Ballast Water Treatment, U.S. Great Lakes Bulk Carrier Engineering and Cost Study. Volume 2: Analysis of On-Board Treatment Methods, Alternative Ballast Water Management Practices, and Implementation Costs

DTIC Science & Technology

2013-11-01

flushing filter, disinfection with injected chlorine dioxide (chlorine dioxide is generated onboard from two component chemicals, sulfuric acid...Management System 400 80 250-8000 (10000) Sulfuric Acid and Purate for ClO2 generation Yes 0.005-0.028 8-18 Decreased sediment, potential corrosion...feed chemicals, Purate and sulfuric acid. 5. Operational and Maintenance Cost: Estimated operating and maintenance cost is $80/1000 m3 of ballast

Methodology evaluation: Effects of independent verification and intergration on one class of application

NASA Technical Reports Server (NTRS)

Page, J.

1981-01-01

The effects of an independent verification and integration (V and I) methodology on one class of application are described. Resource profiles are discussed. The development environment is reviewed. Seven measures are presented to test the hypothesis that V and I improve the development and product. The V and I methodology provided: (1) a decrease in requirements ambiguities and misinterpretation; (2) no decrease in design errors; (3) no decrease in the cost of correcting errors; (4) a decrease in the cost of system and acceptance testing; (5) an increase in early discovery of errors; (6) no improvement in the quality of software put into operation; and (7) a decrease in productivity and an increase in cost.

Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

PubMed

Yates, Brian T; Mannix, Danyelle; Freed, Michael C; Campbell, Jean; Johnsen, Matthew; Jones, Kristine; Blyler, Crystal R

2011-01-01

Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

Loglines. September - October 2012

DTIC Science & Technology

2012-10-01

Improve Customer Service u Decrease Material Costs u Reduce Inventory Decrease Operational Costs u Achieve Audit Readiness LOGLINES DEFENSE...they provide to our military customers . Acquisitions professionals are working hand in hand with our industry partners and customers to develop...our warfighting customers . Every day I read the comments on the “Direct Channel” blog and am constantly impressed with the volume and scope of

Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs.

PubMed

Bogani, Giorgio; Multinu, Francesco; Dowdy, Sean C; Cliby, William A; Wilson, Timothy O; Gostout, Bobbie S; Weaver, Amy L; Borah, Bijan J; Killian, Jill M; Bijlani, Akash; Angioni, Stefano; Mariani, Andrea

2016-05-01

To evaluate how the introduction of robotic-assisted surgery affects treatment-related morbidity and cost of endometrial cancer (EC) staging. We retrospectively reviewed the records of consecutive patients with stage I-III EC undergoing surgical staging between 2007 and 2012 at our institution. Costs (from surgery to 30days after surgery) were set based on the Medicare cost-to-charge ratio for each year and inflated to 2014 values. Inverse probability weighting (IPW) was used to decrease the allocation bias when comparing outcomes between surgical groups. We focused our analysis on the 251 EC patients who had robotic-assisted surgery and the 384 who had open staging. During the study period, the use of robotic-assisted surgery increased and open staging decreased (P<0.001). Correcting group imbalances by using IPW methodology, we observed that patients undergoing robotic-assisted staging had a significantly lower postoperative complication rate, lower blood transfusion rate, longer median operating time, shorter median length of stay, and lower readmission rate than patients undergoing open staging (all P<0.001). Overall 30-day costs were similar between the 2 groups, with robotic-assisted surgery having significantly higher median operating room costs ($2820 difference; P<0.001) but lower median room and board costs ($2929 difference; P<0.001) than open surgery. Increasing experience with robotic-assisted staging was significantly associated with a decrease in median operating time (P=0.002) and length of stay (P=0.003). The implementation of robotic-assisted surgery for EC staging improves patient outcomes. It provides women the benefits of minimally invasive surgery without increasing costs and potentially improves patient turnover. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative analysis for various redox flow batteries chemistries using a cost performance model

NASA Astrophysics Data System (ADS)

Crawford, Alasdair; Viswanathan, Vilayanur; Stephenson, David; Wang, Wei; Thomsen, Edwin; Reed, David; Li, Bin; Balducci, Patrick; Kintner-Meyer, Michael; Sprenkle, Vincent

2015-10-01

The total energy storage system cost is determined by means of a robust performance-based cost model for multiple flow battery chemistries. Systems aspects such as shunt current losses, pumping losses and various flow patterns through electrodes are accounted for. The system cost minimizing objective function determines stack design by optimizing the state of charge operating range, along with current density and current-normalized flow. The model cost estimates are validated using 2-kW stack performance data for the same size electrodes and operating conditions. Using our validated tool, it has been demonstrated that an optimized all-vanadium system has an estimated system cost of < 350 kWh-1 for 4-h application. With an anticipated decrease in component costs facilitated by economies of scale from larger production volumes, coupled with performance improvements enabled by technology development, the system cost is expected to decrease to 160 kWh-1 for a 4-h application, and to 100 kWh-1 for a 10-h application. This tool has been shared with the redox flow battery community to enable cost estimation using their stack data and guide future direction.

High-Speed, High-Temperature Finger Seal Test Results

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.; Kumar, Arun; Delgado, Irebert R.

2002-01-01

Finger seals have significantly lower leakage rates than conventional labyrinth seals used in gas turbine engines and are expected to decrease specific fuel consumption by over 1 percent and to decrease direct operating cost by over 0.5 percent. Their compliant design accommodates shaft growth and motion due to thermal and dynamic loads with minimal wear. The cost to fabricate these finger seals is estimated to be about half the cost to fabricate brush seals. A finger seal has been tested in NASA's High Temperature, High Speed Turbine Seal Test Rig at operating conditions up to 1200 F, 1200 ft/s, and 75 psid. Static, performance and endurance test results are presented. While seal leakage and wear performance are acceptable, further design improvements are needed to reduce the seal power loss.

Reduced length of stay in hospital for burn patients following a change in practice guidelines: financial implications.

PubMed

Jansen, Leigh A; Hynes, Sally L; Macadam, Sheina A; Papp, Anthony

2012-01-01

The objective of this study was to analyze the financial implications of the implementation of new institutional practice guidelines including greater outpatient care and earlier operative intervention in a provincial burn center. A retrospective review was performed including all patients admitted to the Burn Unit with burns up to 20% TBSA between August 2005 and July 2009, including 2 years before and after the new guidelines were introduced. Daily costs for the burn unit were used to calculate this portion of cost. Length of stay (LOS) was based on actual data and representative clinical scenarios. Two hundred sixty-four patients were included. Mean LOS decreased from 10.3 to 3.9 (P < .01) and 21.0 to 13.3 (P > .05) for nonoperative burns 0 to 10% and 10 to 20% TBSA, respectively. Mean LOS for operative burns decreased from 16.6 to 12.9 and 32.3 to 29.8 days for 0 to 10% and 10 to 20% TBSA, respectively (P > .05). Burn patient management requires significant financial resources, and LOS has a large impact on cost. Given per diem rates of Can$1,663, scenario analysis shows potential cost savings of Can$19,956 per patient for operative and nonoperative burns <20% TBSA. With an average of 66 such patients treated each year, potential annual cost savings are Can$1.3 million. If outcomes are not compromised, earlier operative management and greater outpatient care can translate into significant cost savings. A prospective analysis capturing all costs and patient quality of life is required for further assessment.

Space Infrared Telescope Facility (SIRTF) - Operations concept. [decreasing development and operations cost

NASA Technical Reports Server (NTRS)

Miller, Richard B.

1992-01-01

The development and operations costs of the Space IR Telescope Facility (SIRTF) are discussed in the light of minimizing total outlays and optimizing efficiency. The development phase cannot extend into the post-launch segment which is planned to only support system verification and calibration followed by operations with a 70-percent efficiency goal. The importance of reducing the ground-support staff is demonstrated, and the value of the highly sensitive observations to the general astronomical community is described. The Failure Protection Algorithm for the SIRTF is designed for the 5-yr lifetime and the continuous venting of cryogen, and a science driven ground/operations system is described. Attention is given to balancing cost and performance, prototyping during the development phase, incremental development, the utilization of standards, and the integration of ground system/operations with flight system integration and test.

Experiences of operational costs of HPV vaccine delivery strategies in Gavi-supported demonstration projects

PubMed Central

Holroyd, Taylor; Nanda, Shreya; Bloem, Paul; Griffiths, Ulla K.; Sidibe, Anissa; Hutubessy, Raymond C. W.

2017-01-01

From 2012 to 2016, Gavi, the Vaccine Alliance, provided support for countries to conduct small-scale demonstration projects for the introduction of the human papillomavirus vaccine, with the aim of determining which human papillomavirus vaccine delivery strategies might be effective and sustainable upon national scale-up. This study reports on the operational costs and cost determinants of different vaccination delivery strategies within these projects across twelve countries using a standardized micro-costing tool. The World Health Organization Cervical Cancer Prevention and Control Costing Tool was used to collect costing data, which were then aggregated and analyzed to assess the costs and cost determinants of vaccination. Across the one-year demonstration projects, the average economic and financial costs per dose amounted to US$19.98 (standard deviation ±12.5) and US$8.74 (standard deviation ±5.8), respectively. The greatest activities representing the greatest share of financial costs were social mobilization at approximately 30% (range, 6–67%) and service delivery at about 25% (range, 3–46%). Districts implemented varying combinations of school-based, facility-based, or outreach delivery strategies and experienced wide variation in vaccine coverage, drop-out rates, and service delivery costs, including transportation costs and per diems. Size of target population, number of students per school, and average length of time to reach an outreach post influenced cost per dose. Although the operational costs from demonstration projects are much higher than those of other routine vaccine immunization programs, findings from our analysis suggest that HPV vaccination operational costs will decrease substantially for national introduction. Vaccination costs may be decreased further by annual vaccination, high initial investment in social mobilization, or introducing/strengthening school health programs. Our analysis shows that drivers of cost are dependent on country and district characteristics. We therefore recommend that countries carry out detailed planning at the national and district levels to define a sustainable strategy for national HPV vaccine roll-out, in order to achieve the optimal balance between coverage and cost. PMID:29016596

Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.

PubMed

Farber, Scott J; Snyder-Warwick, Alison K; Skolnick, Gary B; Woo, Albert S; Patel, Kamlesh B

2016-09-01

Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.

Test plan for the soils facility demonstration: A petroleum contaminated soil bioremediation facility

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

Lombard, K.H.

1994-08-01

The objectives of this test plan are to show the value added by using bioremediation as an effective and environmentally sound method to remediate petroleum contaminated soils (PCS) by: demonstrating bioremediation as a permanent method for remediating soils contaminated with petroleum products; establishing the best operating conditions for maximizing bioremediation and minimizing volatilization for SRS PCS during different seasons; determining the minimum set of analyses and sampling frequency to allow efficient and cost-effective operation; determining best use of existing site equipment and personnel to optimize facility operations and conserve SRS resources; and as an ancillary objective, demonstrating and optimizing newmore » and innovative analytical techniques that will lower cost, decrease time, and decrease secondary waste streams for required PCS assays.« less

The performance and long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells.

PubMed

Kondaveeti, Sanath; Kakarla, Ramesh; Kim, Hong Suck; Kim, Byung-Goon; Min, Booki

2018-02-01

This study evaluates long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells with domestic wastewater. Low-cost separators tested in this study were nonwoven fabrics (NWF) of polypropylene (PP80, PP100), textile fabrics of polyphenylene sulfide (PPS), sulfonated polyphenylene sulfide (SPPS), and cellulose esters. NWF PP80 separator generated the highest power density of 280 mW/m 2 , which was higher than with ion-exchange membranes (cation exchange membrane; CEM = 271 mW/m 2 , cation exchange membrane; CMI = 196 mW/m 2 , Nafion = 260 mW/m 2 ). MFC operations with other size-selective separators such as SPPS, PPS, and cellulose esters exhibited power densities of 261, 231, and 250 mW/m 2 , respectively. During a 280-day operation, initial power density of PP80 (278 mW/m 2 ) was decreased to 257 mW/m 2 , but this decrease was smaller than with others (Nafion: 265-230 mW/m 2 ; PP100: 220-126 mW/m 2 ). The anode potential of around -430 mV did not change much with all separators in the long-term operation, but the initial cathode potential gradually decreased. Fouling analysis suggested that the presence of carbonaceous substance on Nafion and PP80 after 280 days of operation and Nafion was subject to be more biofouling.

Identification of High Performance, Low Environmental Impact Materials and Processes Using Systematic Substitution (SyS)

NASA Technical Reports Server (NTRS)

Dhooge, P. M.; Nimitz, J. S.

2001-01-01

Process analysis can identify opportunities for efficiency improvement including cost reduction, increased safety, improved quality, and decreased environmental impact. A thorough, systematic approach to materials and process selection is valuable in any analysis. New operations and facilities design offer the best opportunities for proactive cost reduction and environmental improvement, but existing operations and facilities can also benefit greatly. Materials and processes that have been used for many years may be sources of excessive resource use, waste generation, pollution, and cost burden that should be replaced. Operational and purchasing personnel may not recognize some materials and processes as problems. Reasons for materials or process replacement may include quality and efficiency improvements, excessive resource use and waste generation, materials and operational costs, safety (flammability or toxicity), pollution prevention, compatibility with new processes or materials, and new or anticipated regulations.

Acoustical design economic trade off for transport aircraft

NASA Astrophysics Data System (ADS)

Benito, A.

The effects of ICAO fixed certification limits and local ordinances on acoustic emissions from jets on commercial transport aircraft and costs of operations are explored. The regulations effectively ban some aircraft from operation over populated areas, impose curfews on airports and, in conjunction with local civil aviation rules, levy extra taxes and quotas on noisier equipment. Jet engine manufacturers have attempted to increase the flow laminarity, decrease the exhaust speed and develop acoustic liners for selected duct areas. Retrofits are, however, not usually cost effective due to increased operational costs, e.g., fuel consumption can increase after engine modification because of increased weight. Finally, an attempt is made to assess, monetarily, the costs of noise pollution, wherein fines are levied for noisy aircraft and the money is spent insulating homes from noise.

Ferrite Research Aimed at Improving Induction Linac Driven FEL performance. Phase 2

DTIC Science & Technology

1992-10-01

energy costs and decrease our dependence on foreign energy sources. SO 2 control has used flue gas desulfurization scrubbers after combustion, coal...minimizing operating costs. . Dry Mode of Operation Conventional flue - gas treatment processes are generally wet systems which generate waste water and wet ...energy source in the United States. So reducing the SO 2 and NOx emission from flue gas will allow use of abundant, high-sulphur coal resources, lower

Relationship between implant use, operative time, and costs associated with distal biceps tendon reattachment.

PubMed

Grant, John A; Bissell, Benjamin; Hake, Mark E; Miller, Bruce S; Hughes, Richard E; Carpenter, James E

2012-11-01

The suture anchor and transosseous drill hole techniques for reattachment of the distal biceps tendon to the radius have been found to have similar clinical and biomechanical outcomes. However, a comparison of the cost effectiveness of these techniques is lacking. The purpose of this study was to determine whether the use of suture anchors decreases operative time enough to offset the additional cost of the implants. The records of all patients undergoing a distal biceps tendon reattachment were reviewed to determine the method of fixation, operative time, and associated surgical costs. Two surgeons used a technique of fixing the tendon directly to the bone (transosseous group), whereas 3 surgeons used suture anchors. Given the standard nature of the surgical procedure (other than the fixation technique), only the costs that differed between the 2 groups were included. Surgical center costs were obtained from the local outpatient surgical center in 2011 US dollars. Five surgeons treated 70 men (mean age, 45.9±9.2 years). Mean time from injury to surgery was 14 days. Mean operative times for the transosseous and suture anchor groups were 97.6±14.9 and 95.8±25.8 minutes, respectively (P=.74). Two anchors were used in 79% of the anchor cases. The use of anchors cost $474.33 more per patient. However, this value is sensitive to the cost of the individual anchors, intersurgeon variation in operative time, and per-minute value of saved operative time. No operative time was saved with the use of suture anchors. This cost comparison framework can be used to evaluate the balance in surgical resource use due to implant cost vs savings in operative time. Copyright 2012, SLACK Incorporated.

Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery.

PubMed

Epstein, Nancy E; Roberts, Rita; Collins, John

2015-01-01

In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure) occurring during anterior cervical diskectomy/fusion from 20% to 5.8%.[5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014) aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste. The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months), 2013 (12 months), and 2014 (first 9 months) (e.g. data were normalized). Savings from a 2013 Vendor Credit Replacement program were also calculated. From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively). Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012) to 12 (2013) and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564. The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

7 CFR 272.10 - ADP/CIS Model Plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... those which result in effective programs or in cost effective reductions in errors and improvements in management efficiency, such as decreases in program administrative costs. Thus, for those State agencies which operate exceptionally efficient and effective programs, a lesser degree of automation may be...

Empirically observed learning rates for concentrating solar power and their responses to regime change

NASA Astrophysics Data System (ADS)

Lilliestam, Johan; Labordena, Mercè; Patt, Anthony; Pfenninger, Stefan

2017-07-01

Concentrating solar power (CSP) capacity has expanded slower than other renewable technologies and its costs are still high. Until now, there have been too few CSP projects to derive robust conclusions about its cost development. Here we present an empirical study of the cost development of all operating CSP stations and those under construction, examining the roles of capacity growth, industry continuity, and policy support design. We identify distinct CSP expansion phases, each characterized by different cost pressure in the policy regime and different industry continuity. In 2008-2011, with low cost pressure and following industry discontinuity, costs increased. In the current phase, with high cost pressure and continuous industry development, costs decreased rapidly, with learning rates exceeding 20%. Data for projects under construction suggest that this trend is continuing and accelerating. If support policies and industrial structure are sustained, we see no near-term factors that would hinder further cost decreases.

Cost accounting in a surgical unit in a teaching hospital--a pilot study.

PubMed

Malalasekera, A P; Ariyaratne, M H; Fernando, R; Perera, D; Deen, K I

2003-09-01

Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.

Study on the Effect of a Cogeneration System Capacity on its CO2 Emissions

NASA Astrophysics Data System (ADS)

Fonseca, J. G. S., Jr.; Asano, Hitoshi; Fujii, Terushige; Hirasawa, Shigeki

With the global warming problem aggravating and subsequent implementation of the Kyoto Protocol, CO2 emissions are becoming an important factor when verifying the usability of cogeneration systems. Considering this, the purpose of this work is to study the effect of the capacity of a cogeneration system on its CO2 emissions under two kinds of operation strategies: one focused on exergetic efficiency and another on running cost. The system meets the demand pattern typical of a hospital in Japan, operating during one year with an average heat-to-power ratio of 1.3. The main equipments of the cogeneration system are: a gas turbine with waste heat boiler, a main boiler and an auxiliary steam turbine. Each of these equipments was characterized with partial load models, and the turbine efficiencies at full load changed according to the system capacity. Still, it was assumed that eventual surplus of electricity generated could be sold. The main results showed that for any of the capacities simulated, an exergetic efficiency-focused operational strategy always resulted in higher CO2 emissions reduction when compared to the running cost-focused strategy. Furthermore, the amount of reduction in emissions decreased when the system capacity decreased, reaching a value of 1.6% when the system capacity was 33% of the maximum electricity demand with a heat-to-power ratio of 4.1. When the system operated focused on running cost, the economic savings increased with the capacity and reached 42% for a system capacity of 80% of maximum electricity demand and with a heat-to-power ratio of 2.3. In such conditions however, there was an increase in emissions of 8.5%. Still for the same capacity, an exergetic efficiency operation strategy presented the best balance between cost and emissions, generating economic savings of 29% with a decrease in CO2 emissions of 7.1%. The results found showed the importance of an exergy-focused operational strategy and also indicated that lower capacities resulted in lesser gains of both CO2 emissions and running cost reduction.

Physician Engagement in Improving Operative Supply Chain Efficiency Through Review of Surgeon Preference Cards.

PubMed

Harvey, Lara F B; Smith, Katherine A; Curlin, Howard

To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. Quality improvement study (Canadian Task Force classification II-3). Gynecologic surgery suite of an academic medical center. Twenty-one specialized and generalist gynecologic surgeons. The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Research requirements to reduce civil helicopter life cycle cost

NASA Technical Reports Server (NTRS)

Blewitt, S. J.

1978-01-01

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

Operative outcome and hospital cost.

PubMed

Ferraris, V A; Ferraris, S P; Singh, A

1998-03-01

Because of concern about increasing health care costs, we undertook a study to find patient risk factors associated with increased hospital costs and to evaluate the relationship between increased cost and in-hospital mortality and serious morbidity. More than 100 patient variables were screened in 1221 patients undergoing cardiac procedures. Simultaneously, patient hospital costs were computed from the cost-to-charge ratio. Univariate and multivariate statistics were used to explore the relationship between hospital cost and patient outcomes, including operative death, in-hospital morbidity, and length of stay. The greatest costs were for 31 patients who did not survive operation ($74,466, 95% confidence interval $27,102 to $198,025), greater than the costs for 120 patients who had serious, nonfatal morbidity ($60,335, 95% confidence interval $28,381 to $130,897, p = 0.02) and those for 1070 patients who survived operation without complication ($31,459, 95% confidence interval $21,944 to $49,849, p = 0.001). Breakdown of the components of hospital costs in fatalities and in cases with nonfatal complications revealed that the greatest contributions were in anesthesia and operating room costs. Significant (by stepwise linear regression analysis) independent risks for increased hospital cost were as follows (in order of decreasing importance): (1) preoperative congestive heart failure, (2) serum creatinine level greater than 2.5 mg/dl, (3) New York state predicted mortality risk, (4), type of operation (coronary artery bypass grafting, valve, valve plus coronary artery bypass grafting, or other), (5) preoperative hematocrit, (6) need for reoperative procedure, (7) operative priority, and (8) sex. These risks were different than those for in-hospitality death or increased length of stay. Hospital cost correlated with length of stay (r = 0.63, p < 0.001), but there were many outliers at the high end of the hospital cost spectrum. We conclude that operative death is the most costly outcome; length of stay is an unreliable indicator of hospital cost, especially at the high end of the cost spectrum; risks of increased hospital cost are different than those for perioperative mortality or increased length of stay; and ventricular dysfunction in elderly patients undergoing urgent operations for other than coronary disease is associated with increased cost. Certain patient factors, such as preoperative anemia and congestive heart failure, are amenable to preoperative intervention to reduce costs, and a high-risk patient profile can serve as a target for cost-reduction strategies.

Effects of network node consolidation in optical access and aggregation networks on costs and power consumption

NASA Astrophysics Data System (ADS)

Lange, Christoph; Hülsermann, Ralf; Kosiankowski, Dirk; Geilhardt, Frank; Gladisch, Andreas

2010-01-01

The increasing demand for higher bit rates in access networks requires fiber deployment closer to the subscriber resulting in fiber-to-the-home (FTTH) access networks. Besides higher access bit rates optical access network infrastructure and related technologies enable the network operator to establish larger service areas resulting in a simplified network structure with a lower number of network nodes. By changing the network structure network operators want to benefit from a changed network cost structure by decreasing in short and mid term the upfront investments for network equipment due to concentration effects as well as by reducing the energy costs due to a higher energy efficiency of large network sites housing a high amount of network equipment. In long term also savings in operational expenditures (OpEx) due to the closing of central office (CO) sites are expected. In this paper different architectures for optical access networks basing on state-of-the-art technology are analyzed with respect to network installation costs and power consumption in the context of access node consolidation. Network planning and dimensioning results are calculated for a realistic network scenario of Germany. All node consolidation scenarios are compared against a gigabit capable passive optical network (GPON) based FTTH access network operated from the conventional CO sites. The results show that a moderate reduction of the number of access nodes may be beneficial since in that case the capital expenditures (CapEx) do not rise extraordinarily and savings in OpEx related to the access nodes are expected. The total power consumption does not change significantly with decreasing number of access nodes but clustering effects enable a more energyefficient network operation and optimized power purchase order quantities leading to benefits in energy costs.

Association Between Surgeon Scorecard Use and Operating Room Costs.

