancing vapor-to-liquid condensation. This work focuses on development of surfaces with wettability contrast to boost drop wise condensation, which its overall heat transfer efficiency is 2-3 times film wise condensation, while maintaining high conduction rate through the surface at low manufacturing costs. The variation in interfacial energy is achieved through crafting hydrophobic patterns to the surface of the metal via scalable fabrication techniques. The results of experimental and surface optimization studies are also presented.

Producibility aspects of advanced composites for an L-1011 Aileron

NASA Technical Reports Server (NTRS)

Van Hamersveld, J.; Fogg, L. D.

1976-01-01

The design of advanced composite aileron suitable for long-term service on transport aircraft includes Kevlar 49 fabric skins on honeycomb sandwich covers, hybrid graphite/Kevlar 49 ribs and spars, and graphite/epoxy fittings. Weight and cost savings of 28 and 20 percent, respectively, are predicted by comparison with the production metallic aileron. The structural integrity of the design has been substantiated by analysis and static tests of subcomponents. The producibility considerations played a key role in the selection of design concepts with potential for low-cost production. Simplicity in fabrication is a major factor in achieving low cost using advanced tooling and manufacturing methods such as net molding to size, draping, forming broadgoods, and cocuring components. A broadgoods dispensing machine capable of handling unidirectional and bidirectional prepreg materials in widths ranging from 12 to 42 inches is used for rapid layup of component kits and covers. Existing large autoclaves, platen presses, and shop facilities are fully exploited.

Barriers to Building Energy Efficiency (BEE) promotion: A transaction costs perspective

NASA Astrophysics Data System (ADS)

Qian Kun, Queena

Worldwide, buildings account for a surprisingly high 40% of global energy consumption, and the resulting carbon footprint significantly exceeds that of all forms of transportation combined. Large and attractive opportunities exist to reduce buildings' energy use at lower costs and higher returns than in other sectors. This thesis analyzes the concerns of the market stakeholders, mainly real estate developers and end-users, in terms of transaction costs as they make decisions about investing in Building Energy Efficiency (BEE). It provides a detailed analysis of the current situation and future prospects for BEE adoption by the market's stakeholders. It delineates the market and lays out the economic and institutional barriers to the large-scale deployment of energy-efficient building techniques. The aim of this research is to investigate the barriers raised by transaction costs that hinder market stakeholders from investing in BEES. It explains interactions among stakeholders in general and in the specific case of Hong Kong as they consider transaction costs. It focuses on the influence of transaction costs on the decision-making of the stakeholders during the entire process of real estate development. The objectives are: 1) To establish an analytical framework for understanding the barriers to BEE investment with consideration of transaction costs; 2) To build a theoretical game model of decision making among the BEE market stakeholders; 3) To study the empirical data from questionnaire surveys of building designers and from focused interviews with real estate developers in Hong Kong; 4) To triangulate the study's empirical findings with those of the theoretical model and analytical framework. The study shows that a coherent institutional framework needs to be established to ensure that the design and implementation of BEE policies acknowledge the concerns of market stakeholders by taking transaction costs into consideration. Regulatory and incentive options should be integrated into BEE policies to minimize efficiency gaps and to realize a sizeable increase in the number of energy-efficient buildings in the next decades. Specifically, the analysis shows that a thorough understanding of the transaction costs borne by particular stakeholders could improve the energy efficiency of buildings, even without improvements in currently available technology.

Specific Consideration on Superior Performance and Evaluation Methods of Polymer-housed Surge Arresters

NASA Astrophysics Data System (ADS)

Ishizaki, Yoshihiro; Kobayashi, Misao; Suzuki, Hironori; Futagami, Koichi

It is very suitable to select the polymer materials for the housings of surge arresters (SAs), because the polymer materials are generally soft and light weight. Therefore, many kinds of polymer-housed SAs using various polymer materials have been developed, and expanding into many countries. Considering these backgrounds, the JEC technical report (JEC-TR) 23002-2008; polymer-housed surge arrester(1) has been established based on the existent relevant standards of arresters, such as JEC-2371-2003; Insulator-housed surge arresters(2) and IEC 60099-4 Edition 2.2, Metal-oxide surge arresters (MOSAs) without gaps for a.c. systems(3) in order to introduce the technology and provide a common guide for testing of polymer-housed SAs. According as the JEC-TR, the various new applications of the polymer-housed SAs, which are caused by superior advantages such as compact, light weight, safe failure mode, anti-seismic performance, anti-pollution performance and cost efficiency design, have been realized recently in Japan. Therefore, this paper gives specific consideration on the superior performance of the polymer-housed SAs and the evaluation methods of the polymer-housed SAs, because there are some issues in the existent standards to be solved.

Future Launch Vehicle Structures - Expendable and Reusable Elements

NASA Astrophysics Data System (ADS)

Obersteiner, M. H.; Borriello, G.

2002-01-01

Further evolution of existing expendable launch vehicles will be an obvious element influencing the future of space transportation. Besides this reusability might be the change with highest potential for essential improvement. The expected cost reduction and finally contributing to this, the improvement of reliability including safe mission abort capability are driving this idea. Although there are ideas of semi-reusable launch vehicles, typically two stages vehicles - reusable first stage or booster(s) and expendable second or upper stage - it should be kept in mind that the benefit of reusability will only overwhelm if there is a big enough share influencing the cost calculation. Today there is the understanding that additional technology preparation and verification will be necessary to master reusability and get enough benefits compared with existing launch vehicles. This understanding is based on several technology and system concepts preparation and verification programmes mainly done in the US but partially also in Europe and Japan. The major areas of necessary further activities are: - System concepts including business plan considerations - Sub-system or component technologies refinement - System design and operation know-how and capabilities - Verification and demonstration oriented towards future mission mastering: One of the most important aspects for the creation of those coming programmes and activities will be the iterative process of requirements definition derived from concepts analyses including economical considerations and the results achieved and verified within technology and verification programmes. It is the intention of this paper to provide major trends for those requirements focused on future launch vehicles structures. This will include the aspects of requirements only valid for reusable launch vehicles and those common for expendable, semi-reusable and reusable launch vehicles. Structures and materials is and will be one of the important technology areas to be improved. This includes: - Primary structures - Thermal protection systems (for high and low temperatures) - Hot structures (leading edges, engine cowling, ...) - Tanks (for various propellants and fluids, cryo, ...) Requirements to be considered are including materials properties and a variety of loads definition - static and dynamic. Based on existing knowledge and experience for expendable LV (Ariane, ...) and aircraft there is the need to established a combined understanding to provide the basis for an efficient RLV design. Health monitoring will support the cost efficient operation of future reusable structures, but will also need a sound understanding of loads and failure mechanisms as basis. Risk mitigation will ask for several steps of demonstration towards a cost efficient RLV (structures) operation. Typically this has or will start with basic technology, to be evolved to components demonstration (TPS, tanks, ...) and finally to result in the demonstration of the cost efficient reuse operation. This paper will also include a programmatic logic concerning future LV structures demonstration.

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

PubMed

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

Ultra-Wideband Array in PCB for Millimeter-Wave 5G and ISM

NASA Technical Reports Server (NTRS)

Novak, Markus H.; Volakis, John L.; Miranda, Felix A.

2017-01-01

Next generation 5G mobile architectures will take advantage of the millimeter-wave spectrum to deliver unprecedented bandwidth. Concurrently, there is a need to consolidate numerous disparate allocations into a single, multi-functional array. Existing arrays are either narrow-band, prohibitively expensive or cannot be scaled to these frequencies. In this paper, we present the first ultra-wideband millimeter-wave array to operate across the six 5G and ISM bands spanning 24-71 GHz. Critically, the array is realized using low-cost PCB. The design concept and optimized layout are presented, and fabrication and measurement considerations are discussed.

Portable tongue-supported human computer interaction system design and implementation.

PubMed

Quain, Rohan; Khan, Masood Mehmood

2014-01-01

Tongue supported human-computer interaction (TSHCI) systems can help critically ill patients interact with both computers and people. These systems can be particularly useful for patients suffering injuries above C7 on their spinal vertebrae. Despite recent successes in their application, several limitations restrict performance of existing TSHCI systems and discourage their use in real life situations. This paper proposes a low-cost, less-intrusive, portable and easy to use design for implementing a TSHCI system. Two applications of the proposed system are reported. Design considerations and performance of the proposed system are also presented.

Co-existence of GM, conventional and organic crops in developing countries: Main debates and concerns.

PubMed

Azadi, Hossein; Taube, Friedhelm; Taheri, Fatemeh

2017-06-05

The co-existence approach of GM crops with conventional agriculture and organic farming as a feasible agricultural farming system has recently been placed in the center of hot debates at the EU-level and become a source of anxiety in developing countries. The main promises of this approach is to ensure "food security" and "food safety" on the one hand, and to avoid the adventitious presence of GM crops in conventional and organic farming on the other, as well as to present concerns in many debates on implementing the approach in developing countries. Here, we discuss the main debates on ("what," "why," "who," "where," "which," and "how") applying this approach in developing countries and review the main considerations and tradeoffs in this regard. The paper concludes that a peaceful co-existence between GM, conventional, and organic farming is not easy but is still possible. The goal should be to implement rules that are well-established proportionately, efficiently and cost-effectively, using crop-case, farming system-based and should be biodiversity-focused ending up with "codes of good agricultural practice" for co-existence.

Breaking up is hard to do: the economic impact of provisional funding contingent upon evidence development.

PubMed

Mortimer, Duncan; Li, Jing Jing; Watts, Jennifer; Harris, Anthony

2011-10-01

Funding contingent upon evidence development (FED) has recently been the subject of some considerable debate in the literature but relatively little has been made of its economic impact. We argue that FED has the potential to shorten the lag between innovation and access but may also (i) crowd-out more valuable interventions in situations in which there is a fixed dedicated budget; or (ii) lead to a de facto increase in the funding threshold and increased expenditure growth in situations in which the programme budget is open-ended. Although FED would typically entail periodic review of provisional or interim listings, it may prove difficult to withdraw funding even at cost/QALY ratios well in excess of current listing thresholds. Further consideration of the design and implementation of FED processes is therefore required to ensure that its introduction yields net benefits over existing processes.

Machine learning research 1989-90

NASA Technical Reports Server (NTRS)

Porter, Bruce W.; Souther, Arthur

1990-01-01

Multifunctional knowledge bases offer a significant advance in artificial intelligence because they can support numerous expert tasks within a domain. As a result they amortize the costs of building a knowledge base over multiple expert systems and they reduce the brittleness of each system. Due to the inevitable size and complexity of multifunctional knowledge bases, their construction and maintenance require knowledge engineering and acquisition tools that can automatically identify interactions between new and existing knowledge. Furthermore, their use requires software for accessing those portions of the knowledge base that coherently answer questions. Considerable progress was made in developing software for building and accessing multifunctional knowledge bases. A language was developed for representing knowledge, along with software tools for editing and displaying knowledge, a machine learning program for integrating new information into existing knowledge, and a question answering system for accessing the knowledge base.

Dynamic issues in launch vehicle design

NASA Technical Reports Server (NTRS)

Ryan, Robert S.; Jewell, Ronald E.

1993-01-01

Launch vehicles, in general, have been defined using performance requirements and generic payload characteristics which dictated the propulsion system and the payload carrier. The vehicle concept is then selected using these requirements in conjunction with basic criteria and standards. During the design phase, the selected concept must be modified in order to cope with the numerous dynamic and other problems that occur during design and development. This is costly and is, to some extent, unnecessary. The purpose of this paper is to propose an approach for bringing the dynamic issues into focus during concept selection, where the greatest payoff exists. Delaying consideration of the issues to the design phases creates many problems, not the least of which are the impacts levied against the payload community. Volumes of information exist from prior programs on these dynamic issues and serve as the guidelines for this paper.

Secondary analysis of national survey datasets.

PubMed

Boo, Sunjoo; Froelicher, Erika Sivarajan

2013-06-01

This paper describes the methodological issues associated with secondary analysis of large national survey datasets. Issues about survey sampling, data collection, and non-response and missing data in terms of methodological validity and reliability are discussed. Although reanalyzing large national survey datasets is an expedient and cost-efficient way of producing nursing knowledge, successful investigations require a methodological consideration of the intrinsic limitations of secondary survey analysis. Nursing researchers using existing national survey datasets should understand potential sources of error associated with survey sampling, data collection, and non-response and missing data. Although it is impossible to eliminate all potential errors, researchers using existing national survey datasets must be aware of the possible influence of errors on the results of the analyses. © 2012 The Authors. Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science.

Epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany: a systematic review.

PubMed

Damm, Oliver; Witte, Julian; Wetzka, Stefanie; Prosser, Christine; Braun, Sebastian; Welte, Robert; Greiner, Wolfgang

2016-09-01

Despite the availability of vaccines and the existence of public vaccination recommendations, outbreaks of vaccine-preventable childhood diseases still cause public health debate. The objective of this systematic review was to provide an overview of the current epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany. We systematically reviewed studies published since 2000. The literature search was conducted using PubMed and EMBASE. Also, we used German notification data to give an up-to-date overview of the epidemiology of the four diseases under consideration. Thirty-six studies were included in our review. Results suggest that there is still considerable morbidity due to childhood diseases in Germany. Studies providing cost estimates are scarce. Comparative analyses of different data sources (notification data vs. claims data) revealed a potential underestimation of incidence estimates when using notification data. Furthermore, several studies showed regional differences in incidence of some of the diseases under consideration. Our findings underline the need for improved vaccination and communication strategies targeting all susceptible age and risk groups on a national and local level.

Key Considerations for an Economic and Legal Framework Facilitating Medical Travel

PubMed Central

Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

2016-01-01

Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel. PMID:27066467

Key Considerations for an Economic and Legal Framework Facilitating Medical Travel.

PubMed

Hinrichs-Krapels, Saba; Bussmann, Sarah; Dobyns, Christopher; Kácha, Ondřej; Ratzmann, Nora; Holm Thorvaldsen, Julie; Ruggeri, Kai

2016-01-01

Medical travel has the capacity to counter increasing costs of health care by creating new markets and increased revenue for health services, potentially benefiting local populations, economies, and health-care systems. This paper is part of a broad, comprehensive project aimed at developing a global health access policy (GHAP). It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations, when setting up a GHAP, include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those traveling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel.

A topological proof of chaos for two nonlinear heterogeneous triopoly game models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pireddu, Marina, E-mail: marina.pireddu@unimib.it

We rigorously prove the existence of chaotic dynamics for two nonlinear Cournot triopoly game models with heterogeneous players, for which in the existing literature the presence of complex phenomena and strange attractors has been shown via numerical simulations. In the first model that we analyze, costs are linear but the demand function is isoelastic, while, in the second model, the demand function is linear and production costs are quadratic. As concerns the decisional mechanisms adopted by the firms, in both models one firm adopts a myopic adjustment mechanism, considering the marginal profit of the last period; the second firm maximizesmore » its own expected profit under the assumption that the competitors' production levels will not vary with respect to the previous period; the third firm acts adaptively, changing its output proportionally to the difference between its own output in the previous period and the naive expectation value. The topological method we employ in our analysis is the so-called “Stretching Along the Paths” technique, based on the Poincaré-Miranda Theorem and the properties of the cutting surfaces, which allows to prove the existence of a semi-conjugacy between the system under consideration and the Bernoulli shift, so that the former inherits from the latter several crucial chaotic features, among which a positive topological entropy.« less

A Fuzzy Goal Programming for a Multi-Depot Distribution Problem

NASA Astrophysics Data System (ADS)

Nunkaew, Wuttinan; Phruksaphanrat, Busaba

2010-10-01

A fuzzy goal programming model for solving a Multi-Depot Distribution Problem (MDDP) is proposed in this research. This effective proposed model is applied for solving in the first step of Assignment First-Routing Second (AFRS) approach. Practically, a basic transportation model is firstly chosen to solve this kind of problem in the assignment step. After that the Vehicle Routing Problem (VRP) model is used to compute the delivery cost in the routing step. However, in the basic transportation model, only depot to customer relationship is concerned. In addition, the consideration of customer to customer relationship should also be considered since this relationship exists in the routing step. Both considerations of relationships are solved using Preemptive Fuzzy Goal Programming (P-FGP). The first fuzzy goal is set by a total transportation cost and the second fuzzy goal is set by a satisfactory level of the overall independence value. A case study is used for describing the effectiveness of the proposed model. Results from the proposed model are compared with the basic transportation model that has previously been used in this company. The proposed model can reduce the actual delivery cost in the routing step owing to the better result in the assignment step. Defining fuzzy goals by membership functions are more realistic than crisps. Furthermore, flexibility to adjust goals and an acceptable satisfactory level for decision maker can also be increased and the optimal solution can be obtained.

Generic and therapeutic substitutions in the UK: are they a good thing?

PubMed Central

Duerden, Martin G; Hughes, Dyfrig A

2010-01-01

There is considerable interest and debate concerning the place of generic substitution (switching from a brand to generic product); and on therapeutic substitution, that is, switching to a cheaper, but apparently equivalent, product, usually within the drug class. Generic substitution by pharmacists is standard practice in UK hospital settings, and is being proposed for implementation in primary care. Although most prescriptions are already written generically (83% in the community in England in 2008), there are still cost savings that could be made if generic medicines are substituted against prescriptions written by branded name or by getting prescribers to adhere to advice to prescribe generically. Therapeutic substitution is more contentious, as direct evidence to support equivalence is normally lacking. However, the price differential between established drugs whose patents have expired and for which generics are available and newer, branded medicines within the same therapeutic class, makes therapeutic substitution an attractive application of cost-minimization analysis for the more efficient use of healthcare resources. Here we explore the tension that exists between the clinical appropriateness and safety of switching from an individual patient perspective and the consideration of value for money which is required to maximize population health from a health service perspective. Although substitution may affect individual patients (such as, for instance, reduced adherence, increased potential for medication error), it might be a price worth paying given the opportunity cost associated with the use of medicines that are clinically no better than cheaper alternatives. PMID:20716231

The cultural moral right to a basic minimum of accessible health care.

PubMed

Menzel, Paul T

2011-03-01

(1) The conception of a cultural moral right is useful in capturing the social-moral realities that underlie debate about universal health care. In asserting such rights, individuals make claims above and beyond their legal rights, but those claims are based on the society's existing commitments and moral culture. In the United States such a right to accessible basic health care is generated by various empirical social facts, primarily the conjunction of the legal requirement of access to emergency care with widely held principles about unfair free riding and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.

The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review.

PubMed

Remme, Michelle; Siapka, Mariana; Vassall, Anna; Heise, Lori; Jacobi, Jantine; Ahumada, Claudia; Gay, Jill; Watts, Charlotte

2014-01-01

Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. Effective intervention models were identified from an existing evidence review ("what works for women"). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.

The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review

PubMed Central

Remme, Michelle; Siapka, Mariana; Vassall, Anna; Heise, Lori; Jacobi, Jantine; Ahumada, Claudia; Gay, Jill; Watts, Charlotte

2014-01-01

Introduction Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. Methods Effective intervention models were identified from an existing evidence review (“what works for women”). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. Results Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. Conclusions There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework. PMID:25373519

Diversity and dynamics of patient cost-sharing for physicians' and hospital services in the 27 European Union countries.

PubMed

Tambor, Marzena; Pavlova, Milena; Woch, Piotr; Groot, Wim

2011-10-01

During the past decades, many governments have introduced patient cost-sharing in their public health-care system. This trend in health-care reforms affected the European Union (EU) member states as well. This article presents a review of patient cost-sharing for health-care services in the 27 EU countries, and discusses directions for their improvement. Data are collected based on a review of international data bases, national laws and regulations, as well as scientific and policy reports. The analysis presents a combination of qualitative and quantitative research techniques. Patient cost-sharing arrangements in the EU have been changing considerably over the past two decades (mostly being extended) and are quite diverse at present. There is a relation between patient cost-sharing arrangements and some characteristics of the health-care system in a country. In a few EU countries, a mix of formal and informal charges exists, which creates a double financial burden for health-care consumers. The adequacy of patient cost-sharing arrangements in EU countries needs to be reconsidered. Most importantly, it is essential to deal with informal patient payments (where applicable) and to assure adequate exemption mechanisms to diminish the adverse equity effects of patient cost-sharing. A close communication with the public is needed to clarify the objectives and content of a patient payment policy in a country.

The impact of shale gas on the cost and feasibility of meeting climate targets—A global energy system model analysis and an exploration of uncertainties

DOE PAGES

Few, Sheridan; Gambhir, Ajay; Napp, Tamaryn; ...

2017-01-27

There exists considerable uncertainty over both shale and conventional gas resource availability and extraction costs, as well as the fugitive methane emissions associated with shale gas extraction and its possible role in mitigating climate change. This study uses a multi-region energy system model, TIAM (TIMES integrated assessment model), to consider the impact of a range of conventional and shale gas cost and availability assessments on mitigation scenarios aimed at achieving a limit to global warming of below 2 °C in 2100, with a 50% likelihood. When adding shale gas to the global energy mix, the reduction to the global energymore » system cost is relatively small (up to 0.4%), and the mitigation cost increases by 1%–3% under all cost assumptions. The impact of a “dash for shale gas”, of unavailability of carbon capture and storage, of increased barriers to investment in low carbon technologies, and of higher than expected leakage rates, are also considered; and are each found to have the potential to increase the cost and reduce feasibility of meeting global temperature goals. Finally, we conclude that the extraction of shale gas is not likely to significantly reduce the effort required to mitigate climate change under globally coordinated action, but could increase required mitigation effort if not handled sufficiently carefully.« less

The impact of shale gas on the cost and feasibility of meeting climate targets—A global energy system model analysis and an exploration of uncertainties

DOE Office of Scientific and Technical Information (OSTI.GOV)

Few, Sheridan; Gambhir, Ajay; Napp, Tamaryn

There exists considerable uncertainty over both shale and conventional gas resource availability and extraction costs, as well as the fugitive methane emissions associated with shale gas extraction and its possible role in mitigating climate change. This study uses a multi-region energy system model, TIAM (TIMES integrated assessment model), to consider the impact of a range of conventional and shale gas cost and availability assessments on mitigation scenarios aimed at achieving a limit to global warming of below 2 °C in 2100, with a 50% likelihood. When adding shale gas to the global energy mix, the reduction to the global energymore » system cost is relatively small (up to 0.4%), and the mitigation cost increases by 1%–3% under all cost assumptions. The impact of a “dash for shale gas”, of unavailability of carbon capture and storage, of increased barriers to investment in low carbon technologies, and of higher than expected leakage rates, are also considered; and are each found to have the potential to increase the cost and reduce feasibility of meeting global temperature goals. Finally, we conclude that the extraction of shale gas is not likely to significantly reduce the effort required to mitigate climate change under globally coordinated action, but could increase required mitigation effort if not handled sufficiently carefully.« less

Ecosystem services altered by human changes in the nitrogen cycle: A new perspective for assessment

NASA Astrophysics Data System (ADS)

Compton, J. E.; Harrison, J.; Dennis, R. L.; Greaver, T.; Hill, B.; Jordan, S. J.; Walker, H.; Campbell, H. V.

2011-12-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and synthesize existing information concerning the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of 28 per kg NOx-N). We also consider the impacts of nitrogen and climate interactions. Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (< 2.2-56 per kg N). In the current Chesapeake Bay restoration effort, for example, the collection of available damage costs clearly exceeds the projected abatement costs to reduce N loads to the Bay ($8-15 per kg N). Although few damage costs specifically consider climate-nitrogen interactions, changes in precipitation and temperature are expected to have synergistic impacts on drinking water quality and eutrophication in particular. Explicit consideration and accounting of effects on multiple ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution.

Cost-Effectiveness of HBV and HCV Screening Strategies – A Systematic Review of Existing Modelling Techniques

PubMed Central

Geue, Claudia; Wu, Olivia; Xin, Yiqiao; Heggie, Robert; Hutchinson, Sharon; Martin, Natasha K.; Fenwick, Elisabeth; Goldberg, David

2015-01-01

Introduction Studies evaluating the cost-effectiveness of screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are generally heterogeneous in terms of risk groups, settings, screening intervention, outcomes and the economic modelling framework. It is therefore difficult to compare cost-effectiveness results between studies. This systematic review aims to summarise and critically assess existing economic models for HBV and HCV in order to identify the main methodological differences in modelling approaches. Methods A structured search strategy was developed and a systematic review carried out. A critical assessment of the decision-analytic models was carried out according to the guidelines and framework developed for assessment of decision-analytic models in Health Technology Assessment of health care interventions. Results The overall approach to analysing the cost-effectiveness of screening strategies was found to be broadly consistent for HBV and HCV. However, modelling parameters and related structure differed between models, producing different results. More recent publications performed better against a performance matrix, evaluating model components and methodology. Conclusion When assessing screening strategies for HBV and HCV infection, the focus should be on more recent studies, which applied the latest treatment regimes, test methods and had better and more complete data on which to base their models. In addition to parameter selection and associated assumptions, careful consideration of dynamic versus static modelling is recommended. Future research may want to focus on these methodological issues. In addition, the ability to evaluate screening strategies for multiple infectious diseases, (HCV and HIV at the same time) might prove important for decision makers. PMID:26689908

Optimal environmental management strategy and implementation for groundwater contamination prevention and restoration.

PubMed

Wang, Mingyu

2006-04-01

An innovative management strategy is proposed for optimized and integrated environmental management for regional or national groundwater contamination prevention and restoration allied with consideration of sustainable development. This management strategy accounts for availability of limited resources, human health and ecological risks from groundwater contamination, costs for groundwater protection measures, beneficial uses and values from groundwater protection, and sustainable development. Six different categories of costs are identified with regard to groundwater prevention and restoration. In addition, different environmental impacts from groundwater contamination including human health and ecological risks are individually taken into account. System optimization principles are implemented to accomplish decision-makings on the optimal resources allocations of the available resources or budgets to different existing contaminated sites and projected contamination sites for a maximal risk reduction. Established management constraints such as budget limitations under different categories of costs are satisfied at the optimal solution. A stepwise optimization process is proposed in which the first step is to select optimally a limited number of sites where remediation or prevention measures will be taken, from all the existing contaminated and projected contamination sites, based on a total regionally or nationally available budget in a certain time frame such as 10 years. Then, several optimization steps determined year-by-year optimal distributions of the available yearly budgets for those selected sites. A hypothetical case study is presented to demonstrate a practical implementation of the management strategy. Several issues pertaining to groundwater contamination exposure and risk assessments and remediation cost evaluations are briefly discussed for adequately understanding implementations of the management strategy.

Technical considerations for designing low-cost, long-wave infrared objectives

NASA Astrophysics Data System (ADS)

Desroches, Gerard; Dalzell, Kristy; Robitaille, Blaise

2014-06-01

With the growth of uncooled infrared imaging in the consumer market, the balance between cost implications and performance criteria in the objective lens must be examined carefully. The increased availability of consumer-grade, long-wave infrared cameras is related to a decrease in military usage but it is also due to the decreasing costs of the cameras themselves. This has also driven up demand for low-cost, long-wave objectives that can resolve smaller pixels while maintaining high performance. Smaller pixels are traditionally associated with high cost objectives because of higher resolution requirements but, with careful consideration of all the requirements and proper selection of materials, costs can be moderated. This paper examines the cost/performance trade-off implications associated with optical and mechanical requirements of long-wave infrared objectives. Optical performance, f-number, field of view, distortion, focus range and thermal range all affect the cost of the objective. Because raw lens material cost is often the most expensive item in the construction, selection of the material as well as the shape of the lens while maintaining acceptable performance and cost targets were explored. As a result of these considerations, a low-cost, lightweight, well-performing objective was successfully designed, manufactured and tested.

Hydraulic and hydrologic aspects of flood-plain planning

USGS Publications Warehouse

Wiitala, S.W.; Jetter, K.R.; Sommerville, Alan J.

1961-01-01

The valid incentives compelling occupation of the flood plain, up to and eve n into the stream channel, undoubtedly have contributed greatly to the development of the country. But the result has been a heritage of flood disaster, suffering, and enormous costs. Flood destruction awakened a consciousness toward reduction and elimination of flood hazards, originally manifested in the protection of existing developments. More recently, increased knowledge of the problem has shown the impracticability of permitting development that requires costly flood protect/on. The idea of flood zoning, or flood-plain planning, has received greater impetus as a result of this realization. This study shows how hydraulic and hydrologic data concerning the flood regimen of a stream can be used in appraising its flood potential and the risk inherent in occupation of its flood plain. The approach involves the study of flood magnitudes as recorded or computed; flood frequencies based1 on experience shown by many years of gaging-station record; use of existing or computed stagedischarge relations and flood profiles; and, where required, the preparation of flood-zone maps to show the areas inundated by floods of several magnitudes and frequencies. The planner can delineate areas subject to inundation by floods o* specific recurrence intervals for three conditions: (a) for the immediate vicinity of a gaging station; (b) for a gaged stream at a considerable distance from a gaging station; and (c) for an ungaged stream. The average depth for a flood of specific frequency can be estimated on the basis of simple measurements of area of drainage basin, width of channel, and slope of streambed. This simplified approach should be useful in the initial stages of flood-plain planning. Brief discussions are included on various types of flood hazards, the effects of urbanization on flood runoff, and zoning considerations.

The insulin dilemma in resource-limited countries. A way forward?

PubMed

Gill, G V; Yudkin, J S; Keen, H; Beran, D

2011-01-01

The International Insulin Foundation (IIF) has developed and validated a needs-assessment instrument called the Rapid Assessment Protocol for Insulin Access (RAPIA) which has been used in seven countries in four continents to analyse the constraints to delivering effective continuing care for people with diabetes. One major contributor to the difficulties in availability of insulin is a failure to use the least costly sources and types of insulin and other effective drugs for diabetes. The purchase of insulins can consume as much as 10% of government expenditure on drugs, this being highly sensitive to the selection of newer analogue insulins as first-choice options, which cost between three and 13 times more than biosynthetic human insulin. Insulin cartridges for use with injection pens further add to costs. Similar considerations apply to most of the newer treatments for people with type 2 diabetes, which may cost up to 40 times more than metformin and sulfonylureas, still considered first-line drugs by European and US guidelines. Both biosynthetic human insulin and the first-line oral hypoglycaemic drugs are available from generic manufacturers. With the present price differentials, there is thus a growing need for countries involved in tendering for sourcing insulin to be provided with the guarantees of Good Manufacturing Practice, quality and bioequivalence, which would come from a WHO Pre-Qualification Scheme as currently exists for a variety of drugs for chronic diseases, both communicable and non-communicable. The IIF has developed a position statement on the provision and choice of diabetes treatments in resource-limited settings which should be applicable wherever consideration of resources is a component of therapeutic decision making.

Use of fees to fund local public health services in Western Massachusetts.

PubMed

Shila Waritu, A; Bulzacchelli, Maria T; Begay, Michael E

2015-01-01

Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. Fifty-nine LHDs in Western Massachusetts. Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

Data-driven modeling of solar-powered urban microgrids

PubMed Central

Halu, Arda; Scala, Antonio; Khiyami, Abdulaziz; González, Marta C.

2016-01-01

Distributed generation takes center stage in today’s rapidly changing energy landscape. Particularly, locally matching demand and generation in the form of microgrids is becoming a promising alternative to the central distribution paradigm. Infrastructure networks have long been a major focus of complex networks research with their spatial considerations. We present a systemic study of solar-powered microgrids in the urban context, obeying real hourly consumption patterns and spatial constraints of the city. We propose a microgrid model and study its citywide implementation, identifying the self-sufficiency and temporal properties of microgrids. Using a simple optimization scheme, we find microgrid configurations that result in increased resilience under cost constraints. We characterize load-related failures solving power flows in the networks, and we show the robustness behavior of urban microgrids with respect to optimization using percolation methods. Our findings hint at the existence of an optimal balance between cost and robustness in urban microgrids. PMID:26824071

Progress on high-performance rapid prototype aluminum mirrors

NASA Astrophysics Data System (ADS)

Woodard, Kenneth S.; Myrick, Bruce H.

2017-05-01

Near net shape parts can be produced using some very old processes (investment casting) and the relatively new direct metal laser sintering (DMLS) process. These processes have significant advantages for complex blank lightweighting and costs but are not inherently suited for producing high performance mirrors. The DMLS process can provide extremely complex lightweight structures but the high residual stresses left in the material results in unstable mirror figure retention. Although not to the extreme intricacy of DMLS, investment casting can also provide complex lightweight structures at considerably lower costs than DMLS and even conventional wrought mirror blanks but the less than 100% density for casting (and also DMLS) limits finishing quality. This paper will cover the progress that has been made to make both the DMLS and investment casting processes into viable near net shape blank options for high performance aluminum mirrors. Finish and figure results will be presented to show performance commensurate with existing conventional processes.

Beyond Percheron - Launch vehicle systems from the private sector

NASA Astrophysics Data System (ADS)

Horne, W. C.; Pavia, T. C.; Schrick, B. L.; Wolf, R. S.; Fruchterman, J. R.; Ross, D. J.

Private ventures for operation of spacecraft launching services are discussed in terms of alternative strategies for commercialization of space activities. The Percheron was the product of a philosophy of a cost-, rather than a weight-, minimized a lunch vehicle. Although the engine exploded during a static test firing, other private projects continued, including the launch of the Conestoga, an Aries second stage Minuteman I. Consideration is being directed toward commercial production and launch of the Delta rocket, and $1 and a $1.5 billion offers have been tendered for financing a fifth Orbiter for NASA in exchange for marketing rights. Funding for the ventures is contingent upon analyses of the size and projected growth rate of payload markets, a favorable national policy, investor confidence, and agreeable capitalization levels. It is shown that no significant barriers exist against satisfying the criteria, and private space ventures are projected to result in more cost-effective operations due to increased competition.

Understanding Proximal-Distal Economic Projections of the Benefits of Childhood Preventive Interventions

PubMed Central

Slade, Eric P.; Becker, Kimberly D.

2014-01-01

This paper discusses the steps and decisions involved in proximal-distal economic modeling, in which social, behavioral, and academic outcomes data for children may be used to inform projections of the economic consequences of interventions. Economic projections based on proximal-distal modeling techniques may be used in cost-benefit analyses when information is unavailable for certain long term outcomes data in adulthood or to build entire cost-benefit analyses. Although examples of proximal-distal economic analyses of preventive interventions exist in policy reports prepared for governmental agencies, such analyses have rarely been completed in conjunction with research trials. The modeling decisions on which these prediction models are based are often opaque to policymakers and other end-users. This paper aims to illuminate some of the key steps and considerations involved in constructing proximal-distal prediction models and to provide examples and suggestions that may help guide future proximal-distal analyses. PMID:24337979

Data-driven modeling of solar-powered urban microgrids.

PubMed

Halu, Arda; Scala, Antonio; Khiyami, Abdulaziz; González, Marta C

2016-01-01

Distributed generation takes center stage in today's rapidly changing energy landscape. Particularly, locally matching demand and generation in the form of microgrids is becoming a promising alternative to the central distribution paradigm. Infrastructure networks have long been a major focus of complex networks research with their spatial considerations. We present a systemic study of solar-powered microgrids in the urban context, obeying real hourly consumption patterns and spatial constraints of the city. We propose a microgrid model and study its citywide implementation, identifying the self-sufficiency and temporal properties of microgrids. Using a simple optimization scheme, we find microgrid configurations that result in increased resilience under cost constraints. We characterize load-related failures solving power flows in the networks, and we show the robustness behavior of urban microgrids with respect to optimization using percolation methods. Our findings hint at the existence of an optimal balance between cost and robustness in urban microgrids.

The impact of climate change on transportation in the gulf coast

USGS Publications Warehouse

Savonis, M.J.; Burkett, V.R.; Potter, J.R.; Kafalenos, R.; Hyman, R.; Leonard, K.

2009-01-01

Climate affects the design, construction, safety, operations, and maintenance of transportation infrastructure and systems. The prospect of a changing climate raises critical questions regarding how alterations in temperature, precipitation, storm events, and other aspects of the climate could affect the nation's transportation system. This regional assessment of climate change and its potential impacts on transportation systems addresses these questions for the central Gulf Coast between Houston and Mobile. Warming temperatures are likely to increase the costs of transportation construction, maintenance, and operations. More frequent extreme precipitation events will likely disrupt transportation networks with flooding and visibility problems. Relative sea level rise will make much of the existing infrastructure more prone to frequent or permanent inundation. Increased storm intensity may lead to increased service disruption and damage. Consideration of these factors in today's transportation decisions should lead to a more robust, resilient, and cost-effective transportation network in the coming decades. ?? 2009 ASCE.