PubMed

Zygourakis, Corinna C; Valencia, Victoria; Moriates, Christopher; Boscardin, Christy K; Catschegn, Sereina; Rajkomar, Alvin; Bozic, Kevin J; Soo Hoo, Kent; Goldberg, Andrew N; Pitts, Lawrence; Lawton, Michael T; Dudley, R Adams; Gonzales, Ralph

2017-03-01

Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting. Intervention participants were attending surgeons in orthopedic surgery, otolaryngology-head and neck surgery, and neurological surgery (n = 63). Control participants were attending surgeons in cardiothoracic surgery, general surgery, vascular surgery, pediatric surgery, obstetrics/gynecology, ophthalmology, and urology (n = 186). From January 1 to December 31, 2015, each surgeon in the intervention group received standardized monthly scorecards showing the median surgical supply direct cost for each procedure type performed in the prior month compared with the surgeon's baseline (July 1, 2012, to November 30, 2014) and compared with all surgeons at the institution performing the same procedure at baseline. All surgical departments were eligible for a financial incentive if they met a 5% cost reduction goal. The primary outcome was each group's median surgical supply cost per case. Secondary outcome measures included total departmental surgical supply costs, case mix index-adjusted median surgical supply costs, patient outcomes (30-day readmission, 30-day mortality, and discharge status), and surgeon responses to a postintervention study-specific health care value survey. The median surgical supply direct costs per case decreased 6.54% in the intervention group, from $1398 (interquartile range [IQR], $316-$5181) (10 637 cases) in 2014 to $1307 (IQR, $319-$5037) (11 820 cases) in 2015. In contrast, the median surgical supply direct cost increased 7.42% in the control group, from $712 (IQR, $202-$1602) (16 441 cases) in 2014 to $765 (IQR, $233-$1719) (17 227 cases) in 2015. This decrease represents a total savings of $836 147 in the intervention group during the 1-year study. After controlling for surgeon, department, patient demographics, and clinical indicators in a mixed-effects model, there was a 9.95% (95% CI, 3.55%-15.93%; P = .003) surgical supply cost decrease in the intervention group over 1 year. Patient outcomes were equivalent or improved after the intervention, and surgeons who received scorecards reported higher levels of cost awareness on the health care value survey compared with controls. Cost feedback to surgeons, combined with a small departmental financial incentive, was associated with significantly reduced surgical supply costs, without negatively affecting patient outcomes.

Bucking logs to cable yarder capacity can decrease yarding costs and minimize wood wastage

Treesearch

Chris B. LeDoux

1986-01-01

Data from select time and motions studies and a forest model plot, used in a simulation model, show that logging managers planning felling, bucking, and limbing for a cable yarding operation must consider the effect of alternate bucking rules on wood wastage, yarding production rates and cost, the number of choker to fly and total logging costs. Results emphasize then...

The business case for the reduction of surgical complications in VA hospitals.

PubMed

Vaughan-Sarrazin, Mary; Bayman, Levent; Rosenthal, Gary; Henderson, William; Hendricks, Ann; Cullen, Joseph J

2011-04-01

Surgical complications contribute substantially to costs. Most important, surgical complications contribute to morbidity and mortality, and some may be preventable. This study estimates costs of specific surgical complications for patients undergoing general surgery in VA hospitals using merged data from the VA Surgical Quality Improvement Program and VA Decision Support System. Costs associated with 19 potentially preventable complications within 6 broader categories were estimated using generalized, linear mixed regression models to control for patient-level determinants of costs (eg, type of operation, demographics, comorbidity, severity) and hospital-level variation in costs. Costs included costs of the index hospitalization and subsequent 30-day readmissions. In 14,639 patients undergoing general surgical procedures from 10/2005 through 9/2006, 20% of patients developed postoperative surgical complications. The presence of any complication significantly increased unadjusted costs nearly 3-fold ($61,083 vs $22,000), with the largest cost differential attributed to respiratory complications. Patients who developed complications had several markers for greater preoperative severity, including increased age and a lesser presurgery functional health status. After controlling for differences in patient severity, costs for patients with any complication were 1.89 times greater compared to costs for patients with no complications (P < .0001). Within major complication categories, adjusted costs were significantly greater for patients with respiratory, cardiac, central nervous system, urinary, wound, or other complications. Surgical complications contribute markedly to costs of inpatient operations. Investment in quality improvement that decreases the incidence of surgical complications could decrease costs. Copyright © 2011 Mosby, Inc. All rights reserved.

Technoeconomic analysis of large scale production of pre-emergent Pseudomonas fluorescens microbial bioherbicide in Canada.

PubMed

Mupondwa, Edmund; Li, Xue; Boyetchko, Susan; Hynes, Russell; Geissler, Jon

2015-01-01

The study presents an ex ante technoeconomic analysis of commercial production of Pseudomonas fluorescens BRG100 bioherbicide in Canada. An engineering economic model is designed in SuperPro Designer® to investigate capital investment scaling and profitability. Total capital investment for a stand-alone BRG100 fermentation plant at baseline capacity (two 33,000L fermenters; 3602tonnesannum(-1)) is $17.55million. Total annual operating cost is $14.76million. Raw materials account for 50% of operating cost. The fermentation plant is profitable over wide operating scale, evaluated over a range of BRG100 prices and costs of capital. Smaller plants require higher NPV breakeven prices. However, larger plants are more sensitive to changes in the cost of capital. Unit production costs decrease as plant capacity increases, indicating scale economies. A plant operating for less than one year approaches positive NPV for periods as low as 2months. These findings can support bioherbicide R&D investment and commercialization strategies. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

PubMed

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Engine Seal Technology Requirements to Meet NASA's Advanced Subsonic Technology Program Goals

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Hendricks, Robert C.

1994-01-01

Cycle studies have shown the benefits of increasing engine pressure ratios and cycle temperatures to decrease engine weight and improve performance of commercial turbine engines. NASA is working with industry to define technology requirements of advanced engines and engine technology to meet the goals of NASA's Advanced Subsonic Technology Initiative. As engine operating conditions become more severe and customers demand lower operating costs, NASA and engine manufacturers are investigating methods of improving engine efficiency and reducing operating costs. A number of new technologies are being examined that will allow next generation engines to operate at higher pressures and temperatures. Improving seal performance - reducing leakage and increasing service life while operating under more demanding conditions - will play an important role in meeting overall program goals of reducing specific fuel consumption and ultimately reducing direct operating costs. This paper provides an overview of the Advanced Subsonic Technology program goals, discusses the motivation for advanced seal development, and highlights seal technology requirements to meet future engine performance goals.

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.

Techniques for cash management in scheduling manufacturing operations

NASA Astrophysics Data System (ADS)

Morady Gohareh, Mehdy; Shams Gharneh, Naser; Ghasemy Yaghin, Reza

2017-06-01

The objective in traditional scheduling is usually time based. Minimizing the makespan, total flow times, total tardi costs, etc. are instances of these objectives. In manufacturing, processing each job entails a cost paying and price receiving. Thus, the objective should include some notion of managing the flow of cash. We have defined two new objectives: maximization of average and minimum available cash. For single machine scheduling, it is demonstrated that scheduling jobs in decreasing order of profit ratios maximizes the former and improves productivity. Moreover, scheduling jobs in increasing order of costs and breaking ties in decreasing order of prices maximizes the latter and creates protection against financial instability.

[Analysis of medical cost of atlantoaxial disorders in patients receiving innovated treatment technologies].

PubMed

Wu, Yunxia; Liu, Zhongjun

2016-01-19

To explore the effects of innovated technologies and products on improving outcomes and decreasing medical costs by analyzing a total and subtotal medical costs of patients with atlantoaxial disorders. The medical costs of 1 489 patients with atlantoaxial disorders from Peking University Third Hospital from 2005 to 2014, who received innovated technologies and products treatment were retrospectively analyzed and compared.Descriptive analysis and ANOVA were used for statistical analysis, and SPSS 19.0 was used to analyze data. From 2005 to 2014, under the situation of a general increase in medical cost by 327%, the total medical costs were stable for patients who used innovated technologies and products for treatment, fluctuating from 20 851 in 2005 to 20 878 in 2014; however, the cases of operation increased year by year, from 88 in 2005 to 163 in 2014; the average length of stay decreased from 21 in 2005 to 10 in 2014; the total cases of transfusion were 22 from 2005 to 2014; the safety, stability and feasibility of the innovated technologies and products were illustrated through the decrease of average length of stay, the reduction of bleeding and the significance of outcomes. It is illustrated that the innovated technologies and products not only decrease patients' suffering and medical costs but also are safe, stable and feasible.

Economic choice for hardwood sawmill operations (ECHO)

Treesearch

P.H. Steele; Philip A. Araman; C. Boden

2002-01-01

Reductions in sawkerf on headrigs and resaws can dramatically increase lumber recovery. Research has also shown that lumber target size reductions are even more important than kerf reductions in providing increased lumber recovery. Decreases in either sawkerf or lumber size, however, always come at some cost in both capital and variable costs. Determining whether the...

Robotic longitudinal pancreaticojejunostomy for chronic pancreatitis: Comparison of clinical outcomes and cost to the open approach.

PubMed

Kirks, Russell C; Lorimer, Patrick D; Fruscione, Michael; Cochran, Allyson; Baker, Erin H; Iannitti, David A; Vrochides, Dionisios; Martinie, John B

2017-09-01

This study compares clinical and cost outcomes of robot-assisted laparoscopic (RAL) and open longitudinal pancreaticojejunostomy (LPJ) for chronic pancreatitis. Clinical and cost data were retrospectively compared between open and RAL LPJ performed at a single center from 2008-2015. Twenty-six patients underwent LPJ: 19 open and 7 RAL. Two robot-assisted cases converted to open were included in the open group for analysis. Patients undergoing RAL LPJ had less intraoperative blood loss, a shorter surgical length of stay, and lower medication costs. Operation supply cost was higher in the RAL group. No difference in hospitalization cost was found. Versus the open approach, RAL LPJ performed for chronic pancreatitis shortens hospitalization and reduces medication costs; hospitalization costs are equivalent. A higher operative cost for RAL LPJ is mitigated by a shorter hospitalization. Decreased morbidity and healthcare resource economy support use of the robotic approach for LPJ when appropriate. Copyright © 2017 John Wiley & Sons, Ltd.

The Feasibility of a Land Ferry System to Reduce Highway Maintenance Cost and Associated Externalities.

PubMed

Merrill, Steve J; Paz, Alexander; Molano, Victor; Shrestha, Pramen P; Maheshwari, Pankaj; Stephen, Haroon; de la Fuente-Mella, Hanns

2016-01-01

This study provides an economic evaluation for a Land Ferry, which is a rail system capable of carrying trucks and all other types of vehicles, passengers, and cargo. The Land Ferry system involves a sliding loading system to roll heavy loads onto a flatbed; as a result, loading and unloading of all vehicles and cargo could be accomplished simultaneously. The evaluation for this system included (1) the design of a new track alignment over which the Land Ferry system would run, (2) evaluation of various sources of power, (3) estimation of how many local jobs the Land Ferry would generate, and (4) a benefit-cost analysis. It was estimated that the Land Ferry would create over 45,788 temporary jobs in Nevada during the three-year construction period and 318 permanent jobs during operation. The majority of the benefits were attributed to savings in travel time ($356.4 M), vehicle operating costs ($1000.4 M), reduction of accidents ($544.6 M), and pavement maintenance ($503.2 M). These benefits would be a consequence of the shift of trucks from the highway, thus resulting in higher speeds, decrease fuel consumption, and decrease vehicle maintenance costs. The overall benefit-cost ratio of 1.7 implies a cost-effective project.

The Feasibility of a Land Ferry System to Reduce Highway Maintenance Cost and Associated Externalities

PubMed Central

Merrill, Steve J.; Paz, Alexander; Molano, Victor; Shrestha, Pramen P.; Maheshwari, Pankaj; Stephen, Haroon

2016-01-01

This study provides an economic evaluation for a Land Ferry, which is a rail system capable of carrying trucks and all other types of vehicles, passengers, and cargo. The Land Ferry system involves a sliding loading system to roll heavy loads onto a flatbed; as a result, loading and unloading of all vehicles and cargo could be accomplished simultaneously. The evaluation for this system included (1) the design of a new track alignment over which the Land Ferry system would run, (2) evaluation of various sources of power, (3) estimation of how many local jobs the Land Ferry would generate, and (4) a benefit-cost analysis. It was estimated that the Land Ferry would create over 45,788 temporary jobs in Nevada during the three-year construction period and 318 permanent jobs during operation. The majority of the benefits were attributed to savings in travel time ($356.4 M), vehicle operating costs ($1000.4 M), reduction of accidents ($544.6 M), and pavement maintenance ($503.2 M). These benefits would be a consequence of the shift of trucks from the highway, thus resulting in higher speeds, decrease fuel consumption, and decrease vehicle maintenance costs. The overall benefit-cost ratio of 1.7 implies a cost-effective project. PMID:27419201

Integrated waste management system costs in a MPC system

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

Supko, E.M.

1995-12-01

The impact on system costs of including a centralized interim storage facility as part of an integrated waste management system based on multi-purpose canister (MPC) technology was assessed in analyses by Energy Resources International, Inc. A system cost savings of $1 to $2 billion occurs if the Department of Energy begins spent fuel acceptance in 1998 at a centralized interim storage facility. That is, the savings associated with decreased utility spent fuel management costs will be greater than the cost of constructing and operating a centralized interim storage facility.

Evaluating the Use of Tissue Oximetry to Decrease Intensive Unit Monitoring for Free Flap Breast Reconstruction.

PubMed

Ricci, Joseph A; Vargas, Christina R; Ho, Olivia A; Lin, Samuel J; Tobias, Adam M; Lee, Bernard T

2017-07-01

Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008-2014) and cases requiring return to the operating room were identified. Data evaluated included patient demographics, the take back time course, and complications of flap loss and salvage. A cost-benefit analysis was performed to analyse the utility of a postoperative intensive monitoring setting. There were 900 flaps performed and 32 required an unplanned return to the operating room. There were 16 flaps that required a reexploration within the first 24 hours; the standard length of intensive unit monitoring. After 4 hours, there were 7 flaps (44%) detected by tissue oximetry for reexploration. After 15 hours of intensive monitoring postoperatively, cost analysis revealed that the majority (15/16; 94%) of failing flaps had been identified and the cost of identifying each subsequent failing flap exceeded the cost of another hour of intensive monitoring. The postoperative paradigm for microsurgical flaps has historically required intensive unit monitoring. Using tissue oximetry, a fast-track pathway can reduce time spent in an intensive monitoring setting from 24 to 15 hours with significant cost savings and minimal risk of missing a failing free flap.

Evaluating the Effect of Margin Consensus Guideline Publication on Operative Patterns and Financial Impact of Breast Cancer Operation.

PubMed

Bhutiani, Neal; Mercer, Megan K; Bachman, Katelynn C; Heidrich, Samantha R; Martin, Robert C G; Scoggins, Charles R; McMasters, Kelly M; Ajkay, Nicolás

2018-02-09

This study sought to evaluate re-excision rates, patient satisfaction with their breasts, and healthcare costs before and after publication of 2014 Society of Surgical Oncology/American Society of Radiation Oncology consensus guideline on margins for breast conserving operation with whole-breast irradiation for stage I and II breast cancer at an academic institution. Patients with stage I and II invasive carcinomas who underwent partial mastectomy were divided into 2 groups based on whether they were treated before (PRE) or after (POST) guideline publication in March 2014. Groups were compared with respect to re-excision rates, conversion to mastectomy, specimen volumes, mean cost per patient of surgical care, and prospectively collected patient post-procedure quality of life. A total of 237 patients who underwent partial mastectomy were examined (n = 126 in the PRE group and n = 111 in the POST group). Patients in the POST group were less likely to require re-excision (9% POST vs 37% PRE; p < 0.001) and were less likely to undergo conversion to mastectomy (5% POST vs 14% PRE; p = 0.02). After consensus guideline publication, mean operative cost per patient decreased ($4,874 POST vs $5,772 PRE; p < 0.001), and patients had improved breast quality of life scores (77 out of 100 POST vs 61 out of 100 PRE; p = 0.03). On multivariable analysis, publication of the consensus statement was an independent predictor of decreased re-excision rates (odds ratio 0.17; 95% CI 0.08 to 0.38; p < 0.001) and operative cost per patient (odds ratio 0.14; 95% CI 0.78 to 0.30; p < 0.001). Widespread implementation of the consensus guideline on margins for breast conserving operation will likely lead to the intended improvements in operative and financial outcomes, as well as patient satisfaction with breast conserving operation. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Rebuilding and the private cloud of the hospital information system by the virtualization technology.

PubMed

Yamashita, Yoshinori; Ogaito, Tatoku

2013-01-01

In our hospital, we managed an electronic health record system and many section subsystems as a hospital information system. By the expansion of these information systems, a system becomes complicated, and maintenance and operative cost increased. Furthermore, the environment that is available to medical information is demanded anywhere anytime by expansion of the computerization. However, the expansion of the information use becomes necessary for the expansion such as the personal protection of information for security. We became rebuilding and the private cloud of the hospital information system by the virtualization technology to solve such a problem. As a result, we were able to perform a decrease in number of the servers which constituted a system, a decrease in network traffic, reduction of the operative cost.

Overview of NASA Glenn Seal Project

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Dunlap, Patrick; Proctor, Margaret; Delgado, Irebert; Finkbeiner, Josh; DeMange, Jeff; Daniels, Christopher C.; Taylor, Shawn; Oswald, Jay

2006-01-01

NASA Glenn is currently performing seal research supporting both advanced turbine engine development and advanced space vehicle/propulsion system development. Studies have shown that decreasing parasitic leakage through applying advanced seals will increase turbine engine performance and decrease operating costs. Studies have also shown that higher temperature, long life seals are critical in meeting next generation space vehicle and propulsion system goals in the areas of performance, reusability, safety, and cost. NASA Glenn is developing seal technology and providing technical consultation for the Agency s key aero- and space technology development programs.

Comparing drinking water treatment costs to source water protection costs using time series analysis

NASA Astrophysics Data System (ADS)

Heberling, Matthew T.; Nietch, Christopher T.; Thurston, Hale W.; Elovitz, Michael; Birkenhauer, Kelly H.; Panguluri, Srinivas; Ramakrishnan, Balaji; Heiser, Eric; Neyer, Tim

2015-11-01

We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reduction in the watershed rather than pay for treatment on site. To illustrate, we use daily observations from 2007 to 2011 for the Bob McEwen Water Treatment Plant, Clermont County, Ohio, to understand the relationship between treatment costs and water quality and operational variables (e.g., turbidity, total organic carbon [TOC], pool elevation, and production volume). Part of our contribution to understanding drinking water treatment costs is examining both long-run and short-run relationships using error correction models (ECMs). Treatment costs per 1000 gallons (per 3.79 m3) were based on chemical, pumping, and granular activated carbon costs. Results from the ECM suggest that a 1% decrease in turbidity decreases treatment costs by 0.02% immediately and an additional 0.1% over future days. Using mean values for the plant, a 1% decrease in turbidity leads to $1123/year decrease in treatment costs. To compare these costs with source water protection costs, we use a polynomial distributed lag model to link total phosphorus loads, a source water quality parameter affected by land use changes, to turbidity at the plant. We find the costs for source water protection to reduce loads much greater than the reduction in treatment costs during these years. Although we find no incentive to protect source water in our case study, this framework can help DWTPs quantify the trade-offs.

Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

PubMed

Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

2014-03-01

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Materials management: stretching the "household" budget.

PubMed

Carpe, R H; Carroll, P E

1987-11-01

As CFOs assume responsibility for the materials management function because of the potential to maximize cash flow, achieve economies of scale, decrease costs, and streamline operations, they look for guidelines to evaluate performance. Conducting a systems operations audit can aid in assessing that performance. CFOs can determine whether materials management processes are working "smarter, nor harder."

Cost-effectiveness of Crohn’s disease post-operative care

PubMed Central

Wright, Emily K; Kamm, Michael A; Dr Cruz, Peter; Hamilton, Amy L; Ritchie, Kathryn J; Bell, Sally J; Brown, Steven J; Connell, William R; Desmond, Paul V; Liew, Danny

2016-01-01

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection. METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo. RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented. CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated. PMID:27076772

VirSSPA- a virtual reality tool for surgical planning workflow.

PubMed

Suárez, C; Acha, B; Serrano, C; Parra, C; Gómez, T

2009-03-01

A virtual reality tool, called VirSSPA, was developed to optimize the planning of surgical processes. Segmentation algorithms for Computed Tomography (CT) images: a region growing procedure was used for soft tissues and a thresholding algorithm was implemented to segment bones. The algorithms operate semiautomati- cally since they only need seed selection with the mouse on each tissue segmented by the user. The novelty of the paper is the adaptation of an enhancement method based on histogram thresholding applied to CT images for surgical planning, which simplifies subsequent segmentation. A substantial improvement of the virtual reality tool VirSSPA was obtained with these algorithms. VirSSPA was used to optimize surgical planning, to decrease the time spent on surgical planning and to improve operative results. The success rate increases due to surgeons being able to see the exact extent of the patient's ailment. This tool can decrease operating room time, thus resulting in reduced costs. Virtual simulation was effective for optimizing surgical planning, which could, consequently, result in improved outcomes with reduced costs.

A strategy to decide whether to move the last case of the day in an operating room to another empty operating room to decrease overtime labor costs.

PubMed

Dexter, F

2000-10-01

We examined how to program an operating room (OR) information system to assist the OR manager in deciding whether to move the last case of the day in one OR to another OR that is empty to decrease overtime labor costs. We first developed a statistical strategy to predict whether moving the case would decrease overtime labor costs for first shift nurses and anesthesia providers. The strategy was based on using historical case duration data stored in a surgical services information system. Second, we estimated the incremental overtime labor costs achieved if our strategy was used for moving cases versus movement of cases by an OR manager who knew in advance exactly how long each case would last. We found that if our strategy was used to decide whether to move cases, then depending on parameter values, only 2.0 to 4.3 more min of overtime would be required per case than if the OR manager had perfect retrospective knowledge of case durations. The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved. The use of other information technologies to assist in the decision of whether to move a case, such as real-time patient tracking information systems, closed-circuit cameras, or graphical airport-style displays, can, on average, reduce overtime by no more than only 2 to 4 min per case that can be moved.

No place like home.

PubMed

Benavidez, Teresa; Friedman, Beth

2003-07-01

To ease staffing burdens, Seton Healthcare Network established a home coding program. DNFB claims pending the health information management department's code assignment consistently decreased, reducing the organization's dollars holding by 25 percent. Decreases in contract and as-needed labor contributed to an operational cost savings of about $200,000 per year. The organization was able to fill all of its coding vacancies.

Investigating the Relationship between Customer Wait Time and Operational Availability through Simulation Modeling

DTIC Science & Technology

2012-12-01

STATEMENT Approved for public release; distribution is unlimited 12b. DISTRIBUTION CODE A 13. ABSTRACT (maximum 200 words) Customer Wait Time ( CWT ...inventory level, thereby increasing the material readiness of the operating forces. Intuitively, decreasing CWT increases operational availability (Ao...and CWT has led to arbitrary stock policies that do not account for the cost and benefit they provide. This project centers on monetizing the

Cost Analysis In A Multi-Mission Operations Environment

NASA Technical Reports Server (NTRS)

Newhouse, M.; Felton, L.; Bornas, N.; Botts, D.; Roth, K.; Ijames, G.; Montgomery, P.

2014-01-01

Spacecraft control centers have evolved from dedicated, single-mission or single missiontype support to multi-mission, service-oriented support for operating a variety of mission types. At the same time, available money for projects is shrinking and competition for new missions is increasing. These factors drive the need for an accurate and flexible model to support estimating service costs for new or extended missions; the cost model in turn drives the need for an accurate and efficient approach to service cost analysis. The National Aeronautics and Space Administration (NASA) Huntsville Operations Support Center (HOSC) at Marshall Space Flight Center (MSFC) provides operations services to a variety of customers around the world. HOSC customers range from launch vehicle test flights; to International Space Station (ISS) payloads; to small, short duration missions; and has included long duration flagship missions. The HOSC recently completed a detailed analysis of service costs as part of the development of a complete service cost model. The cost analysis process required the team to address a number of issues. One of the primary issues involves the difficulty of reverse engineering individual mission costs in a highly efficient multimission environment, along with a related issue of the value of detailed metrics or data to the cost model versus the cost of obtaining accurate data. Another concern is the difficulty of balancing costs between missions of different types and size and extrapolating costs to different mission types. The cost analysis also had to address issues relating to providing shared, cloud-like services in a government environment, and then assigning an uncertainty or risk factor to cost estimates that are based on current technology, but will be executed using future technology. Finally the cost analysis needed to consider how to validate the resulting cost models taking into account the non-homogeneous nature of the available cost data and the decreasing flight rate. This paper presents the issues encountered during the HOSC cost analysis process, and the associated lessons learned. These lessons can be used when planning for a new multi-mission operations center or in the transformation from a dedicated control center to multi-center operations, as an aid in defining processes that support future cost analysis and estimation. The lessons can also be used by mature serviceoriented, multi-mission control centers to streamline or refine their cost analysis process.

Cost Analysis in a Multi-Mission Operations Environment

NASA Technical Reports Server (NTRS)

Felton, Larry; Newhouse, Marilyn; Bornas, Nick; Botts, Dennis; Ijames, Gayleen; Montgomery, Patty; Roth, Karl

2014-01-01

Spacecraft control centers have evolved from dedicated, single-mission or single mission-type support to multi-mission, service-oriented support for operating a variety of mission types. At the same time, available money for projects is shrinking and competition for new missions is increasing. These factors drive the need for an accurate and flexible model to support estimating service costs for new or extended missions; the cost model in turn drives the need for an accurate and efficient approach to service cost analysis. The National Aeronautics and Space Administration (NASA) Huntsville Operations Support Center (HOSC) at Marshall Space Flight Center (MSFC) provides operations services to a variety of customers around the world. HOSC customers range from launch vehicle test flights; to International Space Station (ISS) payloads; to small, short duration missions; and has included long duration flagship missions. The HOSC recently completed a detailed analysis of service costs as part of the development of a complete service cost model. The cost analysis process required the team to address a number of issues. One of the primary issues involves the difficulty of reverse engineering individual mission costs in a highly efficient multi-mission environment, along with a related issue of the value of detailed metrics or data to the cost model versus the cost of obtaining accurate data. Another concern is the difficulty of balancing costs between missions of different types and size and extrapolating costs to different mission types. The cost analysis also had to address issues relating to providing shared, cloud-like services in a government environment, and then assigning an uncertainty or risk factor to cost estimates that are based on current technology, but will be executed using future technology. Finally the cost analysis needed to consider how to validate the resulting cost models taking into account the non-homogeneous nature of the available cost data and the decreasing flight rate. This paper presents the issues encountered during the HOSC cost analysis process, and the associated lessons learned. These lessons can be used when planning for a new multi-mission operations center or in the transformation from a dedicated control center to multi-center operations, as an aid in defining processes that support future cost analysis and estimation. The lessons can also be used by mature service-oriented, multi-mission control centers to streamline or refine their cost analysis process.

[Cost analysis for navigation in knee endoprosthetics].

PubMed

Cerha, O; Kirschner, S; Günther, K-P; Lützner, J

2009-12-01

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed. The acquisition expenses of various navigation systems (5 and 10 year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated. The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to 300-395 depending on the navigation system. Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

The role of inspiratory muscle training in the management of asthma and exercise-induced bronchoconstriction.

PubMed

Shei, Ren-Jay; Paris, Hunter L R; Wilhite, Daniel P; Chapman, Robert F; Mickleborough, Timothy D

2016-11-01

Asthma is a pathological condition comprising of a variety of symptoms which affect the ability to function in daily life. Due to the high prevalence of asthma and associated healthcare costs, it is important to identify low-cost alternatives to traditional pharmacotherapy. One of these low cost alternatives is the use of inspiratory muscle training (IMT), which is a technique aimed at increasing the strength and endurance of the diaphragm and accessory muscles of respiration. IMT typically consists of taking voluntary inspirations against a resistive load across the entire range of vital capacity while at rest. In healthy individuals, the most notable benefits of IMT are an increase in diaphragm thickness and strength, a decrease in exertional dyspnea, and a decrease in the oxygen cost of breathing. Due to the presence of expiratory flow limitation in asthma and exercise-induced bronchoconstriction, dynamic lung hyperinflation is common. As a result of varying operational lung volumes, due in part to hyperinflation, the respiratory muscles may operate far from the optimal portion of the length-tension curve, and thus may be forced to operate against a low pulmonary compliance. Therefore, the ability of these muscles to generate tension is reduced, and for any given level of ventilation, the work of breathing is increased as compared to non-asthmatics. Evidence that IMT is an effective treatment for asthma is inconclusive, due to limited data and a wide variation in study methodologies. However, IMT has been shown to decrease dyspnea, increase inspiratory muscle strength, and improve exercise capacity in asthmatic individuals. In order to develop more concrete recommendations regarding IMT as an effective low-cost adjunct in addition to traditional asthma treatments, we recommend that a standard treatment protocol be developed and tested in a placebo-controlled clinical trial with a large representative sample.

Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and cost analysis.

PubMed

Steinmetz, Michael P; Mroz, Thomas E; Krishnaney, Ajit; Modic, Michael

2009-12-01

In today's health-care environment, operational efficiency is intrinsic to balancing the need for increased productivity driven by rising costs and potentially decreasing reimbursement. Other operational factors kept constant, decreasing the time for a procedure can be viewed as one marker for increased efficiency. To prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization. STYDY DESIGN: Prospective nonrandomized study. Prospective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft. Time for performance and interpretation of intraoperative localization radiograph. This is a prospective nonrandomized study of patients treated consecutively with a single-level ACDF with allograft and plating. All the patients underwent a conventional approach to the cervical spine. After exposure, a spinal needle was placed in the exposed intervertebral disc and a radiography was performed. Either a conventional or a digital radiography was used in each case. Eighteen patients were enrolled in this study. Ten patients underwent localization with conventional radiography, whereas eight patients underwent localization with digital imaging. The mean time for conventional radiography was 823 seconds (standard deviation [SD], 159), and for digital, it was 100 seconds (SD, 34; p<.001). Current technology provides options for level localization. Digital imaging provides equally accurate information as conventional radiography in a significantly reduced amount of time. Image quality, ease or archival, and manipulation provided by digital radiography are superior to those by provided fluoroscopy. Keeping operational factors constant, decreasing the time for a procedure, and increasing the efficiency of the environment may be viewed as a surrogate for improving the cost basis for a procedure.

The organizational costs of ethical conflicts.

PubMed

Nelson, William A; Weeks, William B; Campfield, Justin M

2008-01-01

Ethical conflicts are a common phenomenon in today's healthcare settings. As healthcare executives focus on balancing quality care and cost containment, recognizing the costs associated with ethical conflicts is only logical. In this article, we present five case vignettes to identify several general cost categories related to ethical conflicts, including operational costs, legal costs, and marketing and public relations costs. In each of these cost categories, the associated direct, indirect, and long-term costs of the ethical conflict are explored as well. Our analysis suggests that organizations have, in addition to philosophical reasons, financial incentives to focus on decreasing the occurrence of ethical conflicts. The cost categories affected by ethical conflicts are not insignificant. Such conflicts can affect staff morale and lower the organization's overall culture and profit margin. Therefore, organizations should develop mechanisms and strategies for decreasing and possibly preventing ethical conflicts. The strategies suggested in this article seek to shift the organization's focus when dealing with conflicts, from just reacting to moving upstream-that is, understanding the root causes of ethical conflicts and employing approaches designed to reduce their occurrence and associated costs. Such an effort has the potential to enhance the organization's overall culture and ultimately lead to organizational success.

Use of optimization to predict the effect of selected parameters on commuter aircraft performance

NASA Technical Reports Server (NTRS)

Wells, V. L.; Shevell, R. S.

1982-01-01

An optimizing computer program determined the turboprop aircraft with lowest direct operating cost for various sets of cruise speed and field length constraints. External variables included wing area, wing aspect ratio and engine sea level static horsepower; tail sizes, climb speed and cruise altitude were varied within the function evaluation program. Direct operating cost was minimized for a 150 n.mi typical mission. Generally, DOC increased with increasing speed and decreasing field length but not by a large amount. Ride roughness, however, increased considerably as speed became higher and field length became shorter.

Agent-Based Model and System Dynamics Model for Peace-Keeping Operations

DTIC Science & Technology

2014-09-01

may lead to increase in profits, or negative re-enforcing effect, e.g., decreasing the cost of sales may lead to increase in profits. The rate at...and smartness. Miller explained that their belief in fate served as a way to disregard the responsibility and accountability for one’s action. The...effects of crime on society include [28]: • Loss of productivity • Increase in health care • Increase in security cost for businesses • Direct costs

The cost of a large-scale hollow fibre MBR.

PubMed

Verrecht, Bart; Maere, Thomas; Nopens, Ingmar; Brepols, Christoph; Judd, Simon

2010-10-01

A cost sensitivity analysis was carried out for a full-scale hollow fibre membrane bioreactor to quantify the effect of design choices and operational parameters on cost. Different options were subjected to a long term dynamic influent profile and evaluated using ASM1 for effluent quality, aeration requirements and sludge production. The results were used to calculate a net present value (NPV), incorporating both capital expenditure (capex), based on costs obtained from equipment manufacturers and full-scale plants, and operating expenditure (opex), accounting for energy demand, sludge production and chemical cleaning costs. Results show that the amount of contingency built in to cope with changes in feedwater flow has a large impact on NPV. Deviation from a constant daily flow increases NPV as mean plant utilisation decreases. Conversely, adding a buffer tank reduces NPV, since less membrane surface is required when average plant utilisation increases. Membrane cost and lifetime is decisive in determining NPV: an increased membrane replacement interval from 5 to 10 years reduces NPV by 19%. Operation at higher SRT increases the NPV, since the reduced costs for sludge treatment are offset by correspondingly higher aeration costs at higher MLSS levels, though the analysis is very sensitive to sludge treatment costs. A higher sustainable flux demands greater membrane aeration, but the subsequent opex increase is offset by the reduced membrane area and the corresponding lower capex. Copyright © 2010 Elsevier Ltd. All rights reserved.

The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques.

PubMed

Lotan, Yair; Cadeddu, Jeffrey A; Gettman, Matthew T

2004-10-01

We evaluated the costs components of laparoscopic (LRP) and robot assisted prostatectomy (RAP), and compared their costs to those of open radical retropubic prostatectomy (RRP). A model was created using commercially available software to compare the costs of treatment with LRP, RAP or RRP. Hospital costs were obtained from a large county hospital. A literature search was performed to determine typical (average) robot costs, length of stay and operative time for RRP, LRP and RAP. We limited our analysis to mature series and included only the most recent efforts. The cost of the robot was estimated at 1,200,000 dollars with a 100,000 dollars yearly maintenance contract. It was assumed that the robot would be used across specialities for a total of 300 cases yearly in a 7-year period. We performed a series of 1 and 2-way sensitivity analyses to evaluate the costs of LRP, RAP and RRP, while varying robot costs, the number of robotic cases, hospital length of stay, operative time and cost of laparoscopic/robotic equipment. RRP was the most cost-effective approach with a cost advantage of 487 dollars and 1,726 dollars over LRP and RAP, respectively. If we excluded the initial cost of purchasing a robot, the cost difference between RRP and RAP was 1,155 dollars. This large difference in RRP and RAP costs resulted from a cost of 857 dollars per case to pay for robot purchase and maintenance, and the high cost of 1,705 dollars for equipment per case. An even shorter RAP operative time (140 vs 160 minutes) and length of stay (1.2 vs 2.5 days) did not compensate for the added expenditure. LRP cost more than RRP primarily due to equipment costs (533 dollars) since the shorter hospital stay (1.3 vs 2.5 days) was compensated for by longer operative time (200 vs 160 minutes). The costs of new technology are typically borne out in the first years of use and RAP is no exception with high robot costs for purchase, maintenance and operative equipment overshadowing savings gained by shorter length of stay. While RRP is currently the least costly approach, LRP has proved to be almost as cost competitive as RRP, whereas RAP will require a significant decrease in the cost of the device and maintenance fees.

Operating room efficiency: benefits of an orthopaedic traumatologist at a level II trauma center.

PubMed

Althausen, Peter L; Kauk, Justin R; Shannon, Steven; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2014-05-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P < 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our community-based trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center.

PubMed

Althausen, Peter L; Kauk, Justin R; Shannon, Steven; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center. Retrospective review. Level II community-based trauma hospital. Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011. Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons. Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel's 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods. A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001). This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Clinical process cost analysis.

PubMed

Marrin, C A; Johnson, L C; Beggs, V L; Batalden, P B

1997-09-01

New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two. Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution. Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization. Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.

The use of hydrogen for aircraft propulsion in view of the fuel crisis

NASA Technical Reports Server (NTRS)

Weiss, S.

1973-01-01

Some factors influencing the technical feasibility of operating a liquid hydrogen-fueled airplane are discussed in light of the projected decrease of fossil fuels. Other sources of energy, such as wind, tidal, solar, and geothermal, are briefly mentioned. In view of projected decreases in available petroleum fuels, interest has been generated in exploiting the potential of liquid hydrogen (LH2) as an aircraft fuel. Cost studies of LH2 production show it to be more expensive than presently used fuels. Regardless of cost considerations, LH2 is viewed as an attractive aircraft fuel because of the potential performance benefits it offers. Accompanying these benefits, however, are many new problems associated with aircraft design and operations; for example, problems related to fuel system design and the handling of LH2 during ground servicing. Some of the factors influencing LH2 fuel tank design, pumping, heat exchange, and flow regulation are discussed.

Integrated digital/electric aircraft concepts study

NASA Technical Reports Server (NTRS)

Cronin, M. J.; Hays, A. P.; Green, F. B.; Radovcich, N. A.; Helsley, C. W.; Rutchik, W. L.

1985-01-01

The integrated digital/electrical aircraft (IDEA) is an aircraft concept which employs all electric secondary power systems and advanced digital flight control systems. After trade analysis, preferred systems were applied to the baseline configuration. An additional configuration, the alternate IDEA, was also considered. For this concept the design ground rules were relaxed in order to quantify additional synergistic benefits. It was proposed that an IDEA configuration and technical risks associated with the IDEA systems concepts be defined and the research and development required activities to reduce these risks be identified. The selected subsystems include: power generation, power distribution, actuators, environmental control system and flight controls systems. When the aircraft was resized, block fuel was predicted to decrease by 11.3 percent, with 7.9 percent decrease in direct operating cost. The alternate IDEA shows a further 3.4 percent reduction in block fuel and 3.1 percent reduction in direct operating cost.

Robotic surgery: current perceptions and the clinical evidence.

PubMed

Ahmad, Arif; Ahmad, Zoha F; Carleton, Jared D; Agarwala, Ashish

2017-01-01

It appears that a discrepancy exists between the perception of robotic-assisted surgery (RAS) and the current clinical evidence regarding robotic-assisted surgery among patients, healthcare providers, and hospital administrators. The purpose of this study was to assess whether or not such a discrepancy exists. We administered survey questionnaires via face-to-face interviews with surgical patients (n = 101), healthcare providers (n = 58), and senior members of hospital administration (n = 6) at a community hospital that performs robotic surgery. The respondents were asked about their perception regarding the infection rate, operative time, operative blood loss, incision size, cost, length of hospital stay (LOS), risk of complications, precision and accuracy, tactile sensation, and technique of robotic-assisted surgery as compared with conventional laparoscopic surgery. We then performed a comprehensive literature review to assess whether or not these perceptions could be corroborated with clinical evidence. The majority of survey respondents perceived RAS as modality to decrease infection rate, increase operative time, decrease operative blood loss, smaller incision size, a shorter LOS, and a lower risk of complications, while increasing the cost. Respondents also believed that robotic surgery provides greater precision, accuracy, and tactile sensation, while improving intra-operative access to organs. A comprehensive literature review found little-to-no clinical evidence that supported the respondent's favorable perceptions of robotic surgery except for the increased costs, and precision and accuracy of the robotic-assisted technique. There is a discrepancy between the perceptions of robotic surgery and the clinical evidence among patients, healthcare providers, and hospital administrators surveyed.

Umbilical hernias: the cost of waiting.

PubMed

Strosberg, David S; Pittman, Matthew; Mikami, Dean

2017-02-01

Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p < 0.0001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p < 0.0001) and 365 (8.69 vs. 11.04 p < 0.0001) day post-index mark. A subgroup analysis demonstrated laparoscopic repair had higher costs compared to open primarily due to higher index procedure costs (p < 0.05). Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

Improving operating room schedules.

PubMed

Li, Fei; Gupta, Diwakar; Potthoff, Sandra

2016-09-01

Operating rooms (ORs) in US hospitals are costly to staff, generate about 70 % of a hospital's revenues, and operate at a staffed-capacity utilization of 60-70 %. Many hospitals allocate blocks of OR time to individual or groups of surgeons as guaranteed allocation, who book surgeries one at a time in their blocks. The booking procedure frequently results in unused time between surgeries. Realizing that this presents an opportunity to improve OR utilization, hospitals manually reschedule surgery start times one or two days before each day of surgical operations. The purpose of rescheduling is to decrease OR staffing costs, which are determined by the number of concurrently staffed ORs. We formulate the rescheduling problem as a variant of the bin-packing problem with interrelated items, which are the surgeries performed by the same surgeon. We develop a lower bound (LB) construction algorithm and prove that the LB is at least (2/3) of the optimal staffing cost. A key feature of our approach is that we allow hospitals to have two shift lengths. Our analytical results form the basis of a branch-and-bound algorithm, which we test on data obtained from three hospitals. Experiments show that rescheduling saves significant staffing costs.

Economic analysis of medical management applied for left colostomy.

PubMed

Savlovschi, C; Serban, D; Andreescu, Cv; Dascalu, Am; Pantu, H

2013-01-01

This paper presents an analysis of surgical treatment costs for left colostomy, aiming to calculate a medium cost per procedure and to identify the means to maximize the economic management of this type of surgicale procedure. A retrospective study was conducted on a group of 8 patients hospitalized in the 4th Surgery Department,Emergency University Hospital Bucharest, during the year 2012 for left colic neoplasms with obstruction signs that were operated on with a left colostomy. The followed parameters in the studied group of patients were represented by medical expenses, divided in: preoperative, intra-operative and immediate postoperative (postop. hospitalization). Two major types of colostomy were performed: left loop colostomy with intact tumour for 6 patients and left end colostomy and tumour resection (Hartmann's procedure) for 2 patients. The medium cost of this type of surgical intervention was 4396.807 RON, representing 1068.742 euro. Statistic data analysis didn't reveal average costs to vary with the type of procedure. The age of the study subjects was between 49 and 88, with an average of 61 years, without it being possible to establish a correlation between patient age and the level of medical spendings. Reducing the costs involved by left colostomy can be efficiently done by decreasing the number of days of hospitalisation in the following ways: preoperative preparation and assessment of the subject in an outpatient regimen; the accuracy of the surgical procedure with the decrease of early postoperative complications and antibiotherapy- the second major cause of increased postoperative costs. Celsius.

Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.

PubMed

Arsenault, Kyle A; Yusuf, Arif M; Crystal, Eugene; Healey, Jeff S; Morillo, Carlos A; Nair, Girish M; Whitlock, Richard P

2013-01-31

Atrial fibrillation is a common post-operative complication of cardiac surgery and is associated with an increased risk of post-operative stroke, increased length of intensive care unit and hospital stays, healthcare costs and mortality. Numerous trials have evaluated various pharmacological and non-pharmacological prophylactic interventions for their efficacy in preventing post-operative atrial fibrillation. We conducted an update to a 2004 Cochrane systematic review and meta-analysis of the literature to gain a better understanding of the effectiveness of these interventions. The primary objective was to assess the effects of pharmacological and non-pharmacological interventions for preventing post-operative atrial fibrillation or supraventricular tachycardia after cardiac surgery. Secondary objectives were to determine the effects on post-operative stroke or cerebrovascular accident, mortality, cardiovascular mortality, length of hospital stay and cost of treatment during the hospital stay. We searched the Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July 2011). We selected randomized controlled trials (RCTs) that included adult patients undergoing cardiac surgery who were allocated to pharmacological or non-pharmacological interventions for the prevention of post-operative atrial fibrillation or supraventricular tachycardia, except digoxin, potassium (K(+)), or steroids. Two review authors independently abstracted study data and assessed trial quality. One hundred and eighteen studies with 138 treatment groups and 17,364 participants were included in this review. Fifty-seven of these studies were included in the original version of this review while 61 were added, including 27 on interventions that were not considered in the original version. Interventions included amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post-operative atrial fibrillation after cardiac surgery compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95% confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34; 95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found to be effective. Prophylactic intervention decreased the hospital length of stay by approximately two-thirds of a day and decreased the cost of hospital treatment by roughly $1250 US. Intervention was also found to reduce the odds of post-operative stroke, though this reduction did not reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%). No significant effect on all-cause or cardiovascular mortality was demonstrated. Prophylaxis to prevent atrial fibrillation after cardiac surgery with any of the studied pharmacological or non-pharmacological interventions may be favored because of its reduction in the rate of atrial fibrillation, decrease in the length of stay and cost of hospital treatment and a possible decrease in the rate of stroke. However, this review is limited by the quality of the available data and heterogeneity between the included studies. Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each approach.

Cyclone performance by velocity

USDA-ARS?s Scientific Manuscript database

Cyclones are used almost exclusively in the US cotton ginning industry for emission abatement on pneumatic conveying system exhausts because of their high efficiency, and low capital and operating cost.. Cyclone performance is improved by increasing collection effectiveness or decreasing energy cons...

Commercialization of Kennedy Space Center Instrumentation Developed to Improve Safety, Reliability, Cost Effectiveness of Space Shuttle Processing, Launch, and Landing

NASA Technical Reports Server (NTRS)

Helms, William R.; Starr, Stanley O.

1997-01-01

Priorities and achievements of the Kennedy Space Center (KSF) Instrumentation Laboratories in improving operational safety and decreasing processing costs associated with the Shuttle vehicle are addressed. Technologies that have been or are in the process of technology transfer are reviewed, and routes by which commercial concerns can obtain licenses to other KSF Instrumentation Laboratory technologies are discussed.

Innovative technology conserves resources and generates savings: a case study from the Sunnybrook Regional Processing Centre.

PubMed

Karim, Abdool Z

2009-01-01

The regional processing centre at Sunnybrook Health Sciences Centre recently faced the substantial challenge of increasing cleaning capacity to meet the current workload and anticipated future demand without increasing its operating budget. The solution, upgrading its cleaning and decontamination system to a highly automated system, met both objectives. An analysis of the impact of the change found that the new system provided additional benefits, including improved productivity and cleaning quality; decreased costs; reduced water, electricity and chemical use; improved worker safety and morale; and decreased overtime. Investing in innovative technology improved key departmental outcomes while meeting institutional environmental and cost savings objectives.

Distributed photovoltaic system impact upon utility load/supply management practices

NASA Astrophysics Data System (ADS)

Vachtsevanos, G. J.; Meliopoulos, A. P.; Paraskevopoulos, B. K.

A methodology is described for simulation of the economic and technical factors of photovoltaic (PV) installations interfacing with utility load/management operations. A probabalistic technique is used to model the expected demand, reliability of the generating units, costs and profits from each unit, expected unserviced energy, and the loss of load probability. The available power from PV arrays is treated stochastically with statistical weighting on the basis of site meteorological data. The goal is to include the PV power while minimizing operational costs, taking into account the level of penetration of the total PV output. Two sample simulations for a utility with a diverse generating mix demonstrate that overall costs would decrease in both cases with PVs on-line through the emphasis on cheaper-fueled generators and peak-load shaving when possible.

Analyzing and Comparing Biomass Feedstock Supply Systems in China: Corn Stover and Sweet Sorghum Case Studies

DOE PAGES

Ren, Lantian; Cafferty, Kara; Roni, Mohammad; ...