Predicting Production Costs for Advanced Aerospace Vehicles

NASA Technical Reports Server (NTRS)

Bao, Han P.; Samareh, J. A.; Weston, R. P.

2002-01-01

For early design concepts, the conventional approach to cost is normally some kind of parametric weight-based cost model. There is now ample evidence that this approach can be misleading and inaccurate. By the nature of its development, a parametric cost model requires historical data and is valid only if the new design is analogous to those for which the model was derived. Advanced aerospace vehicles have no historical production data and are nowhere near the vehicles of the past. Using an existing weight-based cost model would only lead to errors and distortions of the true production cost. This paper outlines the development of a process-based cost model in which the physical elements of the vehicle are soared according to a first-order dynamics model. This theoretical cost model, first advocated by early work at MIT, has been expanded to cover the basic structures of an advanced aerospace vehicle. Elemental costs based on the geometry of the design can be summed up to provide an overall estimation of the total production cost for a design configuration. This capability to directly link any design configuration to realistic cost estimation is a key requirement for high payoff MDO problems. Another important consideration in this paper is the handling of part or product complexity. Here the concept of cost modulus is introduced to take into account variability due to different materials, sizes, shapes, precision of fabrication, and equipment requirements. The most important implication of the development of the proposed process-based cost model is that different design configurations can now be quickly related to their cost estimates in a seamless calculation process easily implemented on any spreadsheet tool.

Is the Venner-PneuX Endotracheal Tube System A Cost-Effective Option For Post Cardiac Surgery Care?

PubMed

Andronis, Lazaros; Oppong, Raymond A; Manga, Na'ngono; Senanayake, Eshan; Gopal, Shameer; Charman, Susan; Giri, Ramesh; Luckraz, Heyman

2018-04-27

Ventilator-associated pneumonia (VAP) is common and costly. In a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal tube system was found to be superior to standard endotracheal tubes (SET) in preventing VAP. However, VPX is considerably more expensive. We evaluated the costs and benefits of VPX to determine whether replacing SET with VPX is a cost-effective option for intensive care units. We developed a decision analytic model to compare intubation with VPX or SET for patients requiring mechanical ventilation post cardiac surgery. The model was populated with existing evidence on costs, effectiveness and quality of life. Cost-effectiveness and cost-utility analyses were conducted from an NHS hospital perspective. Uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Compared to SET, VPX is associated with an expected cost saving of £738 per patient. VPX led to a small increase in quality-adjusted life years (QALYs), indicating that the device is overall less costly and more effective than SET. The probability of VPX being cost-effective at £30,000 per QALY is 97%. VPX would cease to be cost-effective if (i) it led to a risk reduction smaller than 0.02 compared to SET, (ii) the acquisition cost of VPX was as high as £890 or, (iii) the cost of treating a case of VAP was lower than £1,450. VPX resulted in improved outcomes and savings which far offset the cost of the device, suggesting that replacing SET with VPX is overall beneficial. Findings were robust to extreme values of key parameters. Copyright © 2018. Published by Elsevier Inc.

Economic Considerations on the Follow-Up Practice in Gynecologic Cancers: Few Lights and Many Shadows From a Literature Review.

PubMed

Pagano, Eva; Sobrero, Simona; Cavallero, Camilla; Zola, Paolo; Ciccone, Giovannino

2015-09-01

The aim of this review was to analyze the existing literature on the cost of follow-up in gynecology oncology. We performed a literature search in Medline and NHS CRD (University of Oxford) databases. Research strings were mainly based on MESH terms referring to economic studies and to neoplasms follow-up/aftercare and cancer recurrences. Two independent searches were performed for ovarian neoplasm and uterine neoplasm. Some studies were also identified among the references of the selected articles. Potentially relevant studies were identified based on the title and abstract by 2 independent readers. Finally, the reviewing process selected 2 studies on gynecologic cancers in general, including uterine and ovarian cancers, 3 specific on ovarian cancer, 7 on endometrium, and 9 on cervix. The identified economic literature on economic evaluation of gynecologic cancer follow-up procedures showed to be based on weak evidence of effectiveness and to lack formal methodological approaches. In general, such literature is quite recent, relies on small sample observational studies, and suffers from a lack of financial support. There are few available lights in economic considerations on gynecologic cancer follow-up, represented by all the published studies, and many shadows that require to be clarified by properly designed randomized trials including cost-effectiveness analysis.

A comparative study of European rare disease and orphan drug markets.

PubMed

Denis, Alain; Mergaert, Lut; Fostier, Christel; Cleemput, Irina; Simoens, Steven

2010-10-01

This article aims to compare regulatory aspects of rare disease and orphan drug markets in Belgium, France, Italy, the Netherlands, Sweden and the United Kingdom. Information was derived from the international literature, analysis of legal texts, and a survey completed by national experts. These countries adopted varying approaches towards regulating rare disease and orphan drug markets and, hence, the availability, pricing and reimbursement of orphan drugs vary between countries. Strategies to keep down prices include public procurement in Sweden, profit controls in the United Kingdom, and price comparisons with other countries. To gain reimbursement, the cost-effectiveness and/or budget impact of orphan drugs is considered in some countries. Other societal considerations, such as whether the drug treats a life-threatening disease, are sometimes taken into account. Extensive government intervention exists in rare disease and orphan drug markets in the countries studied. Our recommendations are to define priorities for research on rare diseases and orphan drugs at the European level, to set up disease and patient registries with a view to investigating the long-term effectiveness and cost-effectiveness of orphan drugs, to assess the profitability of orphan drugs, and to take into account societal considerations when evaluating orphan drugs. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

E-procurement and automatic identification: enhancing supply chain management in the healthcare industry.

PubMed

Smith, Alan D; Flanegin, Frank R

2004-01-01

The concepts of automated e-procurement, or electronic B2B (business-to-business) trade, are grounded in the strategic leveraging of both tangible/intangible assets for successful implementation and execution of electronic trade, resulting in significant financial benefits for firms. Some of the major reasons for this growth include significant process savings from automation, compliance, and purchasing advantage; and reduced costs that organisations can experience by conducting transactions electronically. Although these are the basic benefits associated with generic e-commerce strategies, a majority of these B2B transactions have focused on the purchase of indirect materials (especially office products and travel services). In fact, more than 93% of medical supplies on hospital shelves appear to have universal product numbers on them--at least while still in their boxes and there is a great potential for huge savings in e-procurement in the healthcare field. However, other types of supply chain-related purchases, including maintenance, repair, and operating and replacement parts, and direct material purchases, are becoming more important operational management considerations. In addition, several other key considerations are: existing procurement strategy, the vendor, technology, suppliers, and total costs of ownership. Companies need to analyse their current procurement strategy before developing an e-procurement plan.

Cost, Coverage, and Comparative Effectiveness Research: The Critical Issues for Oncology

PubMed Central

Pearson, Steven D.

2012-01-01

A new national initiative in comparative effectiveness research (CER) is part of a broad and long-term evolution toward greater reliance on scientific evidence in clinical practice and medical policy. But CER has been controversial because of its high profile in the health care reform effort, its instantiation in a prominent new national research institute, and lingering concerns that the ultimate goal of CER is to empower the government and private insurers to reduce health care costs by restricting access to expensive new medical tests and treatments. This article presents an analysis of the policy development behind CER and focuses on its potential impact on insurance coverage and payment for oncology services. By itself, CER will not solve the tension that exists between the goal of innovative, personalized care and the eroding affordability of cancer treatment in the United States. But CER does offer an important opportunity for progress. Oncologists have taken important first steps in acknowledging their responsibility for addressing cost issues; as a professional society, they should now move forward to assume leadership in the effort to integrate clinical evidence with considerations of cost effectiveness to guide clinical practice and insurer policies. PMID:23071229

Subjective costs drive overly patient foraging strategies in rats on an intertemporal foraging task.

PubMed

Wikenheiser, Andrew M; Stephens, David W; Redish, A David

2013-05-14

Laboratory studies of decision making often take the form of two-alternative, forced-choice paradigms. In natural settings, however, many decision problems arise as stay/go choices. We designed a foraging task to test intertemporal decision making in rats via stay/go decisions. Subjects did not follow the rate-maximizing strategy of choosing only food items associated with short delays. Instead, rats were often willing to wait for surprisingly long periods, and consequently earned a lower rate of food intake than they might have by ignoring long-delay options. We tested whether foraging theory or delay discounting models predicted the behavior we observed but found that these models could not account for the strategies subjects selected. Subjects' behavior was well accounted for by a model that incorporated a cost for rejecting potential food items. Interestingly, subjects' cost sensitivity was proportional to environmental richness. These findings are at odds with traditional normative accounts of decision making but are consistent with retrospective considerations having a deleterious influence on decisions (as in the "sunk-cost" effect). More broadly, these findings highlight the utility of complementing existing assays of decision making with tasks that mimic more natural decision topologies.

The Influence of Targeted Education on Medication Persistence and Generic Substitution among Consumer-Directed Health Care Enrollees

PubMed Central

Sedjo, Rebecca L; Cox, Emily R

2009-01-01

Objective To evaluate an educational outreach among consumer-directed health plan (CDHP) enrollees on medication persistence and lower-cost generic substitution within four chronic medication therapies. Study Setting A cross-sectional analysis using pharmacy claims data from a national employer group that began offering a CDHP in 2006 and implemented an educational outreach to some CDHP enrollees in 2007 was used. Methods The intervention group was comprised of CDHP enrollees who received education outreach and was compared with CDHP enrollees without the educational outreach. Adjusted and unadjusted medication persistence and lower-cost generic substitutions were compared between groups. Principal Findings There was no difference in medication persistence between groups. CDHP enrollees with the educational outreach were more likely to have converted to lower-cost generic alternative antihypertensive medication compared with CDHP enrollees without the educational outreach (ORadj=29.82, 95 percent CI=4.41–201.93). Conclusion Educational outreach directed to CDHP enrollees was associated with increases in lower-cost generic alternatives with no change in patients' chronic medication use. However, considerable opportunity exists to assist CDHP enrollees in making sound health care decisions. PMID:19780849

Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review

PubMed Central

Gibson, Edward; Begum, Najida; Sigmundsson, Birgir; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

2016-01-01

ABSTRACT This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation — 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD). PMID:26837602

Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review.

PubMed

Gibson, Edward; Begum, Najida; Sigmundsson, Birgir; Sackeyfio, Alfred; Hackett, Judith; Rajaram, Sankarasubramanian

2016-05-03

This study compared the economic value of pediatric immunisation programmes for influenza to those for rotavirus (RV), meningococcal disease (MD), pneumococcal disease (PD), human papillomavirus (HPV), hepatitis B (Hep B), and varicella reported in recent (2000 onwards) cost-effectiveness (CE) studies identified in a systematic review of PubMed, health technology, and vaccination databases. The systematic review yielded 51 economic evaluation studies of pediatric immunisation - 10 (20%) for influenza and 41 (80%) for the other selected diseases. The quality of the eligible articles was assessed using Drummond's checklist. Although inherent challenges and limitations exist when comparing economic evaluations of immunisation programmes, an overall comparison of the included studies demonstrated cost-effectiveness/cost saving for influenza from a European-Union-Five (EU5) and United States (US) perspective; point estimates for cost/quality-adjusted life-years (QALY) from dominance (cost-saving with more effect) to ≤45,444 were reported. The economic value of influenza programmes was comparable to the other vaccines of interest, with cost/QALY in general considerably lower than RV, Hep B, MD and PD. Independent of the perspective and type of analysis, the economic impact of a pediatric influenza immunisation program was influenced by vaccine efficacy, immunisation coverage, costs, and most significantly by herd immunity. This review suggests that pediatric influenza immunisation may offer a cost effective strategy when compared with HPV and varicella and possibly more value compared with other childhood vaccines (RV, Hep B, MD and PD).

Cost-effectiveness of health-related lifestyle advice delivered by peer or lay advisors: synthesis of evidence from a systematic review

PubMed Central

2013-01-01

Background Development of new peer or lay health-related lifestyle advisor (HRLA) roles is one response to the need to enhance public engagement in, and improve cost-effectiveness of, health improvement interventions. This article synthesises evidence on the cost-effectiveness of HRLA interventions aimed at adults in developed countries, derived from the first systematic review of the effectiveness, cost-effectiveness, equity and acceptability of different types of HRLA role. Methods The best available evidence on the cost-effectiveness of HRLA interventions was obtained using systematic searches of 20 electronic databases and key journals, as well as searches of the grey literature and the internet. Interventions were classified according to the primary health behaviour targeted and intervention costs were estimated where necessary. Lifetime health gains were estimated (in quality-adjusted life years, where possible), based on evidence of effectiveness of HRLAs in combination with published estimates of the lifetime health gains resulting from lifestyle changes, and assumptions over relapse. Incremental cost-effectiveness ratios are reported. Results Evidence of the cost-effectiveness of HRLAs was identified from 24 trials included in the systematic review. The interventions were grouped into eight areas. We found little evidence of effectiveness of HRLAs for promotion of exercise/improved diets. Where HRLAs were effective cost-effectiveness varied considerably: Incremental Cost effectiveness Ratios were estimated at £6,000 for smoking cessation; £14,000 for a telephone based type 2 diabetes management; and £250,000 or greater for promotion of mammography attendance and for HIV prevention amongst drug users. We lacked sufficient evidence to estimate ICERs for breastfeeding promotion and mental health promotion, or to assess the impact of HRLAs on health inequalities. Conclusions Overall, there is limited evidence suggesting that HRLAs are cost-effective in terms of changing health-related knowledge, behaviours or health outcomes. The evidence that does exist indicates that HRLAs are only cost-effective when they target behaviours likely to have a large impact on overall health-related quality of life. Further development of HRLA interventions needs to target specific population health needs where potential exists for significant improvement, and include rigorous evaluation to ensure that HRLAs provide sufficient value for money. PMID:24304826

Monitoring and control requirement definition study for Dispersed Storage and Generation (DSG). Volume 5, appendix D: Cost-benefit considerations for providing dispersed storage and generation for electric utilities

NASA Technical Reports Server (NTRS)

1980-01-01

Cost benefit considerations are extremely important in obtaining the acceptance of dispersed storage and generation (DSG) by the electric utilities. These considerations involved somewhat different economic analyses depending on whether the generation is utility, customer, or combined ownership. It is necessary to get acceptance of more easily understood methods for evaluating the economics of DSG because much of the benefits of DSG may accrue in the generation and transmission portions of the utility system while the costs tend to be centered in the distribution portion of that system. The influence of factors, such as reliability, capital costs, and other economic measures were also investigated.

Principles of cost-benefit analysis for ERTS experiments, volumes 1 and 2

NASA Technical Reports Server (NTRS)

1973-01-01

The basic elements of a cost-benefit study are discussed along with special considerations for ERTS experiments. Elements required for a complete economic analysis of ERTS are considered to be: statement of objectives, specification of assumptions, enumeration of system alternatives, benefit analysis, cost analysis nonefficiency considerations, and final system selection. A hypothetical cost-benefit example is presented with the assumed objective of an increase in remote sensing surveys of grazing lands to better utilize available forage to lower meat prices.

Improving iSC performance through outsourcing - Considerations for using third-party service providers to increase innovation, capacity and efficiency.

PubMed

Wright, Martin; Forster, Gary; Beale, John

2017-04-19

Development partners and donors have encouraged and incentivized governments in developing countries to explore ways of working with third-party service suppliers to reduce costs and increase service delivery capacity. The distribution of vaccines and medicines has for a long time shown demand for outsourcing but public health systems have struggled to develop the expertise and capital assets necessary to manage such ventures. Existing transport and logistics capacity within public health systems, in particular, is well documented as being insufficient to support existing, let alone future immunization needs. Today, a number of countries are contracting party logistics providers (3PLs) to supplement the in-house distribution operations of public health systems. This commentary reflects on recent, leading examples of outsourcing initiatives to address critical gaps in transport and logistics. Copyright © 2017. Published by Elsevier Ltd.

Medical equipment classification: method and decision-making support based on paraconsistent annotated logic.

PubMed

Oshiyama, Natália F; Bassani, Rosana A; D'Ottaviano, Itala M L; Bassani, José W M

2012-04-01

As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification.

Developing criteria to establish Trusted Digital Repositories

USGS Publications Warehouse

Faundeen, John L.

2017-01-01

This paper details the drivers, methods, and outcomes of the U.S. Geological Survey’s quest to establish criteria by which to judge its own digital preservation resources as Trusted Digital Repositories. Drivers included recent U.S. legislation focused on data and asset management conducted by federal agencies spending $100M USD or more annually on research activities. The methods entailed seeking existing evaluation criteria from national and international organizations such as International Standards Organization (ISO), U.S. Library of Congress, and Data Seal of Approval upon which to model USGS repository evaluations. Certification, complexity, cost, and usability of existing evaluation models were key considerations. The selected evaluation method was derived to allow the repository evaluation process to be transparent, understandable, and defensible; factors that are critical for judging competing, internal units. Implementing the chosen evaluation criteria involved establishing a cross-agency, multi-disciplinary team that interfaced across the organization. 

Efficient greedy algorithms for economic manpower shift planning

NASA Astrophysics Data System (ADS)

Nearchou, A. C.; Giannikos, I. C.; Lagodimos, A. G.

2015-01-01

Consideration is given to the economic manpower shift planning (EMSP) problem, an NP-hard capacity planning problem appearing in various industrial settings including the packing stage of production in process industries and maintenance operations. EMSP aims to determine the manpower needed in each available workday shift of a given planning horizon so as to complete a set of independent jobs at minimum cost. Three greedy heuristics are presented for the EMSP solution. These practically constitute adaptations of an existing algorithm for a simplified version of EMSP which had shown excellent performance in terms of solution quality and speed. Experimentation shows that the new algorithms perform very well in comparison to the results obtained by both the CPLEX optimizer and an existing metaheuristic. Statistical analysis is deployed to rank the algorithms in terms of their solution quality and to identify the effects that critical planning factors may have on their relative efficiency.

Security and privacy issues with health care information technology.

PubMed

Meingast, Marci; Roosta, Tanya; Sastry, Shankar

2006-01-01

The face of health care is changing as new technologies are being incorporated into the existing infrastructure. Electronic patient records and sensor networks for in-home patient monitoring are at the current forefront of new technologies. Paper-based patient records are being put in electronic format enabling patients to access their records via the Internet. Remote patient monitoring is becoming more feasible as specialized sensors can be placed inside homes. The combination of these technologies will improve the quality of health care by making it more personalized and reducing costs and medical errors. While there are benefits to technologies, associated privacy and security issues need to be analyzed to make these systems socially acceptable. In this paper we explore the privacy and security implications of these next-generation health care technologies. We describe existing methods for handling issues as well as discussing which issues need further consideration.

A development framework for artificial intelligence based distributed operations support systems

NASA Technical Reports Server (NTRS)

Adler, Richard M.; Cottman, Bruce H.

1990-01-01

Advanced automation is required to reduce costly human operations support requirements for complex space-based and ground control systems. Existing knowledge based technologies have been used successfully to automate individual operations tasks. Considerably less progress has been made in integrating and coordinating multiple operations applications for unified intelligent support systems. To fill this gap, SOCIAL, a tool set for developing Distributed Artificial Intelligence (DAI) systems is being constructed. SOCIAL consists of three primary language based components defining: models of interprocess communication across heterogeneous platforms; models for interprocess coordination, concurrency control, and fault management; and for accessing heterogeneous information resources. DAI applications subsystems, either new or existing, will access these distributed services non-intrusively, via high-level message-based protocols. SOCIAL will reduce the complexity of distributed communications, control, and integration, enabling developers to concentrate on the design and functionality of the target DAI system itself.

Real-time earthquake monitoring: Early warning and rapid response

NASA Technical Reports Server (NTRS)

1991-01-01

A panel was established to investigate the subject of real-time earthquake monitoring (RTEM) and suggest recommendations on the feasibility of using a real-time earthquake warning system to mitigate earthquake damage in regions of the United States. The findings of the investigation and the related recommendations are described in this report. A brief review of existing real-time seismic systems is presented with particular emphasis given to the current California seismic networks. Specific applications of a real-time monitoring system are discussed along with issues related to system deployment and technical feasibility. In addition, several non-technical considerations are addressed including cost-benefit analysis, public perceptions, safety, and liability.

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Observational Studies.

PubMed

Snyder, Graham M; Young, Heather; Varman, Meera; Milstone, Aaron M; Harris, Anthony D; Munoz-Price, Silvia

2016-10-01

Observational studies compare outcomes among subjects with and without an exposure of interest, without intervention from study investigators. Observational studies can be designed as a prospective or retrospective cohort study or as a case-control study. In healthcare epidemiology, these observational studies often take advantage of existing healthcare databases, making them more cost-effective than clinical trials and allowing analyses of rare outcomes. This paper addresses the importance of selecting a well-defined study population, highlights key considerations for study design, and offers potential solutions including biostatistical tools that are applicable to observational study designs. Infect Control Hosp Epidemiol 2016;1-6.

Obstacle detectors for automated transit vehicles: A technoeconomic and market analysis

NASA Technical Reports Server (NTRS)

Lockerby, C. E.

1979-01-01

A search was conducted to identify the technical and economic characteristics of both NASA and nonNASA obstacle detectors. The findings, along with market information were compiled and analyzed for consideration by DOT and NASA in decisions about any future automated transit vehicle obstacle detector research, development, or applications project. Currently available obstacle detectors and systems under development are identified by type (sonic, capacitance, infrared/optical, guided radar, and probe contact) and compared with the three NASA devices selected as possible improvements or solutions to the problems in existing obstacle detection systems. Cost analyses and market forecasts individually for the AGT and AMTV markets are included.

In-Space Structural Assembly: Applications and Technology

NASA Technical Reports Server (NTRS)

Belvin, W. Keith; Doggett, Bill R.; Watson, Judith J.; Dorsey, John T.; Warren, Jay; Jones, Thomas C.; Komendera, Erik E.; Mann, Troy O.; Bowman, Lynn

2016-01-01

As NASA exploration moves beyond earth's orbit, the need exists for long duration space systems that are resilient to events that compromise safety and performance. Fortunately, technology advances in autonomy, robotic manipulators, and modular plug-and-play architectures over the past two decades have made in-space vehicle assembly and servicing possible at acceptable cost and risk. This study evaluates future space systems needed to support scientific observatories and human/robotic Mars exploration to assess key structural design considerations. The impact of in-space assembly is discussed to identify gaps in structural technology and opportunities for new vehicle designs to support NASA's future long duration missions.

Morphology and microstructure of composite materials

NASA Technical Reports Server (NTRS)

Tiwari, S. N.; Srinivansan, K.

1991-01-01

Lightweight continuous carbon fiber based polymeric composites are currently enjoying increasing acceptance as structural materials capable of replacing metals and alloys in load bearing applications. As with most new materials, these composites are undergoing trials with several competing processing techniques aimed at cost effectively producing void free consolidations with good mechanical properties. As metallic materials have been in use for several centuries, a considerable database exists on their morphology - microstructure; and the interrelationships between structure and properties have been well documented. Numerous studies on composites have established the crucial relationship between microstructure - morphology and properties. The various microstructural and morphological features of composite materials, particularly those accompanying different processing routes, are documented.

Diffusion of cancer education into schools.

PubMed

Anderson, D M; Portnoy, B

1989-05-01

Though implementing health education in schools has numerous advantages, many barriers impede adoption of effective curricula. Diffusion theory provides a framework for understanding why some school systems do not implement comprehensive, sequential, and behaviorally oriented curricula. Reasons for failure to provide optimal health education include competition for time, unawareness of resources and research results, political considerations, long-range planning difficulties, lack of teacher training, lack of testing, other academic priorities, uncertainty about responsibility for health education, and costs. Health educators can overcome such difficulties by working within existing curricular agendas, political interests, and budgets, and by organizing interventions through school health councils, while recognizing local programs, conditions, and resources.

A design procedure for the handling qualities optimization of the X-29A aircraft

NASA Technical Reports Server (NTRS)

Bosworth, John T.; Cox, Timothy H.

1989-01-01

The techniques used to improve the pitch-axis handling qualities of the X-29A wing-canard-planform fighter aircraft are reviewed. The aircraft and its FCS are briefly described, and the design method, which works within the existing FCS architecture, is characterized in detail. Consideration is given to the selection of design goals and design variables, the definition and calculation of the cost function, the validation of the mathematical model on the basis of flight-test data, and the validation of the improved design by means of nonlinear simulations. Flight tests of the improved design are shown to verify the simulation results.

Global issues related to the impact of untreated attention-deficit/hyperactivity disorder from childhood to young adulthood.

PubMed

Barkley, Russell A

2008-09-01

Attention-deficit/hyperactivity disorder (ADHD) is a common, chronic, and costly disorder, with an impact that can span from preschool into adulthood. There are safe and effective therapies that can manage and help prevent many of the associated negative outcomes of ADHD, but treatment rates are far from optimal and considerable obstacles exist in achieving satisfactory treatment adherence. Individuals with untreated ADHD, their families, and other caregivers must be made aware of the impact that this disorder may have on them at every stage of life and, correspondingly, the improved outcomes that can be achieved with the successful management of ADHD.

Estimating the impact of enterprise resource planning project management decisions on post-implementation maintenance costs: a case study using simulation modelling

NASA Astrophysics Data System (ADS)

Fryling, Meg

2010-11-01

Organisations often make implementation decisions with little consideration for the maintenance phase of an enterprise resource planning (ERP) system, resulting in significant recurring maintenance costs. Poor cost estimations are likely related to the lack of an appropriate framework for enterprise-wide pre-packaged software maintenance, which requires an ongoing relationship with the software vendor (Markus, M.L., Tanis, C., and Fenema, P.C., 2000. Multisite ERP implementation. CACM, 43 (4), 42-46). The end result is that critical project decisions are made with little empirical data, resulting in substantial long-term cost impacts. The product of this research is a formal dynamic simulation model that enables theory testing, scenario exploration and policy analysis. The simulation model ERPMAINT1 was developed by combining and extending existing frameworks in several research domains, and by incorporating quantitative and qualitative case study data. The ERPMAINT1 model evaluates tradeoffs between different ERP project management decisions and their impact on post-implementation total cost of ownership (TCO). Through model simulations a variety of dynamic insights were revealed that could assist ERP project managers. Major findings from the simulation show that upfront investments in mentoring and system exposure translate to long-term cost savings. The findings also indicate that in addition to customisations, add-ons have a significant impact on TCO.

The political economy of abortion in India: cost and expenditure patterns.

PubMed

Duggal, Ravi

2004-11-01

Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman's marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount--first trimester abortion averages Rs.500- 1000 and second trimester abortion Rs.2000-3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe abortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.

Alginate-Encapsulation for the Improved Hypothermic Preservation of Human Adipose-Derived Stem Cells

PubMed Central

Swioklo, Stephen; Constantinescu, Andrei

2016-01-01

Despite considerable progress within the cell therapy industry, unmet bioprocessing and logistical challenges associated with the storage and distribution of cells between sites of manufacture and the clinic exist. We examined whether hypothermic (4°C–23°C) preservation of human adipose-derived stem cells could be improved through their encapsulation in 1.2% calcium alginate. Alginate encapsulation improved the recovery of viable cells after 72 hours of storage. Viable cell recovery was highly temperature-dependent, with an optimum temperature of 15°C. At this temperature, alginate encapsulation preserved the ability for recovered cells to attach to tissue culture plastic on rewarming, further increasing its effect on total cell recovery. On attachment, the cells were phenotypically normal, displayed normal growth kinetics, and maintained their capacity for trilineage differentiation. The number of cells encapsulated (up to 2 × 106 cells per milliliter) did not affect viable cell recovery nor did storage of encapsulated cells in a xeno-free, serum-free,current Good Manufacturing Practice-grade medium. We present a simple, low-cost system capable of enhancing the preservation of human adipose-derived stem cells stored at hypothermic temperatures, while maintaining their normal function. The storage of cells in this manner has great potential for extending the time windows for quality assurance and efficacy testing, distribution between the sites of manufacture and the clinic, and reducing the wastage associated with the limited shelf life of cells stored in their liquid state. Significance Despite considerable advancement in the clinical application of cell-based therapies, major logistical challenges exist throughout the cell therapy supply chain associated with the storage and distribution of cells between the sites of manufacture and the clinic. A simple, low-cost system capable of preserving the viability and functionality of human adipose-derived stem cells (a cell with substantial clinical interest) at hypothermic temperatures (0°C–32°C) is presented. Such a system has considerable potential for extending the shelf life of cell therapy products at multiple stages throughout the cell therapy supply chain. PMID:26826163

Enhanced surveillance strategies for detecting and monitoring chronic wasting disease in free-ranging cervids

USGS Publications Warehouse

Walsh, Daniel P.

2012-01-01

The purpose of this document is to provide wildlife management agencies with the foundation upon which they can build scientifically rigorous and cost-effective surveillance and monitoring programs for chronic wasting disease (CWD) or refine their existing programs. The first chapter provides an overview of potential demographic and spatial risk factors of susceptible wildlife populations that may be exploited for CWD surveillance and monitoring. The information contained in this chapter explores historic as well as recent developments in our understanding of CWD disease dynamics. It also contains many literature references for readers who may desire a more thorough review of the topics or CWD in general. The second chapter examines methods for enhancing efforts to detect CWD on the landscape where it is not presently known to exist and focuses on the efficiency and cost-effectiveness of the surveillance program. Specifically, it describes the means of exploiting current knowledge of demographic and spatial risk factors, as described in the first chapter, through a two-stage surveillance scheme that utilizes traditional design-based sampling approaches and novel statistical methods to incorporate information about the attributes of the landscape, environment, populations and individual animals into CWD surveillance activities. By accounting for these attributes, efficiencies can be gained and cost-savings can be realized. The final chapter is unique in relation to the first two chapters. Its focus is on designing programs to monitor CWD once it is discovered within a jurisdiction. Unlike the prior chapters that are more detailed or prescriptive, this chapter by design is considerably more general because providing comprehensive direction for creating monitoring programs for jurisdictions without consideration of their monitoring goals, sociopolitical constraints, or their biological systems, is not possible. Therefore, the authors draw upon their collective experiences implementing disease-monitoring programs to present the important questions to consider, potential tools, and various strategies for those wildlife management agencies endeavoring to create or maintain a CWD monitoring program. Its intent is to aid readers in creating efficient and cost-effective monitoring programs, while avoiding potential pitfalls. It is hoped that these three chapters will be useful tools for wildlife managers struggling to implement efficient and effective CWD disease management programs.

Newman Unit 1 advanced solar repowering advanced conceptual design. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

1982-04-01

The Newman Unit 1 solar repowering design is a water/steam central receiver concept supplying superheated steam. The work reported is to develop a refined baseline conceptual design that has potential for construction and operation by 1986, makes use of existing solar thermal technology, and provides the best economics for this application. Trade studies performed in the design effort are described, both for the conceptual design of the overall system and for the subsystem conceptual design. System-level functional requirements, design, operation, performance, cost, safety, environmental, institutional, and regulatory considerations are described. Subsystems described include the collector, receiver, fossil energy, electrical powermore » generating, and master control subsystems, site and site facilities. The conceptual design, cost, and performance of each subsystem is discussed at length. A detailed economic analysis of the repowered unit is made to realistically assess the economics of the first repowered unit using present cost data for a limited production level for solar hardware. Finally, a development plan is given, including the design, procurement, construction, checkout, startup, performance validation, and commercial operation. (LEW)« less

The Ambulatory and Home Care Record: A Methodological Framework for Economic Analyses in End-of-Life Care

PubMed Central

Guerriere, Denise N.; Coyte, Peter C.

2011-01-01

Provision of end-of-life care in North America takes place across a multitude of settings, including hospitals, ambulatory clinics and home settings. As a result, family caregiving is characteristically a major component of care within the home. Accordingly, economic evaluation of the end-of-life care environment must devote equal consideration to resources provided by the public health system as well as privately financed resources, such as time and money provided by family caregivers. This paper addresses the methods used to measure end-of-life care costs. The existing empirical literature will be reviewed in order to assess care costs with areas neglected in this body of literature to be identified. The Ambulatory and Home Care Record, a framework and tool for comprehensively measuring costs related to the provision and receipt of end-of-life care across all health care settings, will be described and proposed. Finally, areas for future work will be identified, along with their potential contribution to this body of knowledge. PMID:21629752

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

PubMed Central

2010-01-01

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

Marching to the beat of Moore's Law

NASA Astrophysics Data System (ADS)

Borodovsky, Yan

2006-03-01

Area density scaling in integrated circuits, defined as transistor count per unit area, has followed the famous observation-cum-prediction by Gordon Moore for many generations. Known as "Moore's Law" which predicts density doubling every 18-24 month, it has provided all important synchronizing guidance and reference for tools and materials suppliers, IC manufacturers and their customers as to what minimal requirements their products and services need to meet to satisfy technical and financial expectations in support of the infrastructure required for the development and manufacturing of corresponding technology generation nodes. Multiple lithography solutions are usually under considerations for any given node. In general, three broad classes of solutions are considered: evolutionary - technology that is extension of existing technology infrastructure at similar or slightly higher cost and risk to schedule; revolutionary - technology that discards significant parts of the existing infrastructure at similar cost, higher risk to schedule but promises higher capability as compared to the evolutionary approach; and last but not least, disruptive - approach that as a rule promises similar or better capabilities, much lower cost and wholly unpredictable risk to schedule and products yields. This paper examines various lithography approaches, their respective merits against criteria of respective infrastructure availability, affordability and risk to IC manufacturer's schedules and strategy involved in developing and selecting best solution in an attempt to sort out key factors that will impact the decision on the lithography choice for large-scale manufacturing for the future technology nodes.

Modeling for waste management associated with environmental-impact abatement under uncertainty.

PubMed

Li, P; Li, Y P; Huang, G H; Zhang, J L

2015-04-01

Municipal solid waste (MSW) treatment can generate significant amounts of pollutants, and thus pose a risk on human health. Besides, in MSW management, various uncertainties exist in the related costs, impact factors, and objectives, which can affect the optimization processes and the decision schemes generated. In this study, a life cycle assessment-based interval-parameter programming (LCA-IPP) method is developed for MSW management associated with environmental-impact abatement under uncertainty. The LCA-IPP can effectively examine the environmental consequences based on a number of environmental impact categories (i.e., greenhouse gas equivalent, acid gas emissions, and respiratory inorganics), through analyzing each life cycle stage and/or major contributing process related to various MSW management activities. It can also tackle uncertainties existed in the related costs, impact factors, and objectives and expressed as interval numbers. Then, the LCA-IPP method is applied to MSW management for the City of Beijing, the capital of China, where energy consumptions and six environmental parameters [i.e., CO2, CO, CH4, NOX, SO2, inhalable particle (PM10)] are used as systematic tool to quantify environmental releases in entire life cycle stage of waste collection, transportation, treatment, and disposal of. Results associated with system cost, environmental impact, and the related policy implication are generated and analyzed. Results can help identify desired alternatives for managing MSW flows, which has advantages in providing compromised schemes under an integrated consideration of economic efficiency and environmental impact under uncertainty.

Can IR scene projectors reduce total system cost?

NASA Astrophysics Data System (ADS)

Ginn, Robert; Solomon, Steven

2006-05-01

There is an incredible amount of system engineering involved in turning the typical infrared system needs of probability of detection, probability of identification, and probability of false alarm into focal plane array (FPA) requirements of noise equivalent irradiance (NEI), modulation transfer function (MTF), fixed pattern noise (FPN), and defective pixels. Unfortunately, there are no analytic solutions to this problem so many approximations and plenty of "seat of the pants" engineering is employed. This leads to conservative specifications, which needlessly drive up system costs by increasing system engineering costs, reducing FPA yields, increasing test costs, increasing rework and the never ending renegotiation of requirements in an effort to rein in costs. These issues do not include the added complexity to the FPA factory manager of trying to meet varied, and changing, requirements for similar products because different customers have made different approximations and flown down different specifications. Scene generation technology may well be mature and cost effective enough to generate considerable overall savings for FPA based systems. We will compare the costs and capabilities of various existing scene generation systems and estimate the potential savings if implemented at several locations in the IR system fabrication cycle. The costs of implementing this new testing methodology will be compared to the probable savings in systems engineering, test, rework, yield improvement and others. The diverse requirements and techniques required for testing missile warning systems, missile seekers, and FLIRs will be defined. Last, we will discuss both the hardware and software requirements necessary to meet the new test paradigm and discuss additional cost improvements related to the incorporation of these technologies.

Distance still matters. The hard reality of global expansion.

PubMed

Ghemawat, P

2001-09-01

Companies routinely overestimate the attractiveness of foreign markets. Dazzled by the sheer size of untapped markets, they lose sight of the difficulties of pioneering new, often very different territories. The problem is rooted in the analytic tools (the most prominent being country portfolio analysis, or CPA) that managers use to judge international investments. By focusing on national wealth, consumer income, and people's propensity to consume, CPA emphasizes potential sales, ignoring the costs and risks of doing business in a new market. Most of these costs and risks result from the barriers created by distance. "Distance," however, does not refer only to geography; its other dimensions can make foreign markets considerably more or less attractive. The CAGE framework of distance presented here considers four attributes: cultural distance (religious beliefs, race, social norms, and language that are different for the target country and the country of the company considering expansion); administrative or political distance (colony-colonizer links, common currency, and trade arrangements); geographic distance (the physical distance between the two countries, the size of the target country, access to waterways and the ocean, internal topography, and transportation and communications infrastructures); and economic distance (disparities in the two countries' wealth or consumer income and variations in the cost and quality of financial and other resources). This framework can help to identify the ways in which potential markets may be distant from existing ones. The article explores how (and by how much) various types of distance can affect different types of industries and shows how dramatically an explicit consideration of distance can change a company's picture of its strategic options.

An interval-based possibilistic programming method for waste management with cost minimization and environmental-impact abatement under uncertainty.

PubMed

Li, Y P; Huang, G H

2010-09-15

Considerable public concerns have been raised in the past decades since a large amount of pollutant emissions from municipal solid waste (MSW) disposal of processes pose risks on surrounding environment and human health. Moreover, in MSW management, various uncertainties exist in the related costs, impact factors and objectives, which can affect the optimization processes and the decision schemes generated. In this study, an interval-based possibilistic programming (IBPP) method is developed for planning the MSW management with minimized system cost and environmental impact under uncertainty. The developed method can deal with uncertainties expressed as interval values and fuzzy sets in the left- and right-hand sides of constraints and objective function. An interactive algorithm is provided for solving the IBPP problem, which does not lead to more complicated intermediate submodels and has a relatively low computational requirement. The developed model is applied to a case study of planning a MSW management system, where mixed integer linear programming (MILP) technique is introduced into the IBPP framework to facilitate dynamic analysis for decisions of timing, sizing and siting in terms of capacity expansion for waste-management facilities. Three cases based on different waste-management policies are examined. The results obtained indicate that inclusion of environmental impacts in the optimization model can change the traditional waste-allocation pattern merely based on the economic-oriented planning approach. The results obtained can help identify desired alternatives for managing MSW, which has advantages in providing compromised schemes under an integrated consideration of economic efficiency and environmental impact under uncertainty. Copyright 2010 Elsevier B.V. All rights reserved.

Medical technology as a key driver of rising health expenditure: disentangling the relationship

PubMed Central

Sorenson, Corinna; Drummond, Michael; Bhuiyan Khan, Beena

2013-01-01

Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses) were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices) had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in better value in health care and broader socioeconomic benefits. PMID:23807855

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

PubMed Central

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion.

PubMed

Olfert, Jordan A P; Penz, Erika D; Manns, Braden J; Mishra, Eleanor K; Davies, Helen E; Miller, Robert F; Luengo-Fernandez, Ramon; Gao, Song; Rahman, Najib M

2017-05-01

Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was <14 weeks, and was more costly when 2-h nursing time per week was assumed for catheter drainage. IPC is cost-effective when compared with talc, although substantial uncertainty exists around this estimate. IPC appears most cost-effective in patients with limited survival. If significant nursing time is required for catheter drainage, IPC becomes less likely to be cost-effective. Either therapy may be considered as a first-line option in treating malignant pleural effusion in patients without history of prior pleurodesis, with consideration for patient survival, support and preferences. © 2016 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

PubMed Central

Boulanger, L. L.; Lee, L. A.; Odhacha, A.

1999-01-01

Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used. PMID:10593034

Assessing value-for-money in maternal and newborn health

PubMed Central

Madaj, Barbara; Kumar, Shubha

2017-01-01

Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both ‘economy’ and ‘efficiency’ can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case–control studies or randomised controlled trials can be used to assess ‘effectiveness’. To assess ‘cost-effectiveness’, cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such ‘economy’ and ‘efficiency’ are relatively easy to assess. However, ‘effectiveness’ and ‘cost-effectiveness’ which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help. PMID:29081998

Assessing value-for-money in maternal and newborn health.

PubMed

Banke-Thomas, Aduragbemi; Madaj, Barbara; Kumar, Shubha; Ameh, Charles; van den Broek, Nynke

2017-01-01

Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both 'economy' and 'efficiency' can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case-control studies or randomised controlled trials can be used to assess 'effectiveness'. To assess 'cost-effectiveness', cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such 'economy' and 'efficiency' are relatively easy to assess. However, 'effectiveness' and 'cost-effectiveness' which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help.

Cost/benefit analysis of advanced materials technologies for future aircraft turbine engines

NASA Technical Reports Server (NTRS)

Stephens, G. E.

1980-01-01

The materials technologies studied included thermal barrier coatings for turbine airfoils, turbine disks, cases, turbine vanes and engine and nacelle composite materials. The cost/benefit of each technology was determined in terms of Relative Value defined as change in return on investment times probability of success divided by development cost. A recommended final ranking of technologies was based primarily on consideration of Relative Values with secondary consideration given to changes in other economic parameters. Technologies showing the most promising cost/benefits were thermal barrier coated temperature nacelle/engine system composites.

Cost-effectiveness of novel vaccines for tuberculosis control: a decision analysis study

PubMed Central

2011-01-01

Background The development of a successful new tuberculosis (TB) vaccine would circumvent many limitations of current diagnostic and treatment practices. However, vaccine development is complex and costly. We aimed to assess the potential cost effectiveness of novel vaccines for TB control in a sub-Saharan African country - Zambia - relative to the existing strategy of directly observed treatment, short course (DOTS) and current level of bacille Calmette-Guérin (BCG) vaccination coverage. Methods We conducted a decision analysis model-based simulation from the societal perspective, with a 3% discount rate and all costs expressed in 2007 US dollars. Health outcomes and costs were projected over a 30-year period, for persons born in Zambia (population 11,478,000 in 2005) in year 1. Initial development costs for single vaccination and prime-boost strategies were prorated to the Zambian share (0.398%) of global BCG vaccine coverage for newborns. Main outcome measures were TB-related morbidity, mortality, and costs over a range of potential scenarios for vaccine efficacy. Results Relative to the status quo strategy, a BCG replacement vaccine administered at birth, with 70% efficacy in preventing rapid progression to TB disease after initial infection, is estimated to avert 932 TB cases and 422 TB-related deaths (prevention of 199 cases/100,000 vaccinated, and 90 deaths/100,000 vaccinated). This would result in estimated net savings of $3.6 million over 30 years for 468,073 Zambians born in year 1 of the simulation. The addition of a booster at age 10 results in estimated savings of $5.6 million compared to the status quo, averting 1,863 TB cases and 1,011 TB-related deaths (prevention of 398 cases/100,000 vaccinated, and of 216 deaths/100,000 vaccinated). With vaccination at birth alone, net savings would be realized within 1 year, whereas the prime-boost strategy would require an additional 5 years to realize savings, reflecting a greater initial development cost. Conclusions Investment in an improved TB vaccine is predicted to result in considerable cost savings, as well as a reduction in TB morbidity and TB-related mortality, when added to existing control strategies. For a vaccine with waning efficacy, a prime-boost strategy is more cost-effective in the long term. PMID:21269503

The economic considerations of patients and caregivers in choice of dialysis modality

PubMed Central

Howard, Kirsten; Tong, Allison; Palmer, Suetonia C.; Marshall, Mark R.; Morton, Rachael L.

2016-01-01

Abstract Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. PMID:27196634

Comparative analysis of heat pump and biomass boiler for small detached house heating

NASA Astrophysics Data System (ADS)

Olkowski, Tomasz; Lipiński, Seweryn; Olędzka, Aneta

2017-10-01

The purpose of the work is to answer the question - which of the two selected heat sources is more economically beneficial for small detached house: heat pump or biomass boiler fuelled with wood-pellets? The comparative analysis of these sources was carried out to discuss the issue. First, cost of both, equipment and operation of selected heat systems were analysed. Additionally, CO2 emission levels associated with these heat systems were determined. The comparative analysis of the costs of both considered heat systems showed that equipment cost of heat pump system is considerably bigger than the cost of biomass boiler system. The comparison of annual operation costs showed that heat pump operation cost is slightly lower than operation cost of biomass boiler. The analysis of above results shows that lower operation cost of heat pump in comparison with biomass boiler cost lets qualify heat pump as more economically justified only after 38 years of work. For both analysed devices, CO2 emission levels were determined. The considerations take into account the fact that heat pump consumes electricity. It is mostly generated through combustion of coal in Poland. The results show that in Poland biomass boiler can be described as not only more economically justified system but also as considerably more ecological.

Toward a more reliable federal survey for tracking health insurance coverage and access.

PubMed

Kenney, Genevieve; Holahan, John; Nichols, Len

2006-06-01

Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. Assessment of the major federal household surveys that regularly provide information on health insurance and access to care based on an examination of each survey instrument and related survey documentation and the methodological literature. Identification of the data needed to address key policy questions on insurance coverage, assessment of how well existing surveys meet this need, definition of the critical elements of an ideal survey, and examination of the potential for building on existing surveys. Collection and critical assessment of pertinent survey documentation and methodological studies. While all the federal surveys examined provide valuable information, the information available to guide key policy decisions still has major gaps. Issues include measurement of insurance coverage and critical content gaps, inadequate sample sizes to support precise state and substate estimates, considerable delays between data collection and availability, and concerns about response rates and item nonresponse. Our assessment is that the Current Population Survey (CPS) and the National Health Interview Survey could be most readily modified to address these issues. The vast resources devoted to health care and the magnitude of the uninsurance problem make it critical that we have a reliable source for tracking health care and coverage at the national and state levels and for major local areas. It is plausible that this could be more cost effectively done by building on existing surveys than by designing and fielding a new one, but further research is needed to make a definitive judgment. At a minimum, the health insurance information collected on the CPS should be revised to address existing measurement problems.

Broadband network selection issues

NASA Astrophysics Data System (ADS)

Leimer, Michael E.

1996-01-01

Selecting the best network for a given cable or telephone company provider is not as obvious as it appears. The cost and performance trades between Hybrid Fiber Coax (HFC), Fiber to the Curb (FTTC) and Asymmetric Digital Subscriber Line networks lead to very different choices based on the existing plant and the expected interactive subscriber usage model. This paper presents some of the issues and trades that drive network selection. The majority of the Interactive Television trials currently underway or planned are based on HFC networks. As a throw away market trial or a short term strategic incursion into a cable market, HFC may make sense. In the long run, if interactive services see high demand, HFC costs per node and an ever shrinking neighborhood node size to service large numbers of subscribers make FTTC appear attractive. For example, thirty-three 64-QAM modulators are required to fill the 550 MHz to 750 MHz spectrum with compressed video streams in 6 MHz channels. This large amount of hardware at each node drives not only initial build-out costs, but operations and maintenance costs as well. FTTC, with its potential for digitally switching large amounts of bandwidth to an given home, offers the potential to grow with the interactive subscriber base with less downstream cost. Integrated telephony on these networks is an issue that appears to be an afterthought for most of the networks being selected at the present time. The major players seem to be videocentric and include telephony as a simple add-on later. This may be a reasonable view point for the telephone companies that plan to leave their existing phone networks untouched. However, a phone company planning a network upgrade or a cable company jumping into the telephony business needs to carefully weigh the cost and performance issues of the various network choices. Each network type provides varying capability in both upstream and downstream bandwidth for voice channels. The noise characteristics vary as well. Cellular quality will not be tolerated by the home or business consumer. The network choices are not simple or obvious. Careful consideration of the cost and performance trades along with cable or telephone company strategic plans is required to ensure selecting the best network.

Cost-effective conservation of an endangered frog under uncertainty.

PubMed

Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

2016-04-01

How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective conservation under uncertainty. © 2015 Society for Conservation Biology.

Economic evaluation of childhood epilepsy in a resource-challenged setting: A preliminary survey.

PubMed

Ibrahim, Aliyu; Umar, Umar Isa; Usman, Umar Musa; Owolabi, Lukman Femi

2017-11-01

Considerable disease variability exists between patients with epilepsy, and the societal costs for epilepsy care are overall high, because of high frequency in the general population especially in children from developing countries. A cross-sectional study where children with established diagnosis of epilepsy were interviewed using a semi-structured questionnaire. Prevalence-based costs were stratified by patients' sociodemographic characteristics and socioeconomic scores (SES). The 'bottom-up' and 'human capital' approaches were used to generate estimates on the direct and indirect (productivity losses) costs of epilepsy, respectively. All estimates of the financial burden of epilepsy were analyzed from the 'societal perspective' using IBM SPSS statistics software, version 20.0. The study had 103 enrollees with most in the age group of 0-5years (45.6%). Majority (61.3%) belong to the low socioeconomic class (Ogunlesi SES class IV and V) and reside (80.6%) in an urban setting. The total direct and indirect costs per month were ₦2,149,965.00 ($8497.88) and ₦363,187.80 ($1435.52), respectively. The cost of care per patient per annum was ₦292,794.50 ($1157.29), and the total cost for all the patients per year was ₦30,157,833.60 ($119,200.92). Investigative procedures are the principal cost drivers (₦15,861.17 or $18.15) comprising approximately 58.7% of the total direct costs per patient. Cost of investigations contributed immensely to the total direct cost of care in our study. With the present economic situation in the country, out-of-pocket payments may contribute significantly to catastrophic expenditures and worsening of secondary treatment gap in children with epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparative cost evaluation of brand name and generic ophthalmology medications in Ontario.

PubMed

Popovic, Marko; Chan, Clara; Lattanzio, Nisha; El-Defrawy, Sherif; Schlenker, Matthew B

2018-04-01

Medication cost for the same indication can vary considerably and can affect patient compliance. In this comparative cost analysis of commonly prescribed ophthalmology medications, the differences in cost between generic and brand name medications as well as different medications within an individual drug class were evaluated. Eye preparations from the Ontario Drug Benefit Formulary were identified, and further agents commonly prescribed by ophthalmologists were included. The standardized prescription drug cost, which includes the cost of the medication, mark-up, and dispensing cost, was provided by Ontario Shoppers Drug Mart stores in July 2016 for 103 common medications using typical dosages and durations. Based on medication class, the highest and lowest cost medications were antiallergy agents (Zaditor [ketotifen], Vasocon [naphazoline]), antibiotic ophthalmic solutions (Vigamox [moxifloxacin], generic ciprofloxacin), oral antibiotics (Cipro [ciprofloxacin], generic cephalexin), antibiotic ophthalmic ointments (generic erythromycin, Tobrex [tobramycin]), antiviral treatment (Valtrex [oral valacyclovir], Viroptic [topical trifluridine]), blepharitis treatment (Zithromax [oral azithromycin], generic oral tetracycline), beta-adrenergic inhibitors (Timoptic [topical timolol], generic topical timolol), topical prostaglandin analogues (Xalatan [latanoprost], generic travoprost), oral carbonic anhydrase inhibitors (methazolamide, acetazolamide), topical carbonic anhydrase solutions (Trusopt preservative-free [dorzolamide], Azopt [brinzolamide]), topical alpha-adrenergic agonists (Alphagan [brimonidine], generic brimonidine), topical muscarinic agonists (Isopto carpine [pilocarpine], Diocarpine [pilocarpine]), topical combination glaucoma agents (Cosopt [dorzolamide-timolol], generic dorzolamide-timolol), topical lubricants (Lacri-lube, Isopto tears), topical nonsteroidal anti-inflammatory drugs (Acuvail [ketorolac], Ilevro [nepafenac]), and steroids (Durezol [difluprednate], Pred mild [prednisolone]). Substantial cost differences exist between ophthalmology medications of the same class. We encourage ophthalmologists to be aware of the associated costs of the medications they prescribe and to use this information in their decision making. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Inpatient Cost Assessment of Transjugular Intrahepatic Portosystemic Shunt in the USA from 2001 to 2012.

PubMed

Kuei, Andrew; Lee, Edward Wolfgang; Saab, Sammy; Busuttil, Ronald W; Durazo, Francisco; Han, Steven-Huy; ElKabany, Mohamed; McWilliams, Justin P; Kee, Stephen T

2016-10-01

Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS. Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS. Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs. Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001). The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.

The Cost of Online Learning.

ERIC Educational Resources Information Center

Milshtein, Amy

2001-01-01

Examines development considerations and tips for controlling costs when a university decides to develop an online distance learning service. Use of the interactive Web Site for Determining Costs tool for unveiling hidden costs is highlighted. (GR)

Using discrete choice experiments within a cost-benefit analysis framework: some considerations.

PubMed

McIntosh, Emma

2006-01-01

A great advantage of the stated preference discrete choice experiment (SPDCE) approach to economic evaluation methodology is its immense flexibility within applied cost-benefit analyses (CBAs). However, while the use of SPDCEs in healthcare has increased markedly in recent years there has been a distinct lack of equivalent CBAs in healthcare using such SPDCE-derived valuations. This article outlines specific issues and some practical suggestions for consideration relevant to the development of CBAs using SPDCE-derived benefits. The article shows that SPDCE-derived CBA can adopt recent developments in cost-effectiveness methodology including the cost-effectiveness plane, appropriate consideration of uncertainty, the net-benefit framework and probabilistic sensitivity analysis methods, while maintaining the theoretical advantage of the SPDCE approach. The concept of a cost-benefit plane is no different in principle to the cost-effectiveness plane and can be a useful tool for reporting and presenting the results of CBAs.However, there are many challenging issues to address for the advancement of CBA methodology using SPCDEs within healthcare. Particular areas for development include the importance of accounting for uncertainty in SPDCE-derived willingness-to-pay values, the methodology of SPDCEs in clinical trial settings and economic models, measurement issues pertinent to using SPDCEs specifically in healthcare, and the importance of issues such as consideration of the dynamic nature of healthcare and the resulting impact this has on the validity of attribute definitions and context.

Promoting renewable energy and energy efficiency in Africa: a framework to evaluate employment generation and cost effectiveness

NASA Astrophysics Data System (ADS)

Cantore, Nicola; Nussbaumer, Patrick; Wei, Max; Kammen, Daniel M.

2017-03-01

The ongoing debate over the cost-effectiveness of renewable energy (RE) and energy efficiency (EE) deployment often hinges on the current cost of incumbent fossil-fuel technologies versus the long-term benefit of clean energy alternatives. This debate is often focused on mature or ‘industrialized’ economies and externalities such as job creation. In many ways, however, the situation in developing economies is at least as or even more interesting due to the generally faster current rate of economic growth and of infrastructure deployment. On the one hand, RE and EE could help decarbonize economies in developing countries, but on the other hand, higher upfront costs of RE and EE could hamper short-term growth. The methodology developed in this paper confirms the existence of this trade-off for some scenarios, yet at the same time provides considerable evidence about the positive impact of EE and RE from a job creation and employment perspective. By extending and adopting a methodology for Africa designed to calculate employment from electricity generation in the U.S., this study finds that energy savings and the conversion of the electricity supply mix to renewable energy generates employment compared to a reference scenario. It also concludes that the costs per additional job created tend to decrease with increasing levels of both EE adoption and RE shares.

The Value of Heterogeneity for Cost-Effectiveness Subgroup Analysis

PubMed Central

Manca, Andrea; Claxton, Karl; Sculpher, Mark J.

2014-01-01

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. PMID:24944196

The value of heterogeneity for cost-effectiveness subgroup analysis: conceptual framework and application.

PubMed

Espinoza, Manuel A; Manca, Andrea; Claxton, Karl; Sculpher, Mark J

2014-11-01

This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy. © The Author(s) 2014.

The formulary process from a risk management perspective.

PubMed

Raber, Jack H

2010-06-01

During their evolution over the past 6 decades, hospital formularies have become more than a list of drugs that an institution keeps in stock. Today, an agent under formulary consideration must be examined not only in light of its relative efficacy, safety, and acquisition cost, but consideration must also be given to the potential indirect costs that accompany its use. Federal regulations have, for some drugs, added layers of administrative actions that must be followed to ensure their appropriate use. Examples of this are risk evaluation and mitigation strategies (REMS) and duties that may be implied or expressly addressed in the black-box warnings associated with some classes of agents and, in isolated instances, specific drugs within a given class. Regulatory interpretation of these programs and warnings has often led to the expectation that the institution providing the agent will implement effective protocols and procedures to minimize the risk of adverse events to a patient in addition to or in accordance with required programs such as REMS. The consequences for failing to meet this expectation can lead to regulatory sanctions; the potential also exists for liability exposure. Risk management principles apply to all levels of the decision-making process for evaluating a new agent for formulary inclusion or when reevaluating an agent's formulary status. Pharmacists play an important role in mitigating these risks by carefully evaluating every agent from a broader perspective.

Comparing Building and Neighborhood-Scale Variability of CO₂ and O₃ to Inform Deployment Considerations for Low-Cost Sensor System Use.

PubMed

Collier-Oxandale, Ashley; Coffey, Evan; Thorson, Jacob; Johnston, Jill; Hannigan, Michael

2018-04-26

The increased use of low-cost air quality sensor systems, particularly by communities, calls for the further development of best-practices to ensure these systems collect usable data. One area identified as requiring more attention is that of deployment logistics, that is, how to select deployment sites and how to strategically place sensors at these sites. Given that sensors are often placed at homes and businesses, ideal placement is not always possible. Considerations such as convenience, access, aesthetics, and safety are also important. To explore this issue, we placed multiple sensor systems at an existing field site allowing us to examine both neighborhood-level and building-level variability during a concurrent period for CO₂ (a primary pollutant) and O₃ (a secondary pollutant). In line with previous studies, we found that local and transported emissions as well as thermal differences in sensor systems drive variability, particularly for high-time resolution data. While this level of variability is unlikely to affect data on larger averaging scales, this variability could impact analysis if the user is interested in high-time resolution or examining local sources. However, with thoughtful placement and thorough documentation, high-time resolution data at the neighborhood level has the potential to provide us with entirely new information on local air quality trends and emissions.

Gathering Information on Costs of Service: Some Basic Considerations for Implementation of PURPA,

DTIC Science & Technology

1979-10-01

UNCLASSFIED RAND/P-6b22 ML."’ II I I I ll6lllllUi GATHERING INFORMATION ON COSTS OF .SERVICE: SOME BASIC CONSIDERATIONS FOR IMPLEMENTATION OF PURPA ...CONSIDERATIONS FOR IMPLEMENTATION OF PURPA Jan Paul Acton, Frank Camm, Derek McKay P-6422 October 1979 4v, P ,. . • L .... .S -iii- PREFACE In the period following...the passage of the Public Utility Regulatory Policies Act of 1978( PURPA ) the Federal Energy Regulatory Commission was responsible for the generation

Comparing Natural Gas Leakage Detection Technologies Using an Open-Source "Virtual Gas Field" Simulator.

PubMed

Kemp, Chandler E; Ravikumar, Arvind P; Brandt, Adam R

2016-04-19

We present a tool for modeling the performance of methane leak detection and repair programs that can be used to evaluate the effectiveness of detection technologies and proposed mitigation policies. The tool uses a two-state Markov model to simulate the evolution of methane leakage from an artificial natural gas field. Leaks are created stochastically, drawing from the current understanding of the frequency and size distributions at production facilities. Various leak detection and repair programs can be simulated to determine the rate at which each would identify and repair leaks. Integrating the methane leakage over time enables a meaningful comparison between technologies, using both economic and environmental metrics. We simulate four existing or proposed detection technologies: flame ionization detection, manual infrared camera, automated infrared drone, and distributed detectors. Comparing these four technologies, we found that over 80% of simulated leakage could be mitigated with a positive net present value, although the maximum benefit is realized by selectively targeting larger leaks. Our results show that low-cost leak detection programs can rely on high-cost technology, as long as it is applied in a way that allows for rapid detection of large leaks. Any strategy to reduce leakage should require a careful consideration of the differences between low-cost technologies and low-cost programs.

The sum of us: considerations on physician-industry relationships.

PubMed

Flores Rebollar, Armando

2017-05-26

This essay describes critically the physician-industry relationships and how the latter influences economically in the realization of continuing medical education (CME), industry expenses in sponsoring the academic events of medical societies, travel costs and enrollment, payment for consultants and speakers. It also refers to the movements that have been created in the academic world to counteract this influence, such as No Free Lunch (Spanish version “NoGracias”) and PharmFree. And the struggles between major scientific medical journals, with editorials and among editorialists on the concept of conflicts of interest. All this seen through the existence of an academic institution in Mexico and the exemplary life of one of its members.

Embedding clinical interventions into observational studies

PubMed Central

Newman, Anne B.; Avilés-Santa, M. Larissa; Anderson, Garnet; Heiss, Gerardo; Howard, Wm. James; Krucoff, Mitchell; Kuller, Lewis H.; Lewis, Cora E.; Robinson, Jennifer G.; Taylor, Herman; Treviño, Roberto P.; Weintraub, William

2017-01-01

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed. PMID:26611435

Is self-sufficiency financially viable and ethically justifiable?--a commercial viewpoint.

PubMed

Christie, R B

1994-12-01

Manufacturers of blood products have to maintain the highest possible standards for plasma screening and good manufacturing practices to ensure maximum purity and viral safety. The private sector companies have much experience in implementing and complying with national and international regulations. These requirements involve considerable cost in the areas of (1) plasma collection facilities, (2) research and clinical research, (3) manufacture, and (4) quality control. Total self-sufficiency would mean the loss of many existing resources. An alternative would be a collaboration between the public and private sectors to meet the needs of all patients who require plasma derived products. The current definition of self-sufficiency suggests that it is not financially viable.

Engineering and Fabrication Considerations for Cost-Effective Space Reactor Shield Development

NASA Astrophysics Data System (ADS)

Berg, Thomas A.; Disney, Richard K.

2004-02-01

Investment in developing nuclear power for space missions cannot be made on the basis of a single mission. Current efforts in the design and fabrication of the reactor module, including the reactor shield, must be cost-effective and take into account scalability and fabricability for planned and future missions. Engineering considerations for the shield need to accommodate passive thermal management, varying radiation levels and effects, and structural/mechanical issues. Considering these challenges, design principles and cost drivers specific to the engineering and fabrication of the reactor shield are presented that contribute to lower recurring mission costs.

Engineering and Fabrication Considerations for Cost-Effective Space Reactor Shield Development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berg, Thomas A.; Disney, Richard K.

Investment in developing nuclear power for space missions cannot be made on the basis of a single mission. Current efforts in the design and fabrication of the reactor module, including the reactor shield, must be cost-effective and take into account scalability and fabricability for planned and future missions. Engineering considerations for the shield need to accommodate passive thermal management, varying radiation levels and effects, and structural/mechanical issues. Considering these challenges, design principles and cost drivers specific to the engineering and fabrication of the reactor shield are presented that contribute to lower recurring mission costs.

Getting back on tap: the policy context and cost of ensuring access to low-cost drinking water in Massachusetts schools.

PubMed

Cradock, Angie L; Wilking, Cara L; Olliges, Sarah A; Gortmaker, Steven L

2012-09-01

Adequate water intake may have important health benefits for schoolchildren. Layers of federal, state, and local policy are relevant to provision of water within schools. Recently passed state and federal laws require free drinking-water access for students during mealtimes. To review Massachusetts local district wellness policies related to water access, provide estimates of costs for three water-provision strategies, and discuss implications for policy relevant to adequate drinking-water access. Legal research was conducted using the LexisNexis legal database and government websites. Local wellness policies were double-coded using existing research tools. Costs of three water-delivery options were estimated using a 10-year school-district perspective. Prior to 2010, most Massachusetts public school district wellness policies (92%-94%) did not address access to free drinking water. Ten-year costs per school for providing water during mealtimes to students, including dispenser unit, installation, water testing, water, cups, and labor, range between $12,544 and $27,922 (depending on water-delivery option) assuming the average Massachusetts school enrollment. Water-provision strategies relying on tap water are more economical than bottled water in the long term. Policy recommendations and cost considerations deserve attention at the local, state, and federal levels. Recommendations are discussed to ensure access to safe, free drinking water for all students. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Clinical and financial considerations for implementing an ICU telemedicine program.

PubMed

Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

2014-06-01

As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

Good Manufacturing Practices (GMP) manufacturing of advanced therapy medicinal products: a novel tailored model for optimizing performance and estimating costs.

PubMed

Abou-El-Enein, Mohamed; Römhild, Andy; Kaiser, Daniel; Beier, Carola; Bauer, Gerhard; Volk, Hans-Dieter; Reinke, Petra

2013-03-01

Advanced therapy medicinal products (ATMP) have gained considerable attention in academia due to their therapeutic potential. Good Manufacturing Practice (GMP) principles ensure the quality and sterility of manufacturing these products. We developed a model for estimating the manufacturing costs of cell therapy products and optimizing the performance of academic GMP-facilities. The "Clean-Room Technology Assessment Technique" (CTAT) was tested prospectively in the GMP facility of BCRT, Berlin, Germany, then retrospectively in the GMP facility of the University of California-Davis, California, USA. CTAT is a two-level model: level one identifies operational (core) processes and measures their fixed costs; level two identifies production (supporting) processes and measures their variable costs. The model comprises several tools to measure and optimize performance of these processes. Manufacturing costs were itemized using adjusted micro-costing system. CTAT identified GMP activities with strong correlation to the manufacturing process of cell-based products. Building best practice standards allowed for performance improvement and elimination of human errors. The model also demonstrated the unidirectional dependencies that may exist among the core GMP activities. When compared to traditional business models, the CTAT assessment resulted in a more accurate allocation of annual expenses. The estimated expenses were used to set a fee structure for both GMP facilities. A mathematical equation was also developed to provide the final product cost. CTAT can be a useful tool in estimating accurate costs for the ATMPs manufactured in an optimized GMP process. These estimates are useful when analyzing the cost-effectiveness of these novel interventions. Copyright © 2013 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Economic impact of medication error: a systematic review.

PubMed

Walsh, Elaine K; Hansen, Christina Raae; Sahm, Laura J; Kearney, Patricia M; Doherty, Edel; Bradley, Colin P

2017-05-01

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

GME: at what cost?

PubMed

Young, David W

2003-11-01

Current computing methods impede determining the real cost of graduate medical education. However, a more accurate estimate could be obtained if policy makers would allow for the application of basic cost-accounting principles, including consideration of department-level costs, unbundling of joint costs, and other factors.

Analyzing costs of space debris mitigation methods

NASA Astrophysics Data System (ADS)

Wiedemann, C.; Krag, H.; Bendisch, J.; Sdunnus, H.

The steadily increasing number of space objects poses a considerable hazard to all kinds of spacecraft. To reduce the risks to future space missions different debris mitigation measures and spacecraft protection techniques have been investigated during the last years. However, the economic efficiency has not been considered yet in this context. This economical background is not always clear to satellite operators and the space industry. Current studies have the objective to evaluate the mission costs due to space debris in a business as usual (no mitigation) scenario compared to the missions costs considering debris mitigation. The aim i an estimation of thes time until the investment in debris mitigation will lead to an effective reduction of mission costs. This paper presents the results of investigations on the key problems of cost estimation for spacecraft and the influence of debris mitigation and shielding on cost. The shielding of a satellite can be an effective method to protect the spacecraft against debris impact. Mitigation strategies like the reduction of orbital lifetime and de- or re-orbit of non-operational satellites are methods to control the space debris environment. These methods result in an increase of costs. In a first step the overall costs of different types of unmanned satellites are analyzed. The key problem is, that it is not possible to provide a simple cost model that can be applied to all types of satellites. Unmanned spacecraft differ very much in mission, complexity of design, payload and operational lifetime. It is important to classify relevant cost parameters and investigate their influence on the respective mission. The theory of empirical cost estimation and existing cost models are discussed. A selected cost model is simplified and generalized for an application on all operational satellites. In a next step the influence of space debris on cost is treated, if the implementation of mitigation strategies is considered.

Incorporating considerations of cost-effectiveness, affordability, and resource implications in guideline development: article 6 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Hill, Suzanne R; Olson, Leslie G; Falck-Ytter, Yngve; Cruz, Alvaro A; Atkins, David; Baumann, Michael; Jaeschke, Roman; Woitalla, Thomas; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are based on the best available research evidence. This is the sixth of a series of 14 articles prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. In this article, we focused on integrating cost and resource information in guideline development and formulating recommendations focusing on four key questions. We addressed the following specific questions. (1) When is it important to incorporate costs, and/or resource implications, and/or cost-effectiveness, and/or affordability considerations in guidelines? (2) Which costs and which resource use should be considered in guidelines? (3)What sources of evidence should be used to estimate costs, resource use, and cost-effectiveness? (4) How can cost-effectiveness, resource implications, and affordability be taken into account explicitly? Our work was based on a prior review on this topic and our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, "explicit consideration" may need to involve only noting whether the price (easily determined and usually the main component of "acquisition cost") of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.

Additional reductions in Medicare spending growth will likely require shifting costs to beneficiaries.

PubMed

Chernew, Michael E

2013-05-01

Policy makers have considerable interest in reducing Medicare spending growth. Clarity in the debate on reducing Medicare spending growth requires recognition of three important distinctions: the difference between public and total spending on health, the difference between the level of health spending and rate of health spending growth, and the difference between growth per beneficiary and growth in the number of beneficiaries in Medicare. The primary policy issue facing the US health care system is the rate of spending growth in public programs, and solving that problem will probably require reforms to the entire health care sector. The Affordable Care Act created a projected trajectory for Medicare spending per beneficiary that is lower than historical growth rates. Although opportunities for one-time savings exist, any long-term savings from Medicare, beyond those already forecast, will probably require a shift in spending from taxpayers to beneficiaries via higher beneficiary premium contributions (overall or via means testing), changes in eligibility, or greater cost sharing at the point of service.

Operational challenges in delivering CD4 diagnostics in sub-Saharan Africa.

PubMed

Thairu, L; Katzenstein, D; Israelski, D

2011-07-01

Access to reliable and low cost CD4 T-cell enumeration to stage illness and monitor anti-retroviral therapy remains elusive in resource-limited settings. We report challenges in delivering CD4 testing using the microcapillary Fluorescence-Activated Cell Sorter (FACS) methodology (Guava EasyCD4 instrument Guava Technologies, Hayward) in Burkina Faso and Zimbabwe. Resources, instruments, reagents, and training were provided to local laboratories within the existing infrastructure and data on CD4 were collected from routine laboratory testing. Challenges encountered included frequent instrument breakdown; poor manufacturer maintenance; difficulties in managing reagent stocks; high technician turnover; reliance on antiquated data management systems; redundant service provision; and lack of repeat testing in male HIV+ patients and in patients with higher CD4 counts after initial staging. While adopting newer, less expensive technologies such as fluorescent platforms and point of care tests can facilitate access to lower cost CD4 testing, our experience suggests that supply chain, corporate commitment to implementation, and community factors also require consideration.

Linked Data: Forming Partnerships at the Data Layer

NASA Astrophysics Data System (ADS)

Shepherd, A.; Chandler, C. L.; Arko, R. A.; Jones, M. B.; Hitzler, P.; Janowicz, K.; Krisnadhi, A.; Schildhauer, M.; Fils, D.; Narock, T.; Groman, R. C.; O'Brien, M.; Patton, E. W.; Kinkade, D.; Rauch, S.

2015-12-01

The challenges presented by big data are straining data management software architectures of the past. For smaller existing data facilities, the technical refactoring of software layers become costly to scale across the big data landscape. In response to these challenges, data facilities will need partnerships with external entities for improved solutions to perform tasks such as data cataloging, discovery and reuse, and data integration and processing with provenance. At its surface, the concept of linked open data suggests an uncalculated altruism. Yet, in his concept of five star open data, Tim Berners-Lee explains the strategic costs and benefits of deploying linked open data from the perspective of its consumer and producer - a data partnership. The Biological and Chemical Oceanography Data Management Office (BCO-DMO) addresses some of the emerging needs of its research community by partnering with groups doing complementary work and linking their respective data layers using linked open data principles. Examples will show how these links, explicit manifestations of partnerships, reduce technical debt and provide a swift flexibility for future considerations.

Applying rapid 'de-facto' HTA in resource-limited settings: experience from Romania.