2015-06-11

This paper analyzes the rural Chinese biomass supply system and models supply chain operations according to U.S. concepts of logistical unit operations: harvest and collection, storage, transportation, preprocessing, and handling and queuing. In this paper, we quantify the logistics cost of corn stover and sweet sorghum in China under different scenarios. We analyze three scenarios of corn stover logistics from northeast China and three scenarios of sweet sorghum stalks logistics from Inner Mongolia in China. The case study estimates that the logistics cost of corn stover and sweet sorghum stalk to be $52.95/dry metric ton and $52.64/dry metric ton, respectively,more » for the current labor-based biomass logistics system. However, if the feedstock logistics operation is mechanized, the cost of corn stover and sweet sorghum stalk decreases to $36.01/dry metric ton and $35.76/dry metric ton, respectively. The study also includes a sensitivity analysis to identify the cost factors that cause logistics cost variation. Results of the sensitivity analysis show that labor price has the most influence on the logistics cost of corn stover and sweet sorghum stalk, with a variation of $6 to $12/dry metric ton.« less

Analyzing and Comparing Biomass Feedstock Supply Systems in China: Corn Stover and Sweet Sorghum Case Studies

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

Ren, Lantian; Cafferty, Kara; Roni, Mohammad

This paper analyzes the rural Chinese biomass supply system and models supply chain operations according to U.S. concepts of logistical unit operations: harvest and collection, storage, transportation, preprocessing, and handling and queuing. In this paper, we quantify the logistics cost of corn stover and sweet sorghum in China under different scenarios. We analyze three scenarios of corn stover logistics from northeast China and three scenarios of sweet sorghum stalks logistics from Inner Mongolia in China. The case study estimates that the logistics cost of corn stover and sweet sorghum stalk to be $52.95/dry metric ton and $52.64/dry metric ton, respectively,more » for the current labor-based biomass logistics system. However, if the feedstock logistics operation is mechanized, the cost of corn stover and sweet sorghum stalk decreases to $36.01/dry metric ton and $35.76/dry metric ton, respectively. The study also includes a sensitivity analysis to identify the cost factors that cause logistics cost variation. Results of the sensitivity analysis show that labor price has the most influence on the logistics cost of corn stover and sweet sorghum stalk, with a variation of $6 to $12/dry metric ton.« less

The Effect of Utilization Review on Emergency Department Operations.

PubMed

Desai, Shoma; Gruber, Phillip F; Eiting, Erick; Seabury, Seth A; Mack, Wendy J; Voyageur, Christian; Vasquez, Veronica; Kim, Hyung T; Terp, Sophie

2017-11-01

Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Analyzing the cost of screening selectee and non-selectee baggage.

PubMed

Virta, Julie L; Jacobson, Sheldon H; Kobza, John E

2003-10-01

Determining how to effectively operate security devices is as important to overall system performance as developing more sensitive security devices. In light of recent federal mandates for 100% screening of all checked baggage, this research studies the trade-offs between screening only selectee checked baggage and screening both selectee and non-selectee checked baggage for a single baggage screening security device deployed at an airport. This trade-off is represented using a cost model that incorporates the cost of the baggage screening security device, the volume of checked baggage processed through the device, and the outcomes that occur when the device is used. The cost model captures the cost of deploying, maintaining, and operating a single baggage screening security device over a one-year period. The study concludes that as excess baggage screening capacity is used to screen non-selectee checked bags, the expected annual cost increases, the expected annual cost per checked bag screened decreases, and the expected annual cost per expected number of threats detected in the checked bags screened increases. These results indicate that the marginal increase in security per dollar spent is significantly lower when non-selectee checked bags are screened than when only selectee checked bags are screened.

Resource utilization and costs before and after total joint arthroplasty.

PubMed

Bozic, Kevin J; Stacey, Brett; Berger, Ariel; Sadosky, Alesia; Oster, Gerry

2012-03-23

The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.). Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test. 14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553. Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.

Economics of installation of solar heating plants

NASA Astrophysics Data System (ADS)

Popel, O. S.; Frid, S. Y.; Shpiltayn, E. E.

1984-04-01

An engineering-economic analysis of solar heating plants for determination of their cost effectiveness involves calculating the maximum economically feasibile extra capital investment on their installation and calculating the fraction of the total heat demand covered by such a plant which makes replacement of conventional heating plant maximally economical. The annual economic effect of solar heating is calculated in terms of normalized cost differential, as criterion for its competitiveness with conventional heating. Plant performance characteristics, namely dependence of both the percent demand coverage and the annual cost differential on the area of solar radiation collectors is then considered. Analysis of the cost equation, assuming that the extra fixed cost is proportional to the collector area, reveals the necessary and sufficient condition for decrease of annual operating cost.

Higher Education for Our Time

ERIC Educational Resources Information Center

Burnett, Dana D.; Collins, Natalia D.

2010-01-01

Public higher education is currently experiencing a decline in financial support from state governments, an acceleration of enrollment growth, and a shift from a transformational to a transactional student relationship. Private institutions are also struggling with increasing operational costs, and decreases in revenue from endowments and…

Process analysis and economics of drinking water production from coastal aquifers containing chromophoric dissolved organic matter and bromide using nanofiltration and ozonation.

PubMed

Sobhani, R; McVicker, R; Spangenberg, C; Rosso, D

2012-01-01

In regions characterized by water scarcity, such as coastal Southern California, groundwater containing chromophoric dissolved organic matter is a viable source of water supply. In the coastal aquifer of Orange County in California, seawater intrusion driven by coastal groundwater pumping increased the concentration of bromide in extracted groundwater from 0.4 mg l⁻¹ in 2000 to over 0.8 mg l⁻¹ in 2004. Bromide, a precursor to bromate formation is regulated by USEPA and the California Department of Health as a potential carcinogen and therefore must be reduced to a level below 10 μg l⁻¹. This paper compares two processes for treatment of highly coloured groundwater: nanofiltration and ozone injection coupled with biologically activated carbon. The requirement for bromate removal decreased the water production in the ozonation process to compensate for increased maintenance requirements, and required the adoption of catalytic carbon with associated increase in capital and operating costs per unit volume. However, due to the absence of oxidant addition in nanofiltration processes, this process is not affected by bromide. We performed a process analysis and a comparative economic analysis of capital and operating costs for both technologies. Our results show that for the case studied in coastal Southern California, nanofiltration has higher throughput and lower specific capital and operating cost, when compared to ozone injection with biologically activate carbon. Ozone injection with biologically activated carbon, compared to nanofiltration, has 14% higher capital cost and 12% higher operating costs per unit water produced while operating at the initial throughput. Due to reduced ozone concentration required to accommodate for bromate reduction, the ozonation process throughput is reduced and the actual cost increase (per unit water produced) is 68% higher for capital cost and 30% higher for operations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Efficient method of evaluation for Gaussian Hartree-Fock exchange operator for Gau-PBE functional

NASA Astrophysics Data System (ADS)

Song, Jong-Won; Hirao, Kimihiko

2015-07-01

We previously developed an efficient screened hybrid functional called Gaussian-Perdew-Burke-Ernzerhof (Gau-PBE) [Song et al., J. Chem. Phys. 135, 071103 (2011)] for large molecules and extended systems, which is characterized by the usage of a Gaussian function as a modified Coulomb potential for the Hartree-Fock (HF) exchange. We found that the adoption of a Gaussian HF exchange operator considerably decreases the calculation time cost of periodic systems while improving the reproducibility of the bandgaps of semiconductors. We present a distance-based screening scheme here that is tailored for the Gaussian HF exchange integral that utilizes multipole expansion for the Gaussian two-electron integrals. We found a new multipole screening scheme helps to save the time cost for the HF exchange integration by efficiently decreasing the number of integrals of, specifically, the near field region without incurring substantial changes in total energy. In our assessment on the periodic systems of seven semiconductors, the Gau-PBE hybrid functional with a new screening scheme has 1.56 times the time cost of a pure functional while the previous Gau-PBE was 1.84 times and HSE06 was 3.34 times.

Efficient method of evaluation for Gaussian Hartree-Fock exchange operator for Gau-PBE functional

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

Song, Jong-Won; Hirao, Kimihiko, E-mail: hirao@riken.jp

2015-07-14

We previously developed an efficient screened hybrid functional called Gaussian-Perdew–Burke–Ernzerhof (Gau-PBE) [Song et al., J. Chem. Phys. 135, 071103 (2011)] for large molecules and extended systems, which is characterized by the usage of a Gaussian function as a modified Coulomb potential for the Hartree-Fock (HF) exchange. We found that the adoption of a Gaussian HF exchange operator considerably decreases the calculation time cost of periodic systems while improving the reproducibility of the bandgaps of semiconductors. We present a distance-based screening scheme here that is tailored for the Gaussian HF exchange integral that utilizes multipole expansion for the Gaussian two-electron integrals.more » We found a new multipole screening scheme helps to save the time cost for the HF exchange integration by efficiently decreasing the number of integrals of, specifically, the near field region without incurring substantial changes in total energy. In our assessment on the periodic systems of seven semiconductors, the Gau-PBE hybrid functional with a new screening scheme has 1.56 times the time cost of a pure functional while the previous Gau-PBE was 1.84 times and HSE06 was 3.34 times.« less

Demonstration of the coast-down technique for determining train resistances

NASA Technical Reports Server (NTRS)

Dayman, B.

1983-01-01

Full-scale measurement or validation of the various factors of train running resistance is an essential step in decreasing train energy consumption. Such a measurement capability would enable railroads to evaluate the cost benefits of operational and train consistent configuration changes, and new vehicle and truck designs for decreasing aerodynamic drag and rolling resistance. A decrease in the rolling resistance affects more than just a decrease in energy consumption; it also will result in decreased mechanical wear, hence less wheel and rail maintenance and replacement costs. A demonstration of a simple coast-down technique (based on computer-reduction of distance history) was accomplished using specially configured trains on main line rail provided by the Atchison, Topeka and Sante Fe Railway Co. This demonstration test shows that this distance-history coast-down technique for trains is easy to execute in the field. The total running resistance history was accurately determined and subsequently separated into rolling resistance (mechanical friction) and aerodynamic drag.

The effects of total laboratory automation on the management of a clinical chemistry laboratory. Retrospective analysis of 36 years.

PubMed

Sarkozi, Laszlo; Simson, Elkin; Ramanathan, Lakshmi

2003-03-01

Thirty-six years of data and history of laboratory practice at our institution has enabled us to follow the effects of analytical automation, then recently pre-analytical and post-analytical automation on productivity, cost reduction and enhanced quality of service. In 1998, we began the operation of a pre- and post-analytical automation system (robotics), together with an advanced laboratory information system to process specimens prior to analysis, deliver them to various automated analytical instruments, specimen outlet racks and finally to refrigerated stockyards. By the end of 3 years of continuous operation, we compared the chemistry part of the system with the prior 33 years and quantitated the financial impact of the various stages of automation. Between 1965 and 2000, the Consumer Price Index increased by a factor of 5.5 in the United States. During the same 36 years, at our institution's Chemistry Department the productivity (indicated as the number of reported test results/employee/year) increased from 10,600 to 104,558 (9.3-fold). When expressed in constant 1965 dollars, the total cost per test decreased from 0.79 dollars to 0.15 dollars. Turnaround time for availability of results on patient units decreased to the extent that Stat specimens requiring a turnaround time of <1 h do not need to be separately prepared or prioritized on the system. Our experience shows that the introduction of a robotics system for perianalytical automation has brought a large improvement in productivity together with decreased operational cost. It enabled us to significantly increase our workload together with a reduction of personnel. In addition, stats are handled easily and there are benefits such as safer working conditions and improved sample identification, which are difficult to quantify at this stage.

Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

PubMed Central

Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

2017-01-01

Introduction High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. Results ED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), computed tomography mean scans decreased 62% (p<0.001), and OBS/IP length of stay mean days decreased 41% (p<0.001). Gross charges decreased 45% (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001). Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001). Conclusion Individualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care. PMID:28210351

Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users.

PubMed

Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

2017-02-01

High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary's, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. ED mean visits decreased 43% (p<0.001), inpatient mean admissions decreased 44% (p<0.001), outpatient mean visits decreased 17% (p<0.001), computed tomography mean scans decreased 62% (p<0.001), and OBS/IP length of stay mean days decreased 41% (p<0.001). Gross charges decreased 45% (p<0.001), direct expenses decreased 47% (p<0.001), contribution margin improved by 11% (p=0.002), and operating margin improved by 73% (p<0.001). Patients with housing increased 14% (p<0.001), those with primary care increased 15% (p<0.001), and those with insurance increased 16% (p<0.001). Individualized CCMs© for a select group of patients are associated with decreased healthcare system overutilization and cost of care.

North of the 46° parallel: Obstacles and challenges to recycling in Ontario's rural and northern communities.

PubMed

Lakhan, Calvin

2015-10-01

This study examines the economic challenges of recycling in Ontario's rural and northern areas. Specifically, this study quantifies the economic and diversion impact of operating recycling programs in these regions. Using a systems based cost model, focus is placed on analyzing: (1) What would happen to provincial recycling costs and diversion levels if recycling programs were eliminated in "high cost" northern and rural communities? (2) Is it possible to increase the provincial recycling rate by focusing investments in low cost, high performance regions (while simultaneously eliminating recycling programs in rural and northern areas)? (3) How would the mix of material recovered change if recycling programs were eliminated in rural and northern areas? The results of this analysis show that eliminating recycling programs in high cost regions significantly decreased system costs without negatively impacting overall recycling rates. This study also found that it was possible to increase the provincial recycling rate while simultaneously reducing program costs by targeting specific regions for recovery. The findings of this study suggest that Ontario reevaluate whether rural and northern municipalities be legislatively required to operate household recycling programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Applying activity-based costing to the nuclear medicine unit.

PubMed

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

2005-08-01

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

[Economic impact of strategies using ephedrine prefilled syringes].

PubMed

Crégut-Corbaton, J; Malbranche, C; Guignard, M-H; Fagnoni, P

2013-11-01

Ephedrine is an emergency drug available in ampules and syringes need to be prepared in advance according to one of two strategies in our establishment: strategy 1 (S1: 1 ampule per patient) and strategy 2 (S2: 1 ampule per operating room). There are also prefilled syringes. Because of their high cost and conflicting results in the literature, we assessed the economic interest of using prefilled syringes compared with strategies S1 and S2. This was a prospective observational study. The consumption of ephedrine was recorded over two periods of 14 days: P1 with syringes prepared in advance according to S1 or S2 and P2 with the on-demand use of prefilled syringes. The cost of a syringe of ephedrine prepared in advance (nurse time preparation included) was evaluated at €1.65 vs. €3.57 for a prefilled syringe. In operating rooms using S1, the use of prefilled syringes reduced overall the cost per patient about €1.22 and global annual costs by 72% (€2830), while the decrease was about €0.32 for the cost per patient and about 47% (€2760) for global annual costs for operating rooms using S2. The interest of our study is that we investigated different supply strategies for ephedrine within a large number of operating rooms. In our establishment, it was decided to use prefilled syringes in operating rooms that used S1. As well as the economic interest, prefilled syringes contributed to improved safety and saved nursing time. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Overview of NASA Glenn Seal Project

NASA Technical Reports Server (NTRS)

Steinetz, Bruce M.; Dunlap, Patrick H., Jr.; Proctor, Margaret; Delgado, Irebert; Finkbeiner,Joshua; deGroh, Henry; Ritzert, Frank; Daniels, Christopher; DeMange, Jeff; Taylor, Shawn;

Financing Community Colleges: Threats and Opportunities.

ERIC Educational Resources Information Center

Kapraun, E. Daniel; Heard, Don A.

Today many community colleges are faced with a multitude of financial problems that threaten the stability of their educational and operational programs. These problems include decreases in funding, rising costs, outdated funding formulas, and volatile enrollment patterns. The extent to which individual community college leaders understand these…

Three immobilized-cell columnar bioreactors for enhanced production of commodity chemicals

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

Davison, B.H.; Scott, C.D.; Kaufman, E.N.

1993-07-01

Immobilized-cell fluidized-bed bioreactors (FBRS) can be used with a variety of fermentations to increase production of fuels, solvents, organic acids, and other fermentation products. Part of the increased rates and yields are due to the immobilization of the biocatalyst at high concentrations. This FBR system with immobilized Zymomonas mobiles increased ethanol productivity more than tenfold with 99% conversion and near stoichiometric yields. FBRs also offer several additional modes of operation for simultaneous fermentation and separation to further increase production by removing the inhibitory products directly from the continuous fermentation. The production of lactic acid by immobilized Lactobacillus was augmented withmore » the addition and removal of solid adsorbent particles to the FBR. An immiscible organic extractant also was used to extract butanol from the acetone-butanol fermentation by Clostridium acetobutylicum. Demonstrations with these FBR systems have already shown definite advantages by improved overall product yields (decreasing feed costs) and by increased rates (decreasing capital and operating costs). Further demonstration and scale-up continue.« less

Three immobilized-cell columnar bioreactors for enhanced production of commodity chemicals

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

Davison, B.H.; Scott, C.D.; Kaufman, E.N.

1993-12-31

Immobilized-cell fluidized-bed bioreactors (FBRs) can be used with a variety of fermentations to increase production of fuels, solvents, organic acids, and other fermentation products. Part of the increased rates and yields are due to the immobilization of the biocatalyst at high concentrations. This FBR system with immobilized Zymomonas mobilis increased ethanol productivity more than tenfold with 99% conversion and near stoichiometric yields. FBRs also offer several additional modes of operation for simultaneous fermentation and separation to further increase production by removing the inhibitory products directly from the continuous fermentation. The production of lactic acid by immobilized Lactobacillus was augmented withmore » the addition and removal of solid adsorbent particles to the FBR. An immiscible organic extractant also was used to extract butanol from the acetone-butanol fermentation by Clostridium acetobutylicum. Demonstrations with these FBR systems have already shown definite advantages by improved overall product yields (decreasing feed costs) and by increased rates (decreasing capital and operating costs). Further demonstration and scale-up continue.« less

[Opened vs. laparoscopic radical nephrectomy in renal adenocarcinoma cost comparison].

PubMed

Herranz Amo, F; Subirá Ríos, D; Hernández Fernández, C; Martínez Salamanca, J I; Monzó, J I; Cabello Benavente, R

2006-10-01

To undertake a cost comparison (cost minimization) between transperitoneal laparoscopic and opened nephrectomy in renal adenocarcinoma treatment. Retrospective study on the first 26 patients submitted to LN without intra or postoperative complications in the period 2002-2003, using as control 22 patients treated with ON with the same characteristics and in the same period. Demographic variables were evaluated (age, sex, tumor size, etc.), intraoperative (operative time and fungible material used) and postoperative (length of stay in Postanaesthesic Care Unit, Acute Pain Unit needs and hospital stay). Our Hospital costs plus those imputed during year 2003 to the Urology Service, as well as the cost of fungible material for the same year were applied, carrying out a comparison of costs between both groups. There were no differences between the demographic variables between both groups except in the tumor, bigger size in the opened nephrectomy (p=0,001). Transperitoneal laparoscopic was 29,4% globally more expensive than opened nephrectomy. The transperitoneal laparoscopic intraoperative cost (operating room, anesthesia and fungibles) the exceeded in 151,6% to that of the opened nephrectomy, whereas in the opened nephrectomy the postoperative cost was a 63 % higher than in the transperitoneal laparoscopic cases. Transperitoneal laparoscopic in our Center is more expensive than opened nephrectomy due to a major occupation of operating room and that the specific fungible material used at the surgical act has a very high cost. It would be necessary to drastically reduce surgical time and decrease fungible material expenses, thus transperitoneal laparoscopic procedure could be competitive in our Hospital.

Turnaround Time Modeling for Conceptual Rocket Engines

NASA Technical Reports Server (NTRS)

Nix, Michael; Staton, Eric J.

2004-01-01

Recent years have brought about a paradigm shift within NASA and the Space Launch Community regarding the performance of conceptual design. Reliability, maintainability, supportability, and operability are no longer effects of design; they have moved to the forefront and are affecting design. A primary focus of this shift has been a planned decrease in vehicle turnaround time. Potentials for instituting this decrease include attacking the issues of removing, refurbishing, and replacing the engines after each flight. less, it is important to understand the operational affects of an engine on turnaround time, ground support personnel and equipment. One tool for visualizing this relationship involves the creation of a Discrete Event Simulation (DES). A DES model can be used to run a series of trade studies to determine if the engine is meeting its requirements, and, if not, what can be altered to bring it into compliance. Using DES, it is possible to look at the ways in which labor requirements, parallel maintenance versus serial maintenance, and maintenance scheduling affect the overall turnaround time. A detailed DES model of the Space Shuttle Main Engines (SSME) has been developed. Trades may be performed using the SSME Processing Model to see where maintenance bottlenecks occur, what the benefits (if any) are of increasing the numbers of personnel, or the number and location of facilities, in addition to trades previously mentioned, all with the goal of optimizing the operational turnaround time and minimizing operational cost. The SSME Processing Model was developed in such a way that it can easily be used as a foundation for developing DES models of other operational or developmental reusable engines. Performing a DES on a developmental engine during the conceptual phase makes it easier to affect the design and make changes to bring about a decrease in turnaround time and costs.

National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty.

PubMed

Varda, Briony K; Johnson, Emilie K; Clark, Curtis; Chung, Benjamin I; Nelson, Caleb P; Chang, Steven L

2014-04-01

We performed a population based study comparing trends in perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. Specific billing items contributing to cost were also investigated. Using the Perspective database (Premier, Inc., Charlotte, North Carolina), we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 to 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications and costs for the competing surgical approaches. Propensity weighting was used to minimize selection bias. Sampling weights were used to yield a nationally representative sample. A decrease in open pyeloplasty and an increase in minimally invasive pyeloplasty were observed. All procedures had low complication rates. Compared to open pyeloplasty, laparoscopic and robotic pyeloplasty had longer median operative times (240 minutes, p <0.0001 and 270 minutes, p <0.0001, respectively). There was no difference in median length of stay. Median total cost was lower among patients undergoing open vs robotic pyeloplasty ($7,221 vs $10,780, p <0.001). This cost difference was largely attributable to robotic supply costs. During the study period open pyeloplasty made up a declining majority of cases. Use of laparoscopic pyeloplasty plateaued, while robotic pyeloplasty increased. Operative time was longer for minimally invasive pyeloplasty, while length of stay was equivalent across all procedures. A higher cost associated with robotic pyeloplasty was driven by operating room use and robotic equipment costs, which nullified low room and board cost. This study reflects an adoption period for robotic pyeloplasty. With time, perioperative outcomes and cost may improve. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Union Carbide's PECOP cops $500,000 fuel cut

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

Crawford, E.

1979-10-29

Union Carbide's Plant Energy Cost Optimization Program (POCOP) is saving $500,000 a year at a Taft, Louisiana chemical complex. Day-to-day decisions affecting fuel costs and plant operations are based on a system of computerized data-gathering and processing. Although Carbide's system is not unique, it is more extensive and more comprehensive than the systems used by other chemical companies. The plant has decreased its energy consumption 12% below the 1972 level while increasing production by 30%. The system was initiated in response to the shift from raw materials to energy as the major production cost.

A Systems Approach to Costing in the Blood Bank

PubMed Central

Delon, Gerald L.; Smalley, Harold E.

1969-01-01

A macroscopic approach to departmental cost finding is combined with a microscopic approach to the weighting of laboratory tests in a mathematical model which, when incorporated into a relative unit value format, yields unit costs for such tests under a wide variety of operational conditions. The task of updating such costs to reflect changing conditions can be facilitated by a computer program incorporating the capability of pricing the various tests to achieve any desired profit or loss or to break even. Among other potential uses of such a technique, the effects on unit cost per test caused by increasing or decreasing the number of technicians or the volume of tests can be systematically examined, and pricing can be updated each year as hospital costs change. PMID:5799486

A decentralized approach to reducing the social costs of cascading failures

NASA Astrophysics Data System (ADS)

Hines, Paul

Large cascading failures in electrical power networks come with enormous social costs. These can be direct financial costs, such as the loss of refrigerated foods in grocery stores, or more indirect social costs, such as the traffic congestion that results from the failure of traffic signals. While engineers and policy makers have made numerous technical and organizational changes to reduce the frequency and impact of large cascading failures, the existing data, as described in Chapter 2 of this work, indicate that the overall frequency and impact of large electrical blackouts in the United States are not decreasing. Motivated by the cascading failure problem, this thesis describes a new method for Distributed Model Predictive Control and a power systems application. The central goal of the method, when applied to power systems, is to reduce the social costs of cascading failures by making small, targeted reductions in load and generation and changes to generator voltage set points. Unlike some existing schemes that operate from centrally located control centers, the method is operated by software agents located at substations distributed throughout the power network. The resulting multi-agent control system is a new approach to decentralized control, combining Distributed Model Predictive Control and Reciprocal Altruism. Experimental results indicate that this scheme can in fact decrease the average size, and thus social costs, of cascading failures. Over 100 randomly generated disturbances to a model of the IEEE 300 bus test network, the method resulted in nearly an order of magnitude decrease in average event size (measured in cost) relative to cascading failure simulations without remedial control actions. Additionally, the communication requirements for the method are measured, and found to be within the bandwidth capabilities of current communications technology (on the order of 100kB/second). Experiments on several resistor networks with varying structures, including a random graph, a scale-free network and a power grid indicate that the effectiveness of decentralized control schemes, like the method proposed here, is a function of the structure of the network that is to be controlled.