PubMed

Lopert, Ruth; Ruiz, Francis; Chalkidou, Kalipso

2013-10-01

In attempting to constrain healthcare expenditure growth, health technology assessment (HTA) can enable policy-makers to look beyond budget impact and facilitate more rational decision-making. However lack of technical capacity and poor governance can limit use in some countries. Undertaking de facto HTA by adapting decisions taken in countries with established processes is a method that may be applied while building domestic HTA capacity. We explored the potential for applying this approach in Romania. As part of a review of the basic health benefits available to insured Romanians we examined the listing process and content of the Romanian drug reimbursement formulary. We assessed value for money indirectly by drawing on appraisals by UK's NICE, and for products considered cost effective in the UK, adjusting prices by the ratio of Romanian per capita GDP to UK per capita GDP. We found more than 30 of the top 50 medicines on the Romanian formulary unlikely to be cost-effective, suggesting that existing external reference pricing mechanisms may not be delivering good value for money. While not taking into account local costs or treatment patterns, absent local considerations of value for money, this method offers a guide for both drug selection and pricing. Until robust local HTA processes are established this approach could support further analysis of existing prices and pricing mechanisms. Applied more generally, it is arguably preferable to external reference pricing, product delisting or arbitrary price cuts, and may support the future development of more rigorous, evidence-based decision-making. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The large-scale removal of mammalian invasive alien species in Northern Europe.

PubMed

Robertson, Peter A; Adriaens, Tim; Lambin, Xavier; Mill, Aileen; Roy, Sugoto; Shuttleworth, Craig M; Sutton-Croft, Mike

2017-02-01

Numerous examples exist of successful mammalian invasive alien species (IAS) eradications from small islands (<10 km 2 ), but few from more extensive areas. We review 15 large-scale removals (mean area 2627 km 2 ) from Northern Europe since 1900, including edible dormouse, muskrat, coypu, Himalayan porcupine, Pallas' and grey squirrels and American mink, each primarily based on daily checking of static traps. Objectives included true eradication or complete removal to a buffer zone, as distinct from other programmes that involved local control to limit damage or spread. Twelve eradication/removal programmes (80%) were successful. Cost increased with and was best predicted by area, while the cost per unit area decreased; the number of individual animals removed did not add significantly to the model. Doubling the area controlled reduced cost per unit area by 10%, but there was no evidence that cost effectiveness had increased through time. Compared with small islands, larger-scale programmes followed similar patterns of effort in relation to area. However, they brought challenges when defining boundaries and consequent uncertainties around costs, the definition of their objectives, confirmation of success and different considerations for managing recolonisation. Novel technologies or increased use of volunteers may reduce costs. Rapid response to new incursions is recommended as best practice rather than large-scale control to reduce the environmental, financial and welfare costs. © 2016 Crown copyright. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2016 Crown copyright. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Simple Myths and Basic Maths about Greening Irrigation

NASA Astrophysics Data System (ADS)

Dionisio Pérez-Blanco, C.; Gómez, C. Mario

2014-05-01

Managing water is a very complex societal issue that needs to involve legal, environmental, technological, financial and political considerations that are difficult to co-ordinate in an effective manner. This complexity and the lack of an agreed assessment framework have often implied that political decisions, largely driven by transaction costs (especially the bargaining costs required to come to an acceptable agreement with all the parties involved), have overshadowed and prevailed over other considerations. As a result, (financially) expensive solutions such as irrigation modernization programmes have been preferred to their inexpensive alternatives to save water, such as quotas or pricing policies. However, greening the economy is mostly about improving water governance and not only about putting the existing resource saving technical alternatives into practice. Focusing on the second and forgetting the first risks finishing with a highly efficient use of water services at the level of each individual user but with an unsustainable amount of water use for the entire economy. This might be happening already in many places with the modernization of irrigated agriculture, the world's largest water user and the one offering the most promising water saving opportunities. In spite of high expectations, costly modern irrigation techniques seem not to be contributing to reduce water scarcity and increase drought resiliency. In fact, according to the little evidence available, in some areas they are resulting in higher water use. Building on basic economic principles this study aims to show the conditions under which this apparently paradoxical outcome, known as the Jevons' Paradox, might appear. This basic model is expected to serve as guidance for assessing the actual outcomes of increasing irrigation efficiency and to discuss the changes in water governance that would be required for this to make a real contribution to sustainable water management.

Role of self-monitoring of blood glucose in glycemic control.

PubMed

Karter, Andrew J

2006-01-01

To examine the role of self-monitoring of blood glucose (SMBG) in the management of diabetes mellitus. Current trends and published evidence are reviewed. Despite the widespread evidence that lowering glycemic levels reduces the risks of complications in patients with diabetes, little improvement in glycemic control has been noted among patients in the United States and Europe in recent years. Although SMBG has been widely used, considerable controversy surrounds its role in achieving glycemic control. The high cost of test strips has made considerations regarding appropriate recommendations for SMBG a priority, especially in light of the current climate of health-care cost-containment. Existing clinical recommendations lack specific guidance to patients and clinicians regarding SMBG practice intensity and frequency, particularly for those patients not treated with insulin. Previous studies of the association between SMBG and glycemic control often found weak and conflicting results. A reexamination of the role of SMBG is needed, with special attention to the unique needs of patients using different diabetes treatments, within special clinical subpopulations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG needed to reflect the variability in glycemic patterns would facilitate more specific guideline development. Educational programs that focus on teaching patients the recommended SMBG practice, specific glycemic targets, and appropriate responses to various blood glucose readings would be beneficial. Continuing medical education programs for health-care providers should suggest ways to analyze patient SMBG records to tailor medication regimens. For transfer or communication of SMBG reports to the clinical staff, a standardized format that extracts key data elements and allows quick review by health-care providers would be useful. Because the practice of SMBG is expensive, the cost-effectiveness of SMBG needs to be carefully assessed.

Systems Engineering Techniques for ALS Decision Making

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.; Drysdale, Alan E.; Jones, Harry; Levri, Julie A.

2004-01-01

The Advanced Life Support (ALS) Metric is the predominant tool for predicting the cost of ALS systems. Metric goals for the ALS Program are daunting, requiring a threefold increase in the ALS Metric by 2010. Confounding the problem, the rate new ALS technologies reach the maturity required for consideration in the ALS Metric and the rate at which new configurations are developed is slow, limiting the search space and potentially giving the perspective of a ALS technology, the ALS Metric may remain elusive. This paper is a sequel to a paper published in the proceedings of the 2003 ICES conference entitled, "Managing to the metric: an approach to optimizing life support costs." The conclusions of that paper state that the largest contributors to the ALS Metric should be targeted by ALS researchers and management for maximum metric reductions. Certainly, these areas potentially offer large potential benefits to future ALS missions; however, the ALS Metric is not the only decision-making tool available to the community. To facilitate decision-making within the ALS community a combination of metrics should be utilized, such as the Equivalent System Mass (ESM)-based ALS metric, but also those available through techniques such as life cycle costing and faithful consideration of the sensitivity of the assumed models and data. Often a lack of data is cited as the reason why these techniques are not considered for utilization. An existing database development effort within the ALS community, known as OPIS, may provide the opportunity to collect the necessary information to enable the proposed systems analyses. A review of these additional analysis techniques is provided, focusing on the data necessary to enable these. The discussion is concluded by proposing how the data may be utilized by analysts in the future.

Reimbursement of licensed cell and gene therapies across the major European healthcare markets

PubMed Central

Jørgensen, Jesper; Kefalas, Panos

2015-01-01

Objective The aim of this research is to identify the pricing, reimbursement, and market access (P&R&MA) considerations most relevant to advanced therapy medicinal products (ATMPs) in the Big5EU, and to inform their manufacturers about the key drivers for securing adoption at a commercially viable reimbursed price. Methodology The research was structured following three main steps: 1) Identifying the market access pathways relevant to ATMPs through secondary research; 2) Validating the secondary research findings and addressing any data gaps in primary research, by qualitative interviews with national, regional, and local-level payers and their clinical and economic advisors; 3) Collating of primary and secondary findings to compare results across countries. Results The incremental clinical benefit forms the basis for all P&R&MA processes. Budget impact is a key consideration, regardless of geography. Cost-effectiveness analyses are increasingly applied; however, only the United Kingdom has a defined threshold that links the cost per quality-adjusted life year (QALY) specifically and methodologically to the reimbursed price. Funding mechanisms to enable adoption of new and more expensive therapies exist in all countries, albeit to varying extents. Willingness to pay is typically higher in smaller patient populations, especially in populations with high disease burden. Outcomes modelling and risk-sharing agreements (RSAs) provide strategies to address the data gap and uncertainties often associated with trials in niche populations. Conclusions The high cost of ATMPs, coupled with the uncertainty at launch around their long-term claims, present challenges for their adoption at a commercially viable reimbursed price. Targeting populations of high disease burden and unmet needs may be advantageous, as the potential for improvement in clinical benefit is greater, as well as the potential for capitalising on healthcare cost offsets. Also, targeting small populations can also help reduce both payers’ budget impact concerns and the risk of reimbursement restrictions being imposed. PMID:27123175

The influence of patients' decisions on treatment planning in restorative dentistry.

PubMed

Kalsi, Jagdip S; Hemmings, Kenneth

2013-11-01

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out. Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

Individual mobility promotes punishment in evolutionary public goods games.

PubMed

Cong, Rui; Zhao, Qianchuan; Li, Kun; Wang, Long

2017-10-25

In explaining the pressing issue in biology and social sciences how cooperation emerges in a population of self-interested individuals, researchers recently pay intensive attentions to the role altruistic punishment plays. However, as higher-order cooperators, survival of punishers is puzzling due to their extra cost in regulating norm violators. Previous works have highlighted the importance of individual mobility in promoting cooperation. Yet its effect on punishers remains to be explored. In this work we incorporate this feature into modeling the behavior of punishers, who are endowed with a choice between leaving current place or staying and punishing defectors. Results indicate that optimal mobility level of punishers is closely related to the cost of punishing. For considerably large cost, there exists medium tendency of migration which favors the survival of punishers. This holds for both the direct competition between punishers and defectors and the case where cooperators are involved, and can also be observed when various types of punishers with different mobility tendencies fight against defectors simultaneously. For cheap punishment, mobility does not provide with punishers more advantage even when they are initially rare. We hope our work provide more insight into understanding the role individual mobility plays in promoting public cooperation.

Target validation: linking target and chemical properties to desired product profile.

PubMed

Wyatt, Paul G; Gilbert, Ian H; Read, Kevin D; Fairlamb, Alan H

2011-01-01

The discovery of drugs is a lengthy, high-risk and expensive business taking at least 12 years and is estimated to cost upwards of US$800 million for each drug to be successfully approved for clinical use. Much of this cost is driven by the late phase clinical trials and therefore the ability to terminate early those projects destined to fail is paramount to prevent unwanted costs and wasted effort. Although neglected diseases drug discovery is driven more by unmet medical need rather than financial considerations, the need to minimise wasted money and resources is even more vital in this under-funded area. To ensure any drug discovery project is addressing the requirements of the patients and health care providers and delivering a benefit over existing therapies, the ideal attributes of a novel drug needs to be pre-defined by a set of criteria called a target product profile. Using a target product profile the drug discovery process, clinical study design, and compound characteristics can be defined all the way back through to the suitability or druggability of the intended biochemical target. Assessment and prioritisation of the most promising targets for entry into screening programmes is crucial for maximising chances of success.

GHG emission control and solid waste management for megacities with inexact inputs: a case study in Beijing, China.

PubMed

Lu, Hongwei; Sun, Shichao; Ren, Lixia; He, Li

2015-03-02

This study advances an integrated MSW management model under inexact input information for the city of Beijing, China. The model is capable of simultaneously generating MSW management policies, performing GHG emission control, and addressing system uncertainty. Results suggest that: (1) a management strategy with minimal system cost can be obtained even when suspension of certain facilities becomes unavoidable through specific increments of the remaining ones; (2) expansion of facilities depends only on actual needs, rather than enabling the full usage of existing facilities, although it may prove to be a costly proposition; (3) adjustment of waste-stream diversion ratio directly leads to a change in GHG emissions from different disposal facilities. Results are also obtained from the comparison of the model with a conventional one without GHG emissions consideration. It is indicated that (1) the model would reduce the net system cost by [45, 61]% (i.e., [3173, 3520] million dollars) and mitigate GHG emissions by [141, 179]% (i.e., [76, 81] million tons); (2) increased waste would be diverted to integrated waste management facilities to prevent overmuch CH4 emission from the landfills. Copyright © 2014 Elsevier B.V. All rights reserved.

Subjective costs drive overly patient foraging strategies in rats on an intertemporal foraging task

PubMed Central

Wikenheiser, Andrew M.; Stephens, David W.; Redish, A. David

2013-01-01

Laboratory studies of decision making often take the form of two-alternative, forced-choice paradigms. In natural settings, however, many decision problems arise as stay/go choices. We designed a foraging task to test intertemporal decision making in rats via stay/go decisions. Subjects did not follow the rate-maximizing strategy of choosing only food items associated with short delays. Instead, rats were often willing to wait for surprisingly long periods, and consequently earned a lower rate of food intake than they might have by ignoring long-delay options. We tested whether foraging theory or delay discounting models predicted the behavior we observed but found that these models could not account for the strategies subjects selected. Subjects’ behavior was well accounted for by a model that incorporated a cost for rejecting potential food items. Interestingly, subjects’ cost sensitivity was proportional to environmental richness. These findings are at odds with traditional normative accounts of decision making but are consistent with retrospective considerations having a deleterious influence on decisions (as in the “sunk-cost” effect). More broadly, these findings highlight the utility of complementing existing assays of decision making with tasks that mimic more natural decision topologies. PMID:23630289

The determinants of nursing home costs in Nebraska's proprietary nursing homes.

PubMed

Palm, D W; Nelson, S

1984-01-01

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.

Ultra-heavy vertical lift system: The Heli-Stat. [helicopter - airship combination for materials handling

NASA Technical Reports Server (NTRS)

Piasecki, F. N.

1975-01-01

A hybrid VTOL airship which is combined with helicopters is evaluated. The static lift of the airship supports approximately the full empty weight of the entire assembly. The helicopter rotors furnish the lift to support the payload as well as the propulsion and control about all axes. Thus existing helicopters, with no new technology required, can be made to lift payloads of ten times the capacity of each one alone, and considerably more than that of any airship built so far. A vehicle is described which has a 75-ton payload, based on four existing CH-53D helicopters and an airship of 3,600,000 cu. ft. The method of interconnection is described along with discussion of control, instrumentation, drive system and critical design conditions. The vertical lift and positioning capabilities of this vehicle far exceed any other means available today, yet can be built with a minimum of risk, development cost and time.

NFC Internal: An Indoor Navigation System

PubMed Central

Ozdenizci, Busra; Coskun, Vedat; Ok, Kerem

2015-01-01

Indoor navigation systems have recently become a popular research field due to the lack of GPS signals indoors. Several indoors navigation systems have already been proposed in order to eliminate deficiencies; however each of them has several technical and usability limitations. In this study, we propose NFC Internal, a Near Field Communication (NFC)-based indoor navigation system, which enables users to navigate through a building or a complex by enabling a simple location update, simply by touching NFC tags those are spread around and orient users to the destination. In this paper, we initially present the system requirements, give the design details and study the viability of NFC Internal with a prototype application and a case study. Moreover, we evaluate the performance of the system and compare it with existing indoor navigation systems. It is seen that NFC Internal has considerable advantages and significant contributions to existing indoor navigation systems in terms of security and privacy, cost, performance, robustness, complexity, user preference and commercial availability. PMID:25825976

Design and energetic evaluation of a prosthetic knee joint actuator with a lockable parallel spring.

PubMed

Geeroms, J; Flynn, L; Jimenez-Fabian, R; Vanderborght, B; Lefeber, D

2017-02-03

There are disadvantages to existing damping knee prostheses which cause an asymmetric gait and higher metabolic cost during level walking compared to non-amputees. Most existing active knee prostheses which could benefit the amputees use a significant amount of energy and require a considerable motor. In this work, a novel semi-active actuator with a lockable parallel spring for a prosthetic knee joint has been developed and tested. This actuator is able to provide an approximation of the behavior of a healthy knee during most of the gait cycle of level walking. This actuator is expanded with a series-elastic actuator to mimic the full gait cycle and enable its use in other functional tasks like stair climbing and sit-to-stance. The proposed novel actuator reduces the energy consumption for the same trajectory with respect to a compliant or directly-driven prosthetic active knee joint and improves the approximation of healthy knee behavior during level walking compared to passive or variable damping knee prostheses.

Phase polyphenism and preventative locust management.

PubMed

Sword, Gregory A; Lecoq, Michel; Simpson, Stephen J

2010-08-01

The ecology of phase polyphenism plays a major role in locust swarm formation. We describe how recent advances in the understanding of phase polyphenism can be combined with existing management approaches as part of a preventative Desert locust management strategy. We start with a brief overview of phase polyphenism with particular emphasis on the role that resource distribution patterns play in the process of locust phase change. We then review current perspective on preventative locust management, and conclude by proposing a framework for quantitatively assessing the risk that phase change will occur in local locust populations. Importantly, the data required to implement this framework can be readily collected with little additional effort or cost just by slightly modifying locust habitat survey protocols that are already in operation. Incorporating gregarization risk assessment into existing preventative management strategies stands to make a considerable contribution toward realizing sustainable goals of reductions in the pesticide, manpower and financial support necessary to combat Desert locust upsurges, outbreaks and ultimately plagues. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Alternative Radioisotopes for Heat and Power Sources

NASA Astrophysics Data System (ADS)

Tinsley, T.; Sarsfield, M.; Rice, T.

Production of 238Pu requires considerable facilities including a nuclear reactor and reprocessing plants that are very expensive to build and operate. Thus, a more economical alternative is very attractive to the industry. There are many alternative radioisotopes that exist but few that satisfy the criteria of performance, availability and cost to produce. Any alternative to 238Pu must exist in a chemical form that is compatible with the materials required to safely encapsulate the heat source at the high temperatures of operation and potential launch failure scenarios. The chemical form must also have suitable thermal properties to ensure maximum energy conversion efficiencies when integrated into radioisotope thermoelectric generators over the required mission durations. In addition, the radiation dose must be low enough for operators during production and not so prohibitive that excessive shielding mass is required on the space craft. This paper will focus on the preferred European alternative of 241Am, and the issues that will need to be addressed.

Seismic Retrofitting of an Existing Steel Railway Bridge by Fluid Viscous Dampers

NASA Astrophysics Data System (ADS)

Gangopadhyay, Avijit; Ghosh, Aparna Dey

2016-09-01

There are over a lakh of bridges in the Indian Railways, many of which have become seismically deficient, either through aging or due to inadequate seismic design considerations. The extensive damage of bridges all over the world in recent earthquakes has propelled significant advancement in earthquake protection and retrofitting of bridges. Amongst various passive control systems that are reliable as well as cost-effective, Fluid Viscous Dampers (FVDs) are proving to be successful in bridge vibration control. Orificed FVDs, commercially available as Taylor Devices, have already been successfully installed in several bridges worldwide. However, there has been no such application or study related to Indian railway bridges. In this paper, an existing thirty years' old railway bridge in Jharkhand, India, has been analyzed in SAP2000v14 considering reduced stiffness and found deficient when subjected to spectrum-compatible accelerograms. Subsequent retrofitting of the bridge superstructure with FVDs has been carried out and the results indicate substantial reductions in the responses of the bridge deck.

Convex Formulations of Learning from Crowds

NASA Astrophysics Data System (ADS)

Kajino, Hiroshi; Kashima, Hisashi

It has attracted considerable attention to use crowdsourcing services to collect a large amount of labeled data for machine learning, since crowdsourcing services allow one to ask the general public to label data at very low cost through the Internet. The use of crowdsourcing has introduced a new challenge in machine learning, that is, coping with low quality of crowd-generated data. There have been many recent attempts to address the quality problem of multiple labelers, however, there are two serious drawbacks in the existing approaches, that are, (i) non-convexity and (ii) task homogeneity. Most of the existing methods consider true labels as latent variables, which results in non-convex optimization problems. Also, the existing models assume only single homogeneous tasks, while in realistic situations, clients can offer multiple tasks to crowds and crowd workers can work on different tasks in parallel. In this paper, we propose a convex optimization formulation of learning from crowds by introducing personal models of individual crowds without estimating true labels. We further extend the proposed model to multi-task learning based on the resemblance between the proposed formulation and that for an existing multi-task learning model. We also devise efficient iterative methods for solving the convex optimization problems by exploiting conditional independence structures in multiple classifiers.

Biobankonomics: developing a sustainable business model approach for the formation of a human tissue biobank.

PubMed

Vaught, Jimmie; Rogers, Joyce; Carolin, Todd; Compton, Carolyn

2011-01-01

The preservation of high-quality biospecimens and associated data for research purposes is being performed in variety of academic, government, and industrial settings. Often these are multimillion dollar operations, yet despite these sizable investments, the economics of biobanking initiatives is not well understood. Fundamental business principles must be applied to the development and operation of such resources to ensure their long-term sustainability and maximize their impact. The true costs of developing and maintaining operations, which may have a variety of funding sources, must be better understood. Among the issues that must be considered when building a biobank economic model are: understanding the market need for the particular type of biobank under consideration and understanding and efficiently managing the biobank's "value chain," which includes costs for case collection, tissue processing, storage management, sample distribution, and infrastructure and administration. By using these value chain factors, a Total Life Cycle Cost of Ownership (TLCO) model may be developed to estimate all costs arising from owning, operating, and maintaining a large centralized biobank. The TLCO approach allows for a better delineation of a biobank's variable and fixed costs, data that will be needed to implement any cost recovery program. This article represents an overview of the efforts made recently by the National Cancer Institute's Office of Biorepositories and Biospecimen Research as part of its effort to develop an appropriate cost model and cost recovery program for the cancer HUman Biobank (caHUB) initiative. All of these economic factors are discussed in terms of maximizing caHUB's potential for long-term sustainability but have broad applicability to the wide range of biobanking initiatives that currently exist.

Choosing options for ultrasound screening in pregnancy and comparing cost effectiveness: a decision analysis approach.

PubMed

Roberts, T; Mugford, M; Piercy, J

1998-09-01

To compare the cost effectiveness of different programmes of routine antenatal ultrasound screening to detect four key fetal anomalies: serious cardiac anomalies, spina bifida, Down's syndrome and lethal anomalies, using existing evidence. Decision analysis was used based on the best data currently available, including expert opinion from the Royal College of Obstetricians and Gynaecologists, Working Party and secondary data from the literature, to predict the likely outcomes in terms of malformations detected by each screening programme. Results applicable in clinics, hospitals or GP practices delivering antenatal screening. The number of cases with a 'target' malformation correctly detected antenatally. There was substantial overlap between the cost ranges of each screening programme demonstrating considerable uncertainty about the relative economic efficiency of alternative programmes for ultrasound screening. The cheapest, but not the most effective, screening programme consisted of one second trimester ultrasound scan. The cost per target anomaly detected (cost effectiveness) for this programme was in the range 5,000 pound silver-109,000, pound silver but in any 1000 women it will also fail to detect between 3.6 and 4.7 target anomalies. The range of uncertainty in the costs did not allow selection of any one programme as a clear choice for NHS purchasers. The results suggested that the overall allocation of resources for routine ultrasound screening in the UK is not currently economically efficient, but that certain scenarios for ultrasound screening are potentially within the range of cost effectiveness reached by other, possibly competing, screening programmes. The model highlighted the weakness of available evidence and demonstrated the need for more information both about current practice and costs.

Building partnerships in community-based participatory research: budgetary and other cost considerations.

PubMed

Hoeft, Theresa J; Burke, Wylie; Hopkins, Scarlett E; Charles, Walkie; Trinidad, Susan B; James, Rosalina D; Boyer, Bert B

2014-03-01

Community-based participatory research (CBPR) is an important framework for partnering with communities to reduce health disparities. Working in partnership with community incurs additional costs, some that can be represented in a budget summary page and others that are tied to the competing demands placed on community and academic partners. These cost considerations can inform development of community-academic partnerships. We calculated costs from a case study based on an ongoing CBPR project involving a Community Planning Group (CPG) of community co-researchers in rural Alaska and a bicultural liaison group who help bridge communication between CPG and academic co-researchers. Budget considerations specific to CBPR include travel and other communication-related costs, compensation for community partners, and food served at meetings. We also identified sources of competing demands for community and academic partners. Our findings can inform budget discussions in community-academic partnerships. Discussions of competing demands on community partners' time can help plan timelines for CBPR projects. Our findings may also inform discussions about tenure and promotion policies that may represent barriers to participation in CBPR for academic researchers.

Specialty Practice and Cost Considerations in the Management of Uveitis Associated With Juvenile Idiopathic Arthritis.

PubMed

Palestine, Alan G; Singh, Jasleen K; Kolfenbach, Jason R; Ozzello, Daniel J

2016-07-01

To evaluate whether cost, prior insurance authorization concerns, and subspecialty practice influence therapeutic decisions in the treatment of uveitis associated with juvenile idiopathic arthritis. A total of 2,965 pediatric ophthalmologists, uveitis specialists, retina specialists, and rheumatologists across the United States were surveyed via e-mail regarding their choice in long-term therapy for a hypothetical patient with uveitis associated with juvenile idiopathic arthritis. Outcomes of interest were differences in therapy choice based on cost/prior authorization and specialty practice. There were significant differences in the use of methotrexate and biologics among specialists, both with and without consideration for cost and prior authorization. Physicians in four different specialties who treat uveitis associated with juvenile idiopathic arthritis agree on methotrexate as a first-line treatment choice and a biologic immunosuppressive medication as a second choice, but there are significant differences between the specialties in their use of these medications. Cost and insurance considerations did not affect therapy selection. [J Pediatr Ophthalmol Strabismus. 2016;53(4):246-251.]. Copyright 2016, SLACK Incorporated.

Cost of illness of atopic dermatitis in children: a societal perspective.

PubMed

Kemp, Andrew S

2003-01-01

Childhood atopic dermatitis is a disorder with considerable social and financial costs. Consideration of these costs is increasingly important in view of the growing prevalence of atopic dermatitis, particularly in developed countries over recent decades. The family stress related to the care of children with moderate or severe atopic dermatitis is significantly greater than that of the care of children with type 1 diabetes mellitus. The factors contributing to family stress include sleep deprivation, loss of employment, time taken for care of atopic dermatitis and financial costs. The financial costs for the family and community include medical and hospital direct costs of treatments and indirect costs from loss of employment. There are many interventions utilised in the treatment of childhood atopic dermatitis which involve not only medical practitioners but nurses, pharmacists, dieticians, psychologists and purveyors of so-called alternative therapies such as naturopathy, aromatherapy and bioresonance, all of which contribute to the financial burdens on the parents and the community. It is possible that appropriate interventions directed to reducing trigger factors might produce worthwhile savings, although the cost benefit of these measures has not been demonstrated. In conclusion, atopic dermatitis should not be regarded as a minor skin disorder but as a condition which has the potential to be a major handicap with considerable personal, social and financial consequences both to the family and the community.

Frequency choice of eRHIC SRF linac

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, W.; Ben-Zvi, I.; Roser, T.

2016-01-05

eRHIC is a FFAG lattice-based multipass ERL. The eRHIC SRF linac has been decided to change from 422 MHz 5-cell cavity to 647 MHz 5-cell cavity. There are several considerations affecting the frequency choice for a high-current multipass-ERL: the beam structure, bunch length, energy spread, beam-break-up (BBU) threshold, SRF loss considerations. Beyond the physics considerations, cost and complexity or risk is an important consideration for the frequency choice, especially when we are designing a machine to be built in a few years. Although there are some benefits of using a 422 MHz cavity for eRHIC ERL, however, there are somemore » very critical drawbacks, including lack of facilities to fabricate a 422 MHz 5-cell cavity, very few facilities to process such a cavity and no existing facility to test the cavity anywhere. As the cavity size is big and its weight is large, it is difficult to handle it during fabrication, processing and testing, and no one has experience in this area. As the cavity size is large, the cryomodule becomes big as well. All of these considerations drive the risk of building eRHIC ERL with 422 MHz cavities to a very high level. Therefore, a decision was made to change the frequency of main linac to be 647 MHz 5-cell cavities. This note will compare these two linacs: 422MHz 5-cell cavity linac and 647Mz 5-cell cavity SRF linac, from both practical point of view and physics point of view.« less

Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

PubMed

Fleck, Leonard M

2018-04-01

Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

Routing and Scheduling Optimization Model of Sea Transportation

NASA Astrophysics Data System (ADS)

barus, Mika debora br; asyrafy, Habib; nababan, Esther; mawengkang, Herman

2018-01-01

This paper examines the routing and scheduling optimization model of sea transportation. One of the issues discussed is about the transportation of ships carrying crude oil (tankers) which is distributed to many islands. The consideration is the cost of transportation which consists of travel costs and the cost of layover at the port. Crude oil to be distributed consists of several types. This paper develops routing and scheduling model taking into consideration some objective functions and constraints. The formulation of the mathematical model analyzed is to minimize costs based on the total distance visited by the tanker and minimize the cost of the ports. In order for the model of the problem to be more realistic and the cost calculated to be more appropriate then added a parameter that states the multiplier factor of cost increases as the charge of crude oil is filled.

50 CFR 253.11 - Guarantee policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., except: (1) Vessel construction. The Program will not finance this project cost. The Program will only refinance this project cost for an existing vessel whose previous construction cost has already been financed (or otherwise paid). Refinancing this project cost for a vessel that already exists is not...

Development of a framework for the assessment of capacity and throughput technologies within the National Airspace System

NASA Astrophysics Data System (ADS)

Garcia, Elena

The demand for air travel is expanding beyond the capacity of the existing National Airspace System. Excess traffic results in delays and compromised safety. Thus, a number of initiatives to improve airspace capacity have been proposed. To assess the impact of these technologies on air traffic one must move beyond the vehicle to a system-of-systems point of view. This top-level perspective must include consideration of the aircraft, airports, air traffic control and airlines that make up the airspace system. In addition to these components and their interactions economics, safety and government regulations must also be considered. Furthermore, the air transportation system is inherently variable with changes in everything from fuel prices to the weather. The development of a modeling environment that enables a comprehensive probabilistic evaluation of technological impacts was the subject of this thesis. The final modeling environment developed used economics as the thread to tie the airspace components together. Airport capacities and delays were calculated explicitly with due consideration to the impacts of air traffic control. The delay costs were then calculated for an entire fleet, and an airline economic analysis, considering the impact of these costs, was carried out. Airline return on investment was considered the metric of choice since it brings together all costs and revenues, including the cost of delays, landing fees for airport use and aircraft financing costs. Safety was found to require a level of detail unsuitable for a system-of-systems approach and was relegated to future airspace studies. Environmental concerns were considered to be incorporated into airport regulations and procedures and were not explicitly modeled. A deterministic case study was developed to test this modeling environment. The Atlanta airport operations for the year 2000 were used for validation purposes. A 2005 baseline was used as a basis for comparing the four technologies considered: a very large aircraft, Terminal Area Productivity air traffic control technologies, smoothing of an airline schedule, and the addition of a runway. A case including all four technologies simultaneously was also considered. Unfortunately, the complexity of the system prevented full exploration of the probabilistic aspects of the National Airspace System.

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

PubMed Central

2010-01-01

Introduction In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. Methods This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. Results From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. Conclusions The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process. PMID:20579341

Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

PubMed

Tyrrell, Amanda K; Russo, Giuliano; Dussault, Gilles; Ferrinho, Paulo

2010-06-25

In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

Using an Integrated Hydrologic-Economic Model to Develop Minimum Cost Water Supply Portfolios and Manage Supply Risk

NASA Astrophysics Data System (ADS)

Characklis, G. W.; Ramsey, J.

2004-12-01

Water scarcity has become a reality in many areas as a result of population growth, fewer available sources, and reduced tolerance for the environmental impacts of developing the new supplies that do exist. As a result, successfully managing future water supply risk will become more dependent on coordinating the use of existing resources. Toward that end, flexible supply strategies that can rapidly respond to hydrologic variability will provide communities with increasing economic advantages, particularly if the frequency of more extreme events (e.g., drought) increases due to global climate change. Markets for established commodities (e.g., oil, gas) often provide a framework for efficiently responding to changes in supply and demand. Water markets, however, have remained relatively crude, with most transactions involving permanent transfers and long regulatory processes. Recently, interest in the use of flexible short-term transfers (e.g., leases, options) has begun to motivate consideration of more sophisticated strategies for managing supply risk, strategies similar to those used in more mature markets. In this case, communities can benefit from some of the advantages that water enjoys over other commodities, in particular, the ability to accurately characterize the stochastic nature of supply and demand through hydrologic modeling. Hydrologic-economic models are developed for two different water scarce regions supporting active water markets: Edward Aquifer and Lower Rio Grande Valley. These models are used to construct portfolios of water supply transfers (e.g., permanent transfers, options, and spot leases) that minimize the cost of meeting a probabilistic reliability constraint. Real and simulated spot price distributions allow each type of transfer to be priced in a manner consistent with financial theory (e.g., Black-Scholes). Market simulations are integrated with hydrologic models such that variability in supply and demand are linked with price behavior. Decisions on when and how much water to lease (or exercise, in the case of options) are made on the basis of anticipatory rules based on the ratio of expected supply to expected demand, and are used to evaluate the economic consequences of a utilityAƒAøAøâ_sA¬Aøâ_zAøs attitude toward risk. The marginal cost of supply reliability is also explored by varying the water supply reliability constraint, an important consideration as the rising expense of new source development may encourage some communities to accept a nominal number of supply shortfalls. Results demonstrate how changes in the distribution of various transfer types within a portfolio can affect its cost and reliability. Results also suggest that substantial savings can be obtained through the use of market-based risk management strategies, with optimal portfolio costs averaging as much as 35 percent less than the costs of meeting reliability targets through the maintenance of firm capacity. Both the conceptual and modeling approach described in this work are likely to have increasing application as water scarcity continues to drive the search for more efficient approaches to water resource management.

Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives.

PubMed

Fiebig, Denzil G; Viney, Rosalie; Knox, Stephanie; Haas, Marion; Street, Deborah J; Hole, Arne R; Weisberg, Edith; Bateson, Deborah

2017-01-01

Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Commentary: considerations for using the 'Trials within Cohorts' design in a clinical trial of an investigational medicinal product.

PubMed

Bibby, Anna C; Torgerson, David J; Leach, Samantha; Lewis-White, Helen; Maskell, Nick A

2018-01-08

The 'trials within cohorts' (TwiC) design is a pragmatic approach to randomised trials in which trial participants are randomly selected from an existing cohort. The design has multiple potential benefits, including the option of conducting multiple trials within the same cohort. To date, the TwiC design methodology been used in numerous clinical settings but has never been applied to a clinical trial of an investigational medicinal product (CTIMP). We have recently secured the necessary approvals to undertake the first CTIMP using the TwiC design. In this paper, we describe some of the considerations and modifications required to ensure such a trial is compliant with Good Clinical Practice and international clinical trials regulations. We advocate using a two-stage consent process and using the consent stages to explicitly differentiate between trial participants and cohort participants who are providing control data. This distinction ensured compliance but had consequences with respect to costings, recruitment and the trial assessment schedule. We have demonstrated that it is possible to secure ethical and regulatory approval for a CTIMP TwiC. By including certain considerations at the trial design stage, we believe this pragmatic and efficient methodology could be utilised in other CTIMPs in future.

The private duty market: operational and staffing considerations.

PubMed

Considine, C J

2000-01-01

Wouldn't it be nice to get away from Medicare home health regulations and into a business where the provider simply needs an understanding of the difference between a revenue and an expense? Cost reports, disallowances, allocations, cost shifts, and cost limits become a thing of the past. This article will help you plan and evaluate your approach to developing a private duty business. An overview of the market, operational considerations, and a discussion of various key staff positions and their functions allows you to explore this opportunity from many vantage points.

Costs of vaccine programs across 94 low- and middle-income countries.