Impact on public hospitals if private health insurance rates in Victoria declined.

PubMed

Hanning, Brian W T

2004-12-13

The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.

Understanding refractory failures

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

Bases, G.J.

2006-01-15

Compared to most pieces of a power plant, refractory costs very little to install. Yet, if improperly manufactured, specified, stored, mixed installed, cured, or dried, refractory may cause problems that can significantly decrease a plant's operating efficiency and flexibility. Like Rodney Dangerfield, refractory design and installation deserve more respect. 4 photos.

Transnational Crime and the Criminal-Terrorist Nexus: Synergies and Corporate Trends (Walker Paper, Number 1)

DTIC Science & Technology

2005-05-01

terrorists; similar to a business that expands into franchises , splinter groups need resources to sustain themselves, which drives the cost of doing...not be easy. Move to Loosely Affiliated Groups: Franchising As dependency on state-sponsored terrorism decreases, ter- rorist groups operating alone...with the exception of Osama bin Laden) has not prevented the group from operating success- fully. An ideology cannot be decimated. The franchising of

Pilot microscreen separation of Sclerotium rolfsii biomass and broth. [Sclerotium rolfsii

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

Griffith, W.L.; Compere, A.L.; Cravens, J.B.

1981-01-01

Field production of scleroglucan biopolymer for micellular flooding near an injection well could eliminate two major polymer production costs, alcohol precipitation of polymer broth and resuspension of dry polymer in water. The use of microscreening could decrease these and another major polymer production cost, that of diatomaceous earth filtration. Bench and pilot tests using Rexnord 1, 6, and 21-..mu..m screens indicate that they provide efficient removal of gross solids from Sclerotium rolfsii culture broth partially diluted to viscosities suitable for field injection. Pilot centrifuge tests indicate that the microscreen backwash could be concentrated to a solid content of 2 tomore » 3% as volatile suspended solids, suitable for animal feed or by-product use. Although polishing filtration is required to remove residual formation plugging constituents, substantial decreases in capital costs and operating energy appear attainable if microscreening is used. 3 figures, 3 tables.« less

Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

PubMed

Dexter, Franklin; Abouleish, Amr E; Epstein, Richard H; Whitten, Charles W; Lubarsky, David A

2003-10-01

Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

Economics of MRI Operations After Implementation of Interpersonal Skills Training.

PubMed

Ladapo, Joseph A; Spritzer, Charles E; Nguyen, Xuan V; Pool, Judy; Lang, Elvira

2018-03-09

Examine the cost of MRI operations before and after implementation of interpersonal skills training to reduce unanticipated patient-related events in an academic medical center. Teams at four MRI sites (two hospital-based, two freestanding) were trained in evidence-based communication skills in February to April 2015. Training was designed to enable staff members to help patients mobilize their innate coping skills in response to any distress they experienced during their MRI visit. Data were collected before training and afterward from January to June 2016. Staff reported the incidence of disruptive motion, sedation use, MRI delays, incomplete examinations, and no-shows. Cost and revenue associated with MRI operations and staff and physician costs were estimated using Medicare and private insurance rates and data from the US Bureau of Labor Statistics. The study included 12,930 outpatient MRI visits. From baseline to follow-up, average monthly patient volume increased from 1,105 to 1,463 at hospital MRI sites and from 245 to 313 at freestanding MRI sites. Patient factors necessitating sedation or interfering with image progression or quality decreased from 9.0% to 5.5% at hospital sites and from 3.1% to 1.2% at freestanding sites. These changes translated into a reduction in operational costs of $4,600 per 1,000 scheduled patients and an increase in profit of $8,370 per 1,000 scheduled patients in hospital MRI sites, and a corresponding increase in operational costs of $1,570 per 1,000 scheduled-patients and an increase in profit of $12,800 per 1,000 scheduled patients in freestanding MRI sites. We found significant improvements in MRI operational efficiency after interpersonal skills team training, which were associated with reductions in costs and growth in revenue. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Life cycle costing with a discount rate

NASA Technical Reports Server (NTRS)

Posner, E. C.

1978-01-01

This article studies life cycle costing for a capability needed for the indefinite future, and specifically investigates the dependence of optimal policies on the discount rate chosen. The two costs considered are reprocurement cost and maintenance and operations (M and O) cost. The procurement price is assumed known, and the M and O costs are assumed to be a known function, in fact, a non-decreasing function, of the time since last reprocurement. The problem is to choose the optimum reprocurement time so as to minimize the quotient of the total cost over a reprocurement period divided by the period. Or one could assume a discount rate and try to minimize the total discounted costs into the indefinite future. It is shown that the optimum policy in the presence of a small discount rate hardly depends on the discount rate at all, and leads to essentially the same policy as in the case in which discounting is not considered.

Toward a new spacecraft optimal design lifetime? Impact of marginal cost of durability and reduced launch price

NASA Astrophysics Data System (ADS)

Snelgrove, Kailah B.; Saleh, Joseph Homer

2016-10-01

The average design lifetime of satellites continues to increase, in part due to the expectation that the satellite cost per operational day decreases monotonically with increased design lifetime. In this work, we challenge this expectation by revisiting the durability choice problem for spacecraft in the face of reduced launch price and under various cost of durability models. We first provide a brief overview of the economic thought on durability and highlight its limitations as they pertain to our problem (e.g., the assumption of zero marginal cost of durability). We then investigate the merging influence of spacecraft cost of durability and launch price, and we identify conditions that give rise cost-optimal design lifetimes that are shorter than the longest lifetime technically achievable. For example, we find that high costs of durability favor short design lifetimes, and that under these conditions the optimal choice is relatively robust to reduction in launch prices. By contrast, lower costs of durability favor longer design lifetimes, and the optimal choice is highly sensitive to reduction in launch price. In both cases, reduction in launch prices translates into reduction of the optimal design lifetime. Our results identify a number of situations for which satellite operators would be better served by spacecraft with shorter design lifetimes. Beyond cost issues and repeat purchases, other implications of long design lifetime include the increased risk of technological slowdown given the lower frequency of purchases and technology refresh, and the increased risk for satellite operators that the spacecraft will be technologically obsolete before the end of its life (with the corollary of loss of value and competitive advantage). We conclude with the recommendation that, should pressure to extend spacecraft design lifetime continue, satellite manufacturers should explore opportunities to lease their spacecraft to operators, or to take a stake in the ownership of the asset on orbit.

Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer.

PubMed

Tan, Yuyong; Lv, Liang; Duan, Tianying; Zhou, Junfeng; Peng, Dongzi; Tang, Yao; Liu, Deliang

2016-07-01

Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35 mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma. We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35-55 mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS. A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P > 0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P < 0.05). No recurrence was noted in the STER and VATS groups during a mean follow-up of 10.9 and 30.8 months, respectively. The treatment efficacy was comparable between the STER and VATS for esophageal leiomyoma of 35-55 mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.

The Vulnerability Framework Integrates Various Models of Generating Surplus Revenue

ERIC Educational Resources Information Center

Maniaci, Vincent

2004-01-01

Budgets operationalize the strategic planning process, and institutions must have surplus revenue to be able to cope with future operations. There are three approaches to generate surplus revenue: increased revenue, decreased cost, and reallocation of resources. Extending their earlier work, where they established strategic benchmarks for annual…

Mobile Learning: An Analysis of Student Preferences and Perceptions Surrounding Podcasting

ERIC Educational Resources Information Center

McCombs, Shawn William

2010-01-01

Today's learner arrives on our campuses with certain expectations, among them are technology innovation and availability, and the use of modern and efficient technology solutions to communicate and coexist. Meanwhile, institutions of higher learning across the country struggle with increased operating costs, decreasing legislative funding, and…

Stabilizing platinum in phosphoric acid fuel cells

NASA Technical Reports Server (NTRS)

Remick, R. J.

1982-01-01

Platinum sintering on phosphoric acid fuel cell cathodes is discussed. The cathode of the phosphoric acid fuel cell uses a high surface area platinum catalyst dispersed on a conductive carbon support to minimize both cathode polarization and fabrication costs. During operation, however, the active surface area of these electrodes decreases, which in turn leads to decreased cell performance. This loss of active surface area is a major factor in the degradation of fuel cell performance over time.

The burden of asthma in children: a Latin American perspective.

PubMed

Fischer, Gilberto Bueno; Camargos, Paulo Augusto Moreira; Mocelin, Helena Teresinha

2005-03-01

Worldwide, studies on asthma prevalence have shown major rises over the last 30 years. The impact on the burden of asthma is being increasingly recognised. In some countries in Latin America, the prevalence of asthma is among the highest in the world. Asthma admissions are very common in children, leading to high costs for the health systems of those countries. Unfortunately, Latin America has limited resources to pay for appropriate treatment. The main goals of the international guidelines for asthma treatment are not being met. However, asthma programmes operating in some countries are showing promising results in reducing asthma admissions and consequently decreasing the burden of asthma. Local adaptation of international guidelines must be implemented in order to decrease costs and optimise outcomes.

Pilot plant demonstration of stable and efficient high rate biological nutrient removal with low dissolved oxygen conditions.

PubMed

Keene, Natalie A; Reusser, Steve R; Scarborough, Matthew J; Grooms, Alan L; Seib, Matt; Santo Domingo, Jorge; Noguera, Daniel R

2017-09-15

Aeration in biological nutrient removal (BNR) processes accounts for nearly half of the total electricity costs at many wastewater treatment plants. Even though conventional BNR processes are usually operated to have aerated zones with high dissolved oxygen (DO) concentrations, recent research has shown that nitrification can be maintained using very low-DO concentrations (e.g., below 0.2 mg O 2 /L), and therefore, it may be possible to reduce energy use and costs in BNR facilities by decreasing aeration. However, the effect of reduced aeration on enhanced biological phosphorus removal (EBPR) is not understood. In this study, we investigated, at the pilot-scale level, the effect of using minimal aeration on the performance of an EBPR process. Over a 16-month operational period, we performed stepwise decreases in aeration, reaching an average DO concentration of 0.33 mg O 2 /L with stable operation and nearly 90% phosphorus removal. Under these low-DO conditions, nitrification efficiency was maintained, and nearly 70% of the nitrogen was denitrified, without the need for internal recycling of high nitrate aeration basin effluent to the anoxic zone. At the lowest DO conditions used, we estimate a 25% reduction in energy use for aeration compared to conventional BNR operation. Our improved understanding of the efficiency of low-DO BNR contributes to the global goal of reducing energy consumption during wastewater treatment operations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Interconnection-wide hour-ahead scheduling in the presence of intermittent renewables and demand response: A surplus maximizing approach

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

Behboodi, Sahand; Chassin, David P.; Djilali, Ned

This study describes a new approach for solving the multi-area electricity resource allocation problem when considering both intermittent renewables and demand response. The method determines the hourly inter-area export/import set that maximizes the interconnection (global) surplus satisfying transmission, generation and load constraints. The optimal inter-area transfer set effectively makes the electricity price uniform over the interconnection apart from constrained areas, which overall increases the consumer surplus more than it decreases the producer surplus. The method is computationally efficient and suitable for use in simulations that depend on optimal scheduling models. The method is demonstrated on a system that represents Northmore » America Western Interconnection for the planning year of 2024. Simulation results indicate that effective use of interties reduces the system operation cost substantially. Excluding demand response, both the unconstrained and the constrained scheduling solutions decrease the global production cost (and equivalently increase the global economic surplus) by 12.30B and 10.67B per year, respectively, when compared to the standalone case in which each control area relies only on its local supply resources. This cost saving is equal to 25% and 22% of the annual production cost. Including 5% demand response, the constrained solution decreases the annual production cost by 10.70B, while increases the annual surplus by 9.32B in comparison to the standalone case.« less

Interconnection-wide hour-ahead scheduling in the presence of intermittent renewables and demand response: A surplus maximizing approach

DOE PAGES

Behboodi, Sahand; Chassin, David P.; Djilali, Ned; ...

2016-12-23

This study describes a new approach for solving the multi-area electricity resource allocation problem when considering both intermittent renewables and demand response. The method determines the hourly inter-area export/import set that maximizes the interconnection (global) surplus satisfying transmission, generation and load constraints. The optimal inter-area transfer set effectively makes the electricity price uniform over the interconnection apart from constrained areas, which overall increases the consumer surplus more than it decreases the producer surplus. The method is computationally efficient and suitable for use in simulations that depend on optimal scheduling models. The method is demonstrated on a system that represents Northmore » America Western Interconnection for the planning year of 2024. Simulation results indicate that effective use of interties reduces the system operation cost substantially. Excluding demand response, both the unconstrained and the constrained scheduling solutions decrease the global production cost (and equivalently increase the global economic surplus) by 12.30B and 10.67B per year, respectively, when compared to the standalone case in which each control area relies only on its local supply resources. This cost saving is equal to 25% and 22% of the annual production cost. Including 5% demand response, the constrained solution decreases the annual production cost by 10.70B, while increases the annual surplus by 9.32B in comparison to the standalone case.« less

Construction and Operation Costs of Wastewater Treatment and Implications for the Paper Industry in China.

PubMed

Niu, Kunyu; Wu, Jian; Yu, Fang; Guo, Jingli

2016-11-15

This paper aims to develop a construction and operation cost model of wastewater treatment for the paper industry in China and explores the main factors that determine these costs. Previous models mainly involved factors relating to the treatment scale and efficiency of treatment facilities for deriving the cost function. We considered the factors more comprehensively by adding a regional variable to represent the economic development level, a corporate ownership factor to represent the plant characteristics, a subsector variable to capture pollutant characteristics, and a detailed-classification technology variable. We applied a unique data set from a national pollution source census for the model simulation. The major findings include the following: (1) Wastewater treatment costs in the paper industry are determined by scale, technology, degree of treatment, ownership, and regional factors; (2) Wastewater treatment costs show a large decreasing scale effect; (3) The current level of pollutant discharge fees is far lower than the marginal treatment costs for meeting the wastewater discharge standard. Key implications are as follows: (1) Cost characteristics and impact factors should be fully recognized when planning or making policies relating to wastewater treatment projects or technology development; (2) There is potential to reduce treatment costs by centralizing wastewater treatment via industrial parks; (3) Wastewater discharge fee rates should be increased; (4) Energy efficient technology should become the future focus of wastewater treatment.

Peri-operative physiotherapy.

PubMed

Makhabah, Dewi Nurul; Martino, Federica; Ambrosino, Nicolino

2013-01-23

Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient's quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient's ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.

A cost-effective approach to establishing a surgical skills laboratory.

PubMed

Berg, David A; Milner, Richard E; Fisher, Carol A; Goldberg, Amy J; Dempsey, Daniel T; Grewal, Harsh

2007-11-01

Recent studies comparing inexpensive low-fidelity box trainers to expensive computer-based virtual reality systems demonstrate similar acquisition of surgical skills and transferability to the clinical setting. With new mandates emerging that all surgical residency programs have access to a surgical skills laboratory, we describe our cost-effective approach to teaching basic and advanced open and laparoscopic skills utilizing inexpensive bench models, box trainers, and animate models. Open models (basic skills, bowel anastomosis, vascular anastomosis, trauma skills) and laparoscopic models (basic skills, cholecystectomy, Nissen fundoplication, suturing and knot tying, advanced in vivo skills) are constructed using a combination of materials found in our surgical research laboratories, retail stores, or donated by industry. Expired surgical materials are obtained from our hospital operating room and animal organs from food-processing plants. In vivo models are performed in an approved research facility. Operation, maintenance, and administration of the surgical skills laboratory are coordinated by a salaried manager, and instruction is the responsibility of all surgical faculty from our institution. Overall, the cost analyses of our initial startup costs and operational expenditures over a 3-year period revealed a progressive decrease in yearly cost per resident (2002-2003, $1,151; 2003-2004, $1,049; and 2004-2005, $982). Our approach to surgical skills education can serve as a template for any surgery program with limited financial resources.

Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance.

PubMed

Heller, Michael; Zanocco, Kyle; Zydowicz, Sara; Elaraj, Dina; Nayar, Ritu; Sturgeon, Cord

2012-09-01

The 2007 National Cancer Institute (NCI) conference on Thyroid Fine-Needle Aspiration (FNA) introduced the category atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Repeat FNA in 3 to 6 months was recommended for low-risk patients. Compliance with these recommendations has been suboptimal. We hypothesized that repeat FNA would be more effective than diagnostic lobectomy, with decreased costs and improved rates of cancer detection. Cost-effectiveness analysis was performed in which we compared diagnostic lobectomy with repeat FNA. A Markov model was developed. Outcomes and probabilities were identified from literature review. Third-party payer costs were estimated in 2010 US dollars. Outcomes were weighted by use of the quality-of-life utility factors, yielding quality-adjusted life years (QALYs). Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost, and utility estimates. The diagnostic lobectomy strategy cost $8,057 and produced 23.99 QALYs. Repeat FNA cost $2,462 and produced 24.05 QALYs. Repeat FNA was dominant until the cost of FNA increased to $6,091. Dominance of the repeat FNA strategy was not sensitive to the cost of operation or the complication rate. The NCI recommendations for repeat FNA regarding follow-up of AUS/FLUS results are cost-effective. Improving compliance with these guidelines should lead to less overall costs, greater quality of life, and fewer unnecessary operations. Copyright © 2012 Mosby, Inc. All rights reserved.

The Langley turbo-prop commuter design: A complete project description

NASA Technical Reports Server (NTRS)

Buttram, Greg; Horton, Keith; Keeter, Tim; Millhouse, Paul; Newberry, Kelli; Obyrne, Brian

1991-01-01

The primary objective of this project was to propose and prove the possibility of a new, advanced technology commuter aircraft design. Among the specifications were short to medium range capabilities, low seat per mile cost, fuel efficiency, and passenger comfort. Based on market evaluation, we found that the optimum size for new regional aircraft is around 50 passengers; we have designed our aircraft for this capacity. Turboprop engines provide substantial reductions in operating costs due to lower fuel consumption. We have therefore chosen an advanced turboprop engine. Composite materials, while more expensive to purchase and manufacture, result in decreased costs later through weight savings and ease of replacement.

Lean Stability augmentation study

NASA Technical Reports Server (NTRS)

Mcvey, J. B.; Kennedy, J. B.

1979-01-01

An analytical and experimental program was conducted to investigate techniques and develop technology for improving the lean combustion limits of premixing, prevaporizing combustors applicable to gas turbine engine main burners. Three concepts for improving lean stability limits were selected for experimental evaluation among twelve approaches considered. Concepts were selected on the basis of the potential for improving stability limits and achieving emission goals, the technological risks associated with development of practical burners employing the concepts, and the penalties to airline direct operating costs resulting from decreased combustor performance, increased engine cost, increased maintenance cost and increased engine weight associated with implementation of the concepts. Tests of flameholders embodying the selected concepts were conducted.

Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

PubMed Central

Gonzalez, Tyler A.; Bluman, Eric M.; Palms, David; Smith, Jeremy T.; Chiodo, Christopher P.

2016-01-01

Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety. PMID:26894212

Effect of land tenure and stakeholders attitudes on optimization of conservation practices in agricultural watersheds

NASA Astrophysics Data System (ADS)

Piemonti, A. D.; Babbar-Sebens, M.; Luzar, E. J.

2012-12-01

Modeled watershed management plans have become valuable tools for evaluating the effectiveness and impacts of conservation practices on hydrologic processes in watersheds. In multi-objective optimization approaches, several studies have focused on maximizing physical, ecological, or economic benefits of practices in a specific location, without considering the relationship between social systems and social attitudes on the overall optimality of the practice at that location. For example, objectives that have been commonly used in spatial optimization of practices are economic costs, sediment loads, nutrient loads and pesticide loads. Though the benefits derived from these objectives are generally oriented towards community preferences, they do not represent attitudes of landowners who might operate their land differently than their neighbors (e.g. farm their own land or rent the land to someone else) and might have different social/personal drivers that motivate them to adopt the practices. In addition, a distribution of such landowners could exist in the watershed, leading to spatially varying preferences to practices. In this study we evaluated the effect of three different land tenure types on the spatial-optimization of conservation practices. To perform the optimization, we used a uniform distribution of land tenure type and a spatially varying distribution of land tenure type. Our results show that for a typical Midwestern agricultural watershed, the most optimal solutions (i.e. highest benefits for minimum economic costs) found were for a uniform distribution of landowners who operate their own land. When a different land-tenure was used for the watershed, the optimized alternatives did not change significantly for nitrates reduction benefits and sediment reduction benefits, but were attained at economic costs much higher than the costs of the landowner who farms her/his own land. For example, landowners who rent to cash-renters would have to spend ~120% higher costs than landowners who operate their own land, to attain the same benefits. We also tested the effect of different social attitudes on the final preferences of the optimized alternatives and its consequences over the total effectiveness of the standard optimization approaches. The results suggest that, for example, when practices were removed from the system due to landowners' attitudes driven by economic profits, then the modified alternatives experienced a decrease in nitrates reduction by 2-50%, and decrease in peak flow reductions by 11-98 %, and decrease in sediments reduction by 20-77%.

Limiting technologies for particle beams and high energy physics

NASA Astrophysics Data System (ADS)

Panofsky, W. K. H.

1985-07-01

Since 1930 the energy of accelerators had grown by an order of magnitude roughly every 7 years. Like all exponential growths, be they human population, the size of computers, or anything else, this eventually will have to come to an end. When will this happen to the growth of the energy of particle accelerators and colliders? Fortunately, as the energy of accelerators has grown the cost per unit energy has decreased almost as fast as has the increase in energy. The result is that while the energy has increased so dramatically the cost per new installation has increased only by roughly an order of magnitude since the 1930's (corrected for inflation), while the number of accelerators operating at the frontier of the field has shrunk. As is shown in the by now familiar Livingston chart this dramatic decrease in cost has been achieved largely by a succession of new technologies, in addition to the more moderate gains in efficiency due to improved design, economies of scale, etc. We are therefore facing two questions: (1) Is there good reason scientifically to maintain the exponential growth, and (2) Are there new technologies in sight which promise continued decreases in unit costs. The answer to the first question is definitely yes; the answer to the second question is maybe.

Activity-based costing evaluation of a [(18)F]-fludeoxyglucose positron emission tomography study.

PubMed

Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Borght, Thierry Vander

2009-10-01

The aim of the study is to use the activity-based costing approach to give a better insight in the actual cost structure of a positron emission tomography procedure (FDG-PET) by defining the constituting components and by simulating the impact of possible resource or practice changes. The cost data were obtained from the hospital administration, personnel and vendor interviews as well as from structured questionnaires. A process map separates the process in 16 patient- and non-patient-related activities, to which the detailed cost data are related. One-way sensitivity analyses shows to which degree of uncertainty the different parameters affect the individual cost and evaluate the impact of possible resource or practice changes like the acquisition of a hybrid PET/CT device, the patient throughput or the sales price of a 370MBq (18)F-FDG patient dose. The PET centre spends 73% of time in clinical activities and the resting time after injection of the tracer (42%) is the single largest departmental cost element. The tracer cost and the operational time have the most influence on cost per procedure. The analysis shows a total cost per FDG-PET ranging from 859 Euro for a BGO PET camera to 1142 Euro for a 16 slices PET-CT system, with a distribution of the resource costs in decreasing order: materials (44%), equipment (24%), wage (16%), space (6%) and hospital overhead (10%). The cost of FDG-PET is mainly influenced by the cost of the radiopharmaceutical. Therefore, the latter rather than the operational time should be reduced in order to improve its cost-effectiveness.

Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study.

PubMed

Ly, Dan P; Cutler, David M

2018-02-14

Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers. The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013. There are 2824 hospitals as subjects of this study. The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013. Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year. Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.

A proactive outreach intervention that decreases readmission after hepatectomy.

PubMed

Narula, Nisha; Kim, Bradford J; Davis, Catherine H; Dewhurst, Whitney L; Samp, Leigh A; Aloia, Thomas A

2018-04-01

After hepatectomy, 7%-19% of patients are readmitted within 30 days, accounting for substantial cost and poor patient experience. The purpose of this study was to analyze the impact of a proactive outreach intervention on readmissions. Consecutive patients undergoing hepatectomy by a single surgeon 2012-2016 were identified in a prospectively maintained database. In August 2013 a postoperative intervention was implemented; an advanced practice provider called each patient within 72 hours of discharge. Readmission rates were compared pre- and postintervention using standard statistics. Two hundred thirty-one patients met the inclusion criteria and major hepatectomy was performed in 45.5% of patients. Although the complication rate was similar (25.0% preintervention and 19.4% postintervention, P = .324), readmissions within 30 days of operation decreased from 14.5% pre- to 6.5% postintervention (P = .046). Approximately 30% of outreach interactions required outpatient intervention. Factors associated with readmission on univariate analysis included increased operative time (P = .007), major hepatectomy (P = .012), hemi or extended hepatectomy (P = .032), second stage operation (P = .031), bile leak (P = 0.022), and any complication/modified Accordion complication ≥ 3 within 30 days (P <.0001). On multivariate analysis, lack of post-discharge intervention (P = .012) and bile leak (P = .031) were independently associated with readmission. These data demonstrate the efficacy of a proactive communication intervention after discharge to decrease readmissions after hepatectomy. The additional work created by the intervention is likely offset by decreased inpatient care needs and costs. Identification of high-risk populations and application of technology are likely to lead to further improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.

PubMed

McLaughlin, Nancy; Upadhyaya, Pooja; Buxey, Farzad; Martin, Neil A

2014-09-01

Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all three groups. Forty-four patients were included in the study. Average preparation time pre-incision decreased from 73 to 65 to 45 minutes in Groups 1, 2, and 3, respectively. The average total OR time and OR cost were 434 minutes and $8513 in Group 1; 348 minutes and $7592 in Group 2; and 407 minutes and $8333 in Group 3. The average cost for IOM, excluding electrode needles, was $1557, $1585, and $1263, respectively, in Groups 1, 2, and 3. Average total cost for bed assignment was $5747, $5198, and $4535, respectively, in Groups 1, 2, and 3. The average total LOS decreased from 3.16 days in Group 1 to 2.14 days in Group 3. Complete relief of or a significant decrease in preoperative symptomatology was achieved in 42 of the 44 patients, respectively. Overall, the average cost of a surgical care episode (index hospitalization + readmission/reoperation) decreased 25% from Group 1 to 3. Linking cost-containment and cost-reduction strategies to ongoing outcome improvement measures is an important step toward the optimization of value-based delivery of care.

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

PubMed

Althausen, Peter L; Shannon, Steven; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Comprehensive Planning Model and Delivery System for Leadership Training Programs.

ERIC Educational Resources Information Center

Janosik, Steven M.; Sina, Julie A.

1988-01-01

Presents an eight-step planning model that operationally defines a comprehensive delivery systems approach to campuswide leadership training. Lists four goals of the model: to increase efficiency of leadership training through shared resources, to decrease costs, to provide quality control, and to increase impact of programming effort by creating…

Cutting hardwood cants can boost sawmill profits

Treesearch

George R. Niskala; Thomas W., Jr. Church

1966-01-01

The markets for hardwood lumber are now strong, and sawmill profits are increasing. But this favorable market-price situation is the exception rather than the rule. Usually hardwood sawmill operators are confronted with ever-decreasing profit margins. During the past decade, while lumber prices have remained relatively constant, most logging and sawmilling costs have...

"QUESTIONS AS BIG AS THE WORLD AND AS ENDURING AS ETERNITY."

ERIC Educational Resources Information Center

MORSE, WAYNE

NATIONAL INTEREST CALLS FOR MORE ADEQUATELY MEETING OPERATIONAL AND CAPITAL COSTS OF HIGHER EDUCATION. SOME OF THE CONSEQUENCES OF THE DECREASED FEDERAL AID TO EDUCATION ARE DISCUSSED AND PROPOSALS FOR POLICY CONSIDERATIONS ARE ADVANCED. AMONG THE AREAS MOST INFLUENCED BY INADEQUATE FEDERAL SUPPORT ARE SCHOOL LUNCH PROGRAMS, COMMUNITY SERVICES,…

One fish, two fish, red fish, blue fish: effects of price frames, brand names, and choice set size on Medicare Part D insurance plan decisions.

PubMed

Barnes, Andrew J; Hanoch, Yaniv; Wood, Stacey; Liu, Pi-Ju; Rice, Thomas

2012-08-01

Because many seniors choose Medicare Part D plans offering poorer coverage at greater cost, the authors examined the effect of price frames, brand names, and choice set size on participants' ability to choose the lowest cost plan. A 2×2×2 within-subjects design was used with 126 participants aged 18 to 91 years old. Mouselab, a web-based program, allowed participants to choose drug plans across eight trials that varied using numeric or symbolic prices, real or fictitious drug plan names, and three or nine drug plan options. Results from the multilevel models suggest numeric versus symbolic prices decreased the likelihood of choosing the lowest cost plan (-8.0 percentage points, 95% confidence interval=-14.7 to -0.9). The likelihood of choosing the lowest cost plan decreased as the amount of information increased suggesting that decision cues operated independently and collectively when selecting a drug plan. Redesigning the current Medicare Part D plan decision environment could improve seniors' drug plan choices.

Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? - From Chinese healthcare system perspective.

PubMed

Wang, Yu-ting; Huang, Gang

2012-08-01

The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China. Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis. Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B-A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B-A), and decrease of palliative therapy cost could reduce both the ICER and overall cost. The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Summary appraisals of the Nation's ground-water resources; Lower Colorado region

USGS Publications Warehouse

Davidson, E.S.

1979-01-01

The potential for greater development of ground water in the southwestern part of the region is constrained by land subsidence, earth cracks, increasing costs of pumping and transportation, and moderate to poor chemical quality of water. More ground water can be developed in the northeastern part of the region, where the major constraint is pumping cost owing to low to moderate well yields and depth to water. Some benefits can be realized everywhere in the region through changes in current use and greater efficiencies of use. Additional supplies may be made available by capture of natural evapotranspiration. Increasing the efficiency of use is possible hydrologically but, in the near term, is more expensive than increasing groundwater development. Decrease of irrigation, change to water-saving methods of irrigation, use of saline water, decrease of per capita public- supply use, and more reuse of water in almost every type of use could help extend the supply and thereby reduce the current rate of ground-water depletion. Financial problems have not yet caused an overall decrease in pumpage, but, locally, operating costs or partial dewatering of the aquifer has eliminated or decreased withdrawal. Current water laws in all States of the region, except Arizona, control or allocate the use of ground water.

HVAC modifications and computerized energy analysis for the Operations Support Building at the Mars Deep Space Station at Goldstone

NASA Technical Reports Server (NTRS)

Halperin, A.; Stelzmuller, P.

1986-01-01

The key heating, ventilation, and air-conditioning (HVAC) modifications implemented at the Mars Deep Space Station's Operation Support Building at Jet Propulsion Laboratories (JPL) in order to reduce energy consumption and decrease operating costs are described. An energy analysis comparison between the computer simulated model for the building and the actual meter data was presented. The measurement performance data showed that the cumulative energy savings was about 21% for the period 1979 to 1981. The deviation from simulated data to measurement performance data was only about 3%.

On the Road to Transportation Efficiency

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

None

2014-04-21

Reducing emissions and oil consumption are crucial worldwide goals. Reducing transportation emissions, in particular, is key to reducing overall emissions. Electric vehicles driving on electrified roadways could be a significant part of the solution. E-roadways offer a variety of benefits: reduce petroleum consumption (electricity is used instead of gasoline), decrease vehicular operating costs (from about 12 cents per mile to 4 cents per mile), and extend the operational range of electric vehicles. Plus, e-roadway power can come from renewable sources.

On the Road to Transportation Efficiency

ScienceCinema

None

2018-01-16

Reducing emissions and oil consumption are crucial worldwide goals. Reducing transportation emissions, in particular, is key to reducing overall emissions. Electric vehicles driving on electrified roadways could be a significant part of the solution. E-roadways offer a variety of benefits: reduce petroleum consumption (electricity is used instead of gasoline), decrease vehicular operating costs (from about 12 cents per mile to 4 cents per mile), and extend the operational range of electric vehicles. Plus, e-roadway power can come from renewable sources.

Technologies for user-preferred routing

NASA Astrophysics Data System (ADS)

McNally, B. D.; Sridhar, Banavar

1996-05-01

The 1995 report of the RTCA Board of Directors' Select Committee on Free Flight states that 'insufficient capacity, limited access, and excessive operating restrictions have escalated operating costs, increase delays, and decreased efficiency for all users' of the national airspace system. The Air Transport Association estimates the annual loss to be 3.5 billion dollars. The goal of the user preferred routing research is to develop integrated airborne and ground technologies that enable the highest possible level of unconstrained, user-preferred routing in enroute airspace.

Constrained Optimization of Average Arrival Time via a Probabilistic Approach to Transport Reliability

PubMed Central

Namazi-Rad, Mohammad-Reza; Dunbar, Michelle; Ghaderi, Hadi; Mokhtarian, Payam

2015-01-01

To achieve greater transit-time reduction and improvement in reliability of transport services, there is an increasing need to assist transport planners in understanding the value of punctuality; i.e. the potential improvements, not only to service quality and the consumer but also to the actual profitability of the service. In order for this to be achieved, it is important to understand the network-specific aspects that affect both the ability to decrease transit-time, and the associated cost-benefit of doing so. In this paper, we outline a framework for evaluating the effectiveness of proposed changes to average transit-time, so as to determine the optimal choice of average arrival time subject to desired punctuality levels whilst simultaneously minimizing operational costs. We model the service transit-time variability using a truncated probability density function, and simultaneously compare the trade-off between potential gains and increased service costs, for several commonly employed cost-benefit functions of general form. We formulate this problem as a constrained optimization problem to determine the optimal choice of average transit time, so as to increase the level of service punctuality, whilst simultaneously ensuring a minimum level of cost-benefit to the service operator. PMID:25992902

The role of the donor liaison officer at PlusLife (Perth Bone and Tissue Bank Inc.), Western Australia.

PubMed

Smythe, Claire; White, Nicola; Winter, Joyleen; Cowie, Anne

2015-06-01

Femoral head donation at the time of hip replacement surgery provides a much needed resource of bone allograft to orthopaedic surgeons. Prior to 2005, potential femoral head donors were identified and consented in the hospital setting on the day of surgery. This resulted in over 40 % of donations failing post operatively suggesting that more effort could be given to pre-operative screening resulting in substantial savings in the cost associated with collection and testing of donors who were subsequently failed. The Donor Liaison role was implemented in 2005 to coordinate a Femoral Head Donation program maximising the number of successful donations through pre-operative screening. This study reviews the effectiveness of pre-operative screening of potential femoral head donors at PlusLife from 2002-2012. A retrospective audit of the database was undertaken 2002-2012 and medical/social reasons for pre-operative and postoperative failures were collated into 4 main categories to enable comparison: malignancy, autoimmune conditions, variant Creutzfeldt Jakob disease risk and general medical/social reasons. The number of femoral heads failed post operatively has decreased significantly from 26 % in 2003 to 6 % in 2012. A cost of $121,000 was expended on femoral heads failed post operatively in 2004, as compared to $20,350 in 2012. Donors excluded due to the 4 main categories (medical/social history) were identified pre-operatively in over 80 % of all cases. Preoperative screening of femoral head donors through a coordinated Femoral Head Donation Program is a safe and cost effective method.

Analysis of environmental constraints on expanding reserves in current and future reservoirs in wetlands. Final report

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

Harder, B.J.

1995-03-01

Louisiana wetlands require careful management to allow exploitation of non-renewable resources without destroying renewable resources. Current regulatory requirements have been moderately successful in meeting this goal by restricting development in wetland habitats. Continuing public emphasis on reducing environmental impacts of resource development is causing regulators to reassess their regulations and operators to rethink their compliance strategies. We examined the regulatory system and found that reducing the number of applications required by going to a single application process and having a coherent map of the steps required for operations in wetland areas would reduce regulatory burdens. Incremental changes can be mademore » to regulations to allow one agency to be the lead for wetland permitting at minimal cost to operators. Operators need cost effective means of access that will reduce environmental impacts, decrease permitting time, and limit future liability. Regulators and industry must partner to develop incentive based regulations that can provide significant environmental impact reduction for minimal economic cost. In addition regulators need forecasts of future E&P trends to estimate the impact of future regulations. To determine future activity we attempted to survey potential operators when this approach was unsuccessful we created two econometric models of north and south Louisiana relating drilling activity, success ratio, and price to predict future wetland activity. Results of the econometric models indicate that environmental regulations have a small but statistically significant effect on drilling operations in wetland areas of Louisiana. We examined current wetland practices and evaluated those practices comparing environmental versus economic costs and created a method for ranking the practices.« less

Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: a case series and cost analysis.

PubMed

Forner, D; Phillips, T; Rigby, M; Hart, R; Taylor, M; Trites, J

2016-02-05

In Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps. Charts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution. Mean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > 0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group. We have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.

Duke Energy Photovoltaic Integration Study: Carolinas Service Areas

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

Lu, Shuai; Samaan, Nader A.; Meng, Da

2014-03-01

Solar energy collected using photovoltaic (PV) technology is a clean and renewable energy source that offers multiple benefits to the electric utility industry and its customers, such as cost predictability, reduced emissions, and loss reduction by distributed installations. Renewable energy goals established in North Carolina Senate Bill 3 (SB3), in combination with the state tax credit and decreases in the cost of energy from PV panels, have resulted in rapid solar power penetration within the Carolinas services areas of Duke Energy. Continued decreases in PV prices are expected to lead to greater PV penetration rates than currently required in SB3.more » Despite the potential benefits, significant penetration of PV energy is of concern to the utility industry because of its impact on operating reliability and integration cost to customers, and equally important, how any additional costs may be allocated to different customer groups. Some of these impacts might become limiting factors for PV energy, especially growing distributed generation installed at customer sites. Recognizing the importance of renewable energy developments for a sustainable energy future and economic growth, Duke Energy has commissioned this study to simulate the effects of high-PV penetration rates and to initiate the process of quantifying the impacts. The objective of the study is to inform resource plans, guide operation improvements, and drive infrastructure investments for a steady and smooth transition to a new energy mix that provides optimal values to customers. The study team consists of experts from Pacific Northwest National Laboratory (PNNL), Power Costs, Inc. (PCI), Clean Power Research (CPR), Alstom Grid, and Duke Energy. PNNL, PCI, and CPR performed the study on generation impacts; Duke Energy modeled the transmission cases; and distribution simulations were conducted by Alstom Grid. PNNL analyzed the results from each work stream and produced the report.« less

Developing a cross-docking network design model under uncertain environment

NASA Astrophysics Data System (ADS)

Seyedhoseini, S. M.; Rashid, Reza; Teimoury, E.

2015-06-01

Cross-docking is a logistic concept, which plays an important role in supply chain management by decreasing inventory holding, order packing, transportation costs and delivery time. Paying attention to these concerns, and importance of the congestion in cross docks, we present a mixed-integer model to optimize the location and design of cross docks at the same time to minimize the total transportation and operating costs. The model combines queuing theory for design aspects, for that matter, we consider a network of cross docks and customers where two M/M/c queues have been represented to describe operations of indoor trucks and outdoor trucks in each cross dock. To prepare a perfect illustration for performance of the model, a real case also has been examined that indicated effectiveness of the proposed model.

Cost effectiveness of the US Geological Survey's stream-gaging program in New York

USGS Publications Warehouse

Wolcott, S.W.; Gannon, W.B.; Johnston, W.H.

1986-01-01

The U.S. Geological Survey conducted a 5-year nationwide analysis to define and document the most cost effective means of obtaining streamflow data. This report describes the stream gaging network in New York and documents the cost effectiveness of its operation; it also identifies data uses and funding sources for the 174 continuous-record stream gages currently operated (1983). Those gages as well as 189 crest-stage, stage-only, and groundwater gages are operated with a budget of $1.068 million. One gaging station was identified as having insufficient reason for continuous operation and was converted to a crest-stage gage. Current operation of the 363-station program requires a budget of $1.068 million/yr. The average standard error of estimation of continuous streamflow data is 13.4%. Results indicate that this degree of accuracy could be maintained with a budget of approximately $1.006 million if the gaging resources were redistributed among the gages. The average standard error for 174 stations was calculated for five hypothetical budgets. A minimum budget of $970,000 would be needed to operated the 363-gage program; a budget less than this does not permit proper servicing and maintenance of the gages and recorders. Under the restrictions of a minimum budget, the average standard error would be 16.0%. The maximum budget analyzed was $1.2 million, which would decrease the average standard error to 9.4%. (Author 's abstract)

Cost effectiveness of the stream-gaging program in South Carolina

USGS Publications Warehouse

Barker, A.C.; Wright, B.C.; Bennett, C.S.

1985-01-01

The cost effectiveness of the stream-gaging program in South Carolina was documented for the 1983 water yr. Data uses and funding sources were identified for the 76 continuous stream gages currently being operated in South Carolina. The budget of $422,200 for collecting and analyzing streamflow data also includes the cost of operating stage-only and crest-stage stations. The streamflow records for one stream gage can be determined by alternate, less costly methods, and should be discontinued. The remaining 75 stations should be maintained in the program for the foreseeable future. The current policy for the operation of the 75 stations including the crest-stage and stage-only stations would require a budget of $417,200/yr. The average standard error of estimation of streamflow records is 16.9% for the present budget with missing record included. However, the standard error of estimation would decrease to 8.5% if complete streamflow records could be obtained. It was shown that the average standard error of estimation of 16.9% could be obtained at the 75 sites with a budget of approximately $395,000 if the gaging resources were redistributed among the gages. A minimum budget of $383,500 is required to operate the program; a budget less than this does not permit proper service and maintenance of the gages and recorders. At the minimum budget, the average standard error is 18.6%. The maximum budget analyzed was $850,000, which resulted in an average standard error of 7.6 %. (Author 's abstract)

Financial Impact of Dual Vendor, Matrix Pricing, and Sole-Source Contracting on Implant Costs.

PubMed

Althausen, Peter L; Lapham, Joan; Mead, Lisa

2016-12-01

Implant costs comprise the largest proportion of operating room supply costs for orthopedic trauma care. Over the years, hospitals have devised several methods of controlling these costs with the help of physicians. With increasing economic pressure, these negotiations have a tremendous ability to decrease the cost of trauma care. In the past, physicians have taken no responsibility for implant pricing which has made cost control difficult. The reasons have been multifactorial. However, industry surgeon consulting fees, research support, and surgeon comfort with certain implant systems have played a large role in slowing adoption of cost-control measures. With the advent of physician gainsharing and comanagement agreements, physicians now have impetus to change. At our facility, we have used 3 methods for cost containment since 2009: dual vendor, matrix pricing, and sole-source contracting. Each has been increasingly successful, resulting in massive savings for the institution. This article describes the process and benefits of each model.

Heritage and Advanced Technology Systems Engineering Lessons Learned from NASA Space Missions

NASA Technical Reports Server (NTRS)

Barley, Bryan; Newhouse, Marilyn; Bacskay, Allen

2010-01-01

Use of heritage and new technology is necessary/enabling to implementing small, low cost missions, yet overruns decrease the ability to sustain future mission flight rates The majority of the cost growth drivers seen in the D&NF study were embedded early during formulation phase and later realized during the development and I&T phases Cost drivers can be avoided or significantly decreased by project management and SE emphasis on early identification of risks and realistic analyses SE processes that emphasize an assessment of technology within the mission system to identify technical issues in the design or operational use of the technology. Realistic assessment of new and heritage spacecraft technology assumptions , identification of risks and mitigation strategies. Realistic estimates of effort required to inherit existing or qualify new technology, identification of risks to estimates and develop mitigation strategies. Allocation of project reserves for risk-based mitigation strategies of each individual area of heritage or new technology. Careful tailoring of inheritance processes to ensure due diligence.

Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.

PubMed

Croft, Katherine; Mattingly, Patricia J; Bosse, Patrick; Naumann, R Wendel

2017-01-01

To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure. Prospective cohort study (Canadian Task Force classification III). Academic-affiliated community hospital. Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015. The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education. Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually. Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Battery Thermal Characterization

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

Keyser, Matthew A

The operating temperature is critical in achieving the right balance between performance, cost, and life for both Li-ion batteries and ultracapacitors. The chemistries of advanced energy-storage devices - such as lithium-based batteries - are very sensitive to operating temperature. High temperatures degrade batteries faster while low temperatures decrease their power and capacity, affecting vehicle range, performance, and cost. Understanding heat generation in battery systems - from the individual cells within a module, to the inter-connects between the cells, and across the entire battery system - is imperative for designing effective thermal-management systems and battery packs. At NREL, we have developedmore » unique capabilities to measure the thermal properties of cells and evaluate thermal performance of battery packs (air or liquid cooled). We also use our electro-thermal finite element models to analyze the thermal performance of battery systems in order to aid battery developers with improved thermal designs. NREL's tools are used to meet the weight, life, cost, and volume goals set by the U.S. Department of Energy for electric drive vehicles.« less

Total quality management in the hospital setting.

PubMed

Ernst, D F

1994-01-01

With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

PubMed

Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

2017-12-01

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization. There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts. SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

Senior Officer Course Manual. Military Justice and Civil Law

DTIC Science & Technology

1996-12-01

that a LT in the Operations Department has been selling AMWAY products to military and civil service personnel as well as actively recruiting others...effects of sexual harassment on productivity and readiness, including increased absenteeism, greater personnel turnover, lower morale, decreased... productivity and readiness. These include costs associated with increased Enclosure (3) absenteeism, greater personnel turnover, lower morale

The low risk and high return of integrative health services.

PubMed

Russo, Ruthann; Diener, Ian; Stitcher, Michael

2015-11-01

Supplemental treatments and practices such as yoga, acupuncture, guided imagery, and meditation can benefit not only patients in their recovery but also hospitals and health systems financially and operationally. Benefits include: > Savings in sedation costs for patients who use guided imagery during procedures > Increased revenue due to measurably increased patient satisfaction > Decreased length of stay.

76 FR 14658 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-17

... Activities; Submission to OMB for Review and Approval; Comment Request; National Emission Standards for... report of any physical or operational changes, initial performance tests, and periodic reports and... Estimates: There is a net decrease in labor hours and a net increase in cost to the Respondents in this ICR...

Association of Colleges of Applied Arts and Technology of Ontario 2002 Environmental Scan.

ERIC Educational Resources Information Center

Association of Colleges of Applied Arts and Technology of Ontario, Toronto.

This environmental scan is designed to assist Ontario's colleges in their strategic planning processes. Ontario's colleges have supported a 35% increase in enrollment, with a 40% decrease in funding, over the last ten years, while operating costs have risen. In addition, Ontario eliminated the secondary school Ontario Academic Courses (OACs),…

Self-organizing maps for learning the edit costs in graph matching.

PubMed

Neuhaus, Michel; Bunke, Horst

2005-06-01

Although graph matching and graph edit distance computation have become areas of intensive research recently, the automatic inference of the cost of edit operations has remained an open problem. In the present paper, we address the issue of learning graph edit distance cost functions for numerically labeled graphs from a corpus of sample graphs. We propose a system of self-organizing maps (SOMs) that represent the distance measuring spaces of node and edge labels. Our learning process is based on the concept of self-organization. It adapts the edit costs in such a way that the similarity of graphs from the same class is increased, whereas the similarity of graphs from different classes decreases. The learning procedure is demonstrated on two different applications involving line drawing graphs and graphs representing diatoms, respectively.

SCW Pressure-Channel Nuclear Reactor Some Design Features

NASA Astrophysics Data System (ADS)

Pioro, Igor L.; Khan, Mosin; Hopps, Victory; Jacobs, Chris; Patkunam, Ruban; Gopaul, Sandeep; Bakan, Kurtulus

Concepts of nuclear reactors cooled with water at supercritical pressures were studied as early as the 1950s and 1960s in the USA and Russia. After a 30-year break, the idea of developing nuclear reactors cooled with SuperCritical Water (SCW) became attractive again as the ultimate development path for water cooling. The main objectives of using SCW in nuclear reactors are: 1) to increase the thermal efficiency of modern Nuclear Power Plants (NPPs) from 30-35% to about 45-48%, and 2) to decrease capital and operational costs and hence decrease electrical energy costs (˜1000 US/kW or even less). SCW NPPs will have much higher operating parameters compared to modern NPPs (pressure about 25 MPa and outlet temperature up to 625°C), and a simplified flow circuit, in which steam generators, steam dryers, steam separators, etc., can be eliminated. Also, higher SCW temperatures allow direct thermo-chemical production of hydrogen at low cost, due to increased reaction rates. Pressure-tube or pressure-channel SCW nuclear reactor concepts are being developed in Canada and Russia for some time. Some design features of the Canadian concept related to fuel channels are discussed in this paper. The main conclusion is that the development of SCW pressure-tube nuclear reactors is feasible and significant benefits can be expected over other thermal-energy systems.