PubMed

Portnoy, Allison; Ozawa, Sachiko; Grewal, Simrun; Norman, Bryan A; Rajgopal, Jayant; Gorham, Katrin M; Haidari, Leila A; Brown, Shawn T; Lee, Bruce Y

2015-05-07

While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance. Vaccine introductions and coverage levels were projected primarily based on GAVI's Adjusted Demand Forecast. Supply chain costs including costs of transportation, storage, and labor were estimated by developing a mechanistic model using data generated by the HERMES discrete event simulation models. Service delivery costs were abstracted from comprehensive multi-year plans for the majority of GAVI-eligible countries and regression analysis was conducted to extrapolate costs to additional countries. The analysis shows that the delivery of the full vaccination program across 94 countries would cost a total of $62 billion (95% uncertainty range: $43-$87 billion) over the decade, including $51 billion ($34-$73 billion) for routine immunization and $11 billion ($7-$17 billion) for SIAs. More than half of these costs stem from service delivery at $34 billion ($21-$51 billion)-with an additional $24 billion ($13-$41 billion) in vaccine costs and $4 billion ($3-$5 billion) in supply chain costs. The findings present the global costs to attain the goals envisioned during the Decade of Vaccines to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities. By projecting the full costs of immunization programs, our findings may aid to garner greater country and donor commitments toward adequate resource mobilization and efficient allocation. As service delivery costs have increasingly become the main driver of vaccination program costs, it is essential to pay additional consideration to health systems strengthening. Copyright © 2015 Elsevier Ltd. All rights reserved.

Some Conditions for Cost Efficiency in Hypermedia.

ERIC Educational Resources Information Center

Westland, J. Christopher

1998-01-01

Models administrative and operating costs surrounding a hypermedia database and identifies seven conditions for the cost justification of hypermedia. Concludes that cost considerations aside, hypermedia offers significant data retrieval benefits in accessing text, video, still pictures, and sound, and provides substantially better human…

Navy Program Manager’s Guide, 1985 Edition

DTIC Science & Technology

1985-01-01

1-7 Relationship of Development Cost in System Life -Cycle Cost (LCC) ......................... 1-7 Realistic Costing and Budgeting...Review (PROR)..... 4-53 x MI *) First-Article Configuration Inspection (FACI) ...... 4-54 Cost Management- Life -Cycle Costing (LCC) ..................... 4...innovation and minimize costs. 4. Consideration of life -cycle cost (LCC) such that affordability is put on an equal basis with system performance, schedule

Environmental control implications of generating electric power from coal. 1977 technology status report. Appendix D. Assessment of NO/sub x/ control technology for coal fired utility boilers. [Low-excess-air, staged combustion, flu gas recirculation and burner design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1977-12-01

An NOx control technology assessment study was conducted to examine the effectiveness of low-excess-air firing, staged combustion, flue gas recirculation, and current burner/boiler designs as applied to coal-fired utility boilers. Significant variations in NOx emissions exist with boiler type, firing method, and coal type, but a relative comparison of emissions control performance, cost, and operational considerations is presented for each method. The study emphasized the numerous operational factors that are of major importance to the user in selecting and implementing a combustion modification technique. Staged combustion and low-excess-air operation were identified as the most cost-effective methods for existing units. Closemore » control of local air/fuel ratios and rigorous combustion equipment maintenance are essential to the success of both methods. Flue gas recirculation is relatively ineffective and has the added concern of tube erosion. More research is needed to resolve potential corrosion concerns with low-NOx operating modes. Low-NOx burners in conjunction with a compartmentalized windbox are capable of meeting a 0.6-lb/million Btu emission level on new units. Advanced burner designs are being developed to meet research emission goals of approximately 0.25 lb/MBtu.« less

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.

PubMed

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2016-05-01

While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.

Endometrial 'scratching': what the data show.

PubMed

Santamaria, Xavier; Katzorke, Nora; Simón, Carlos

2016-08-01

Since its first description in 2003, the endometrial scratching procedure has been the topic of over 1000 studies. This procedure, used to improve endometrial receptivity for assisted reproduction, is accessible - any gynecologist can easily perform it - and has been adapted into clinical routine by some reproductive units. However, the available data are controversial, and no biological plausibility exists to support the use of this intervention. This study aims to critically review the existing data, focusing on the last 2 years, regarding the efficiency of endometrial scratching. A total of five randomized controlled studies, one meta-analysis, and a systematic review related to endometrial scratching/injury were published in 2014 and 2015. Considerable heterogeneity exists among these studies regarding the selected population, type of treatment, and even timing and devices used to perform the endometrial injury. Importantly, none of these studies reported improved reproductive outcomes in terms of live birth rates following endometrial scratching. Overall, data from properly designed and powered randomized controlled studies demonstrate no beneficial effect of this intervention that is based on unknown biological effects. Endometrial scratching produces pain, costs money, and the side-effects of systematic scratching in the production of Asherman syndrome remain to be seen. Think before scratching.

Exploring parameter effects on the economic outcomes of groundwater-based developments in remote, low-resource settings

NASA Astrophysics Data System (ADS)

Abramson, Adam; Adar, Eilon; Lazarovitch, Naftali

2014-06-01

Groundwater is often the most or only feasible safe drinking water source in remote, low-resource areas, yet the economics of its development have not been systematically outlined. We applied AWARE (Assessing Water Alternatives in Remote Economies), a recently developed Decision Support System, to investigate the costs and benefits of groundwater access and abstraction for non-networked, rural supplies. Synthetic profiles of community water services (n = 17,962), defined across 13 parameters' values and ranges relevant to remote areas, were applied to the decision framework, and the parameter effects on economic outcomes were investigated. Regressions and analysis of output distributions indicate that the most important factors determining the cost of water improvements include the technological approach, the water service target, hydrological parameters, and population density. New source construction is less cost-effective than the use or improvement of existing wells, but necessary for expanding access to isolated households. We also explored three financing approaches - willingness-to-pay, -borrow, and -work - and found that they significantly impact the prospects of achieving demand-driven cost recovery. The net benefit under willingness to work, in which water infrastructure is coupled to community irrigation and cash payments replaced by labor commitments, is impacted most strongly by groundwater yield and managerial factors. These findings suggest that the cost-benefit dynamics of groundwater-based water supply improvements vary considerably by many parameters, and that the relative strengths of different development strategies may be leveraged for achieving optimal outcomes.

Mass Media’s Perspective on the Challenges of Information and Communication Technology (ICT) in Indonesia

NASA Astrophysics Data System (ADS)

Junaidi

2017-12-01

This study investigated the challenges of Information and Communication Technology (ICT) in Indonesia based on mass media’s perspective. The challenges of ICT on mass media’s perspective are very complex. Some of these challenges include the consideration of the advantages and disadvantages of ICT, threats to the unity of the country, cultural problems, regulation, business competition among operators, Pokemon Go booming, the existence of social media which triggers hostility between people and the increasing rate of the interconnection cost. Among the main reasons to this phenomenon is a need of massive investment to build the infrastructures. This study used Robert N. Entman framing model to analyze the headlines of Majalah ICT (an ICT magazine).

Sealing scientific probes against deep space and the Venusian environment A tough job

NASA Technical Reports Server (NTRS)

Pokras, J.; Reinert, R. P.; Switz, R. J.

1978-01-01

The Pioneer Venus mission evolved from studies conducted during the late 1960s and early 1970s. It was found that a need existed for low cost orbiters and landers to explore the planet. The considered mission was to be accomplished with six separate vehicles arriving at Venus nearly simultaneously in mid-December 1978. The probes are designed to survive entry and descent into the atmosphere. A description is presented of the approaches used to maintain sealing integrity for the large and small probes under the constraints imposed by the harsh Venusian environment. Attention is given to probe vehicle configuration, pressure vessel sealing requirements, material and configuration considerations, permanent seals, separable seals, development problems, and aspects of seal testing.

Embedding clinical interventions into observational studies.

PubMed

Newman, Anne B; Avilés-Santa, M Larissa; Anderson, Garnet; Heiss, Gerardo; Howard, Wm James; Krucoff, Mitchell; Kuller, Lewis H; Lewis, Cora E; Robinson, Jennifer G; Taylor, Herman; Treviño, Roberto P; Weintraub, William

2016-01-01

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed. Copyright © 2015. Published by Elsevier Inc.

R/M Analysis of Electromechanical Equipments.

DTIC Science & Technology

1982-05-01

modifying existing R/M prediction and demonstration techniques to account for considerations of R/M performance of E/M equipments in the C31 systems...00 a’a - CC C a a a a’ a a ~ a’ a a’ a 000 CeCa’ 0Ca’Ca’ OCOtOaC CC a’ a-, C’.a’ CC a’a’ a S -C a’ a’ -~ a~g a’a a’ C C C~ CC fla’C - acCa ’ CCOCa~. 00...any of the other systems studied. The data are also higher quality because of the command interest in this high cost system and because of the safety

Sexual Cannibalism as a Manifestation of Sexual Conflict

PubMed Central

Schneider, Jutta M.

2014-01-01

Sexual cannibalism is a well-known example for sexual conflict and has many facets that determine the costs and benefits for the cannibal and the victim. Here, I focus on species in which sexual cannibalism is a general component of a mating system in which males invest maximally in mating with a single (monogyny) or two (bigyny) females. Sexual cannibalism can be a male strategy to maximize paternity and a female strategy to prevent paternity monopolization by any or a particular male. Considerable variation exists between species (1) in the potential of males to monopolize females, and (2) in the success of females in preventing monopolization by males. This opens up exciting future possibilities to investigate sexually antagonistic coevolution in a largely unstudied mating system. PMID:25213095

Silicon-Based Thermoelectrics: Harvesting Low Quality Heat Using Economically Printed Flexible Nanostructured Stacked Thermoelectric Junctions

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2010-03-01

Broad Funding Opportunity Announcement Project: UIUC is experimenting with silicon-based materials to develop flexible thermoelectric devices—which convert heat into energy—that can be mass-produced at low cost. A thermoelectric device, which resembles a computer chip, creates electricity when a different temperature is applied to each of its sides. Existing commercial thermoelectric devices contain the element tellurium, which limits production levels because tellurium has become increasingly rare. UIUC is replacing this material with microscopic silicon wires that are considerably cheaper and could be equally effective. Improvements in thermoelectric device production could return enough wasted heat to add up to 23% to ourmore » current annual electricity production.« less

Model-Based Data Integration and Process Standardization Techniques for Fault Management: A Feasibility Study

NASA Technical Reports Server (NTRS)

Haste, Deepak; Ghoshal, Sudipto; Johnson, Stephen B.; Moore, Craig

2018-01-01

This paper describes the theory and considerations in the application of model-based techniques to assimilate information from disjoint knowledge sources for performing NASA's Fault Management (FM)-related activities using the TEAMS® toolset. FM consists of the operational mitigation of existing and impending spacecraft failures. NASA's FM directives have both design-phase and operational-phase goals. This paper highlights recent studies by QSI and DST of the capabilities required in the TEAMS® toolset for conducting FM activities with the aim of reducing operating costs, increasing autonomy, and conforming to time schedules. These studies use and extend the analytic capabilities of QSI's TEAMS® toolset to conduct a range of FM activities within a centralized platform.

The hidden cost of 'free' maternity care in Dhaka, Bangladesh.

PubMed

Nahar, S; Costello, A

1998-12-01

We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.

The direct and indirect costs of both overweight and obesity: a systematic review

PubMed Central

2014-01-01

Background The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. Methods A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. Results Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. Conclusion A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons. PMID:24739239

The direct and indirect costs of both overweight and obesity: a systematic review.

PubMed

Dee, Anne; Kearns, Karen; O'Neill, Ciaran; Sharp, Linda; Staines, Anthony; O'Dwyer, Victoria; Fitzgerald, Sarah; Perry, Ivan J

2014-04-16

The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.

Considerations for the Next Revision of STRS

NASA Technical Reports Server (NTRS)

Johnson, Sandra K.; Handler, Louis M.; Briones, Janette C.

2016-01-01

Development of NASAs Software Defined Radio architecture, the Space Telecommunication Radio System (STRS), was initiated in 2004 with a goal of reducing the cost, risk and schedule when implementing Software Defined Radios (SDR) for NASA space missions. Since STRS was first flown in 2012 on three Software Defined Radios on the Space Communication and Navigation (SCaN) Testbed, only minor changes have been made to the architecture. Multiple entities have since implemented the architecture and have provided significant feedback for consideration for the next revision of the standard. The focus for the first set of updates to the architecture is items that enhance application portability. Items that require modifications to existing applications before migrating to the updated architecture will only be considered if there is compelling reasons to make the change. The significant suggestions that were further evaluated for consideration include expanding and clarifying the timing Application Programming Interfaces (APIs), improving handle name and identification (ID) definitions and use, and multiple items related to implementation of STRS Devices. In addition to ideas suggested while implementing STRS, SDR technology has evolved significantly and this impact to the architecture needs to be considered. These include incorporating cognitive concepts - learning from past decisions and making new decisions that the radio can act upon. SDRs are also being developed that do not contain a General Purpose Module which is currently required for the platform to be STRS compliant. The purpose of this paper is to discuss the comments received, provide a summary of the evaluation considerations, and examine planned dispositions

Fundamental Considerations for Determining Cost Information in Higher Education.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC.

Costing has been recognized by business, financial, and other administrators in higher education as a valuable management tool. A growing interest in the determination of costs and their use revealed a lack of uniformity in cost definitions and cost determination methods and approaches in a language that was readily applicable to higher education.…

A methodology for optimal MSW management, with an application in the waste transportation of Attica Region, Greece.

PubMed

Economopoulou, M A; Economopoulou, A A; Economopoulos, A P

2013-11-01

The paper describes a software system capable of formulating alternative optimal Municipal Solid Wastes (MSWs) management plans, each of which meets a set of constraints that may reflect selected objections and/or wishes of local communities. The objective function to be minimized in each plan is the sum of the annualized capital investment and annual operating cost of all transportation, treatment and final disposal operations involved, taking into consideration the possible income from the sale of products and any other financial incentives or disincentives that may exist. For each plan formulated, the system generates several reports that define the plan, analyze its cost elements and yield an indicative profile of selected types of installations, as well as data files that facilitate the geographic representation of the optimal solution in maps through the use of GIS. A number of these reports compare the technical and economic data from all scenarios considered at the study area, municipality and installation level constituting in effect sensitivity analysis. The generation of alternative plans offers local authorities the opportunity of choice and the results of the sensitivity analysis allow them to choose wisely and with consensus. The paper presents also an application of this software system in the capital Region of Attica in Greece, for the purpose of developing an optimal waste transportation system in line with its approved waste management plan. The formulated plan was able to: (a) serve 113 Municipalities and Communities that generate nearly 2 milliont/y of comingled MSW with distinctly different waste collection patterns, (b) take into consideration several existing waste transfer stations (WTS) and optimize their use within the overall plan, (c) select the most appropriate sites among the potentially suitable (new and in use) ones, (d) generate the optimal profile of each WTS proposed, and (e) perform sensitivity analysis so as to define the impact of selected sets of constraints (limitations in the availability of sites and in the capacity of their installations) on the design and cost of the ensuing optimal waste transfer system. The results show that optimal planning offers significant economic savings to municipalities, while reducing at the same time the present levels of traffic, fuel consumptions and air emissions in the congested Athens basin. Copyright © 2013 Elsevier Ltd. All rights reserved.

Considerations in pharmaceutical conversion: focus on antihistamines.

PubMed

Garbus, S B; Moulton, B W; Meltzer, E O; Reich, P R; Weinreb, L F; Friedman, J A; Orland, B I

1997-04-01

The practice of pharmaceutical conversion, which encompasses three types of drug interchange (generic, brand, and therapeutic substitution), is increasing in managed care settings. Pharmaceutical conversion has numerous implications for managed care organizations, their healthcare providers, and their customers. Although drug cost may be a driving consideration in pharmaceutical conversion, a number of other considerations are of equal or greater importance in the decision-making process may affect the overall cost of patient care. Among these considerations are clinical, psychosocial, and safety issues; patient adherence; patient satisfaction; and legal implications of pharmaceutical conversion. Patient-centered care must always remain central to decisions about pharmaceutical conversion. This article discusses the issues related to, and implications of, pharmaceutical conversion utilizing the antihistamines class of drugs as the case situation.

Satellite scheduling considering maximum observation coverage time and minimum orbital transfer fuel cost

NASA Astrophysics Data System (ADS)

Zhu, Kai-Jian; Li, Jun-Feng; Baoyin, He-Xi

2010-01-01

In case of an emergency like the Wenchuan earthquake, it is impossible to observe a given target on earth by immediately launching new satellites. There is an urgent need for efficient satellite scheduling within a limited time period, so we must find a way to reasonably utilize the existing satellites to rapidly image the affected area during a short time period. Generally, the main consideration in orbit design is satellite coverage with the subsatellite nadir point as a standard of reference. Two factors must be taken into consideration simultaneously in orbit design, i.e., the maximum observation coverage time and the minimum orbital transfer fuel cost. The local time of visiting the given observation sites must satisfy the solar radiation requirement. When calculating the operational orbit elements as optimal parameters to be evaluated, we obtain the minimum objective function by comparing the results derived from the primer vector theory with those derived from the Hohmann transfer because the operational orbit for observing the disaster area with impulse maneuvers is considered in this paper. The primer vector theory is utilized to optimize the transfer trajectory with three impulses and the Hohmann transfer is utilized for coplanar and small inclination of non-coplanar cases. Finally, we applied this method in a simulation of the rescue mission at Wenchuan city. The results of optimizing orbit design with a hybrid PSO and DE algorithm show that the primer vector and Hohmann transfer theory proved to be effective methods for multi-object orbit optimization.

Oxidative shielding and the cost of reproduction.

PubMed

Blount, Jonathan D; Vitikainen, Emma I K; Stott, Iain; Cant, Michael A

2016-05-01

Life-history theory assumes that reproduction and lifespan are constrained by trade-offs which prevent their simultaneous increase. Recently, there has been considerable interest in the possibility that this cost of reproduction is mediated by oxidative stress. However, empirical tests of this theory have yielded equivocal support. We carried out a meta-analysis to examine associations between reproduction and oxidative damage across markers and tissues. We show that oxidative damage is positively associated with reproductive effort across females of various species. Yet paradoxically, categorical comparisons of breeders versus non-breeders reveal that transition to the reproductive state is associated with a step-change reduction in oxidative damage in certain tissues and markers. Developing offspring may be particularly sensitive to harm caused by oxidative damage in mothers. Therefore, such reductions could potentially function to shield reproducing mothers, gametes and developing offspring from oxidative insults that inevitably increase as a consequence of reproductive effort. According to this perspective, we hypothesise that the cost of reproduction is mediated by dual impacts of maternally-derived oxidative damage on mothers and offspring, and that mothers may be selected to diminish such damage. Such oxidative shielding may explain why many existing studies have concluded that reproduction has little or no oxidative cost. Future advance in life-history theory therefore needs to take account of potential transgenerational impacts of the mechanisms underlying life-history trade-offs. © 2015 Cambridge Philosophical Society.

Avionics Integrity Program (AVIP). Volume 4. Force Management - Economic Life Considerations.

DTIC Science & Technology

1984-03-01

often used to refer to the period of time during which financial considerations justify the continued use of an existing system. The study addresses...rejporLs incl-ude contractor ei forts between September 1983 and Marih 1984. Each report represents a completed study in a specific area and stands alone...during which financial considerations justify the selection or continued use of a system. A variety of definitions currently exist for economic life. One

Formal Methods Specification and Verification Guidebook for Software and Computer Systems. Volume 1; Planning and Technology Insertion

NASA Technical Reports Server (NTRS)

1995-01-01

The Formal Methods Specification and Verification Guidebook for Software and Computer Systems describes a set of techniques called Formal Methods (FM), and outlines their use in the specification and verification of computer systems and software. Development of increasingly complex systems has created a need for improved specification and verification techniques. NASA's Safety and Mission Quality Office has supported the investigation of techniques such as FM, which are now an accepted method for enhancing the quality of aerospace applications. The guidebook provides information for managers and practitioners who are interested in integrating FM into an existing systems development process. Information includes technical and administrative considerations that must be addressed when establishing the use of FM on a specific project. The guidebook is intended to aid decision makers in the successful application of FM to the development of high-quality systems at reasonable cost. This is the first volume of a planned two-volume set. The current volume focuses on administrative and planning considerations for the successful application of FM.

Risk assessment for ecotoxicity of pharmaceuticals--an emerging issue.

PubMed

Kar, Supratik; Roy, Kunal

2012-03-01

Existence of a large amount of pharmaceuticals and their active metabolites in the environment has recently been considered as one of the most serious concerns in environmental sciences. Large diversity of pharmaceuticals has been found in the environmental domain in considerable amounts that are not only destructive to environment but also fatal for human and animal fraternity. There is a considerable lack of knowledge about the environmental fate and quantification of a large number of pharmaceuticals. This communication aims to review the literature information regarding occurrence of pharmaceuticals and their metabolites in the environment, their persistence, environmental fate and toxicity as well as application of theoretical, non-experimental, non-animal, alternative and, in particular, in silico methods to provide information about the basic physicochemical and fate properties of pharmaceuticals to the environment. The reader will gain an overview of risk assessment strategies for ecotoxicity of pharmaceuticals and advances in application of quantitative structure-toxicity relationship (QSTR) in this field. This review justifies the need to develop more QSTR models for prediction of ecotoxicity of pharmaceuticals in order to reduce time and cost involvement in such exercise.

Exploration of a Preflight Acuity Scale for Fixed Wing Air Ambulance Transport.

PubMed

Phipps, Marcy; Conley, Virginia; Constantine, William H

Despite the prevalence of fixed wing medical flights for specialized care and repatriation, few acuity rating scales exist aimed at the prediction of adverse in-flight medical events. An acuity scoring system can provide information to flight crews, allowing for staffing enhancements, protocol modifications, and flight planning, with the aim of improving patient care, outcomes, and preventing losses to providers because of costly diversions. Our medical crew developed an acuity scale, which was applied retrospectively to 296 patients transported between January 2016 and March 2017. Patients received scores based on conditions identified during the preflight medical report, the initial patient assessment, demographics, and flight factors. Five patients were identified as high-risk transports based on our scale. Three patients suffered adverse events according to our defined criteria, 2 of which occurred before transport and 1 during transport. The 3 patients suffering adverse events did not receive a score that indicated adverse events in flight. Our scale was not predictive of adverse events in flight. However, it did illuminate factors worthy of consideration. Consideration of these factors may have prevented adverse events. Published by Elsevier Inc.

Low energy stage study. Volume 4: Cost benefits analysis and recommendations. [orbital launching of space shuttle payloads

NASA Technical Reports Server (NTRS)

1978-01-01

The costs and benefits of existing/planned systems, new propulsion concepts, and adaptations of existing/planned systems (as supported by Orbiter interface requirements and operations requirements) were quantified. Scenarios of these propulsion approaches were established which accommodate the low energy regime as defined by the new low energy payload mission model. These scenarios were screened on a cost and then a benefits basis. A propulsion approach comprising existing/planned systems and a new propulsion concept were selected as the most cost effective approach to accommodate the model payloads and the low energy regime they represent. Key cost drivers and sensitivity trends were identified. All costs were derived in 1977 dollars.

Cost considerations for long-term ecological monitoring

USGS Publications Warehouse

Caughlan, L.; Oakley, K.L.

2001-01-01

For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program's focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs--what dollars are spent on--and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program's longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occur during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost-effectiveness, of each program element can be evaluated. Moving into the implementation phase without careful evaluation of costs and benefits is risky because if costs are later found to exceed benefits, the program will fail. The costs of development, which can be quite high, will have been largely wasted. Realistic expectations of costs and benefits will help ensure that monitoring programs survive the early, turbulent stages of development and the challenges posed by fluctuating budgets during implementation.

Cost-effective treatment of existing guardrail systems.

DOT National Transportation Integrated Search

2013-05-01

A cost-effective means for upgrading existing guardrail systems with deviations from current practice (i.e., low-rail heights, antiquated end : treatments, and improper installation) does not exist. As a result these systems remain on U.S. highways. ...

Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

PubMed

Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

2013-01-01

Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

A roadmap for cost-of-goods planning to guide economic production of cell therapy products.

PubMed

Lipsitz, Yonatan Y; Milligan, William D; Fitzpatrick, Ian; Stalmeijer, Evelien; Farid, Suzanne S; Tan, Kah Yong; Smith, David; Perry, Robert; Carmen, Jessica; Chen, Allen; Mooney, Charles; Fink, John

2017-12-01

Cell therapy products are frequently developed and produced without incorporating cost considerations into process development, contributing to prohibitively costly products. Herein we contextualize individual process development decisions within a broad framework for cost-efficient therapeutic manufacturing. This roadmap guides the analysis of cost of goods (COG) arising from tissue procurement, material acquisition, facility operation, production, and storage. We present the specific COG considerations related to each of these elements as identified through a 2013 International Society for Cellular Therapy COG survey, highlighting the differences between autologous and allogeneic products. Planning and accounting for COG at each step in the production process could reduce costs, allowing for more affordable market pricing to improve the long-term viability of the cell therapy product and facilitate broader patient access to novel and transformative cell therapies. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Cost-Effectiveness Analysis of the Automation of a Circulation System.

ERIC Educational Resources Information Center

Mosley, Isobel

A general methodology for cost effectiveness analysis was developed and applied to the Colorado State University library loan desk. The cost effectiveness of the existing semi-automated circulation system was compared with that of a fully manual one, based on the existing manual subsystem. Faculty users' time and computer operating costs were…

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... exists, the deferred charge may be included in capital-related costs to the extent of increasing the... exists, the deferred charge may be included in the capital-related costs to the extent of increasing the... included in capital-related costs to the extent of increasing the reduced rental to an amount not in excess...

Oil palm biomass as an adsorbent for heavy metals.

PubMed

Vakili, Mohammadtaghi; Rafatullah, Mohd; Ibrahim, Mahamad Hakimi; Abdullah, Ahmad Zuhairi; Salamatinia, Babak; Gholami, Zahra

2014-01-01

Many industries discharge untreated wastewater into the environment. Heavy metals from many industrial processes end up as hazardous pollutants of wastewaters.Heavy metal pollution has increased in recent decades and there is a growing concern for the public health risk they may pose. To remove heavy metal ions from polluted waste streams, adsorption processes are among the most common and effective treatment methods. The adsorbents that are used to remove heavy metal ions from aqueous media have both advantages and disadvantages. Cost and effectiveness are two of the most prominent criteria for choosing adsorbents. Because cost is so important, great effort has been extended to study and find effective lower cost adsorbents.One class of adsorbents that is gaining considerable attention is agricultural wastes. Among many alternatives, palm oil biomasses have shown promise as effective adsorbents for removing heavy metals from wastewater. The palm oil industry has rapidly expanded in recent years, and a large amount of palm oil biomass is available. This biomass is a low-cost agricultural waste that exhibits, either in its raw form or after being processed, the potential for eliminating heavy metal ions from wastewater. In this article, we provide background information on oil palm biomass and describe studies that indicate its potential as an alternative adsorbent for removing heavy metal ions from wastewater. From having reviewed the cogent literature on this topic we are encouraged that low-cost oil-palm-related adsorbents have already demonstrated outstanding removal capabilities for various pollutants.Because cost is so important to those who choose to clean waste streams by using adsorbents, the use of cheap sources of unconventional adsorbents is increasingly being investigated. An adsorbent is considered to be inexpensive when it is readily available, is environmentally friendly, is cost-effective and be effectively used in economical processes. The advantages that oil palm biomass has includes the following:available and exists in abundance, appears to be effective technically, and can be integrated into existing processes. Despite these advantages, oil palm biomasses have disadvantages such as low adsorption capacity, increased COD, BOD and TOC. These disadvantages can be overcome by modifying the biomass either chemically or thermally. Such modification creates a charged surface and increases the heavy metal ion binding capacity of the adsorbent.

Personalized medicine could transform healthcare

PubMed Central

Mathur, Sunil; Sutton, Joseph

2017-01-01

Personalized medicine (PM) is about tailoring a treatment as individualized as the disease. The approach relies on identifying genetic, epigenomic, and clinical information that allows the breakthroughs in our understanding of how a person's unique genomic portfolio makes them vulnerable to certain diseases. PM approach is a complete extension of traditional approach (One-Size-Fits-All) to increasing our ability to predict which medical treatments will be safe and effective for individual patient, and which ones will not be, based on the patient's unique genetic profile. Implementation of PM has the potential to reduce financial and time expenditure, and increase quality of life and life extension of patients. Knowledge of PM facilitates earlier disease detection via enhanced use of existing biomarkers and detection of early genomic and epigenomic events in disease development, particularly carcinogenesis. The PM approach predominantly focuses on preventative medicine and favours taking pro-active actions rather than just reactive. This approach delays or prevents the need to apply more severe treatments which are usually less tolerated and with increased quality of life and financial considerations. Increasing healthcare costs have placed additional pressure on government funded healthcare systems globally, especially regarding end of life care. PM may increase the effectiveness of existing treatments and negate the inherent problems associated with non-PM approaches. PM is a young but rapidly expanding field of healthcare where a physician can select a treatment based on a patient's genetic profile that may not only minimize harmful side effects and guarantee a more successful result, but can be less cost effective compared with a ‘trial-and-error’ approach to disease treatment. The less efficient non-PM (‘trial-and-error’) approach, which can lead to drug toxicity, severe side effects, reactive treatment and misdiagnosis continue to contribute to increasing healthcare costs. Increased patient stratification will allow for the enhanced application of PM and pro-active treatment regimens, resulting in reduced costs and quality of life enhancement. PMID:28685051

Operating experiences with rotary air-to-air heat exchangers: hospitals, schools, nursing homes, swimming pools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pearson, R.J.

1976-01-01

Systems utilizing rotary air-to-air heat exchangers are discussed. Basic considerations of use (fresh air requirements, system configurations, cost considerations), typical system layout/design considerations, and operating observations by engineers, staff and maintenance personnel are described.

Consideration of Cosmetic Surgery As Part of Women's Benefit-Provisioning Mate Retention Strategy.

PubMed

Atari, Mohammad; Barbaro, Nicole; Sela, Yael; Shackelford, Todd K; Chegeni, Razieh

2017-01-01

Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women's consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women) in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective.

Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes

PubMed Central

Son, K H; Lim, N-K; Lee, J-W; Cho, M-C; Park, H-Y

2015-01-01

Aims To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Methods Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. Results Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. Conclusions The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications. PMID:25472691

Technology Applications that Support Space Exploration

NASA Technical Reports Server (NTRS)

Henderson, Edward M.; Holderman, Mark L.

2011-01-01

Several enabling technologies have been identified that would provide significant benefits for future space exploration. In-Space demonstrations should be chosen so that these technologies will have a timely opportunity to improve efficiencies and reduce risks for future spaceflight. An early window exists to conduct ground and flight demonstrations that make use of existing assets that were developed for the Space Shuttle and the Constellation programs. The work could be mostly performed using residual program civil servants, existing facilities and current commercial launch capabilities. Partnering these abilities with the emerging commercial sector, along with other government agencies, academia and with international partners would provide an affordable and timely approach to get the launch costs down for these payloads, while increasing the derived benefits to a larger community. There is a wide scope of varied technologies that are being considered to help future space exploration. However, the cost and schedule would be prohibitive to demonstrate all these in the near term. Determining which technologies would yield the best return in meeting our future space needs is critical to building an achievable Space Architecture that allows exploration beyond Low Earth Orbit. The best mix of technologies is clearly to be based on our future needs, but also must take into account the availability of existing assets and supporting partners. Selecting those technologies that have complimentary applications will provide the most knowledge, with reasonable cost, for future use The plan is to develop those applications that not only mature the technology but actually perform a useful task or mission. These might include such functions as satellite servicing, a propulsion stage, processing lunar regolith, generating and transmitting solar power, cryogenic fluid transfer and storage and artificial gravity. Applications have been selected for assessment for future consideration and are addressed in this paper. These applications have been made available to the various NASA study groups that are determining the next steps the Agency must take to secure a sound foundation for future space exploration The paper also addresses how follow-on demonstrations, as launch performance grows, can build on the earlier applications to provide increased benefits for both the commercial and scientific communities. The architecture of incrementally building upon previous successes and insights dramatically lowers the overall associated risk for developing and maturing the key enabling technologies. The goal is to establish a potential business case that encourages commercial activity, thereby reducing the cost for the demonstration while using the technology maturation in developing readiness for future space exploration with overall less risk.

Indirect costs in chronic obstructive pulmonary disease: a review of the economic burden on employers and individuals in the United States.

PubMed

Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

2014-01-01

To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987-2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%-18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27-63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3-19.4 days. Estimates of bed confinement range from 13-32 days per year. Estimated mean annual indirect costs were $893-$2,234/person (US dollars) with COPD ($1,521-$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%-61% of total costs, depending on the population studied. COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD.

Deep Brain Stimulation for Parkinson's Disease with Early Motor Complications: A UK Cost-Effectiveness Analysis.

PubMed

Fundament, Tomasz; Eldridge, Paul R; Green, Alexander L; Whone, Alan L; Taylor, Rod S; Williams, Adrian C; Schuepbach, W M Michael

2016-01-01

Parkinson's disease (PD) is a debilitating illness associated with considerable impairment of quality of life and substantial costs to health care systems. Deep brain stimulation (DBS) is an established surgical treatment option for some patients with advanced PD. The EARLYSTIM trial has recently demonstrated its clinical benefit also in patients with early motor complications. We sought to evaluate the cost-effectiveness of DBS, compared to best medical therapy (BMT), among PD patients with early onset of motor complications, from a United Kingdom (UK) payer perspective. We developed a Markov model to represent the progression of PD as rated using the Unified Parkinson's Disease Rating Scale (UPDRS) over time in patients with early PD. Evidence sources were a systematic review of clinical evidence; data from the EARLYSTIM study; and a UK Clinical Practice Research Datalink (CPRD) dataset including DBS patients. A mapping algorithm was developed to generate utility values based on UPDRS data for each intervention. The cost-effectiveness was expressed as the incremental cost per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were undertaken to explore the effect of parameter uncertainty. Over a 15-year time horizon, DBS was predicted to lead to additional mean cost per patient of £26,799 compared with BMT (£73,077/patient versus £46,278/patient) and an additional mean 1.35 QALYs (6.69 QALYs versus 5.35 QALYs), resulting in an incremental cost-effectiveness ratio of £19,887 per QALY gained with a 99% probability of DBS being cost-effective at a threshold of £30,000/QALY. One-way sensitivity analyses suggested that the results were not significantly impacted by plausible changes in the input parameter values. These results indicate that DBS is a cost-effective intervention in PD patients with early motor complications when compared with existing interventions, offering additional health benefits at acceptable incremental cost. This supports the extended use of DBS among patients with early onset of motor complications.

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

PubMed Central

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

2014-01-01

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

Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

PubMed Central

Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

2014-01-01

Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

48 CFR 2152.244-70 - Subcontracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost or pricing data and Certificate of Current Cost or Pricing Data, if required by other contract... consideration controlling establishment of initial or revised prices; (iii) The reason cost or pricing data were... subcontractor's cost or pricing data in determining the price objective and in negotiating the final price; (v...

Environmental Assessment. Moanalua Shopping Center Redevelopment Oahu, Hawaii

DTIC Science & Technology

2004-08-01

redevelop the approximately 15-acre MSC site as in-kind consideration for the fair market rent which would be due under a 40-year lease of the...the existing approximately 15-acre (6-hectare) MSC site as in-kind consideration for the fair market rent which would be due under a 40-year lease of...would redevelop the existing MSC site as in-kind consideration for the fair market rent which would be due under a 40-year lease of the properties

Integrated Cost Accounting System.

DTIC Science & Technology

1992-07-27

D., Srikant M. Datar, and Sunder Kekre . "Relevant Costs, Congestion, and Stochasticity in Production Environments." unpublished working paper...School, 1984. 113 Kekre , Sunder . "Strategic Consideration of Order Flexibility, Costs, and Delivery in Long-Term Contracts." Unpublished Working Paper

Energy efficiency in California laboratory-type facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mills, E.; Bell, G.; Sartor, D.

The central aim of this project is to provide knowledge and tools for increasing the energy efficiency and performance of new and existing laboratory-type facilities in California. We approach the task along three avenues: (1) identification of current energy use and savings potential, (2) development of a {ital Design guide for energy- Efficient Research Laboratories}, and (3) development of a research agenda for focused technology development and improving out understanding of the market. Laboratory-type facilities use a considerable amount of energy resources. They are also important to the local and state economy, and energy costs are a factor in themore » overall competitiveness of industries utilizing laboratory-type facilities. Although the potential for energy savings is considerable, improving energy efficiency in laboratory-type facilities is no easy task, and there are many formidable barriers to improving energy efficiency in these specialized facilities. Insufficient motivation for individual stake holders to invest in improving energy efficiency using existing technologies as well as conducting related R&D is indicative of the ``public goods`` nature of the opportunity to achieve energy savings in this sector. Due to demanding environmental control requirements and specialized processes, laboratory-type facilities epitomize the important intersection between energy demands in the buildings sector and the industrial sector. Moreover, given the high importance and value of the activities conducted in laboratory-type facilities, they represent one of the most powerful contexts in which energy efficiency improvements stand to yield abundant non-energy benefits if properly applied.« less

Local, national, and service component cost variations in the management of low back pain: Considerations for the clinician.