An Application of Six Sigma to Reduce Supplier Quality Cost

NASA Astrophysics Data System (ADS)

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

2016-01-01

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

Cost-effectiveness of the U.S. Geological Survey's stream-gaging programs in Massachusetts and Rhode Island

USGS Publications Warehouse

Gadoury, R.A.; Smath, J.A.; Fontaine, R.A.

1985-01-01

The report documents the results of a study of the cost-effectiveness of the U.S. Geological Survey 's continuous-record stream-gaging programs in Massachusetts and Rhode Island. Data uses and funding sources were identified for 91 gaging stations being operated in Massachusetts are being operated to provide data for two special purpose hydrologic studies, and they are planned to be discontinued at the conclusion of the studies. Cost-effectiveness analyses were performed on 63 continuous-record gaging stations in Massachusetts and 15 stations in Rhode Island, at budgets of $353,000 and $60,500, respectively. Current operations policies result in average standard errors per station of 12.3% in Massachusetts and 9.7% in Rhode Island. Minimum possible budgets to maintain the present numbers of gaging stations in the two States are estimated to be $340,000 and $59,000, with average errors per station of 12.8% and 10.0%, respectively. If the present budget levels were doubled, average standards errors per station would decrease to 8.1% and 4.2%, respectively. Further budget increases would not improve the standard errors significantly. (USGS)

How run-of-river operation affects hydropower generation and value.

PubMed

Jager, Henriette I; Bevelhimer, Mark S

2007-12-01

Regulated rivers in the United States are required to support human water uses while preserving aquatic ecosystems. However, the effectiveness of hydropower license requirements nationwide has not been demonstrated. One requirement that has become more common is "run-of-river" (ROR) operation, which restores a natural flow regime. It is widely believed that ROR requirements (1) are mandated to protect aquatic biota, (2) decrease hydropower generation per unit flow, and (3) decrease energy revenue. We tested these three assumptions by reviewing hydropower projects with license-mandated changes from peaking to ROR operation. We found that ROR operation was often prescribed in states with strong water-quality certification requirements and migratory fish species. Although benefits to aquatic resources were frequently cited, changes were often motivated by other considerations. After controlling for climate, the overall change in annual generation efficiency across projects because of the change in operation was not significant. However, significant decreases were detected at one quarter of individual hydropower projects. As expected, we observed a decrease in flow during peak demand at 7 of 10 projects. At the remaining projects, diurnal fluctuations actually increased because of operation of upstream storage projects. The economic implications of these results, including both producer costs and ecologic benefits, are discussed. We conclude that regional-scale studies of hydropower regulation, such as this one, are long overdue. Public dissemination of flow data, license provisions, and monitoring data by way of on-line access would facilitate regional policy analysis while increasing regulatory transparency and providing feedback to decision makers.

Carbon dioxide capture from atmospheric air using sodium hydroxide spray.

PubMed

Stolaroff, Joshuah K; Keith, David W; Lowry, Gregory V

2008-04-15

In contrast to conventional carbon capture systems for power plants and other large point sources, the system described in this paper captures CO2 directly from ambient air. This has the advantages that emissions from diffuse sources and past emissions may be captured. The objective of this research is to determine the feasibility of a NaOH spray-based contactor for use in an air capture system by estimating the cost and energy requirements per unit CO2 captured. A prototype system is constructed and tested to measure CO2 absorption, energy use, and evaporative water loss and compared with theoretical predictions. A numerical model of drop collision and coalescence is used to estimate operating parameters for a full-scale system, and the cost of operating the system per unit CO2 captured is estimated. The analysis indicates that CO2 capture from air for climate change mitigation is technically feasible using off-the-shelf technology. Drop coalescence significantly decreases the CO2 absorption efficiency; however, fan and pump energy requirements are manageable. Water loss is significant (20 mol H2O/mol CO2 at 15 degrees C and 65% RH) but can be lowered by appropriately designing and operating the system. The cost of CO2 capture using NaOH spray (excluding solution recovery and CO2 sequestration, which may be comparable) in the full-scale system is 96 $/ton-CO2 in the base case, and ranges from 53 to 127 $/ton-CO2 under alternate operating parameters and assumptions regarding capital costs and mass transfer rate. The low end of the cost range is reached by a spray with 50 microm mean drop diameter, which is achievable with commercially available spray nozzles.

Is robotic surgery cost-effective: yes.

PubMed

Liberman, Daniel; Trinh, Quoc-Dien; Jeldres, Claudio; Zorn, Kevin C

2012-01-01

With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities. The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness. Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.

Turbine Seal Research at NASA GRC

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.; Steinetz, Bruce M.; Delgado, Irebert R.; Hendricks, Robert C.

2011-01-01

Low-leakage, long-life turbomachinery seals are important to both Space and Aeronautics Missions. (1) Increased payload capability (2) Decreased specific fuel consumption and emissions (3) Decreased direct operating costs. NASA GRC has a history of significant accomplishments and collaboration with industry and academia in seals research. NASA's unique, state-of-the-art High Temperature, High Speed Turbine Seal Test Facility is an asset to the U.S. Engine / Seal Community. Current focus is on developing experimentally validated compliant, non-contacting, high temperature seal designs, analysis, and design methodologies to enable commercialization.

Towards microalgal triglycerides in the commodity markets.

PubMed

Benvenuti, Giulia; Ruiz, Jesús; Lamers, Packo P; Bosma, Rouke; Wijffels, René H; Barbosa, Maria J

2017-01-01

Microalgal triglycerides (TAGs) hold great promise as sustainable feedstock for commodity industries. However, to determine research priorities and support business decisions, solid techno-economic studies are essential. Here, we present a techno-economic analysis of two-step TAG production (growth reactors are operated in continuous mode such that multiple batch-operated stress reactors are inoculated and harvested sequentially) for a 100-ha plant in southern Spain using vertically stacked tubular photobioreactors. The base case is established with outdoor pilot-scale data and based on current process technology. For the base case, production costs of 6.7 € per kg of biomass containing 24% TAG (w/w) were found. Several scenarios with reduced production costs were then presented based on the latest biological and technological advances. For instance, much effort should focus on increasing the photosynthetic efficiency during the stress and growth phases, as this is the most influential parameter on production costs (30 and 14% cost reduction from base case). Next, biological and technological solutions should be implemented for a reduction in cooling requirements (10 and 4.5% cost reduction from base case when active cooling is avoided and cooling setpoint is increased, respectively). When implementing all the suggested improvements, production costs can be decreased to 3.3 € per kg of biomass containing 60% TAG (w/w) within the next 8 years. With our techno-economic analysis, we indicated a roadmap for a substantial cost reduction. However, microalgal TAGs are not yet cost efficient when compared to their present market value. Cost-competiveness strictly relies on the valorization of the whole biomass components and on cheaper PBR designs (e.g. plastic film flat panels). In particular, further research should focus on the development and commercialization of PBRs where active cooling is avoided and stable operating temperatures are maintained by the water basin in which the reactor is placed.

Evaluation of effects of an operational multidisciplinary team on antibiotic use in the medium to long term at a French university hospital.

PubMed

Demoré, Béatrice; Humbert, Pauline; Boschetti, Emmanuelle; Bevilacqua, Sibylle; Clerc-Urmès, Isabelle; May, Thierry; Pulcini, Céline; Thilly, Nathalie

2017-10-01

Background Antibiotic-resistant bacteria are a major public health problem throughout the world. In 2006, in accordance with the national guidelines for antibiotic use, the CHRU of Nancy created an operational multidisciplinary antibiotic team at one of its sites. In 2011, a cluster-controlled trial showed that the operational multidisciplinary antibiotic team (the intervention) had a favourable short-term effect on antibiotic use and costs. Objective Our objective was to determine whether these effects continued over the medium to long term (that is, 2-7 years after creation of the operational multidisciplinary antibiotic team, 2009-2014). Setting The 1800-bed University Hospital of Nancy (France). Method The effect in the medium to long term is measured according to the same criteria and assessed by the same methods as the first study. A cluster controlled trial was performed on the period 2009-2014. The intervention group comprised 11 medical and surgical wards in settings where the operational multidisciplinary antibiotic team was implemented and the control group comprised 6 wards without this operational team. Main outcome measure Consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1000 patient-days) and costs savings (in €). Results The reduction in antibiotic use and costs continued, but at a lower rate than in the short term (11% between 2009 and 2014 compared with 33% between 2007 and 2009) at the site of the intervention. The principal decreases concerned fluoroquinolones and glycopeptides. At the site without an operational multidisciplinary antibiotic team (the control group), total antibiotic use remained stable. Between 2009 and 2014, costs fell 10.5% in the intervention group and 5.7% in the control group. Conclusion This study shows that it is possible to maintain the effectiveness over time of such an intervention and demonstrates its role in defining a hospital's antibiotic policy.

Mathematical Modelling-Based Energy System Operation Strategy Considering Energy Storage Systems

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

Ryu, Jun-Hyung; Hodge, Bri-Mathias

2016-06-25

Renewable energy resources are widely recognized as an alternative to environmentally harmful fossil fuels. More renewable energy technologies will need to penetrate into fossil fuel dominated energy systems to mitigate the globally witnessed climate changes and environmental pollutions. It is necessary to prepare for the potential problems with increased proportions of renewable energy in the energy system, to prevent higher costs and decreased reliability. Motivated by this need, this paper addresses the operation of an energy system with an energy storage system in the context of developing a decision-supporting framework.

Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

PubMed

Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

2016-11-01

To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Disposable laparoscopic surgical instruments and the economic effects of repackaging.

PubMed

Takeuchi, Hiroyuki; Kikuchi, Iwaho; Kitade, Mari; Kumakiri, Jun; Kinoshita, Katsuyuki; Takehiro, Yuka; Tanimura, Emiko

2005-04-01

The purpose of this study was to evaluate the economic effects of repackaging disposable laparoscopic surgical instruments. We repacked a total of 28 disposable instruments for gynecologic laparoscopic surgery into one package. The time of preparation of surgical instruments, the amount of medical waste, and other economic effects were compared before and after the repackaging of disposable instruments. The time required for the preparation of surgical instruments was shortened by 22 minutes per operation, and medical waste decreased by 400 g, by repackaging the instruments, resulting in an estimated direct economic saving of $10,000 per year. Indirect economic effects might include savings due to a reduced inventory of surgical instruments and simplified cost-accounting for each operation. It is likely that preparation for surgery can be significantly improved and the cost reduced by repackaging the laparoscopic surgical instruments.

The cost of conversion in robotic and laparoscopic colorectal surgery.

PubMed

Cleary, Robert K; Mullard, Andrew J; Ferraro, Jane; Regenbogen, Scott E

2018-03-01

Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments. This is an observational study from a linked data registry including clinical data from the Michigan Surgical Quality Collaborative and payment data from the Michigan Value Collaborative between July 2012 and April 2015. We evaluated colorectal resections initiated with open and minimally invasive approaches, and compared reported risk-adjusted and price-standardized 30-day episode payments and their components. We identified 1061 open, 1604 laparoscopic, and 275 robotic colorectal resections. Adjusted episode payments were significantly higher for open operations than for minimally invasive procedures completed without conversion ($19,489 vs. $15,518, p < 0.001). The conversion rate was significantly higher with laparoscopic than robotic operations (15.1 vs. 7.6%, p < 0.001). Adjusted episode payments for minimally invasive operations converted to open were significantly higher than for those completed by minimally invasive approaches ($18,098 vs. $15,518, p < 0.001). Payments for operations completed robotically were greater than those completed laparoscopically ($16,949 vs. $15,250, p < 0.001), but the difference was substantially decreased when conversion to open cases was included ($16,939 vs. $15,699, p = 0.041). Episode payments for open colorectal surgery exceed both laparoscopic and robotic minimally invasive options. Conversion to open surgery significantly increases the payments associated with minimally invasive colorectal surgery. Because conversion rates in robotic colorectal operations are half of those in laparoscopy, the excess expenditures attributable to robotics are attenuated by consideration of the cost of conversions.

Life Cycle Systems Engineering Approach to NASA's 2nd Generation Reusable Launch Vehicle

NASA Technical Reports Server (NTRS)

Thomas, Dale; Smith, Charles; Safie, Fayssal; Kittredge, Sheryl

2002-01-01

The overall goal of the 2nd Generation RLV Program is to substantially reduce technical and business risks associated with developing a new class of reusable launch vehicles. NASA's specific goals are to improve the safety of a 2nd- generation system by 2 orders of magnitude - equivalent to a crew risk of 1 -in- 10,000 missions - and decrease the cost tenfold, to approximately $1,000 per pound of payload launched. Architecture definition is being conducted in parallel with the maturating of key technologies specifically identified to improve safety and reliability, while reducing operational costs. An architecture broadly includes an Earth-to-orbit reusable launch vehicle, on-orbit transfer vehicles and upper stages, mission planning, ground and flight operations, and support infrastructure, both on the ground and in orbit. The systems engineering approach ensures that the technologies developed - such as lightweight structures, long-life rocket engines, reliable crew escape, and robust thermal protection systems - will synergistically integrate into the optimum vehicle. Given a candidate architecture that possesses credible physical processes and realistic technology assumptions, the next set of analyses address the system's functionality across the spread of operational scenarios characterized by the design reference missions. The safety/reliability and cost/economics associated with operating the system will also be modeled and analyzed to answer the questions "How safe is it?" and "How much will it cost to acquire and operate?" The systems engineering review process factors in comprehensive budget estimates, detailed project schedules, and business and performance plans, against the goals of safety, reliability, and cost, in addition to overall technical feasibility. This approach forms the basis for investment decisions in the 2nd Generation RLV Program's risk-reduction activities. Through this process, NASA will continually refine its specialized needs and identify where Defense and commercial requirements overlap those of civil missions.

Efficient cost-sensitive human-machine collaboration for offline signature verification

NASA Astrophysics Data System (ADS)

Coetzer, Johannes; Swanepoel, Jacques; Sabourin, Robert

2012-01-01

We propose a novel strategy for the optimal combination of human and machine decisions in a cost-sensitive environment. The proposed algorithm should be especially beneficial to financial institutions where off-line signatures, each associated with a specific transaction value, require authentication. When presented with a collection of genuine and fraudulent training signatures, produced by so-called guinea pig writers, the proficiency of a workforce of human employees and a score-generating machine can be estimated and represented in receiver operating characteristic (ROC) space. Using a set of Boolean fusion functions, the majority vote decision of the human workforce is combined with each threshold-specific machine-generated decision. The performance of the candidate ensembles is estimated and represented in ROC space, after which only the optimal ensembles and associated decision trees are retained. When presented with a questioned signature linked to an arbitrary writer, the system first uses the ROC-based cost gradient associated with the transaction value to select the ensemble that minimises the expected cost, and then uses the corresponding decision tree to authenticate the signature in question. We show that, when utilising the entire human workforce, the incorporation of a machine streamlines the authentication process and decreases the expected cost for all operating conditions.

Physician Impact on the Total Cost of Care

PubMed Central

Taheri, Paul A.; Butz, David; Griffes, Louisa C.; Morlock, David R.; Greenfield, Lazar J.

2000-01-01

Background and Objectives Physicians’ efforts at cost containment focus on decreased resource utilization and reduced length of stay. Although these efforts appear to be appropriate, little data exist to gauge their success. As such, the goal of this study is to determine trauma service cost allocations and how this information can help physicians to contain costs. Materials and Methods The authors analyzed the costs for 696 trauma admissions at a level I trauma center for fiscal year 1997. Data were obtained from the hospital costing system. Costs analyzed were variable direct, fixed direct, and Indirect costs. Together, the fixed and indirect costs are referred to as “hospital overhead.” Total Cost equals variable direct plus fixed direct plus indirect costs. Results The mean variable, fixed, and indirect costs per patient were $7,998, $3,534, and $11,086, respectively. Mean total cost per patient was $22,618. Conclusion The 35% variable direct cost represents the percentage of total cost that is typically under the immediate influence of physicians, in contrast to the 65% of total cost over which physicians have little control. Physicians must gain a better understanding of cost drivers and must participate in the operations and allocations of institutional fixed direct and indirect costs if the overall cost of care is to be reduced. PMID:10714637

Spares Management : Optimizing Hardware Usage for the Space Shuttle Main Engine

NASA Technical Reports Server (NTRS)

Gulbrandsen, K. A.

1999-01-01

The complexity of the Space Shuttle Main Engine (SSME), combined with mounting requirements to reduce operations costs have increased demands for accurate tracking, maintenance, and projections of SSME assets. The SSME Logistics Team is developing an integrated asset management process. This PC-based tool provides a user-friendly asset database for daily decision making, plus a variable-input hardware usage simulation with complex logic yielding output that addresses essential asset management issues. Cycle times on critical tasks are significantly reduced. Associated costs have decreased as asset data quality and decision-making capability has increased.

Wound closure with Karydakis flap is decreasing the perioperative costs after pilonidal sinus excision as compared to lay-open approach.

PubMed

Borel, F; Gaudin, C; Duchalais, E; Lehur, P-A; Meurette, G

2017-12-01

To assess the impact of a simple flap closing procedure by Karydakis flap (KF) after pilonidal sinus excision on the costs and healing time as compared to routine lay-open technique. Out of 44 consecutive patients operated on for pilonidal excision (November 2013-March 2015), 17 had a Karydakis flap and 27 a lay-open procedure. For each patient, the length of stay, the operating time (OT), the time needed for complete healing and postoperative care resources were recorded. The global costs included OT, nursing care quantity, and modalities until complete scar healing. One reoperation in the lay-open group was necessary during the follow-up (8±5months). No recurrence occurred. Postoperative morbidity was similar in both groups. Results showed that KF global cost was inferior as compared to lay-open technique (941±178€ vs. 1601±399€; P=0.0001), KF healed faster (32±17 vs. 59±22days; P=0.0001), whereas OT was longer in KF group (16±7 vs. 25±4min; P=0.001). KF allows a faster healing time and a 41% lower cost than lay-open technique. Preferential use of KF rather than lay-open procedure could allow a significant health cost saving. Copyright © 2017. Published by Elsevier Masson SAS.

Small, Low Cost, Launch Capability Development

NASA Technical Reports Server (NTRS)

Brown, Thomas

2014-01-01

A recent explosion in nano-sat, small-sat, and university class payloads has been driven by low cost electronics and sensors, wide component availability, as well as low cost, miniature computational capability and open source code. Increasing numbers of these very small spacecraft are being launched as secondary payloads, dramatically decreasing costs, and allowing greater access to operations and experimentation using actual space flight systems. While manifesting as a secondary payload provides inexpensive rides to orbit, these arrangements also have certain limitations. Small, secondary payloads are typically included with very limited payload accommodations, supported on a non interference basis (to the prime payload), and are delivered to orbital conditions driven by the primary launch customer. Integration of propulsion systems or other hazardous capabilities will further complicate secondary launch arrangements, and accommodation requirements. The National Aeronautics and Space Administration's Marshall Space Flight Center has begun work on the development of small, low cost launch system concepts that could provide dedicated, affordable launch alternatives to small, high risk university type payloads and spacecraft. These efforts include development of small propulsion systems and highly optimized structural efficiency, utilizing modern advanced manufacturing techniques. This paper outlines the plans and accomplishments of these efforts and investigates opportunities for truly revolutionary reductions in launch and operations costs. Both evolution of existing sounding rocket systems to orbital delivery, and the development of clean sheet, optimized small launch systems are addressed.

One hospital, one appendectomy: The cost effectiveness of a standardized doctor's preference card.

PubMed

Skarda, David E; Rollins, Michael; Andrews, Seth; McFadden, Molly; Barnhart, Doug; Meyers, Rebecka; Scaife, Eric

2015-06-01

Appendicitis in children provides a unique opportunity to explore changes that reduce variation, reduce cost, and improve value. In this study we sought to evaluate the effectiveness of standardization of surgical technique and intraoperative disposable device utilization for laparoscopic appendectomy among all surgeons at a tertiary children's hospital. All 6 surgeons at our tertiary children's hospital agreed to standardize to a single technique of performing a laparoscopic appendectomy. We collected data on all pediatric patients who had a laparoscopic appendectomy following implementation of the uniform doctor's preference card (DPC) (March 1, 2013 to February 28, 2014) and compared them to a historical control group. Implementation of the uniform DPC decreased the device cost per appendectomy from $844.11 to $305.32. Operative times (skin incision to skin closure) were 34.8 minutes prior to the uniform DPC and 37.0 minutes using the uniform DPC. There were no significant differences in postappendectomy outcomes. We have demonstrated that implementation of a uniform DPC and technical standardization for laparoscopic appendectomy can significantly reduce cost. Furthermore, this can occur without dramatically increasing operative times, length of stay, or postoperative complications. Copyright © 2015 Elsevier Inc. All rights reserved.

U.S. DOE Progress Towards Developing Low-Cost, High Performance, Durable Polymer Electrolyte Membranes for Fuel Cell Applications.

PubMed

Houchins, Cassidy; Kleen, Greg J; Spendelow, Jacob S; Kopasz, John; Peterson, David; Garland, Nancy L; Ho, Donna Lee; Marcinkoski, Jason; Martin, Kathi Epping; Tyler, Reginald; Papageorgopoulos, Dimitrios C

2012-12-18

Low cost, durable, and selective membranes with high ionic conductivity are a priority need for wide-spread adoption of polymer electrolyte membrane fuel cells (PEMFCs) and direct methanol fuel cells (DMFCs). Electrolyte membranes are a major cost component of PEMFC stacks at low production volumes. PEMFC membranes also impose limitations on fuel cell system operating conditions that add system complexity and cost. Reactant gas and fuel permeation through the membrane leads to decreased fuel cell performance, loss of efficiency, and reduced durability in both PEMFCs and DMFCs. To address these challenges, the U.S. Department of Energy (DOE) Fuel Cell Technologies Program, in the Office of Energy Efficiency and Renewable Energy, supports research and development aimed at improving ion exchange membranes for fuel cells. For PEMFCs, efforts are primarily focused on developing materials for higher temperature operation (up to 120 °C) in automotive applications. For DMFCs, efforts are focused on developing membranes with reduced methanol permeability. In this paper, the recently revised DOE membrane targets, strategies, and highlights of DOE-funded projects to develop new, inexpensive membranes that have good performance in hot and dry conditions (PEMFC) and that reduce methanol crossover (DMFC) will be discussed.

Save medical personnel's time by improved user interfaces.

PubMed

Kindler, H

1997-01-01

Common objectives in the industrial countries are the improvement of quality of care, clinical effectiveness, and cost control. Cost control, in particular, has been addressed through the introduction of case mix systems for reimbursement by social-security institutions. More data is required to enable quality improvement, increases in clinical effectiveness and for juridical reasons. At first glance, this documentation effort is contradictory to cost reduction. However, integrated services for resource management based on better documentation should help to reduce costs. The clerical effort for documentation should be decreased by providing a co-operative working environment for healthcare professionals applying sophisticated human-computer interface technology. Additional services, e.g., automatic report generation, increase the efficiency of healthcare personnel. Modelling the medical work flow forms an essential prerequisite for integrated resource management services and for co-operative user interfaces. A user interface aware of the work flow provides intelligent assistance by offering the appropriate tools at the right moment. Nowadays there is a trend to client/server systems with relational databases or object-oriented databases as repository. The work flows used for controlling purposes and to steer the user interfaces must be represented in the repository.

[Health insurance in the contributive and subsidized regimes and its impact on the service providers].

PubMed

Prada, Luis M

2004-01-01

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.

Magnetic fields of green.