PubMed

Babu, Ashwin N; McCormick, Zachary; Kennedy, David J; Press, Joel

2016-11-21

In the past two decades, the cost associated with managing low back pain has increased significantly. Improved consciousness of how clinicians utilize resources when managing low back pain is necessary in the current economic climate. The goal of this review is to examine the component costs associated with managing low back pain and provide practical solutions for reducing healthcare costs. This is accomplished by utilizing examples from a major metropolitan area with several major academic institutions and private health care centers. It is clear that there is considerable local and national variation in the component costs of managing low back pain, including physician visits, imaging studies, medications, and therapy services. By being well informed about these variations in one's environment, clinicians and patients alike can make strides towards reducing the financial impact of low back pain. Investigation of the cost discrepancies for services within one's community of practice is important. Improved public access to both cost and outcomes data is needed.

A National Approach to Reimbursement Decision-Making on Drugs for Rare Diseases in Canada? Insights from Across the Ponds.

PubMed

Short, Hilary; Stafinski, Tania; Menon, Devidas

2015-05-01

Regardless of the type of health system or payer, coverage decisions on drugs for rare diseases (DRDs) are challenging. While these drugs typically represent the only active treatment option for a progressive and/or life-threatening condition, evidence of clinical benefit is often limited because of small patient populations and the costs are high. Thus, decisions come with considerable uncertainty and risk. In Canada, interest in developing a pan-Canadian decision-making approach informed by international experiences exists. To develop an inventory of existing policies and processes for making coverage decisions on DRDs around the world. A systematic review of published and unpublished documents describing current policies and processes in the top 20 gross domestic product countries was conducted. Bibliographic databases, the Internet and government/health technology assessment organization websites in each country were searched. Two researchers independently extracted information and tabulated it to facilitate qualitative comparative analyses. Policy experts from each country were contacted and asked to review the information collected for accuracy and completeness. Almost all countries have multiple mechanisms through which coverage for a DRD may be sought. However, they typically begin with a review that follows the same process as drugs for more common conditions (i.e., the centralized review process), although specific submission requirements could differ (e.g., no need to submit a cost-effectiveness analysis). When drugs fail to receive a positive recommendation/decision, they are reconsidered by "safety net"-type programs. Eligibility criteria vary across countries, as do the decision options, which may be applied to individual patients or patient groups. With few exceptions, countries have not created separate centralized review processes for DRDs. Instead, they have modified components of existing mechanisms and added safety nets. Copyright © 2015 Longwoods Publishing.

Cost considerations in database selection - A comparison of DIALOG and ESA/IRS

NASA Technical Reports Server (NTRS)

Jack, R. F.

1984-01-01

It is pointed out that there are many factors which affect the decision-making process in determining which databases should be selected for conducting the online search on a given topic. In many cases, however, the major consideration will be related to cost. The present investigation is concerned with a comparison of the costs involved in making use of DIALOG and the European Space Agency's Information Retrieval Service (ESA/IRS). The two services are very comparable in many respects. Attention is given to pricing structure, telecommunications, the number of databases, prints, time requirements, a table listing online costs for DIALOG and ESA/IRS, and differences in mounting databases. It is found that ESA/IRS is competitively priced when compared to DIALOG, and, despite occasionally higher telecommunications costs, may be even more economical to use in some cases.

Introduction to Local Area Networks for Microcomputers — Characteristics, Costs, Implementation Considerations

PubMed Central

Haney, James P.

1984-01-01

The essence of a local area network (LAN) is that the whole is greater than the sum of its parts. A local area network can save in hardware costs when expensive peripherals are shared; it can save time when large blocks of data are rapidly exchanged among users. The need for more cost-effective and capable communications has inspired the emergence of rapidly developing markets and technologies for local area networks. The purpose of this paper is to provide an understanding of the characteristics, components, costs, and implementation considerations of local area networks. The paper does not compare or define specific vendor offerings; however, recent IBM announcements regarding local area networks are summarized in the last section of the paper.

A System Dynamics Approach for the Selection of Contaminated Land Management Options

NASA Astrophysics Data System (ADS)

McKnight, U. S.; Kuebert, M.; Finkel, M.; Bieg, M.

2006-12-01

Large-scale contaminated land and groundwater is a widespread problem that can severely impact human health, the environment and the economy at many urban sites all over the world. Usually a considerable number of potential management solutions exist at each of these sites. A detailed investigation of all these options, however, is not economically feasible which makes streamlining of the planning and decision process a mandatory requirement. Decisions to be taken should be made as early as possible in order to reduce expenditures on site investigation. Therefore, a tiered decision-making procedure is required, including (i) identification and prioritization of focal areas of risks, (ii) feasibility screening of remediation targets and available management alternatives to narrow the range of possible options for (iii) subsequent detailed investigations of only a select group of preferable options. For each of these elements, tailored decision and investigation concepts are required. These concepts and applied methods should be specifically adapted to the type and scale of the particular decision to be taken- more target-oriented, cost-efficient investigation programs, as well as model-based assessment methods are needed (Ruegner et al. 2006). A gap exists within this framework with respect to preliminary assessment methodologies representing the first decision level. To fill this gap, a new system dynamics approach has been developed that represents the system of source- pathway-receptor sequences by means of a mass flux model. The dynamics are governed by the effects of possible remedial actions, which are described as mass flux change over time (Serapiglia et al. 2005). This approach has been implemented in the preliminary evaluation tool CARO-plus (Cost-efficiency Assessment of Remediation Options) that models the effects of potential remedial actions, including tackling the contaminant source and managing the groundwater plume. The model represents the causal relationships that exist between the state of the system, the effects of the technologies and their costs, and may considerably impact the outcome to be predicted. The tool enables a fast and effective "screening" of management scenarios using simplified approaches (analytical models). Replacing the concept of total cleanup of sites based on concentration standards, the evaluation tool contains risk modules that describe exposure pathways, i.e. transfer of contaminants from groundwater to the receptor "human being", in accordance to MEPAS (Strenge & Chamberlain 1995). As multiple lines of evidence may apply, the effects of remediation options can be analyzed on the basis of contaminant mass flux, concentrations, and/or risk indices (carcinogenic/noncarcinogenic). Costs are calculated in terms of net present values. Uncertainty is taken into account using Monte-Carlo sensitivity analyses. In the presentation, examples will be shown for how the proposed approach helps to pre-select compatible remediation options by giving an overview to the following set of questions: (i) what is the time scale for risks expected at a particular site, (ii) does the scenario reduce/control risk at the receptor, (iii) is the scenario compatible with cleanup objectives (e.g. in the case that concentration standards are still required for specific compounds present at a site), (iv) does the scenario satisfy cost objectives and can therefore be considered financially viable, (v) is the scenario acceptable to regulators and the community, and (vi) what factors are most critical to the decision-making process.

Cost consideration for aircraft configuration changes, 1

NASA Technical Reports Server (NTRS)

Tumlinson, R. R.

1975-01-01

The costs of improvements in aircraft drag reduction design changes are outlined in the context of production decisions. A drag reduction design with increased airframe weight requires cost increases for direct labor, overhead and direct expenses, plus general and administrative expenses.

Renewable generation technology choice and policies in a competitive electricity supply industry

NASA Astrophysics Data System (ADS)

Sarkar, Ashok

Renewable energy generation technologies have lower externality costs but higher private costs than fossil fuel-based generation. As a result, the choice of renewables in the future generation mix could be affected by the industry's future market-oriented structure because market objectives based on private value judgments may conflict with social policy objectives toward better environmental quality. This research assesses how renewable energy generation choices would be affected in a restructured electricity generation market. A multi-period linear programming-based model (Resource Planning Model) is used to characterize today's electricity supply market in the United States. The model simulates long-range (2000-2020) generation capacity planning and operation decisions under alternative market paradigms. Price-sensitive demand is used to simulate customer preferences in the market. Dynamically changing costs for renewables and a two-step load duration curve are used. A Reference Case represents the benchmark for a socially-optimal diffusion of renewables and a basis for comparing outcomes under alternative market structures. It internalizes externality costs associated with emissions of sulfur dioxide (SOsb2), nitrous oxides (NOsbx), and carbon dioxide (COsb2). A Competitive Case represents a market with many generation suppliers and decision-making based on private costs. Finally, a Market Power Case models the extreme case of market power: monopoly. The results suggest that the share of renewables would decrease (and emissions would increase) considerably in both the Competitive and the Market Power Cases with respect to the Reference Case. The reduction is greater in the Market Power Case due to pricing decisions under existing supply capability. The research evaluates the following environmental policy options that could overcome market failures in achieving an appropriate level of renewable generation: COsb2 emissions tax, SOsb2 emissions cap, renewable portfolio standards (RPS), and enhanced research and development (R&D). RPS would best ensure an appropriate share of renewables, whereas SOsb2 emissions caps would not support a shift to renewables in an era of inexpensive natural gas. The effectiveness of the policies are dependent on the market structure. If market power exists, the analyses indicate that generally higher levels of intervention would be necessary to achieve a shift to renewables.

Optimising UK urban road verge contributions to biodiversity and ecosystem services with cost-effective management.

PubMed

O'Sullivan, Odhran S; Holt, Alison R; Warren, Philip H; Evans, Karl L

2017-04-15

Urban road verges can contain significant biodiversity, contribute to structural connectivity between other urban greenspaces, and due to their proximity to road traffic are well placed to provide ecosystem services. Using the UK as a case study we review and critically evaluate a broad range of evidence to assess how this considerable potential can be enhanced despite financial, contractual and public opinion constraints. Reduced mowing frequency and other alterations would enhance biodiversity, aesthetics and pollination services, whilst delivering costs savings and potentially being publically acceptable. Retaining mature trees and planting additional ones is favourable to residents and would enhance biodiversity, pollution and climate regulation, carbon storage, and stormwater management. Optimising these services requires improved selection of tree species, and creating a more diverse tree stock. Due to establishment costs additional tree planting and maintenance could benefit from payment for ecosystem service schemes. Verges could also provide areas for cultivation of biofuels and possibly food production. Maximising the contribution of verges to urban biodiversity and ecosystem services is economical and becoming an increasingly urgent priority as the road network expands and other urban greenspace is lost, requiring enhancement of existing greenspace to facilitate sustainable urban development. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Technological substitution: the potential of plastic as primary packaging material in the US brewing industry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roeleveld, J.J.

1985-01-01

This dissertation develops a general model of technological substitution that could be of help to planners and decision makers in industry who are faced with the problems created by continual technological change. The model as presented differs from existing models in the theoretical literature because of its emphasis on analyzing current and potential technologies in an attempt to understand the underlying factors contributing to technological substitution. The general model and the cost model that is part of it belong to that step in the interactive planning cycle called the formulation of the mess. The methodology underlying the cost model ismore » a combination of life-cycle analysis (i.e., from raw materials in nature, through all intermediate products, to waste returned to the environment) and resoumetrics, which is an engineering approach to measuring all physical inputs required to produce a certain level of output. The models are illustrated with a specific field of interest: substitution of primary packaging technologies in the US brewing industry. The physical costs of packaging beer in different containers are compared. Strategic considerations for a brewery deciding to adopt plastic packaging technology are discussed. Attention is given to another potential fruitful application of the model in the field of technology transfer to developing countries.« less

Eagle RTS: A design of a regional transport

NASA Technical Reports Server (NTRS)

Bryer, Paul; Buckles, Jon; Lemke, Paul; Peake, Kirk

1992-01-01

The Eagle RTS (Regional Transport System) is a 66-passenger aircraft designed to satisfy the need for accessible and economical regional travel. The first design objective for the Eagle RTS is safety. Safety results primarily from avoidance of the hub airport air traffic, implementation of anti-stall characteristics by tailoring the canard, and proper positioning of the engines for blade shedding. To provide the most economical aircraft, the Eagle RTS will use existing technology to lower production and maintenance costs by decreasing the amount of new training required. In selecting the propulsion system, the effects on the environment were a main consideration. Two advantages of turbo-prop engines are the high fuel efficiency and low noise levels produced by this type of engine. This ensures the aircraft's usage during times of rising fuel costs and growing aircraft noise restrictions. The design of the Eagle RTS is for spoke-to-spoke transportation. It must be capable of landing on shorter runways and have speeds comparable to that of the larger aircraft to make its service beneficial to the airlines. With the use of turbo-prop engines and high lift devices, the Eagle RTS is highly adaptable to regional airports. The design topics discussed include: aerodynamics, stability, structures and materials, propulsion, and cost.

A strategic plan for integrating cost-effectiveness analysis into the US healthcare system.

PubMed

Neumann, Peter J; Palmer, Jennifer A; Daniels, Norman; Quigley, Karen; Gold, Marthe R; Chao, Schumarry

2008-04-01

The Panel on Integrating Cost-Effectiveness Considerations into Health Policy Decisions, composed of medical and pharmacy directors at public and private health plans, was convened to (1) explore the views of health plan purchasers about cost-effectiveness analysis (CEA) and (2) to develop a strategic plan for policymakers to address obstacles and to integrate CEA into health policy decisions, drawing on stakeholders as part of the solution. Panelists expressed strong support for a greater role for CEA in US health policy decisions, although they also highlighted barriers in the current system and challenges involved in moving forward. The strategic plan involves a series of activities to advance the use of CEA in the United States, including research and demonstration projects to illustrate potential gains from using the technique and ongoing consensus- building steps (eg, workshops, conferences, town meetings) involving a broad coalition of stakeholders. Funding and leadership from policymakers and nonprofit foundations will be needed, as well as the active engagement of legislators and business and consumer groups. Panelists emphasized the importance of the Medicare program taking a lead role, and the need for new "infrastructure," in the form of either a new institute for conducting research or increased funding for existing institutions.

24 CFR 200.96 - Certificates of actual cost.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Continuing Eligibility Requirements for Existing Projects Cost Certification § 200.96 Certificates of actual... before final endorsement, except that in the case of an existing project that does not require..., directors, stockholders, partners or other entity member ownership, of construction and other costs, as...

Work-related trauma, PTSD, and workers compensation legislation: Implications for practice and policy.

PubMed

Wise, Edward A; Beck, J Gayle

2015-09-01

The current review examines work-related traumatic events, with particular focus on posttraumatic stress disorder (PTSD) as a potential mental health outcome. Despite considerable empirical knowledge about trauma and PTSD, a gap exists with respect to laws undergirding Workers Compensation (WC) insurance coverage for work-related mental health injuries. In this article, state and federal WC statutes are examined with an eye toward coverage of PTSD following work-related trauma. Examples of differences between states, as well as state-specific idiosyncratic facets of WC laws, are discussed. Federal WC programs are also examined. Two policy issues are highlighted: (a) lack of parity between WC coverage for work-related physical versus mental health injuries and (b) lack of reliance on psychological science in scripting legislation and determining WC benefits. The cost of untreated PTSD following work-related trauma is examined, focusing on costs to the individual, the employer, and society at large. The authors provide 3 recommendations designed to address discrepancies related to compensable psychological injuries following work-related trauma exposure. (c) 2015 APA, all rights reserved).

A marketing clinical doctorate programs.

PubMed

Montoya, Isaac D; Kimball, Olive M

2007-01-01

Over the past decade, clinical doctorate programs in health disciplines have proliferated amid both support and controversy among educators, professional organizations, practitioners, administrators, and third-party payers. Supporters argue that the explosion of new knowledge and increasing sophistication of technology have created a need for advanced practice models to enhance patient care and safety and to reduce costs. Critics argue that necessary technological advances can be incorporated into existing programs and believe that clinical doctorates will increase health care costs, not reduce them. Despite the controversy, many health disciplines have advanced the clinical doctorate (the most recent is the doctor of nursing practice in 2004), with some professions mandating the doctorate as the entry-level degree (i.e., psychology, pharmacy, audiology, and so on). One aspect of the introduction of clinical doctoral degrees has been largely overlooked, and that is the marketing aspect. Because of marketing considerations, some clinical doctorates have been more successfully implemented and accepted than others. Marketing is composed of variables commonly known as "the four P's of marketing": product, price, promotion, and place. This report explores these four P's within the context of clinical doctorates in the health disciplines.

Thermal System Upgrade of the Space Environment Simulation Test Chamber

NASA Technical Reports Server (NTRS)

Desai, Ashok B.

1997-01-01

The paper deals with the refurbishing and upgrade of the thermal system for the existing thermal vacuum test facility, the Space Environment Simulator, at NASA's Goddard Space Flight Center. The chamber is the largest such facility at the center. This upgrade is the third phase of the long range upgrade of the chamber that has been underway for last few years. The first phase dealt with its vacuum system, the second phase involved the GHe subsystem. The paper describes the considerations of design philosophy options for the thermal system; approaches taken and methodology applied, in the evaluation of the remaining "life" in the chamber shrouds and related equipment by conducting special tests and studies; feasibility and extent of automation, using computer interfaces and Programmable Logic Controllers in the control system and finally, matching the old components to the new ones into an integrated, highly reliable and cost effective thermal system for the facility. This is a multi-year project just started and the paper deals mainly with the plans and approaches to implement the project successfully within schedule and costs.

A multi-period capacitated school location problem with modular equipment and closest assignment considerations

NASA Astrophysics Data System (ADS)

Delmelle, Eric M.; Thill, Jean-Claude; Peeters, Dominique; Thomas, Isabelle

2014-07-01

In rapidly growing urban areas, it is deemed vital to expand (or contract) an existing network of public facilities to meet anticipated changes in the level of demand. We present a multi-period capacitated median model for school network facility location planning that minimizes transportation costs, while functional costs are subject to a budget constraint. The proposed Vintage Flexible Capacitated Location Problem (ViFCLP) has the flexibility to account for a minimum school-age closing requirement, while the maximum capacity of each school can be adjusted by the addition of modular units. Non-closest assignments are controlled by the introduction of a parameter penalizing excess travel. The applicability of the ViFCLP is illustrated on a large US school system (Charlotte-Mecklenburg, North Carolina) where high school demand is expected to grow faster with distance to the city center. Higher school capacities and greater penalty on travel impedance parameter reduce the number of non-closest assignments. The proposed model is beneficial to policy makers seeking to improve the provision and efficiency of public services over a multi-period planning horizon.

Australia’s $40 per pack cigarette tax plans: the need to consider equity

PubMed Central

Smith, Katherine E

2018-01-01

In May 2016, the Australian Government announced that it would implement annual increases in tobacco excise of 12.5% up to and including 2020, raising the cost of a pack of cigarettes to $A40. This increase will lead to Australia having one of the highest prices of cigarettes in the world. Increasing the cost of tobacco is considered by public health experts to be one of the most effective strategies to reduce tobacco use, and is generally well supported by the public. However, tobacco tax increases differentially impact various subgroups of the population. Based on a review of existing literature, this paper examines some of the potential (unintended) consequences of the tax to individual and family income; illicit trade; social stigma and opportunities for lobbying by the tobacco industry. In light of these considerations, we offer strategies that might be used by policymakers to mitigate potential harms. While this paper focuses on the impacts primarily on populations in Australia, the consequences and strategies offered may be useful to other countries implementing tobacco excise increases. PMID:28396484

Infrastructure and the Virtual Observatory

NASA Astrophysics Data System (ADS)

Dowler, P.; Gaudet, S.; Schade, D.

2011-07-01

The modern data center is faced with architectural and software engineering challenges that grow along with the challenges facing observatories: massive data flow, distributed computing environments, and distributed teams collaborating on large and small projects. By using VO standards as key components of the infrastructure, projects can take advantage of a decade of intellectual investment by the IVOA community. By their nature, these standards are proven and tested designs that already exist. Adopting VO standards saves considerable design effort, allows projects to take advantage of open-source software and test suites to speed development, and enables the use of third party tools that understand the VO protocols. The evolving CADC architecture now makes heavy use of VO standards. We show examples of how these standards may be used directly, coupled with non-VO standards, or extended with custom capabilities to solve real problems and provide value to our users. In the end, we use VO services as major parts of the core infrastructure to reduce cost rather than as an extra layer with additional cost and we can deliver more general purpose and robust services to our user community.

Waste reduction and recycling initiatives in Japanese cities: lessons from Yokohama and Kamakura.

PubMed

Hotta, Yasuhiko; Aoki-Suzuki, Chika

2014-09-01

Waste reduction and recycling at the city level will acquire greater significance in the near future due to rising global volumes of waste. This paper seeks to identify policy-relevant drivers for successful promotion of waste reduction and recycling. Factors influencing the success of waste reduction and recycling campaigns are identified. Two case study cities in Japan which depict the successful use of the 3Rs (reduce, reuse and recycle) at the municipal level are presented. In these cases, the existence of incinerators, which are generally considered as disincentives for recycling, was not functioning as a disincentive but rather as an incentive for waste reduction. Owing to the high cost of incineration facilities, the movement to close incinerators has become a strong incentive for waste reduction and recycling in these two cities. The study suggests that careful consideration is necessary when making decisions concerning high-cost waste treatment facilities with high installation, maintenance and renewal outlays. In addition, intensive source separation and other municipal recycling initiatives have a high potential for producing positive results. © The Author(s) 2014.

Alleviating inequality in climate policy costs: an integrated perspective on mitigation, damage and adaptation

NASA Astrophysics Data System (ADS)

De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, D. P.

2016-07-01

Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of including adaptation and residual damage in equity considerations by determining how the allocation of emission allowances would change to counteract regional differences in total climate costs, defined as the costs of mitigation, adaptation, and residual damage. We compare emission levels resulting from a global carbon tax with two allocations of emission allowances under a global cap-and-trade system: one equating mitigation costs and one equating total climate costs as share of GDP. To account for uncertainties in both mitigation and adaptation, we use a model-comparison approach employing two alternative modeling frameworks with different damage, adaptation cost, and mitigation cost estimates, and look at two different climate goals. Despite the identified model uncertainties, we derive unambiguous results on the change in emission allowance allocation that could lessen the unequal distribution of adaptation costs and residual damages through the financial transfers associated with emission trading.

Relative Costs of Various Types of Assessments.

ERIC Educational Resources Information Center

Wheeler, Patricia H.

Issues of the relative costs of multiple choice tests and alternative types of assessment are explored. Before alternative assessments in large-scale or small-scale programs are used, attention must be given to cost considerations and the resources required to develop and implement the assessment. Major categories of cost to be considered are…

Research requirements to reduce maintenance costs of civil helicopters

NASA Technical Reports Server (NTRS)

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

1978-01-01

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

Cost-effectiveness analysis of the bivalent and quadrivalent human papillomavirus vaccines from a societal perspective in Colombia.

PubMed

Aponte-González, Johanna; Fajardo-Bernal, Luisa; Diaz, Jorge; Eslava-Schmalbach, Javier; Gamboa, Oscar; Hay, Joel W

2013-01-01

To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be 'cost-effective' vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

Cost-Effectiveness Analysis of the Bivalent and Quadrivalent Human Papillomavirus Vaccines from a Societal Perspective in Colombia

PubMed Central

Aponte-González, Johanna; Fajardo-Bernal, Luisa; Diaz, Jorge; Eslava-Schmalbach, Javier; Gamboa, Oscar; Hay, Joel W.

2013-01-01

Objective To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. Methods A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). Results At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be ‘cost-effective’ vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. Conclusions HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program. PMID:24260441

Mimetic Theory and Scapegoating in the Age of Cyberbullying: The Case of Phoebe Prince

ERIC Educational Resources Information Center

Norman, James O'Higgins; Connolly, Justin

2011-01-01

Whilst traditional forms of bullying have and continue to receive considerable attention in the literature, research on technology-enabled bullying remains in an embryonic stage and considerable deficits exist in our understanding of the nature, extent, dynamics and consequents of this new form of bullying. Of the limited studies that exist on…

Assessing the potential effects and cost-effectiveness of programmatic herpes zoster vaccination of elderly in the Netherlands

PubMed Central

2010-01-01

Background Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion of new vaccines in the Dutch National Immunization Program. Methods An analytical framework was used combining a checklist, which structured relevant data on the vaccine, pathogen and disease, and a cost-effectiveness analysis. The cost-effectiveness analysis was performed from a societal perspective, using a Markov-cohort-model. Simultaneous vaccination with influenza was assumed. Results Due to the combination of waning immunity after vaccination and a reduced efficacy of vaccination at high ages, the most optimal cost-effectiveness ratio (€21716 per QALY) for HZ vaccination in the Netherlands was found for 70-year olds. This estimated ratio is just above the socially accepted threshold in the Netherlands of €20000 per QALY. If additional reduction of postherpetic neuralgia was included, the cost-effectiveness ratio improved (~€10000 per QALY) but uncertainty for this scenario is high. Conclusions Vaccination against HZ at the age of 70 years seems marginally cost-effective in the Netherlands. Due to limited vaccine efficacy a considerable part of the disease burden caused by HZ will remain, even with optimal acceptance of programmatic vaccination. PMID:20707884

Assessing the potential effects and cost-effectiveness of programmatic herpes zoster vaccination of elderly in the Netherlands.

PubMed

van Lier, Alies; van Hoek, Albert Jan; Opstelten, Wim; Boot, Hein J; de Melker, Hester E

2010-08-13

Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion of new vaccines in the Dutch National Immunization Program. An analytical framework was used combining a checklist, which structured relevant data on the vaccine, pathogen and disease, and a cost-effectiveness analysis. The cost-effectiveness analysis was performed from a societal perspective, using a Markov-cohort-model. Simultaneous vaccination with influenza was assumed. Due to the combination of waning immunity after vaccination and a reduced efficacy of vaccination at high ages, the most optimal cost-effectiveness ratio (21716 euro per QALY) for HZ vaccination in the Netherlands was found for 70-year olds. This estimated ratio is just above the socially accepted threshold in the Netherlands of 20000 euro per QALY. If additional reduction of postherpetic neuralgia was included, the cost-effectiveness ratio improved (approximately 10000 euro per QALY) but uncertainty for this scenario is high. Vaccination against HZ at the age of 70 years seems marginally cost-effective in the Netherlands. Due to limited vaccine efficacy a considerable part of the disease burden caused by HZ will remain, even with optimal acceptance of programmatic vaccination.

How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.

PubMed

Azman, Andrew S; Golub, Jonathan E; Dowdy, David W

2014-10-30

Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850-2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706-6,392) in China, and $9,400 (95% UR 6,957-13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra case of active TB.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

PubMed Central

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2015-01-01

Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218

The effect of pre-existing health conditions on the cost of recovery from road traffic injury: insights from data linkage of medicare and compensable injury claims in Victoria, Australia.

PubMed

Hassani-Mahmooei, Behrooz; Berecki-Gisolf, Janneke; Hahn, Youjin; McClure, Roderick J

2016-04-29

Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury. Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis. PBS and MBS records dating from 12 months prior to injury were provided by the Department of Human Services (Canberra, Australia). Pre-injury use of health service items and pharmaceuticals were considered to indicate pre-existing health condition. Bayesian Model Averaging techniques were used to identify the items that were most strongly correlated with recovery cost. Multivariate regression models were used to determine the impact of these items on the cost of injury recovery in terms of compensated ambulance, hospital, medical, and overall claim cost. Out of the 738 study participants, 688 used at least one medical item (total of 15,625 items) and 427 used at least one pharmaceutical item (total of 9846). The total health service cost of recovery was $10,115,714. The results show that while pre-existing conditions did not have any significant impact on the total cost of recovery, categorical costs were affected: e.g. on average, for every anaesthetic in the year before the accident, hospital cost of recovery increased by 24 % [95 % CI: 13, 36 %] and for each pathological test related to established diabetes, hospital cost increased by $10,407 [5466.78, 15346.28]. For medical costs, each anaesthetic led to $258 higher cost [174.16, 341.16] and every prescription of drugs used in diabetes increased the cost by 8 % [5, 11 %]. Services related to pre-existing conditions, mainly chronic and surgery-related, are likely to increase certain components of cost of recovery after road traffic trauma but pre-existing physical health has little impact on the overall recovery costs.

Analysis and design of algorithm-based fault-tolerant systems

NASA Technical Reports Server (NTRS)

Nair, V. S. Sukumaran

1990-01-01

An important consideration in the design of high performance multiprocessor systems is to ensure the correctness of the results computed in the presence of transient and intermittent failures. Concurrent error detection and correction have been applied to such systems in order to achieve reliability. Algorithm Based Fault Tolerance (ABFT) was suggested as a cost-effective concurrent error detection scheme. The research was motivated by the complexity involved in the analysis and design of ABFT systems. To that end, a matrix-based model was developed and, based on that, algorithms for both the design and analysis of ABFT systems are formulated. These algorithms are less complex than the existing ones. In order to reduce the complexity further, a hierarchical approach is developed for the analysis of large systems.

Modelling of high-frequency structure-borne sound transmission on FEM grids using the Discrete Flow Mapping technique

NASA Astrophysics Data System (ADS)

Hartmann, Timo; Tanner, Gregor; Xie, Gang; Chappell, David; Bajars, Janis

2016-09-01

Dynamical Energy Analysis (DEA) combined with the Discrete Flow Mapping technique (DFM) has recently been introduced as a mesh-based high frequency method modelling structure borne sound for complex built-up structures. This has proven to enhance vibro-acoustic simulations considerably by making it possible to work directly on existing finite element meshes circumventing time-consuming and costly re-modelling strategies. In addition, DFM provides detailed spatial information about the vibrational energy distribution within a complex structure in the mid-to-high frequency range. We will present here progress in the development of the DEA method towards handling complex FEM-meshes including Rigid Body Elements. In addition, structure borne transmission paths due to spot welds are considered. We will present applications for a car floor structure.

Space station experiment definition: Long-term cryogenic fluid storage

NASA Technical Reports Server (NTRS)

Jetley, R. L.; Scarlotti, R. D.

1987-01-01

The conceptual design of a space station Technology Development Mission (TDM) experiment to demonstrate and evaluate cryogenic fluid storage and transfer technologies is presented. The experiment will be deployed on the initial operational capability (IOC) space station for a four-year duration. It is modular in design, consisting of three phases to test the following technologies: passive thermal technologies (phase 1), fluid transfer (phase 2), and active refrigeration (phase 3). Use of existing hardware was a primary consideration throughout the design effort. A conceptual design of the experiment was completed, including configuration sketches, system schematics, equipment specifications, and space station resources and interface requirements. These requirements were entered into the NASA Space Station Mission Data Base. A program plan was developed defining a twelve-year development and flight plan. Program cost estimates are given.

NASA technology utilization survey on composite materials

NASA Technical Reports Server (NTRS)

Leeds, M. A.; Schwartz, S.; Holm, G. J.; Krainess, A. M.; Wykes, D. M.; Delzell, M. T.; Veazie, W. H., Jr.

1972-01-01

NASA and NASA-funded contractor contributions to the field of composite materials are surveyed. Existing and potential non-aerospace applications of the newer composite materials are emphasized. Economic factors for selection of a composite for a particular application are weight savings, performance (high strength, high elastic modulus, low coefficient of expansion, heat resistance, corrosion resistance,), longer service life, and reduced maintenance. Applications for composites in agriculture, chemical and petrochemical industries, construction, consumer goods, machinery, power generation and distribution, transportation, biomedicine, and safety are presented. With the continuing trend toward further cost reductions, composites warrant consideration in a wide range of non-aerospace applications. Composite materials discussed include filamentary reinforced materials, laminates, multiphase alloys, solid multiphase lubricants, and multiphase ceramics. New processes developed to aid in fabrication of composites are given.

Satellite communications for disaster relief operations

NASA Technical Reports Server (NTRS)

Sivo, J. N.

1979-01-01

The use of existing and planned communication satellite systems to provide assistance in the implementation of disaster relief operations on a global basis was discussed along with satellite communications system implications and their potential impact on field operations in disaster situations. Consideration are given to the utilization of both INTELSAT and MARISAT systems operating at frequencies ranging from 1.5 to 4 GHz and to the size and type of ground terminals necessary for satellite access. Estimates of communication requirements for a global system are given. Some discussion of cost estimates for satellite services to support operations are included. Studies of communication satellites for both pre and post disaster applications conducted for NOAA are included as well as recent experiments conducted in conjunction with the Office of Foreign Disaster Assistance of the Agency for International Development.

The Influence of Boundary Layer Parameters on Interior Noise

NASA Technical Reports Server (NTRS)

Palumbo, Daniel L.; Rocha, Joana

2012-01-01

Predictions of the wall pressure in the turbulent boundary of an aerospace vehicle can differ substantially from measurement due to phenomena that are not well understood. Characterizing the phenomena will require additional testing at considerable cost. Before expending scarce resources, it is desired to quantify the effect of the uncertainty in wall pressure predictions and measurements on structural response and acoustic radiation. A sensitivity analysis is performed on four parameters of the Corcos cross spectrum model: power spectrum, streamwise and cross stream coherence lengths and Mach number. It is found that at lower frequencies where high power levels and long coherence lengths exist, the radiated sound power prediction has up to 7 dB of uncertainty in power spectrum levels with streamwise and cross stream coherence lengths contributing equally to the total.

Hypersonic airframe structures: Technology needs and flight test requirements

NASA Technical Reports Server (NTRS)

Stone, J. E.; Koch, L. C.

1979-01-01

Hypersonic vehicles, that may be produced by the year 2000, were identified. Candidate thermal/structural concepts that merit consideration for these vehicles were described. The current status of analytical methods, materials, manufacturing techniques, and conceptual developments pertaining to these concepts were reviewed. Guidelines establishing meaningful technology goals were defined and twenty-eight specific technology needs were identified. The extent to which these technology needs can be satisfied, using existing capabilities and facilities without the benefit of a hypersonic research aircraft, was assessed. The role that a research aircraft can fill in advancing this technology was discussed and a flight test program was outlined. Research aircraft thermal/structural design philosophy was also discussed. Programs, integrating technology advancements with the projected vehicle needs, were presented. Program options were provided to reflect various scheduling and cost possibilities.

Economic Considerations for Moving beyond the Kato-Katz Technique for Diagnosing Intestinal Parasites As We Move Towards Elimination.

PubMed

Turner, Hugo C; Bettis, Alison A; Dunn, Julia C; Whitton, Jane M; Hollingsworth, T Déirdre; Fleming, Fiona M; Anderson, Roy M

2017-06-01

While the need for more sensitive diagnostics for intestinal helminths is well known, the cost of developing and implementing new tests is considered relatively high compared to the Kato-Katz technique. Here, we review the reported costs of performing the Kato-Katz technique. We also outline several economic arguments we believe highlight the need for further investment in alternative diagnostics, and considerations that should be made when comparing their costs. In our opinion, we highlight that, without new diagnostic methods, it will be difficult for policy makers to make the most cost-effective decisions and that the potentially higher unit costs of new methods can be outweighed by the long-term programmatic benefits they have (such as the ability to detect the interruption of transmission). Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Collecting behavioural data using the world wide web: considerations for researchers

PubMed Central

Rhodes, S; Bowie, D; Hergenrather, K

2003-01-01

Objective: To identify and describe advantages, challenges, and ethical considerations of web based behavioural data collection. Methods: This discussion is based on the authors' experiences in survey development and study design, respondent recruitment, and internet research, and on the experiences of others as found in the literature. Results: The advantages of using the world wide web to collect behavioural data include rapid access to numerous potential respondents and previously hidden populations, respondent openness and full participation, opportunities for student research, and reduced research costs. Challenges identified include issues related to sampling and sample representativeness, competition for the attention of respondents, and potential limitations resulting from the much cited "digital divide", literacy, and disability. Ethical considerations include anonymity and privacy, providing and substantiating informed consent, and potential risks of malfeasance. Conclusions: Computer mediated communications, including electronic mail, the world wide web, and interactive programs will play an ever increasing part in the future of behavioural science research. Justifiable concerns regarding the use of the world wide web in research exist, but as access to, and use of, the internet becomes more widely and representatively distributed globally, the world wide web will become more applicable. In fact, the world wide web may be the only research tool able to reach some previously hidden population subgroups. Furthermore, many of the criticisms of online data collection are common to other survey research methodologies. PMID:12490652

Collecting behavioural data using the world wide web: considerations for researchers.

PubMed

Rhodes, S D; Bowie, D A; Hergenrather, K C

2003-01-01

To identify and describe advantages, challenges, and ethical considerations of web based behavioural data collection. This discussion is based on the authors' experiences in survey development and study design, respondent recruitment, and internet research, and on the experiences of others as found in the literature. The advantages of using the world wide web to collect behavioural data include rapid access to numerous potential respondents and previously hidden populations, respondent openness and full participation, opportunities for student research, and reduced research costs. Challenges identified include issues related to sampling and sample representativeness, competition for the attention of respondents, and potential limitations resulting from the much cited "digital divide", literacy, and disability. Ethical considerations include anonymity and privacy, providing and substantiating informed consent, and potential risks of malfeasance. Computer mediated communications, including electronic mail, the world wide web, and interactive programs will play an ever increasing part in the future of behavioural science research. Justifiable concerns regarding the use of the world wide web in research exist, but as access to, and use of, the internet becomes more widely and representatively distributed globally, the world wide web will become more applicable. In fact, the world wide web may be the only research tool able to reach some previously hidden population subgroups. Furthermore, many of the criticisms of online data collection are common to other survey research methodologies.

A vision for chronic disease prevention intervention research: report from a workshop.

PubMed

Ashbury, Frederick D; Little, Julian; Ioannidis, John P A; Kreiger, Nancy; Palmer, Lyle J; Relton, Clare; Taylor, Peter

2014-04-17

The Population Studies Research Network of Cancer Care Ontario hosted a strategic planning workshop to establish an agenda for a prevention intervention research program in Ontario, including priority topics for investigation and design considerations. The two-day workshop included: presentations on background papers developed to facilitate participants' preparation for and discussions in the workshop; keynote presentations on intervention research concerning primary prevention of chronic diseases, design and study implementation considerations; a dedicated session on critical and creative thinking to stimulate participation and discussion topics; break out groups to identify, discuss and present study ideas, designs, implementation considerations; and a consensus process to discuss and identify recommendations for research priorities and next steps. The retreat yielded the following recommendations: 1) develop an intervention research agenda that includes working with existing large-scale cohorts; 2) develop an intervention research agenda that includes novel research designs that could target individuals or groups; and 3) develop an intervention research agenda in which studies collect data on costs, define stakeholders, and ensure clear strategies for stakeholder engagement and knowledge transfer. The Population Studies Research Network will develop options from these recommendations and release a call for proposals in 2014 for intervention research pilot projects that reflect these recommendations. Pilot projects will be evaluated based on their fit with the retreat's recommendations, and their potential to scale up to full studies and application in practice.

Mind the gaps: what's missing from current economic evaluations of universal HPV vaccination?

PubMed

Marsh, Kevin; Chapman, Ruth; Baggaley, Rebecca F; Largeron, Nathalie; Bresse, Xavier

2014-06-24

Since the original licensing of human papilloma virus (HPV) vaccination for women, evidence is accumulating of its effectiveness in preventing HPV-related conditions in men, and universal vaccination (vaccinating men and women) is now recommended in some countries. Several models of the cost-effectiveness of universal HPV vaccination have been published, but results have been mixed. This article assesses the extent to which economic studies have captured the range of values associated with universal HPV vaccination, and how this influences estimates of its cost-effectiveness. Eight published economic evaluations of universal HPV vaccination were reviewed to identify which of the values associated with universal HPV vaccination were included in each analysis. Studies of the cost-effectiveness of universal HPV vaccination capture only a fraction of the values generated. Most studies focused on impacts on health and health system cost, and only captured these partially. A range of values is excluded from most studies, including impacts on productivity, patient time and costs, carers and family costs, and broader social values such as the right to access treatment. Further, those studies that attempted to capture these values only did so partially. Decisions to invest in universal HPV vaccination need to be based on a complete assessment of the value that it generates. This is not provided by existing economic evaluations. Further work is required to understand this value. First, research is required to understand how HPV-related health outcomes impact on society including, for instance, their impact on productivity. Second, consideration should be given to alternative approaches to capture this broader set of values in a manner useful to decisions-makers, such as multi-criteria decision analysis. Copyright © 2014 Elsevier Ltd. All rights reserved.

Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

PubMed

Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

2016-03-01

Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Soil-transmitted helminthiasis in Latin America and the Caribbean: modelling the determinants, prevalence, population at risk and costs of control at sub-national level.

PubMed

Colston, Josh; Saboyá, Martha

2013-05-01

We present an example of a tool for quantifying the burden, the population in need of intervention and resources need to contribute for the control of soil-transmitted helminth (STH) infection at multiple administrative levels for the region of Latin America and the Caribbean (LAC). The tool relies on published STH prevalence data along with data on the distribution of several STH transmission determinants for 12,273 sub-national administrative units in 22 LAC countries taken from national censuses. Data on these determinants was aggregated into a single risk index based on a conceptual framework and the statistical significance of the association between this index and the STH prevalence indicators was tested using simple linear regression. The coefficient and constant from the output of this regression was then put into a regression formula that was applied to the risk index values for all of the administrative units in order to model the estimated prevalence of each STH species. We then combine these estimates with population data, treatment thresholds and unit cost data to calculate total control costs. The model predicts an annual cost for the procurement of preventive chemotherapy of around US$ 1.7 million and a total cost of US$ 47 million for implementing a comprehensive STH control programme targeting an estimated 78.7 million school-aged children according to the WHO guidelines throughout the entirety of the countries included in the study. Considerable savings to this cost could potentially be made by embedding STH control interventions within existing health programmes and systems. A study of this scope is prone to many limitations which restrict the interpretation of the results and the uses to which its findings may be put. We discuss several of these limitations.

Are telehealth technologies for hypertension care and self-management effective or simply risky and costly?

PubMed

McKoy, June; Fitzner, Karen; Margetts, Miranda; Heckinger, Elizabeth; Specker, James; Roth, Laura; Izenberg, Maxwell; Siegel, Molly; McKinney, Shannon; Moss, Gail

2015-06-01

Hypertension is a prevalent chronic disease that requires ongoing management and self-care. The disease affects 31% of American adults and contributed to or caused the deaths of 348,000 Americans in 2008, fewer than 50% of whom effectively self-managed the disease. However, self-management is complex, with patients requiring ongoing support and easy access to care. Telehealth may help foster the knowledge and skills necessary for those with hypertension to engage in successful self-management. This paper considers the applicability, efficacy, associated risks, and cost-effectiveness of telehealth for individuals and populations with hypertension. Telehealth is a broad term, encompassing telemedicine and mobile health that is used for physician-patient interactions, diagnostics, care delivery, education, information sharing, monitoring, and reminders. Telemedicine may have considerable utility for people diagnosed with hypertension who have poor access or social barriers that constrain access, but potential risks exist. Telehealth technology is evolving rapidly, even in the absence of fully proven cost-effectiveness and efficacy. Considering the cost of inpatient and emergency department care for patients with hypertension, telehealth is a highly attractive alternative, but there are risks to consider. Incorporating telehealth, which is increasingly characterized by mobile health, can increase both the capacity of health care providers and the reach of patient support, clinical management, and self-care. Telehealth studies need improvement; long-term outcome data on cardiovascular events must be obtained, and robust risk analyses and economic studies are needed to prospectively evaluate the safety and cost savings for hypertension self-management.

Design considerations for legalizing cannabis: lessons inspired by analysis of California's Proposition 19.

PubMed

Caulkins, Jonathan P; Kilmer, Beau; MacCoun, Robert J; Pacula, Rosalie Liccardo; Reuter, Peter

2012-05-01

No modern jurisdiction has ever legalized commercial production, distribution and possession of cannabis for recreational purposes. This paper presents insights about the effect of legalization on production costs and consumption and highlights important design choices. Insights were uncovered through our analysis of recent legalization proposals in California. The effect on the cost of producing cannabis is largely based on existing estimates of current wholesale prices, current costs of producing cannabis and other legal agricultural goods, and the type(s) of production that will be permitted. The effect on consumption is based on production costs, regulatory regime, tax rate, price elasticity of demand, shape of the demand curve and non-price effects (e.g. change in stigma). Removing prohibitions on producing and distributing cannabis will dramatically reduce wholesale prices. The effect on consumption and tax revenues will depend on many design choices, including: the tax level, whether there is an incentive for a continued black market, whether to tax and/or regulate cannabinoid levels, whether there are allowances for home cultivation, whether advertising is restricted, and how the regulatory system is designed and adjusted. The legal production costs of cannabis will be dramatically below current wholesale prices, enough so that taxes and regulation will be insufficient to raise retail price to prohibition levels. We expect legalization will increase consumption substantially, but the size of the increase is uncertain since it depends on design choices and the unknown shape of the cannabis demand curve. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

A Monte Carlo simulation of advanced HIV disease: application to prevention of CMV infection.

PubMed

Paltiel, A D; Scharfstein, J A; Seage, G R; Losina, E; Goldie, S J; Weinstein, M C; Craven, D E; Freedberg, K A

1998-01-01

Disagreement exists among decision makers regarding the allocation of limited HIV patient care resources and, specifically, the comparative value of preventing opportunistic infections in late-stage disease. A Monte Carlo simulation framework was used to evaluate a state-transition model of the natural history of HIV illness in patients with CD4 counts below 300/mm3 and to project the costs and consequences of alternative strategies for preventing AIDS-related complications. The authors describe the model and demonstrate how it may be employed to assess the cost-effectiveness of oral ganciclovir for prevention of cytomegalovirus (CMV) infection. Ganciclovir prophylaxis confers an estimated additional 0.7 quality-adjusted month of life at a net cost of $10,700, implying an incremental cost-effectiveness ratio of roughly $173,000 per quality-adjusted life year gained. Sensitivity analysis reveals that this baseline result is stable over a wide range of input data estimates, including quality of life and drug efficacy, but it is sensitive to CMV incidence and drug price assumptions. The Monte Carlo simulation framework offers decision makers a powerful and flexible tool for evaluating choices in the realm of chronic disease patient care. The authors have used it to assess HIV-related treatment options and continue to refine it to reflect advances in defining the pathogenesis and treatment of AIDS. Compared with alternative interventions, CMV prophylaxis does not appear to be a cost-effective use of scarce HIV clinical care funds. However, targeted prevention in patients identified to be at higher risk for CMV-related disease may warrant consideration.

Cost considerations for long-term ecological monitoring

USGS Publications Warehouse

Caughlan, L.; Oakley, K.L.

2001-01-01

For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program’s focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs, what dollars are spent on, and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program’s longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occurs during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost-effectiveness, of each program element can be evaluated. Moving into the implementation phase without careful evaluation of costs and benefits is risky because if costs are later found to exceed benefits, the program will fail. The costs of development, which can be quite high, will have been largely wasted. Realistic expectations of costs and benefits will help ensure that monitoring programs survive the early, turbulent stages of development and the challenges posed by fluctuating budgets during implementation.

The fee-for-service shift to bundled payments: financial considerations for hospitals.

PubMed

Scamperle, Keely

2013-01-01

Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

Energy monitoring in gins

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for cotton gins, accounting for 27% of variable costs. Energy use has typically not been a major consideration in gin design, and previous studies of energy use have utilized instantaneous readings or aggregated season-long values. In this...

Energy Monitoring in Gins - 2011

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for gins, accounting for 27% of variable costs. Energy use has typically not been a major consideration in gin design and previous studies of energy use have utilized instantaneous readings or aggregated season-long values. Electricity u...

Electricity use patterns in cotton gins

USDA-ARS?s Scientific Manuscript database

Energy costs are the second largest source of variable costs for cotton gins, with electricity accounting for 18% of variable costs. Energy use has typically not been a major consideration in gin design and previous studies of energy use have utilized instantaneous readings or aggregated season-lon...

Operational Reserve: Costs and Considerations

DTIC Science & Technology

material way. Findings include relevant RC costs at approximately 132% of those of a hypothetical equivalent AC unit. The primary contributor to...the Deputy Commandant for Manpower and Reserve Affairs (DC, M and RA), should monitor the totality of relevant monetary and non -monetary costs for any

BAUM: improving genome assembly by adaptive unique mapping and local overlap-layout-consensus approach.

PubMed

Wang, Anqi; Wang, Zhanyu; Li, Zheng; Li, Lei M

2018-06-15

It is highly desirable to assemble genomes of high continuity and consistency at low cost. The current bottleneck of draft genome continuity using the second generation sequencing (SGS) reads is primarily caused by uncertainty among repetitive sequences. Even though the single-molecule real-time sequencing technology is very promising to overcome the uncertainty issue, its relatively high cost and error rate add burden on budget or computation. Many long-read assemblers take the overlap-layout-consensus (OLC) paradigm, which is less sensitive to sequencing errors, heterozygosity and variability of coverage. However, current assemblers of SGS data do not sufficiently take advantage of the OLC approach. Aiming at minimizing uncertainty, the proposed method BAUM, breaks the whole genome into regions by adaptive unique mapping; then the local OLC is used to assemble each region in parallel. BAUM can (i) perform reference-assisted assembly based on the genome of a close species (ii) or improve the results of existing assemblies that are obtained based on short or long sequencing reads. The tests on two eukaryote genomes, a wild rice Oryza longistaminata and a parrot Melopsittacus undulatus, show that BAUM achieved substantial improvement on genome size and continuity. Besides, BAUM reconstructed a considerable amount of repetitive regions that failed to be assembled by existing short read assemblers. We also propose statistical approaches to control the uncertainty in different steps of BAUM. http://www.zhanyuwang.xin/wordpress/index.php/2017/07/21/baum. Supplementary data are available at Bioinformatics online.

WEEE flow and mitigating measures in China.

PubMed

Yang, Jianxin; Lu, Bin; Xu, Cheng

2008-01-01

The research presented in this paper shows that Waste Electrical and Electronic Equipment (WEEE) issues associated with home appliances, such as TV sets, refrigerators, washing machines, air conditioners, and personal computers, are linked in the WEEE flow and recycling systems and are important to matters of public policy and regulation. In this paper, the sources and generation of WEEE in China are identified, and WEEE volumes are calculated. The results show that recycling capacity must increase if the rising quantity of domestic WEEE is to be handled properly. Simultaneously, suitable WEEE treatment will generate large volumes of secondary resources. Environmental problems caused by the existing recycling processes have been investigated in a case study. Problems mainly stem from open burning of plastic-metal parts and from precious metals leaching techniques that utilize acids. The existing WEEE flow at the national level was investigated and described. It became obvious that a considerable amount of obsolete items are stored in homes and offices and have not yet entered the recycling system. The reuse of used appliances has become a high priority for WEEE collectors and dealers because reuse generates higher economic profits than simple material recovery. The results of a cost analysis of WEEE flow shows that management and collection costs significantly influence current WEEE management. Heated discussions are ongoing in political and administrative bodies as to whether extended producer responsibilities policies are promoting WEEE recycling and management. This paper also discusses future challenges and strategies for WEEE management in China.

Breaking out of the biomed box: an audit assessment and recommendations for an in-house biomedical engineering program.

PubMed

Dickey, David M; Jagiela, Steven; Fetters, Dennis

2003-01-01

In order to assess the current performance and to identify future growth opportunities of an in-house biomedical engineering (BME) program, senior management of Lehigh Valley Hospital (Allentown, Penn) engaged (in July 2001) the services of a clinical engineering consultant. Although the current in-house program was both functionally and financially sound, an independent audit had not been performed in over 4 years, and there were growing concerns by the BME staff related to the department's future leadership and long-term support from senior management. After an initial 2-month audit of the existing program, the consultant presented 41 separate recommendations for management's consideration. In order to refine and implement these recommendations, 5 separate committees were established to further evaluate a consolidated version of them, with the consultant acting as the facilitator for each group. Outcomes from each of the committees were used in the development of a formal business plan, which, upon full implementation, would not only strengthen and refine the current in-house service model but could also result in a substantial 3-year cost savings for the organization ($1,100,000 from existing operations, $500,000 in cost avoidance by in-sourcing postwarranty support of future capital equipment acquisitions). Another key outcome of the project was related to the development of a new master policy, titled the "Medical Equipment Management Program," complete with a newly defined state-of-the-art equipment scheduled inspection frequency model.

Effectiveness comparison of partially executed t-way test suite based generated by existing strategies

NASA Astrophysics Data System (ADS)

Othman, Rozmie R.; Ahmad, Mohd Zamri Zahir; Ali, Mohd Shaiful Aziz Rashid; Zakaria, Hasneeza Liza; Rahman, Md. Mostafijur

2015-05-01

Consuming 40 to 50 percent of software development cost, software testing is one of the most resource consuming activities in software development lifecycle. To ensure an acceptable level of quality and reliability of a typical software product, it is desirable to test every possible combination of input data under various configurations. Due to combinatorial explosion problem, considering all exhaustive testing is practically impossible. Resource constraints, costing factors as well as strict time-to-market deadlines are amongst the main factors that inhibit such consideration. Earlier work suggests that sampling strategy (i.e. based on t-way parameter interaction or called as t-way testing) can be effective to reduce number of test cases without effecting the fault detection capability. However, for a very large system, even t-way strategy will produce a large test suite that need to be executed. In the end, only part of the planned test suite can be executed in order to meet the aforementioned constraints. Here, there is a need for test engineers to measure the effectiveness of partially executed test suite in order for them to assess the risk they have to take. Motivated by the abovementioned problem, this paper presents the effectiveness comparison of partially executed t-way test suite generated by existing strategies using tuples coverage method. Here, test engineers can predict the effectiveness of the testing process if only part of the original test cases is executed.

Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease.

PubMed

Hopkins, Robert B; Garg, Amit X; Levin, Adeera; Molzahn, Anita; Rigatto, Claudio; Singer, Joel; Soltys, George; Soroka, Steven; Parfrey, Patrick S; Barrett, Brendan J; Goeree, Ron

2011-06-01

Potential cost and effectiveness of a nephrologist/nurse-based multifaceted intervention for stage 3 to 4 chronic kidney disease are not known. This study examines the cost-effectiveness of a chronic disease management model for chronic kidney disease. Cost and cost-effectiveness were prospectively gathered alongside a multicenter trial. The Canadian Prevention of Renal and Cardiovascular Endpoints Trial (CanPREVENT) randomized 236 patients to receive usual care (controls) and another 238 patients to multifaceted nurse/nephrologist-supported care that targeted factors associated with development of kidney and cardiovascular disease (intervention). Cost and outcomes over 2 years were examined to determine the incremental cost-effectiveness of the intervention. Base-case analysis included disease-related costs, and sensitivity analysis included all costs. Consideration of all costs produced statistically significant differences. A lower number of days in hospital explained most of the cost difference. For both base-case and sensitivity analyses with all costs included, the intervention group required fewer resources and had higher quality of life. The direction of the results was unchanged to inclusion of various types of costs, consideration of payer or societal perspective, changes to the discount rate, and levels of GFR. The nephrologist/nurse-based multifaceted intervention represents good value for money because it reduces costs without reducing quality of life for patients with chronic kidney disease.

[Hospital costs estimation by micro and gross-costing approaches].

PubMed

Guerre, P; Hayes, N; Bertaux, A-C

2018-03-01

Cost analysis has become increasingly commonplace in healthcare facilities in recent years. Regardless of the aim, the first consideration for a hospital costing process is to determine the point of view, or perspective, to adopt. Should the cost figures reflect the healthcare facility's point of view or enlighten perspectives for the public health insurance system? Another consideration is in regard to the method to adopt, as there are several. The two most widely used methods to determine the costs of hospital treatments in France are the micro-costing method and the gross-costing method. The aims of this work are: (1) to describe each of these methods (e.g. data collection, assignment of monetary value to resource consumption) with their advantages and shortcomings as they relate to the difficulties encountered with their implementation in hospitals; (2) to present a review of the literature comparing the two methods and their possible combination; and (3) to propose ways to address the questions that need to be asked before compiling resource consumption data and assigning monetary value to hospital costs. A final diagram summarizes methodologies to be preferred according to the evaluation strategy and the impact on patient care. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Ecosystem Services from Edible Insects in Agricultural Systems: A Review

PubMed Central

Payne, Charlotte L. R.; Van Itterbeeck, Joost

2017-01-01

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems. PMID:28218635

Piezoelectric technology in otolaryngology, and head and neck surgery: a review.

PubMed

Meller, C; Havas, T E

2017-07-01

Piezoelectric technology has existed for many years as a surgical tool for precise removal of soft tissue and bone. The existing literature regarding its use specifically for otolaryngology, and head and neck surgery was reviewed. The databases Medline, the Cochrane Central Register of Controlled Trials, PubMed, Embase and Cambridge Scientific Abstracts were searched. Studies were selected and reviewed based on relevance. Sixty studies were identified and examined for evidence of benefits and disadvantages of piezoelectric surgery and its application in otolaryngology. The technique was compared with traditional surgical methods, in terms of intra-operative bleeding, histology, learning curve, operative time and post-operative pain. Piezoelectric technology has been successfully employed, particularly in otology and skull base surgery, where its specific advantages versus traditional drills include a lack of 'blunting' and tissue selectivity. Technical advantages include ease of use, a short learning curve and improved visibility. Its higher cost warrants consideration given that clinically significant improvements in operative time and morbidity have not yet been proven. Further studies may define the evolving role of piezoelectric surgery in otolaryngology, and head and neck surgery.

Ecosystem Services from Edible Insects in Agricultural Systems: A Review.

PubMed

Payne, Charlotte L R; Van Itterbeeck, Joost

2017-02-17

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems.

Considerations for the Next Revision of NASA's Space Telecommunications Radio System Architecture

NASA Technical Reports Server (NTRS)

Johnson, Sandra K.; Handler, Louis M.; Briones, Janette C.

2016-01-01

Development of NASA's Software Defined Radio architecture, the Space Telecommunication Radio System (STRS), was initiated in 2004 with a goal of reducing the cost, risk and schedule when implementing Software Defined Radios (SDR) for National Aeronautics and Space Administration (NASA) space missions. Since STRS was first flown in 2012 on three Software Defined Radios on the Space Communication and Navigation (SCaN) Testbed, only minor changes have been made to the architecture. Multiple entities have since implemented the architecture and provided significant feedback for consideration for the next revision of the standard. The focus for the first set of updates to the architecture is items that enhance application portability. Items that require modifications to existing applications before migrating to the updated architecture will only be considered if there is compelling reasons to make the change. The significant suggestions that were further evaluated for consideration include expanding and clarifying the timing Application Programming Interfaces (APIs), improving handle name and identification (ID) definitions and use, and multiple items related to implementation of STRS Devices. In addition to ideas suggested while implementing STRS, SDR technology has evolved significantly and this impact to the architecture needs to be considered. These include incorporating cognitive concepts - learning from past decisions and making new decisions that the radio can act upon. SDRs are also being developed that do not contain a General Purpose Module - which is currently required for the platform to be STRS compliant. The purpose of this paper is to discuss the comments received, provide a summary of the evaluation considerations, and examine planned dispositions.

NREL: News - New Design Tool Analyzes Cost of Operating a Building Over its

Science.gov Websites

Lifetime Analyzes Cost of Operating a Building Over its Lifetime Golden, Colo., August 2, 2002 taking into consideration such factors as the initial cost of construction, mortgage payments, annual supply their own cost estimates. "Energy-10 allows the user to play 'what if' games while designing

Development and Implementation Costs of Student Learning Objectives: Considerations for TIF Grantees

ERIC Educational Resources Information Center

Fermanich, Mark; Carl, Brad; Finster, Matthew

2015-01-01

This brief explores the costs of developing and implementing Student Learning Objectives (SLOs) in order to help Teacher Incentive Fund (TIF) grantees interested in adopting SLOs anticipate and understand the costs of implementing them in a district or school. The brief focuses on the costs involved with the initial design and implementation of an…

18 CFR 367.50 - Service company property to be recorded at cost.

Code of Federal Regulations, 2010 CFR

2010-04-01

... property to be recorded at cost. 367.50 Section 367.50 Conservation of Power and Water Resources FEDERAL... cost. (a) All amounts included in the accounts for service company property must be stated at the cost... is other than cash, the value of the consideration must be determined on a cash basis (See, however...

[Screening for cancer - economic consideration and cost-effectiveness].

PubMed

Kjellberg, Jakob

2014-06-09

Cost-effectiveness analysis has become an accepted method to evaluate medical technology and allocate scarce health-care resources. Published decision analyses show that screening for cancer in general is cost-effective. However, cost-effectiveness analyses are only as good as the clinical data and the results are sensitive to the chosen methods and perspective of the analysis.

Launching a medicare advantage plan: smart planning saves headaches.

PubMed

Abrams, Robert J; Mullaney, Teri L

2007-11-01

If you're considering setting up a Medicare Advantage plan, the following are important considerations: Financial analysis. Payment rates. Medical costs. Marketing and operational costs. Technology infrastructure. Staffing.

Capturing Budget Impact Considerations Within Economic Evaluations: A Systematic Review of Economic Evaluations of Rotavirus Vaccine in Low- and Middle-Income Countries and a Proposed Assessment Framework.

PubMed

Carvalho, Natalie; Jit, Mark; Cox, Sarah; Yoong, Joanne; Hutubessy, Raymond C W

2018-01-01

In low- and middle-income countries, budget impact is an important criterion for funding new interventions, particularly for large public health investments such as new vaccines. However, budget impact analyses remain less frequently conducted and less well researched than cost-effectiveness analyses. The objective of this study was to fill the gap in research on budget impact analyses by assessing (1) the quality of stand-alone budget impact analyses, and (2) the feasibility of extending cost-effectiveness analyses to capture budget impact. We developed a budget impact analysis checklist and scoring system for budget impact analyses, which we then adapted for cost-effectiveness analyses, based on current International Society for Pharmacoeconomics and Outcomes Research Task Force recommendations. We applied both budget impact analysis and cost-effectiveness analysis checklists and scoring systems to examine the extent to which existing economic evaluations provide sufficient evidence about budget impact to enable decision making. We used rotavirus vaccination as an illustrative case in which low- and middle-income countries uptake has been limited despite demonstrated cost effectiveness. A systematic literature review was conducted to identify economic evaluations of rotavirus vaccine in low- and middle-income countries published between January 2000 and February 2017. We critically appraised the quality of budget impact analyses, and assessed the extension of cost-effectiveness analyses to provide useful budget impact information. Six budget impact analyses and 60 cost-effectiveness analyses were identified. Budget impact analyses adhered to most International Society for Pharmacoeconomics and Outcomes Research recommendations, with key exceptions being provision of undiscounted financial streams for each budget period and model validation. Most cost-effectiveness analyses could not be extended to provide useful budget impact information; cost-effectiveness analyses also rarely presented undiscounted annual costs, or estimated financial streams during the first years of programme scale-up. Cost-effectiveness analyses vastly outnumber budget impact analyses of rotavirus vaccination, despite both being critical for policy decision making. Straightforward changes to the presentation of cost-effectiveness analyses results could facilitate their adaptation into budget impact analyses.

Cost considerations in automating the library.

PubMed Central

Bolef, D

1987-01-01

The purchase price of a computer and its software is but a part of the cost of any automated system. There are many additional costs, including one-time costs of terminals, printers, multiplexors, microcomputers, consultants, workstations and retrospective conversion, and ongoing costs of maintenance and maintenance contracts for the equipment and software, telecommunications, and supplies. This paper examines those costs in an effort to produce a more realistic picture of an automated system. PMID:3594021

Consideration of Cosmetic Surgery As Part of Women’s Benefit-Provisioning Mate Retention Strategy

PubMed Central

Atari, Mohammad; Barbaro, Nicole; Sela, Yael; Shackelford, Todd K.; Chegeni, Razieh

2017-01-01

Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women’s consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women) in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective. PMID:28855884

A nationwide survey of patient centered medical home demonstration projects.

PubMed

Bitton, Asaf; Martin, Carina; Landon, Bruce E

2010-06-01

The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

Lunar Polar Coring Lander

NASA Technical Reports Server (NTRS)

Angell, David; Bealmear, David; Benarroche, Patrice; Henry, Alan; Hudson, Raymond; Rivellini, Tommaso; Tolmachoff, Alex

1990-01-01

Plans to build a lunar base are presently being studied with a number of considerations. One of the most important considerations is qualifying the presence of water on the Moon. The existence of water on the Moon implies that future lunar settlements may be able to use this resource to produce things such as drinking water and rocket fuel. Due to the very high cost of transporting these materials to the Moon, in situ production could save billions of dollars in operating costs of the lunar base. Scientists have suggested that the polar regions of the Moon may contain some amounts of water ice in the regolith. Six possible mission scenarios are suggested which would allow lunar polar soil samples to be collected for analysis. The options presented are: remote sensing satellite, two unmanned robotic lunar coring missions (one is a sample return and one is a data return only), two combined manned and robotic polar coring missions, and one fully manned core retrieval mission. One of the combined manned and robotic missions has been singled out for detailed analysis. This mission proposes sending at least three unmanned robotic landers to the lunar pole to take core samples as deep as 15 meters. Upon successful completion of the coring operations, a manned mission would be sent to retrieve the samples and perform extensive experiments of the polar region. Man's first step in returning to the Moon is recommended to investigate the issue of lunar polar water. The potential benefits of lunar water more than warrant sending either astronauts, robots or both to the Moon before any permanent facility is constructed.

48 CFR 48.104-4 - Sharing alternative-no-cost settlement method.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contract, the contracting officer shall analyze the different approaches available to determine which one... the contracting officer's judgment, reliance on other VECP approaches likely would not be more cost-effective, and the no-cost settlement would provide adequate consideration to the Government. Under this...

48 CFR 48.104-4 - Sharing alternative-no-cost settlement method.

Code of Federal Regulations, 2011 CFR

2011-10-01

... contract, the contracting officer shall analyze the different approaches available to determine which one... the contracting officer's judgment, reliance on other VECP approaches likely would not be more cost-effective, and the no-cost settlement would provide adequate consideration to the Government. Under this...

Designing Energy Supply Chains with the P-graph Framework under Cost Constraints and Sustainability Considerations

EPA Science Inventory

A computer-aided methodology for designing sustainable supply chains is presented using the P-graph framework to develop supply chain structures which are analyzed using cost, the cost of producing electricity, and two sustainability metrics: ecological footprint and emergy. They...

Designing Energy Supply Chains with the P-Graph Framework under Cost Constraints andSustainability Considerations

EPA Science Inventory

A computer-aided methodology for designing sustainable supply chains is presented using the P-graph framework to develop supply chain structures which are analyzed using cost, the cost of producing electricity, and two sustainability metrics: ecological footprint and emergy. They...

Methodological Considerations in Social Cost Studies of Addictive Substances: A Systematic Literature Review.

PubMed

Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

2016-01-01

Alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals' use is associated with a higher likelihood of developing several diseases and injuries and, as a consequence, considerable health-care expenditures. There is yet a lack of consistent methodologies to estimate the economic impact of addictive substances to society. The aim was to assess the methodological approaches applied in social cost studies estimating the economic impact of alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals. A systematic literature review through the electronic databases, Medline (PubMed) and Web of Science, was performed. Studies in English published from 1997 examining the social costs of the addictive substances alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals were eligible for inclusion. Twelve social cost studies met the inclusion criteria. In all studies, the direct and indirect costs were measured, but the intangible costs were seldom taken into account. A wide variety in cost items included across studies was observed. Sensitivity analyses to address the uncertainty around certain cost estimates were conducted in eight studies considered in the review. Differences in cost items included in cost-of-illness studies limit the comparison across studies. It is clear that it is difficult to deal with all consequences of substance use in cost-of-illness studies. Future social cost studies should be based on sound methodological principles in order to result in more reliable cost estimates of the economic burden of substance use.

Analysing and recommending options for maintaining universal coverage with long-lasting insecticidal nets: the case of Tanzania in 2011

PubMed Central

2013-01-01

Background Tanzania achieved universal coverage with long-lasting insecticidal nets (LLINs) in October 2011, after three years of free mass net distribution campaigns and is now faced with the challenge of maintaining high coverage as nets wear out and the population grows. A process of exploring options for a continuous or “Keep-Up” distribution system was initiated in early 2011. This paper presents for the first time a comprehensive national process to review the major considerations, findings and recommendations for the implementation of a new strategy. Methods Stakeholder meetings and site visits were conducted in five locations in Tanzania to garner stakeholder input on the proposed distribution systems. Coverage levels for LLINs and their decline over time were modelled using NetCALC software, taking realistic net decay rates, current demographic profiles and other relevant parameters into consideration. Costs of the different distribution systems were estimated using local data. Results LLIN delivery was considered via mass campaigns, Antenatal Care-Expanded Programme on Immunization (ANC/EPI), community-based distribution, schools, the commercial sector and different combinations of the above. Most approaches appeared unlikely to maintain universal coverage when used alone. Mass campaigns, even when combined with a continuation of the Tanzania National Voucher Scheme (TNVS), would produce large temporal fluctuations in coverage levels; over 10 years this strategy would require 63.3 million LLINs and a total cost of $444 million USD. Community mechanisms, while able to deliver the required numbers of LLINs, would require a massive scale-up in monitoring, evaluation and supervision systems to ensure accurate application of identification criteria at the community level. School-based approaches combined with the existing TNVS would reach most Tanzanian households and deliver 65.4 million LLINs over 10 years at a total cost of $449 million USD and ensure continuous coverage. The cost of each strategy was largely driven by the number of LLINs delivered. Conclusions The most cost-efficient strategy to maintain universal coverage is one that best optimizes the numbers of LLINs needed over time. A school-based approach using vouchers targeting all students in Standards 1, 3, 5, 7 and Forms 1 and 2 in combination with the TNVS appears to meet best the criteria of effectiveness, equity and efficiency. PMID:23641705

Cost of Special Education Programs in California.

ERIC Educational Resources Information Center

Keefe, R. F.; And Others

The document reports a study for the California State Department of Education to provide clarification of existing studies and reports on the cost of special education in California. Chapter 1 covers the background of the study, purpose and plan, study design (which included review of existing cost reports and studies and structured interviews…

Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: Review of current approaches

PubMed Central

Stärk, Katharina DC; Regula, Gertraud; Hernandez, Jorge; Knopf, Lea; Fuchs, Klemens; Morris, Roger S; Davies, Peter

2006-01-01

Background Emerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases. Discussion The principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems. Summary Risk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations. PMID:16507106

Social cost considerations and legal constraints in implementing modular integrated utility systems

NASA Technical Reports Server (NTRS)

Lede, N. W.; Dixon, H. W.; King, O.; Hill, D. K.

1974-01-01

Social costs associated with the design, demonstration, and implementation of the Modular Integrated Utility System are considered including the social climate of communities, leadership patterns, conflicts and cleavages, specific developmental values, MIUS utility goal assessment, and the suitability of certian alternative options for use in a program of implementation. General considerations are discussed in the field of socio-technological planning. These include guidelines for understanding the conflict and diversity; some relevant goal choices and ideas useful to planners of the MIUS facility.

Terrestrial adaptation of the thermal heliotrope.

NASA Technical Reports Server (NTRS)

Fairbanks, J. W.; Morse, F. H.

1971-01-01

The principle of using bimetal helical coils to cause solar arrays to track the sun in space is presently under consideration for array orientation on several spacecraft. Adaptation of this thermal heliotrope to terrestrial applications introduces additional design considerations. The dominance of solar-radiation energy input to the helical coil over convective energy losses has to be ensured, and wind effects must be minimized. As long as the cost of solar cells remains high, orientation will always result in a significant cost saving for the converter.

10 CFR 600.30 - Cost sharing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirement does not apply to: (1) An award under the small business innovation research program or the small..., taking into consideration any technological risk relating to the activity. (d) Cost share shall be...

Cost Considerations in Nonlinear Finite-Element Computing

NASA Technical Reports Server (NTRS)

Utku, S.; Melosh, R. J.; Islam, M.; Salama, M.

1985-01-01

Conference paper discusses computational requirements for finiteelement analysis using quasi-linear approach to nonlinear problems. Paper evaluates computational efficiency of different computer architecturtural types in terms of relative cost and computing time.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar

2017-05-05

This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign. This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them.

Reagent and labor cost optimization through automation of fluorescence in situ hybridization (FISH) with the VP 2000: an Italian case study.

PubMed

Zanatta, Lucia; Valori, Laura; Cappelletto, Eleonora; Pozzebon, Maria Elena; Pavan, Elisabetta; Dei Tos, Angelo Paolo; Merkle, Dennis

2015-02-01

In the modern molecular diagnostic laboratory, cost considerations are of paramount importance. Automation of complex molecular assays not only allows a laboratory to accommodate higher test volumes and throughput but also has a considerable impact on the cost of testing from the perspective of reagent costs, as well as hands-on time for skilled laboratory personnel. The following study tracked the cost of labor (hands-on time) and reagents for fluorescence in situ hybridization (FISH) testing in a routine, high-volume pathology and cytogenetics laboratory in Treviso, Italy, over a 2-y period (2011-2013). The laboratory automated FISH testing with the VP 2000 Processor, a deparaffinization, pretreatment, and special staining instrument produced by Abbott Molecular, and compared hands-on time and reagent costs to manual FISH testing. The results indicated significant cost and time saving when automating FISH with VP 2000 when more than six FISH tests were run per week. At 12 FISH assays per week, an approximate total cost reduction of 55% was observed. When running 46 FISH specimens per week, the cost saving increased to 89% versus manual testing. The results demonstrate that the VP 2000 processor can significantly reduce the cost of FISH testing in diagnostic laboratories. © 2014 Society for Laboratory Automation and Screening.

Study of activity based costing implementation for palm oil production using value-added and non-value-added activity consideration in PT XYZ palm oil mill

NASA Astrophysics Data System (ADS)

Sembiring, M. T.; Wahyuni, D.; Sinaga, T. S.; Silaban, A.

2018-02-01

Cost allocation at manufacturing industry particularly in Palm Oil Mill still widely practiced based on estimation. It leads to cost distortion. Besides, processing time determined by company is not in accordance with actual processing time in work station. Hence, the purpose of this study is to eliminates non-value-added activities therefore processing time could be shortened and production cost could be reduced. Activity Based Costing Method is used in this research to calculate production cost with Value Added and Non-Value-Added Activities consideration. The result of this study is processing time decreasing for 35.75% at Weighting Bridge Station, 29.77% at Sorting Station, 5.05% at Loading Ramp Station, and 0.79% at Sterilizer Station. Cost of Manufactured for Crude Palm Oil are IDR 5.236,81/kg calculated by Traditional Method, IDR 4.583,37/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.581,71/kg after implementation of Activity Improvement Meanwhile Cost of Manufactured for Palm Kernel are IDR 2.159,50/kg calculated by Traditional Method, IDR 4.584,63/kg calculated by Activity Based Costing Method before implementation of Activity Improvement and IDR 4.582,97/kg after implementation of Activity Improvement.

Cut Costs with Thin Client Computing.

ERIC Educational Resources Information Center

Hartley, Patrick H.

2001-01-01

Discusses how school districts can considerably increase the number of administrative computers in their districts without a corresponding increase in costs by using the "Thin Client" component of the Total Cost of Ownership (TCC) model. TCC and Thin Client are described, including its software and hardware components. An example of a…

76 FR 76640 - Telecommunications Act Accessibility Guidelines; Electronic and Information Technology...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-08

... benefits and costs, and recommended alternatives. The Board also invites the public to identify any gaps in... guidelines, alternative policies to those presented, and information on benefits and costs. After reviewing... with considerable potential cost in relation to the benefit. Because this requirement potentially would...

44 CFR 206.110 - Federal assistance to individuals and households.

Code of Federal Regulations, 2010 CFR

2010-10-01

... housing assistance to be provided under this section based on considerations of cost effectiveness... needs; or (4) Housing is not available on the private market. (i) Cost sharing. (1) Except as provided in paragraph (i)(2) of this section, the Federal share of eligible costs paid under this subpart...

CONSIDERATIONS IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which in...

48 CFR 215.404-73 - Alternate structured approaches.

Code of Federal Regulations, 2011 CFR

2011-10-01

... an element of contract cost (see FAR 31.205-10) and reductions were made directly to the profit... the alternate, but it shall include— (1) Consideration of the three basic components of profit... prenegotiation profit objective by the amount of facilities capital cost of money under Cost Accounting Standard...

48 CFR 215.404-73 - Alternate structured approaches.

Code of Federal Regulations, 2010 CFR

2010-10-01

... an element of contract cost (see FAR 31.205-10) and reductions were made directly to the profit... the alternate, but it shall include— (1) Consideration of the three basic components of profit... prenegotiation profit objective by the amount of facilities capital cost of money under Cost Accounting Standard...

CONSIDERATION IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which involve ...

Rhetoric vs. reality: employer views on consumer-driven health care.

PubMed

Trude, Sally; Conwell, Leslie

2004-07-01

Because of rising premiums, employers are investigating new health insurance approaches that maintain workers' broad choice of providers while raising awareness of health care costs through increased patient financial responsibility. Employers' knowledge of new health plan products, including consumer-driven health plans and tiered-provider networks, has grown considerably in recent years, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visit to 12 nationally representative communities. But employers are concerned that consumer-driven health plans would take considerable effort to implement without much cost savings. They also are skeptical that tiered-provider networks can adequately capture both cost and quality information in a way that is understandable to patients.

Paint it Black: One-Step Etch Cuts Solar Cell Costs - Continuum Magazine

Science.gov Websites

quicker, cheaper way to produce large volumes of high-performance PV devices. Cost is a major obstacle for propel PV toward cost-competitiveness. A New Approach to Antireflection Any light reflected from a solar etching large pyramids into the cell surface, add considerable cost to a solar cell-and they succeed only

Measuring the Cost of Quality in Higher Education: A Faculty Perspective

ERIC Educational Resources Information Center

Ruhupatty, LeRoy; Maguad, Ben A.

2015-01-01

Most critical activities in colleges and universities are driven by financial considerations. It is thus important that revenues are found to support these activities or ways identified to streamline costs. One way to cut cost is to improve the efficiency of schools to address the issue of poor quality. In this paper, the cost of poor quality in…

Sensitivity of whitewater rafting consumers surplus to pecuniary travel cost specifications

Treesearch

Donald B.K. English; J. Michael Bowker

1996-01-01

Considerable research has examined how different ways of accounting for onsite and travel time affect surplus estimates from travel cost models. However, little has been done regarding different definitions of out-of-pocket costs. Estimates of per trip consumer surplus are developed for a zonal travel cost model for outfitted rafting on the Chattooga River. Nine price...

The cost-effectiveness of health communication programs: what do we know?

PubMed

Hutchinson, Paul; Wheeler, Jennifer

2006-01-01

While a considerable body of evidence has emerged supporting the effectiveness of communication programs in augmenting health, only a very small subset of studies has examined also whether these programs are cost-effective, that is, whether they achieve greater health gains for available financial resources than alternative interventions. In this article, we examine the available literature on the cost-effectiveness of health behavior change communication programs, focusing on communication interventions involving mass media, and, to a lesser extent, community mobilization and interpersonal communication or counseling. Our objective is to identify the state of past and current research efforts of the cost-effectiveness of behavior change communication programs. This review makes three principal conclusions. First, the analysis of the cost-effectiveness of health communication programs commonly has not been performed. Second, the studies reviewed here have utilized a considerable diversity of methods and have reflected varying levels of quality and adherence to standard cost-effectiveness methodologies. This leads to problems of transparency, comparability, and generalizability. Third, while the available studies generally are indicative of the cost-effectiveness of communication interventions relative to alternatives, the evidence base clearly needs to be expanded by additional rigorous cost-effectiveness analyses.

Cost/Effort Drivers and Decision Analysis

NASA Technical Reports Server (NTRS)

Seidel, Jonathan

2010-01-01

Engineering trade study analyses demand consideration of performance, cost and schedule impacts across the spectrum of alternative concepts and in direct reference to product requirements. Prior to detailed design, requirements are too often ill-defined (only goals ) and prone to creep, extending well beyond the Systems Requirements Review. Though lack of engineering design and definitive requirements inhibit the ability to perform detailed cost analyses, affordability trades still comprise the foundation of these future product decisions and must evolve in concert. This presentation excerpts results of the recent NASA subsonic Engine Concept Study for an Advanced Single Aisle Transport to demonstrate an affordability evaluation of performance characteristics and the subsequent impacts on engine architecture decisions. Applying the Process Based Economic Analysis Tool (PBEAT), development cost, production cost, as well as operation and support costs were considered in a traditional weighted ranking of the following system-level figures of merit: mission fuel burn, take-off noise, NOx emissions, and cruise speed. Weighting factors were varied to ascertain the architecture ranking sensitivities to these performance figures of merit with companion cost considerations. A more detailed examination of supersonic variable cycle engine cost is also briefly presented, with observations and recommendations for further refinements.

78 FR 52854 - Use of Differential Income Stream as an Application of the Income Method and as a Consideration...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-27

... Differential Income Stream as an Application of the Income Method and as a Consideration in Assessing the Best Method AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations and removal of... differential income stream as a consideration in assessing the best method in connection with a cost sharing...

Life-cycle costing: Practical considerations

NASA Technical Reports Server (NTRS)

Eisenberger, I.; Lorden, G.

1977-01-01

The history and methodology of life-cycle costing are presented and analyzed, contrasting the potential benefits of the technique with the difficulties of its application. Examples and a short survey of the literature are given.

Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions

PubMed Central

Argent, Andrew C.

2018-01-01

It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC) in low- and middle-income countries (LMICs), and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available), likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions. PMID:29637061

[Atosiban treatment for preterm labor--financial considerations and savings by implementing clinical guidelines].

PubMed

Hadar, Eran; Mansur, Nariman; Ambar, Irit; Hod, Moshe

2011-06-01

Preterm delivery is a significant cause of neonatal morbidity and mortality. Pregnant women, with symptoms and signs consistent with preterm labor, can be treated with various tocolytic drugs. Atosiban is one of many drugs indicated to arrest imminent preterm labor. Various studies show that the efficacy of atosiban is similar to other tocolytic drugs. The main advantage of atosiban is a relativeLy low incidence of adverse maternal reactions. Its considerable shortcoming is the financial cost, compared to other available drugs. In view of its cost, we have decided to implement a strict protocol to direct the use of atosiban, with the intent to reduce costs, without hampering quality of care. The protocol was implemented from July 2009, and it outlines the medical and procedural terms to use atosiban. We compared similar time periods before and after implementation of the protocol. The outcomes compared included: treatment success, rates of preterm deliveries and financial costs. Within the timeframe that the protocol was implemented, we have been able to demonstrate a 40% reduction in atosiban related costs, compared to a parallel period, when the clinical guidelines were not implemented. This translates into savings of about NIS 40,000 (New Israeli Shekel) (approximately $10,000). This was achieved without an increase in the rate of preterm deliveries. Implementing and enforcing a simple protocol of supervision on the use of atosiban enables a considerable reduction of financial costs related to atosiban, without hampering medical care.

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics.

PubMed

Larson, Trent; Gudavalli, Ravindra; Prater, Dean; Sutton, Scott

2015-04-01

Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4-5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.

Design and analysis issues for economic analysis alongside clinical trials.

PubMed

Marshall, Deborah A; Hux, Margaret

2009-07-01

Clinical trials can offer a valuable and efficient opportunity to collect the health resource use and outcomes data for economic evaluation. However, economic and clinical studies differ fundamentally in the question they seek to answer. The design and analysis of trial-based cost-effectiveness studies require special consideration, which are reviewed in this article. Traditional randomized controlled trials, using an experimental design with a controlled protocol, are designed to measure safety and efficacy for product registration. Cost-effectiveness analysis seeks to measure effectiveness in the context of routine clinical practice, and requires collection of health care resources to allow estimation of cost over an equal timeframe for each treatment alternative. In assessing suitability of a trial for economic data collection, the comparator treatment and other protocol factors need to reflect current clinical practice and the trial follow-up must be sufficiently long to capture important costs and effects. The broadest available population and a measure of effectiveness reflecting important benefits for patients are preferred for economic analyses. Special analytical issues include dealing with missing and censored cost data, assessing uncertainty of the incremental cost-effectiveness ratio, and accounting for the underlying heterogeneity in patient subgroups. Careful consideration also needs to be given to data from multinational studies since practice patterns can differ across countries. Although clinical trials can be an efficient opportunity to collect data for economic evaluation, careful consideration of the suitability of the study design, and appropriate analytical methods must be applied to obtain rigorous results.

SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. We suggest four questions that can be considered when assessing resource use and the cost consequences of an option. These are: 1. What are the most important impacts on resource use? 2. What evidence is there for important impacts on resource use? 3. How confident is it possible to be in the evidence for impacts on resource use? 4. Have the impacts on resource use been valued appropriately in terms of their true costs? PMID:20018102

The role of satisfaction and switching costs in Medicare Part D choices.

PubMed

Han, Jayoung; Ko, Dong Woo; Urmie, Julie M

2014-01-01

Most U.S. states had over 50 Medicare Prescription Drug Plans (PDPs) in 2007. Medicare beneficiaries are expected to switch Part D plans based on their health and financial needs; however, the switching rate has been low. Such consumer inertia potentially has negative effects on both beneficiaries and the insurance market, resulting in a critical need to investigate its cause. To 1) describe how Medicare beneficiaries who were satisfied with their current Part D plan differed from those who were not satisfied; 2) examine the effect of switching costs on consideration of switching among Medicare beneficiaries who were dissatisfied with their current Part D plan. Data from the 2007 Prescription Drug Study supplement to the Health and Retirement Study (HRS) survey were used in this study. The satisfied and dissatisfied groups were compared in terms of cost variables, switching costs, and perception of Part D complexity. Structural equation modeling was used to examine relationships among switching costs, Part D complexity, cost variables, and consideration of switching for beneficiaries who were dissatisfied with their current Part D coverage. Out of 467 participants, a total of 255 (54.6%) were satisfied with their current Part D plan. The satisfied group paid lower out-of-pocket costs ($50.63 vs. $114.60) and premiums ($30.88 vs. $40.77) than the dissatisfied group. They also had lower switching costs. Only 11.3% of the dissatisfied beneficiaries switched plans. Among respondents who were dissatisfied with their current plan, those who perceived Part D as complex had high switching costs and were less likely to consider switching plans. Out-of-pocket cost did not have a statistically significant association with consideration of switching. Medicare beneficiaries who were satisfied with their current Part D plans had lower out-of-pocket costs and premiums as well as higher switching costs. Among beneficiaries who were dissatisfied with their current Part D plan, those who had higher switching costs were less likely to consider switching Part D plans. Copyright © 2014 Elsevier Inc. All rights reserved.

Changing perspectives of stress gastritis prophylaxis.

PubMed

Smythe, M A; Zarowitz, B J

1994-09-01

To present recent advances in stress gastritis prophylaxis in the critically ill and review considerations in selection of a prophylactic agent. Information was obtained from MEDLINE search, reference lists from articles identified in search, and from review articles. Emphasis was placed on controlled trials conducted within the last 5 years. All literature was assessed for methodology, results, and conclusions. Results of prospective, randomized trials, and meta-analyses are summarized. Histamine2-receptor antagonists, antacids, and sucralfate appear equally effective in preventing stress gastritis in the critically ill. A definitive cause-effect relationship between histamine2-receptor antagonists and increased incidence of nosocomial pneumonia has not yet been established. The indications for using a prophylactic agent and consideration in selecting an agent should include an evaluation of the following: risk factors for gastritis including the type of intensive care patient, comparative efficacy, adverse effects, drug interactions, cost, and ease of administration. The least expensive, safest agent requiring minimal monitoring is sucralfate. Prevention of stress gastritis has never been shown to reduce morbidity or mortality significantly. Controversies still exist regarding the need to provide prophylaxis, the choice of an agent, and the relative importance of previously identified risk factors. Further well-designed studies are needed before consensus can be reached.

The development, past achievements, and future directions of brain PET

PubMed Central

Jones, Terry; Rabiner, Eugenii A

2012-01-01

The early developments of brain positron emission tomography (PET), including the methodological advances that have driven progress, are outlined. The considerable past achievements of brain PET have been summarized in collaboration with contributing experts in specific clinical applications including cerebrovascular disease, movement disorders, dementia, epilepsy, schizophrenia, addiction, depression and anxiety, brain tumors, drug development, and the normal healthy brain. Despite a history of improving methodology and considerable achievements, brain PET research activity is not growing and appears to have diminished. Assessments of the reasons for decline are presented and strategies proposed for reinvigorating brain PET research. Central to this is widening the access to advanced PET procedures through the introduction of lower cost cyclotron and radiochemistry technologies. The support and expertize of the existing major PET centers, and the recruitment of new biologists, bio-mathematicians and chemists to the field would be important for such a revival. New future applications need to be identified, the scope of targets imaged broadened, and the developed expertize exploited in other areas of medical research. Such reinvigoration of the field would enable PET to continue making significant contributions to advance the understanding of the normal and diseased brain and support the development of advanced treatments. PMID:22434067

What Does a Swiss Franc Mortgage Cost? The Tale of Polish Trust for Foreign Currency Denominated Mortgages: Implications for Well-Being and Health.

PubMed

Białowolski, Piotr; Węziak-Białowolska, Dorota

2017-01-01

It is commonly agreed that excessive household financial debts are detrimental to psychological and physical health. Research also demonstrates that housing instability, mortgage indebtedness and mortgage foreclosure negatively influence subjective well-being. In Poland at the beginning of 2015, homeowners with Swiss franc denominated mortgages suffered from an abrupt swing in the Swiss franc/Polish zloty (CHF/PLN) exchange rate, which resulted in considerable increase in the local currency value of their mortgages. These adverse financial circumstances were hypothesised to affect not only household finance but also negatively affect the psychological well-being and physical health of peoples. The 2013 and 2015 waves of the Polish representative household panel 'Social Diagnosis' were used to examine impact of the abrupt change in the CHF/PLN exchange rate in Jan. 2015 on well-being and health. Causal inference was investigated using a difference-in-differences matching estimator. Results showed that although impact of Swiss franc appreciation on the mortgage related financial burden was considerable, it did not affect well-being or health outcomes. Any manifestation of adverse effects was absent in the short term, which does not however preclude their long term existence.

Planning for Long-Term Follow-Up: Strategies Learned from Longitudinal Studies.

PubMed

Hill, Karl G; Woodward, Danielle; Woelfel, Tiffany; Hawkins, J David; Green, Sara

2016-10-01

Preventive interventions are often designed and tested with the immediate program period in mind, and little thought that the intervention sample might be followed up for years or even decades beyond the initial trial. However, depending on the type of intervention and the nature of the outcomes, long-term follow-up may well be appropriate. The advantages of long-term follow-up of preventive interventions are discussed and include the capacity to examine program effects across multiple later life outcomes, the ability to examine the etiological processes involved in the development of the outcomes of interest, and the ability to provide more concrete estimates of the relative benefits and costs of an intervention. In addition, researchers have identified potential methodological risks of long-term follow-up such as inflation of type 1 error through post hoc selection of outcomes, selection bias, and problems stemming from attrition over time. The present paper presents a set of seven recommendations for the design or evaluation of studies for potential long-term follow-up organized under four areas: Intervention Logic Model, Developmental Theory and Measurement Issues; Design for Retention; Dealing with Missing Data; and Unique Considerations for Intervention Studies. These recommendations include conceptual considerations in the design of a study, pragmatic concerns in the design and implementation of the data collection for long-term follow-up, as well as criteria to be considered for the evaluation of an existing intervention for potential for long-term follow-up. Concrete examples from existing intervention studies that have been followed up over the long term are provided.

Planning for Long-Term Follow-up: Strategies Learned from Longitudinal Studies

PubMed Central

Hill, Karl G.; Woodward, Danielle; Woelfel, Tiffany; Hawkins, J. David; Green, Sara

2017-01-01

Preventive interventions are often designed and tested with the immediate program period in mind, and little thought that the intervention sample might be followed up for years, or even decades beyond the initial trial. However, depending on the type of intervention and the nature of the outcomes, long-term follow-up may well be appropriate. The advantages of long-term follow-up of preventive interventions are discussed, and include the capacity to examine program effects across multiple later life outcomes, the ability to examine the etiological processes involved in the development of the outcomes of interest and the ability to provide more concrete estimates of the relative benefits and costs of an intervention. In addition, researchers have identified potential methodological risks of long-term follow-up such as inflation of type 1 error through post-hoc selection of outcomes, selection bias and problems stemming from attrition over time. The present paper presents a set of seven recommendations for the design or evaluation of studies for potential long-term follow-up organized under four areas: Intervention Logic Model, Developmental Theory and Measurement Issues; Design for Retention; Dealing with Missing Data; and Unique Considerations for Intervention Studies. These recommendations include conceptual considerations in the design of a study, pragmatic concerns in the design and implementation of the data collection for long-term follow-up, as well as criteria to be considered for the evaluation of an existing intervention for potential for long-term follow-up. Concrete examples from existing intervention studies that have been followed up over the long-term are provided. PMID:26453453

SSTO vs TSTO design considerations—an assessment of the overall performance, design considerations, technologies, costs, and sensitivities of SSTO and TSTO designs using modern technologies

NASA Astrophysics Data System (ADS)

Penn, Jay P.

1996-03-01

It is generally believed by those skilled in launch system design that Single-Stage-To-Orbit (SSTO) designs are more technically challenging, more performance sensitive, and yield larger lift-off weights than do Two-Stage-To-Orbit designs (TSTO's) offering similar payload delivery capability. Without additional insight into the other considerations which drive the development, recurring costs, operability, and reliability of a launch fleet, an analyst may easily conclude that the higher performing, less sensitive TSTO designs, thus yield a better solution to achieving low cost payload delivery. This limited insight could justify an argument to eliminate the X-33 SSTO technology/demonstration development effort, and thus proceed directly to less risky TSTO designs. Insight into real world design considerations of launch vehicles makes the choice of SSTO vs TSTO much less clear. The presentation addresses a more comprehensive evaluation of the general class of SSTO and TSTO concepts. These include pure SSTO's, augmented SSTO's, Siamese Twin, and Pure TSTO designs. The assessment considers vehicle performance and scaling relationships which characterize real vehicle designs. The assessment also addresses technology requirements, operations and supportability, cost implications, and sensitivities. Results of the assessment indicate that the trade space between various SSTO and TSTO design approaches is complex and not yet fully understood. The results of the X-33 technology demonstrators, as well as additional parametric analysis is required to better define the relative performance and costs of the various design approaches. The results also indicate that with modern technologies and today's better understanding of vehicle design considerations, the perception that SSTO's are dramatically heavier and more sensitive than TSTO designs is more of a myth, than reality.

Economic considerations in the use of inhaled anesthetic agents.

PubMed

Golembiewski, Julie

2010-04-15

To describe the components of and factors contributing to the costs of inhaled anesthesia, basis for quantifying and comparing these costs, and practical strategies for performing pharmacoeconomic analyses and reducing the costs of inhaled anesthetic agents. Inhaled anesthesia can be costly, and some of the variable costs, including fresh gas flow rates and vaporizer settings, are potential targets for cost savings. The use of a low fresh gas flow rate maximizes rebreathing of exhaled anesthetic gas and is less costly than a high flow rate, but it provides less control of the level of anesthesia. The minimum alveolar concentration (MAC) hour is a measure that can be used to compare the cost of inhaled anesthetic agents at various fresh gas flow rates. Anesthesia records provide a sense of patterns of inhaled anesthetic agent use, but the amount of detail can be limited. Cost savings have resulted from efforts to reduce the direct costs of inhaled anesthetic agents, but reductions in indirect costs through shortened times to patient recovery and discharge following the judicious use of these agents are more difficult to demonstrate. The patient case mix, fresh gas flow rates typically used during inhaled anesthesia, availability and location of vaporizers, and anesthesia care provider preferences and practices should be taken into consideration in pharmacoeconomic evaluations and recommendations for controlling the costs of inhaled anesthesia. Understanding factors that contribute to the costs of inhaled anesthesia and considering those factors in pharmacoeconomic analyses and recommendations for use of these agents can result in cost savings.

How rebates, copayments, and administration costs affect the cost-effectiveness of osteoporosis therapies.

PubMed

Ferko, Nicole C; Borisova, Natalie; Airia, Parisa; Grima, Daniel T; Thompson, Melissa F

2012-11-01

Because of rising drug expenditures, cost considerations have become essential, necessitating the requirement for cost-effectiveness analyses for managed care organizations (MCOs). The study objective is to examine the impact of various drug-cost components, in addition to wholesale acquisition cost (WAC), on the cost-effectiveness of osteoporosis therapies. A Markov model of osteoporosis was used to exemplify different drug cost scenarios. We examined the effect of varying rebates for oral bisphosphonates--risedronate and ibandronate--as well as considering the impact of varying copayments and administration costs for intravenous zoledronate. The population modeled was 1,000 American women, > or = 50 years with osteoporosis. Patients were followed for 1 year to reflect an annual budget review of formularies by MCOs. The cost of therapy was based on an adjusted WAC, and is referred to as net drug cost. The total annual cost incurred by an MCO for each drug regimen was calculated using the net drug cost and fracture cost. We estimated cost on a quality adjusted life year (QALY) basis. When considering different rebates, results for risedronate versus ibandronate vary from cost-savings (i.e., costs less and more effective) to approximately $70,000 per QALY. With no risedronate rebate, an ibandronate rebate of approximately 65% is required before cost per QALY surpasses $50,000. With rebates greater than 25% for risedronate, irrespective of ibandronate rebates, results become cost-saving. Results also showed the magnitude of cost savings to the MCO varied by as much as 65% when considering no administration cost and the highest coinsurance rate for zoledronate. Our study showed that cost-effectiveness varies considerably when factors in addition to the WAC are considered. This paper provides recommendations for pharmaceutical manufacturers and MCOs when developing and interpreting such analyses.

Noise Considerations for V/STOL Transports

NASA Technical Reports Server (NTRS)

Kenyon, George C.

1968-01-01

Noise consideration may well be as important a factor in future aircraft concept selection as such economic factors as operating cost and profitability. The impact of noise on some of the design and operational aspects of future V/STOL transports is examined in detail, including consideration of configuration, attitude-control system, lift system, and terminal flight pattern. Extended vertical rise of VTOL aircraft as a method of limiting the intense noise exposure to the terminal area is shown to be only partially effective as well as costly. Comparisons are made of noise contours for conceptual V/STOL transports for several PNdB criteria. The variation in extent of affected area with configuration and criterion emphasizes the importance of establishing an "acceptable" noise level for "city-center" operation.

Estimation of marginal costs at existing waste treatment facilities.

PubMed

Martinez-Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus; Riber, Christian; Kamuk, Bettina; Astrup, Thomas F

2016-04-01

This investigation aims at providing an improved basis for assessing economic consequences of alternative Solid Waste Management (SWM) strategies for existing waste facilities. A bottom-up methodology was developed to determine marginal costs in existing facilities due to changes in the SWM system, based on the determination of average costs in such waste facilities as function of key facility and waste compositional parameters. The applicability of the method was demonstrated through a case study including two existing Waste-to-Energy (WtE) facilities, one with co-generation of heat and power (CHP) and another with only power generation (Power), affected by diversion strategies of five waste fractions (fibres, plastic, metals, organics and glass), named "target fractions". The study assumed three possible responses to waste diversion in the WtE facilities: (i) biomass was added to maintain a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven times larger than average costs and dependent on the response in the WtE plant. Marginal cost of diversion were between 39 and 287 € Mg(-1) target fraction when biomass was added in a CHP (from 34 to 303 € Mg(-1) target fraction in the only Power case), between -2 and 300 € Mg(-1) target fraction when RDF was added in a CHP (from -2 to 294 € Mg(-1) target fraction in the only Power case) and between 40 and 303 € Mg(-1) target fraction when no reaction happened in a CHP (from 35 to 296 € Mg(-1) target fraction in the only Power case). Although average costs at WtE facilities were highly influenced by energy selling prices, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading conclusions, economic assessment of alternative SWM solutions should not only consider potential costs associated with alternative treatment but also include marginal costs associated with existing facilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Teaching Professionalism: Passing the Torch.

ERIC Educational Resources Information Center

Hensel, William A.; Dickey, Nancy W.

1998-01-01

Medical faculty must ensure that students understand the appropriate balance between financial and professional considerations. Faculty should place financial considerations in proper perspective and should teach the basic components of professionalism, how current cost-containment efforts may threaten medicine's professional status, appropriate…

Manufacturing and Cost Considerations in Multidisciplinary Aircraft Design (Research on Mathematical Modeling of Manufacturability Factors)

NASA Technical Reports Server (NTRS)

Rais-Rohani, Masoud

1996-01-01

The identification of airframe Manufacturability Factors/Cost Drivers (MFCD) and the method by which the relationships between MFCD and designer-controlled parameters could be properly modeled are described.

Cost-Effective Experiments on the Diffraction and Interference of Light.

ERIC Educational Resources Information Center

Sprigham, S. V.

2000-01-01

Presents an alternative experimental arrangement that results in a considerable cost savings by reducing the number of sensors and other apparati required while giving excellent quantitative results for comparison with theory. (Author/CCM)

Increasing Consistency and Transparency in Considering Costs and Benefits in the Rulemaking Process

EPA Pesticide Factsheets

Advance notice of proposed rulemaking for standardizing terminology and specificity provided in each law regarding the nature and scope of the cost and benefit considerations when setting pollution standards.

Biotechnology: Economic and Behavioral Considerations.

ERIC Educational Resources Information Center

McGhan, William F.; Beardsley, Robert S.

1990-01-01

The paper reviews factors related to effects of biotechnology on the discipline of pharmacy administration including needs assessment, diffusion of technology, cost benefit analysis, marketing, cost containment, patient education and compliance, ethics, and health professions training. (DB)

EoC Study Update to Examine the Cost, Schedule and Technical Changes to NASA Projects

NASA Technical Reports Server (NTRS)

Bitten, Bob; Emmons, Debra; Shinn, Stephen; Scolese, Chris

2018-01-01

The original National Aeronautics and Space Administration (NASA) Explanation of Change (EoC) study was conducted in 2010 to understand the underlying causes of cost and schedule growth. The first study consisted of 25 missions launched from 2000 to 2010 and looked at the events that led to growth. These events were categorized into different bins that were rolled up to quantify whether the growth was due to internal planning, or internal execution, or from external forces and found that the growth was evenly distributed among those three categories. The result of the study presented nine considerations focused at reducing growth due to project external events and internal planning events. Although no one 'magic bullet' consideration was discovered in the previous work, the nine considerations taken as a whole were postulated to help reduce cost and schedule change in future NASA missions. A recent update was conducted that included investigating 8 missions developed since the previous study to determine if the results were different. Cost, schedule, and mass increases were analyzed from the start of Phase B through Preliminary Design Review and Critical Design Review to Launch. As shown in this paper, the results are better with overall cost and schedule growth being reduced. The paper will show a comparison of the previous results to the updated results to show specific reductions and provide an explanation of which recommendations were followed.

Assessing the costs and benefits of US renewable portfolio standards

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiser, Ryan; Mai, Trieu T.; Millstein, Dev

In this study, renewable portfolio standards (RPS) exist in 29 US states and the District of Columbia. This article summarizes the first national-level, integrated assessment of the future costs and benefits of existing RPS policies; the same metrics are evaluated under a second scenario in which widespread expansion of these policies is assumed to occur. Depending on assumptions about renewable energy technology advancement and natural gas prices, existing RPS policies increase electric system costs by as much as 31 billion dollars, on a present-value basis over 2015-2050. The expanded renewable deployment scenario yields incremental costs that range from 23 billionmore » to 194 billion dollars, depending on the assumptions employed. The monetized value of improved air quality and reduced climate damages exceed these costs. Using central assumptions, existing RPS policies yield 97 billion dollars in air-pollution health benefits and 161 billion dollars in climate damage reductions. Under the expanded RPS case, health benefits total 558 billion dollars and climate benefits equal 599 billion dollars. These scenarios also yield benefits in the form of reduced water use. RPS programs are not likely to represent the most cost effective path towards achieving air quality and climate benefits. Nonetheless, the findings suggest that US RPS programs are, on a national basis, cost effective when considering externalities.« less

Assessing the costs and benefits of US renewable portfolio standards

NASA Astrophysics Data System (ADS)

Wiser, Ryan; Mai, Trieu; Millstein, Dev; Barbose, Galen; Bird, Lori; Heeter, Jenny; Keyser, David; Krishnan, Venkat; Macknick, Jordan

2017-09-01

Renewable portfolio standards (RPS) exist in 29 US states and the District of Columbia. This article summarizes the first national-level, integrated assessment of the future costs and benefits of existing RPS policies; the same metrics are evaluated under a second scenario in which widespread expansion of these policies is assumed to occur. Depending on assumptions about renewable energy technology advancement and natural gas prices, existing RPS policies increase electric system costs by as much as 31 billion, on a present-value basis over 2015-2050. The expanded renewable deployment scenario yields incremental costs that range from 23 billion to 194 billion, depending on the assumptions employed. The monetized value of improved air quality and reduced climate damages exceed these costs. Using central assumptions, existing RPS policies yield 97 billion in air-pollution health benefits and 161 billion in climate damage reductions. Under the expanded RPS case, health benefits total 558 billion and climate benefits equal 599 billion. These scenarios also yield benefits in the form of reduced water use. RPS programs are not likely to represent the most cost effective path towards achieving air quality and climate benefits. Nonetheless, the findings suggest that US RPS programs are, on a national basis, cost effective when considering externalities.

Assessing the costs and benefits of US renewable portfolio standards

DOE PAGES

Wiser, Ryan; Mai, Trieu T.; Millstein, Dev; ...

2017-09-26

In this study, renewable portfolio standards (RPS) exist in 29 US states and the District of Columbia. This article summarizes the first national-level, integrated assessment of the future costs and benefits of existing RPS policies; the same metrics are evaluated under a second scenario in which widespread expansion of these policies is assumed to occur. Depending on assumptions about renewable energy technology advancement and natural gas prices, existing RPS policies increase electric system costs by as much as 31 billion dollars, on a present-value basis over 2015-2050. The expanded renewable deployment scenario yields incremental costs that range from 23 billionmore » to 194 billion dollars, depending on the assumptions employed. The monetized value of improved air quality and reduced climate damages exceed these costs. Using central assumptions, existing RPS policies yield 97 billion dollars in air-pollution health benefits and 161 billion dollars in climate damage reductions. Under the expanded RPS case, health benefits total 558 billion dollars and climate benefits equal 599 billion dollars. These scenarios also yield benefits in the form of reduced water use. RPS programs are not likely to represent the most cost effective path towards achieving air quality and climate benefits. Nonetheless, the findings suggest that US RPS programs are, on a national basis, cost effective when considering externalities.« less

Manchester Coding Option for SpaceWire: Providing Choices for System Level Design

NASA Technical Reports Server (NTRS)

Rakow, Glenn; Kisin, Alex

2014-01-01

This paper proposes an optional coding scheme for SpaceWire in lieu of the current Data Strobe scheme for three reasons. First reason is to provide a straightforward method for electrical isolation of the interface; secondly to provide ability to reduce the mass and bend radius of the SpaceWire cable; and thirdly to provide a means for a common physical layer over which multiple spacecraft onboard data link protocols could operate for a wide range of data rates. The intent is to accomplish these goals without significant change to existing SpaceWire design investments. The ability to optionally use Manchester coding in place of the current Data Strobe coding provides the ability to DC balanced the signal transitions unlike the SpaceWire Data Strobe coding; and therefore the ability to isolate the electrical interface without concern. Additionally, because the Manchester code has the clock and data encoded on the same signal, the number of wires of the existing SpaceWire cable could be optionally reduced by 50. This reduction could be an important consideration for many users of SpaceWire as indicated by the already existing effort underway by the SpaceWire working group to reduce the cable mass and bend radius by elimination of shields. However, reducing the signal count by half would provide even greater gains. It is proposed to restrict the data rate for the optional Manchester coding to a fixed data rate of 10 Megabits per second (Mbps) in order to make the necessary changes simple and still able to run in current radiation tolerant Field Programmable Gate Arrays (FPGAs). Even with this constraint, 10 Mbps will meet many applications where SpaceWire is used. These include command and control applications and many instruments applications with have moderate data rate. For most NASA flight implementations, SpaceWire designs are in rad-tolerant FPGAs, and the desire to preserve the heritage design investment is important for cost and risk considerations. The Manchester coding option can be accommodated in existing designs with only changes to the FPGA.

13 CFR 107.855 - Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”).

Code of Federal Regulations, 2012 CFR

2012-01-01

... § 107.855 Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”). “Cost of Money” means the interest and other consideration that you receive from a Small Business. Subject to lower ceilings prescribed by local law, the Cost of Money to the Small Business must not exceed...

13 CFR 107.855 - Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”).

Code of Federal Regulations, 2014 CFR

2014-01-01

... § 107.855 Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”). “Cost of Money” means the interest and other consideration that you receive from a Small Business. Subject to lower ceilings prescribed by local law, the Cost of Money to the Small Business must not exceed...

13 CFR 107.855 - Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”).

Code of Federal Regulations, 2013 CFR

2013-01-01

... § 107.855 Interest rate ceiling and limitations on fees charged to Small Businesses (“Cost of Money”). “Cost of Money” means the interest and other consideration that you receive from a Small Business. Subject to lower ceilings prescribed by local law, the Cost of Money to the Small Business must not exceed...