PubMed

Branton, Scott; Lile, Lawrence

2011-01-01

By incorporating even the basic elements of a more environmentally friendly, "green"construction and design in an MRI setting can create a safer, more pleasant space for the patients and staff, better images, and operational cost savings. Using building systems that have reduced amounts of steel can decrease construction time, increase thermal insulation, and reduce the weight of the structure meaning less energy required to transport and install. HVAC systems and lighting design can also play a major role in creating a "green"MRI suite. LEED certification places a focus on quality of the built environment, life cycle cost, and a productive indoor environment, as well as impact on the exterior environment. An LEED certified building considers costs and benefits for the lifetime of the building.

Sensitivity analysis of physiological factors in space habitat design

NASA Technical Reports Server (NTRS)

Billingham, J.

1982-01-01

The costs incurred by design conservatism in space habitat design are discussed from a structural standpoint, and areas of physiological research into less than earth-normal conditions that offer the greatest potential decrease in habitat construction and operating costs are studied. The established range of human tolerance limits is defined for those physiological conditions which directly affect habitat structural design. These entire ranges or portions thereof are set as habitat design constraints as a function of habitat population and degree of ecological closure. Calculations are performed to determine the structural weight and cost associated with each discrete population size and its selected environmental conditions, on the basis of habitable volume equivalence for four basic habitat configurations: sphere, cylinder with hemispherical ends, torus, and crystal palace.

Spatial and temporal modeling of sub- and supercritical thermal energy storage

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

Tse, LA; Ganapathi, GB; Wirz, RE

2014-05-01

This paper describes a thermodynamic model that simulates the discharge cycle of a single-tank thermal energy storage (TES) system that can operate from the two-phase (liquid-vapor) to supercritical regimes for storage fluid temperatures typical of concentrating solar power plants. State-of-the-art TES design utilizes a two-tank system with molten nitrate salts; one major problem is the high capital cost of the salts (International Renewable Energy Agency, 2012). The alternate approach explored here opens up the use of low-cost fluids by considering operation at higher pressures associated with the two-phase and supercritical regimes. The main challenge to such a system is itsmore » high pressures and temperatures which necessitate a relatively high-cost containment vessel that represents a large fraction of the system capital cost. To mitigate this cost, the proposed design utilizes a single-tank TES system, effectively halving the required wall material. A single-tank approach also significantly reduces the complexity of the system in comparison to the two-tank systems, which require expensive pumps and external heat exchangers. A thermodynamic model is used to evaluate system performance; in particular it predicts the volume of tank wall material needed to encapsulate the storage fluid. The transient temperature of the tank is observed to remain hottest at the storage tank exit, which is beneficial to system operation. It is also shown that there is an optimum storage fluid loading that generates a given turbine energy output while minimizing the required tank wall material. Overall, this study explores opportunities to further improve current solar thermal technologies. The proposed single-tank system shows promise for decreasing the cost of thermal energy storage. (C) 2014 Elsevier Ltd. All rights reserved.« less

Actual and estimated costs of disposable materials used during surgical procedures.

PubMed

Toyabe, Shin-Ichi; Cao, Pengyu; Kurashima, Sachiko; Nakayama, Yukiko; Ishii, Yuko; Hosoyama, Noriko; Akazawa, Kouhei

2005-07-01

It is difficult to estimate precisely the costs of disposable materials used during surgical operations. To evaluate the actual costs of disposable materials, we calculated the actual costs of disposable materials used in 59 operations by taking account of costs of all disposable materials used for each operation. The costs of the disposable materials varied significantly from operation to operation (US$ 38-4230 per operation), and the median [25-percentile and 75-percentile] of the sum total of disposable material costs of a single operation was found to be US$ 686 [205 and 993]. Multiple regression analysis with a stepwise regression method showed that costs of disposable materials significantly correlated only with operation time (p<0.001). Based on the results, we propose a simple method for estimating costs of disposable materials by measuring operation time, and we found that the method gives reliable results. Since costs of disposable materials used during surgical operations are considerable, precise estimation of the costs is essential for hospital cost accounting. Our method should be useful for planning hospital administration strategies.

Preliminary study of advanced turboprop and turboshaft engines for light aircraft. [cost effectiveness

NASA Technical Reports Server (NTRS)

Knip, G.; Plencner, R. M.; Eisenberg, J. D.

1980-01-01

The effects of engine configuration, advanced component technology, compressor pressure ratio and turbine rotor-inlet temperature on such figures of merit as vehicle gross weight, mission fuel, aircraft acquisition cost, operating, cost and life cycle cost are determined for three fixed- and two rotary-wing aircraft. Compared with a current production turboprop, an advanced technology (1988) engine results in a 23 percent decrease in specific fuel consumption. Depending on the figure of merit and the mission, turbine engine cost reductions required to achieve aircraft cost parity with a current spark ignition reciprocating (SIR) engine vary from 0 to 60 percent and from 6 to 74 percent with a hypothetical advanced SIR engine. Compared with a hypothetical turboshaft using currently available technology (1978), an advanced technology (1988) engine installed in a light twin-engine helicopter results in a 16 percent reduction in mission fuel and about 11 percent in most of the other figures of merit.

Cost effectiveness of robotic mitral valve surgery.

PubMed

Moss, Emmanuel; Halkos, Michael E

2017-01-01

Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a "gold standard" valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches.

Structural health and prognostics management for offshore wind turbines :

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

Griffith, Daniel; Resor, Brian Ray; White, Jonathan Randall

2012-12-01

Operations and maintenance costs for offshore wind plants are expected to be significantly higher than the current costs for onshore plants. One way in which these costs may be able to be reduced is through the use of a structural health and prognostic management system as part of a condition based maintenance paradigm with smart load management. To facilitate the creation of such a system a multiscale modeling approach has been developed to identify how the underlying physics of the system are affected by the presence of damage and how these changes manifest themselves in the operational response of amore » full turbine. The developed methodology was used to investigate the effects of a candidate blade damage feature, a trailing edge disbond, on a 5-MW offshore wind turbine and the measurements that demonstrated the highest sensitivity to the damage were the local pitching moments around the disbond. The multiscale method demonstrated that these changes were caused by a local decrease in the blades torsional stiffness due to the disbond, which also resulted in changes in the blades local strain field. Full turbine simulations were also used to demonstrate that derating the turbine power by as little as 5% could extend the fatigue life of a blade by as much as a factor of 3. The integration of the health monitoring information, conceptual repair cost versus damage size information, and this load management methodology provides an initial roadmap for reducing operations and maintenance costs for offshore wind farms while increasing turbine availability and overall profit.« less

Establishing a community pharmacy residency at an independent pharmacy: Time allocation and valuation.

PubMed

Shugart, Katherine; Bryant, Jason; Kress, Dean; Ziegler, Bryan; Connelly, Lynn; Brittain, Kristy

2015-12-01

The value of a first-year community pharmacy residency program (CPRP) at an independent pharmacy was estimated based on time allocation for resident responsibilities. Predefined time allocation categories for the pharmacy resident were used to consistently classify and document time completing residency activities. Benefit-to-cost ratio was determined by tabulating total costs and total benefits of the residency program. A retrospective-prospective comparison of overall change in revenue, operating expense, and prescription volume was performed between the preresident time period (July 2012 to June 2013) and the postresident time period (July 2013 to June 2014). This comparison accounted for resident activities that did not directly generate revenue. Time allocations for the resident out of 2,221 total hours logged were dispensing (40%), clinical setup (16%), research (8%), professional meetings (7%), clinical activities (5%), resident education (5%), site precepting (4%), residency meetings (4%), didactic teaching (3%), miscellaneous (3%), marketing (2%), training (2%), and public health promotion (1%). Total costs were $77,422, and total benefits were $118,410. The benefit-to-cost ratio was 1.53. The postresident time interval had $172,451 more revenue and $6,622 more in operating expenses than the preresident time interval, and prescription volume decreased by 2,000 prescriptions compared to the previous year. The benefit-to-cost analysis indicated a $1.53 return for every $1.00 invested into a CPRP. An increase in revenue and operating expenses for the pharmacy was observed after implementation of the CPRP compared to the previous year. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs.

PubMed

Englesbe, Michael J; Grenda, Dane R; Sullivan, June A; Derstine, Brian A; Kenney, Brooke N; Sheetz, Kyle H; Palazzolo, William C; Wang, Nicholas C; Goulson, Rebecca L; Lee, Jay S; Wang, Stewart C

2017-06-01

The Michigan Surgical Home and Optimization Program is a structured, home-based, preoperative training program targeting physical, nutritional, and psychological guidance. The purpose of this study was to determine if participation in this program was associated with reduced hospital duration of stay and health care costs. We conducted a retrospective, single center, cohort study evaluating patients who participated in the Michigan Surgical Home and Optimization Program and subsequently underwent major elective general and thoracic operative care between June 2014 and December 2015. Propensity score matching was used to match program participants to a control group who underwent operative care prior to program implementation. Primary outcome measures were hospital duration of stay and payer costs. Multivariate regression was used to determine the covariate-adjusted effect of program participation. A total of 641 patients participated in the program; 82% were actively engaged in the program, recording physical activity at least 3 times per week for the majority of the program; 182 patients were propensity matched to patients who underwent operative care prior to program implementation. Multivariate analysis demonstrated that participation in the Michigan Surgical Home and Optimization Program was associated with a 31% reduction in hospital duration of stay (P < .001) and 28% lower total costs (P < .001) after adjusting for covariates. A home-based, preoperative training program decreased hospital duration of stay, lowered costs of care, and was well accepted by patients. Further efforts will focus on broader implementation and linking participation to postoperative complications and rigorous patient-reported outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Launch Vehicle Production and Operations Cost Metrics

NASA Technical Reports Server (NTRS)

Watson, Michael D.; Neeley, James R.; Blackburn, Ruby F.

2014-01-01

Traditionally, launch vehicle cost has been evaluated based on $/Kg to orbit. This metric is calculated based on assumptions not typically met by a specific mission. These assumptions include the specified orbit whether Low Earth Orbit (LEO), Geostationary Earth Orbit (GEO), or both. The metric also assumes the payload utilizes the full lift mass of the launch vehicle, which is rarely true even with secondary payloads.1,2,3 Other approaches for cost metrics have been evaluated including unit cost of the launch vehicle and an approach to consider the full program production and operations costs.4 Unit cost considers the variable cost of the vehicle and the definition of variable costs are discussed. The full program production and operation costs include both the variable costs and the manufacturing base. This metric also distinguishes operations costs from production costs, including pre-flight operational testing. Operations costs also consider the costs of flight operations, including control center operation and maintenance. Each of these 3 cost metrics show different sensitivities to various aspects of launch vehicle cost drivers. The comparison of these metrics provides the strengths and weaknesses of each yielding an assessment useful for cost metric selection for launch vehicle programs.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Understanding the Benefits and Limitations of Increasing Maximum Rotor Tip Speed for Utility-Scale Wind Turbines

NASA Astrophysics Data System (ADS)

Ning, A.; Dykes, K.

2014-06-01

For utility-scale wind turbines, the maximum rotor rotation speed is generally constrained by noise considerations. Innovations in acoustics and/or siting in remote locations may enable future wind turbine designs to operate with higher tip speeds. Wind turbines designed to take advantage of higher tip speeds are expected to be able to capture more energy and utilize lighter drivetrains because of their decreased maximum torque loads. However, the magnitude of the potential cost savings is unclear, and the potential trade-offs with rotor and tower sizing are not well understood. A multidisciplinary, system-level framework was developed to facilitate wind turbine and wind plant analysis and optimization. The rotors, nacelles, and towers of wind turbines are optimized for minimum cost of energy subject to a large number of structural, manufacturing, and transportation constraints. These optimization studies suggest that allowing for higher maximum tip speeds could result in a decrease in the cost of energy of up to 5% for land-based sites and 2% for offshore sites when using current technology. Almost all of the cost savings are attributed to the decrease in gearbox mass as a consequence of the reduced maximum rotor torque. Although there is some increased energy capture, it is very minimal (less than 0.5%). Extreme increases in tip speed are unnecessary; benefits for maximum tip speeds greater than 100-110 m/s are small to nonexistent.

National Space Transportation System (NSTS) technology needs

NASA Technical Reports Server (NTRS)

Winterhalter, David L.; Ulrich, Kimberly K.

1990-01-01

The National Space Transportation System (NSTS) is one of the Nation's most valuable resources, providing manned transportation to and from space in support of payloads and scientific research. The NSTS program is currently faced with the problem of hardware obsolescence, which could result in unacceptable schedule and cost impacts to the flight program. Obsolescence problems occur because certain components are no longer being manufactured or repair turnaround time is excessive. In order to achieve a long-term, reliable transportation system that can support manned access to space through 2010 and beyond, NASA must develop a strategic plan for a phased implementation of enhancements which will satisfy this long-term goal. The NSTS program has initiated the Assured Shuttle Availability (ASA) project with the following objectives: eliminate hardware obsolescence in critical areas, increase reliability and safety of the vehicle, decrease operational costs and turnaround time, and improve operational capability. The strategy for ASA will be to first meet the mandatory needs - keep the Shuttle flying. Non-mandatory changes that will improve operational capability and enhance performance will then be considered if funding is adequate. Upgrade packages should be developed to install within designated inspection periods, grouped in a systematic approach to reduce cost and schedule impacts, and allow the capability to provide a Block 2 Shuttle (Phase 3).

Heat and moisture exchange devices for patients undergoing total laryngectomy.

PubMed

Icuspit, Pearl; Yarlagadda, Bharat; Garg, Shweta; Johnson, Theresa; Deschler, Daniel

2014-01-01

Patients undergoing total laryngectomy face the challenge of an altered anatomy with the resultant changes in quality of life and significant requirements for post-operative care. Increased production of secretions and sputum, the need for ongoing suctioning, and the formation of stomal crusting require meticulous post-operative care. The use of Heat and Moisture Exchange (HME) devices has been shown to decrease the effect of these factors. This article describes the nature of these devices and their use. The literature is reviewed regarding the long term benefits and new data are presented suggesting an immediate post-operative benefit as well. Finally, costs and other considerations for successful use of HME devices are presented.

Automating Base Fuels Accounting.

DTIC Science & Technology

1986-03-01

base fuels accounting system as a means to decrease operating cost and increase capability. Author reviews the present accounting system, then proposes...g .:..: . . ; ,N :’- .’ :+-" : :*- . ’++ : :,:- :1:.-’ ."-..: :.:.:’’ AIR WAR COLLEGE No. AU-AWC86-0 9 0 00a AUTOMATING BASE FUELS ACCOUNTING ... ACCOUNTING by Victor E. Hardin Lieutenant Colonel, USAF A RESEARCH REPORT SUBMITTED TO THE FACULTY IN FULFILLMENT OF THE RESEARCH REQUI REMENT

A new systems engineering approach to streamlined science and mission operations for the Far Ultraviolet Spectroscopic Explorer (FUSE)

NASA Technical Reports Server (NTRS)

Butler, Madeline J.; Sonneborn, George; Perkins, Dorothy C.

1994-01-01

The Mission Operations and Data Systems Directorate (MO&DSD, Code 500), the Space Sciences Directorate (Code 600), and the Flight Projects Directorate (Code 400) have developed a new approach to combine the science and mission operations for the FUSE mission. FUSE, the last of the Delta-class Explorer missions, will obtain high resolution far ultraviolet spectra (910 - 1220 A) of stellar and extragalactic sources to study the evolution of galaxies and conditions in the early universe. FUSE will be launched in 2000 into a 24-hour highly eccentric orbit. Science operations will be conducted in real time for 16-18 hours per day, in a manner similar to the operations performed today for the International Ultraviolet Explorer. In a radical departure from previous missions, the operations concept combines spacecraft and science operations and data processing functions in a single facility to be housed in the Laboratory for Astronomy and Solar Physics (Code 680). A small missions operations team will provide the spacecraft control, telescope operations and data handling functions in a facility designated as the Science and Mission Operations Center (SMOC). This approach will utilize the Transportable Payload Operations Control Center (TPOCC) architecture for both spacecraft and instrument commanding. Other concepts of integrated operations being developed by the Code 500 Renaissance Project will also be employed for the FUSE SMOC. The primary objective of this approach is to reduce development and mission operations costs. The operations concept, integration of mission and science operations, and extensive use of existing hardware and software tools will decrease both development and operations costs extensively. This paper describes the FUSE operations concept, discusses the systems engineering approach used for its development, and the software, hardware and management tools that will make its implementation feasible.

Cost Analysis of Operation Theatre Services at an Apex Tertiary Care Trauma Centre of India.

PubMed

Siddharth, Vijaydeep; Kumar, Subodh; Vij, Aarti; Gupta, Shakti Kumar

2015-12-01

Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54).

A Cost Simulation Tool for Estimating the Cost of Operating Government Owned and Operated Ships

DTIC Science & Technology

1994-09-01

Horngren , C.T., Foster, G., Datar, S.M., Cost Accounting : A Management Emphasis, Prentice-Hall, Englewood Cliffs, NJ, 1994 IBM Corporation, A Graphical...4. TITLE AND SUBTITLE A COST SIMULATION TOOL FOR 5. FUNDING NUMBERS ESTIMATING THE COST OF OPERATING GOVERNMENT OWNED AND OPERATED SHIPS 6. AUTHOR( S ...normally does not present a problem to the accounting department. The final category, the cost of operating the government owned and operated ships is

Micro-Grids for Colonias (TX)

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

Dean Schneider; Michael Martin; Renee Berry

2012-07-31

This report describes the results of the final implementation and testing of a hybrid micro-grid system designed for off-grid applications in underserved Colonias along the Texas/Mexico border. The project is a federally funded follow-on to a project funded by the Texas State Energy Conservation Office in 2007 that developed and demonstrated initial prototype hybrid generation systems consisting of a proprietary energy storage technology, high efficiency charging and inverting systems, photovoltaic cells, a wind turbine, and bio-diesel generators. This combination of technologies provided continuous power to dwellings that are not grid connected, with a significant savings in fuel by allowing powermore » generation at highly efficient operating conditions. The objective of this project was to complete development of the prototype systems and to finalize and engineering design; to install and operate the systems in the intended environment, and to evaluate the technical and economic effectiveness of the systems. The objectives of this project were met. This report documents the final design that was achieved and includes the engineering design documents for the system. The system operated as designed, with the system availability limited by maintenance requirements of the diesel gensets. Overall, the system achieved a 96% availability over the operation of the three deployed systems. Capital costs of the systems were dependent upon both the size of the generation system and the scope of the distribution grid, but, in this instance, the systems averaged $0.72/kWh delivered. This cost would decrease significantly as utilization of the system increased. The system with the highest utilization achieved a capitol cost amortized value of $0.34/kWh produced. The average amortized fuel and maintenance cost was $0.48/kWh which was dependent upon the amount of maintenance required by the diesel generator. Economically, the system is difficult to justify as an alternative to grid power. However, the operational costs are reasonable if grid power is unavailable, e.g. in a remote area or in a disaster recovery situation. In fact, avoided fuel costs for the smaller of the systems in use during this project would have a payback of the capital costs of that system in 2.3 years, far short of the effective system life.« less

Cost-effectiveness of the stream-gaging program in Missouri

USGS Publications Warehouse

Waite, L.A.

1987-01-01

This report documents the results of an evaluation of the cost effectiveness of the 1986 stream-gaging program in Missouri. Alternative methods of developing streamflow information and cost-effective resource allocation were used to evaluate the Missouri program. Alternative methods were considered statewide, but the cost effective resource allocation study was restricted to the area covered by the Rolla field headquarters. The average standard error of estimate for records of instantaneous discharge was 17 percent; assuming the 1986 budget and operating schedule, it was shown that this overall degree of accuracy could be improved to 16 percent by altering the 1986 schedule of station visitations. A minimum budget of $203,870, with a corresponding average standard error of estimate 17 percent, is required to operate the 1986 program for the Rolla field headquarters; a budget of less than this would not permit proper service and maintenance of the stations or adequate definition of stage-discharge relations. The maximum budget analyzed was $418,870, which resulted in an average standard error of estimate of 14 percent. Improved instrumentation can have a positive effect on streamflow uncertainties by decreasing lost records. An earlier study of data uses found that data uses were sufficient to justify continued operation of all stations. One of the stations investigated, Current River at Doniphan (07068000) was suitable for the application of alternative methods for simulating discharge records. However, the station was continued because of data use requirements. (Author 's abstract)

Space Station Freedom operations costs

NASA Technical Reports Server (NTRS)

Accola, Anne L.; Williams, Gregory J.

1988-01-01

Measures to reduce the operation costs of the Space Station which can be implemented in the design and development stages are discussed. Operational functions are described in the context of an overall operations concept. The provisions for operations cost responsibilities among the partners in the Space Station program are presented. Cost estimating methodologies and the way in which operations costs affect the design and development process are examined.

Can Technological Improvements Reduce the Cost of Proton Radiation Therapy?

PubMed

Schippers, Jacobus Maarten; Lomax, Anthony; Garonna, Adriano; Parodi, Katia

2018-04-01

In recent years there has been increasing interest in the more extensive application of proton therapy in a clinical and preferably hospital-based environment. However, broader adoption of proton therapy has been hindered by the costs of treatment, which are still much higher than those in advanced photon therapy. This article presents an overview of on-going technical developments, which have a reduction of the capital investment or operational costs either as a major goal or as a potential outcome. Developments in instrumentation for proton therapy, such as gantries and accelerators, as well as facility layout and efficiency in treatment logistics will be discussed in this context. Some of these developments are indeed expected to reduce the costs. The examples will show, however, that a dramatic cost reduction of proton therapy is not expected in the near future. Although current developments will certainly contribute to a gradual decrease of the treatment costs in the coming years, many steps will still have to be made to achieve a much lower cost per treatment. Copyright © 2018. Published by Elsevier Inc.

Theoretical and experimental researches on the operating costs of a wastewater treatment plant

NASA Astrophysics Data System (ADS)

Panaitescu, M.; Panaitescu, F.-V.; Anton, I.-A.

2015-11-01

Purpose of the work: The total cost of a sewage plants is often determined by the present value method. All of the annual operating costs for each process are converted to the value of today's correspondence and added to the costs of investment for each process, which leads to getting the current net value. The operating costs of the sewage plants are subdivided, in general, in the premises of the investment and operating costs. The latter can be stable (normal operation and maintenance, the establishment of power) or variables (chemical and power sludge treatment and disposal, of effluent charges). For the purpose of evaluating the preliminary costs so that an installation can choose between different alternatives in an incipient phase of a project, can be used cost functions. In this paper will be calculated the operational cost to make several scenarios in order to optimize its. Total operational cost (fixed and variable) is dependent global parameters of wastewater treatment plant. Research and methodology: The wastewater treatment plant costs are subdivided in investment and operating costs. We can use different cost functions to estimate fixed and variable operating costs. In this study we have used the statistical formulas for cost functions. The method which was applied to study the impact of the influent characteristics on the costs is economic analysis. Optimization of plant design consist in firstly, to assess the ability of the smallest design to treat the maximum loading rates to a given effluent quality and, secondly, to compare the cost of the two alternatives for average and maximum loading rates. Results: In this paper we obtained the statistical values for the investment cost functions, operational fixed costs and operational variable costs for wastewater treatment plant and its graphical representations. All costs were compared to the net values. Finally we observe that it is more economical to build a larger plant, especially if maximum loading rates are reached. The actual target of operational management is to directly implement the presented cost functions in a software tool, in which the design of a plant and the simulation of its behaviour are evaluated simultaneously.

An Ownership/Lease Cost Comparison Analysis of Heavy Equipment Motor Vehicles in Air Force Materiel Command

DTIC Science & Technology

1994-09-01

costs are the costs associated with a particular piece of equipment that do not change despite change in variable operating cost ( Horngren and Foster...The Operating and maintenance costs account for direct and indirect costs associated with their respective functions and vary with the utilization of...each vehicle. The operating direct cost includes all on-base and off- base fuel cost . Indirect operations costs account for bench 28 stock items

Research on battery-operated electric road vehicles

NASA Technical Reports Server (NTRS)

Varpetian, V. S.

1977-01-01

Mathematical analysis of battery-operated electric vehicles is presented. Attention is focused on assessing the influence of the battery on the mechanical and dynamical characteristics of dc electric motors with series and parallel excitation, as well as on evaluating the influence of the excitation mode and speed control system on the performance of the battery. The superiority of series excitation over parallel excitation with respect to vehicle performance is demonstrated. It is also shown that pulsed control of the electric motor, as compared to potentiometric control, provides a more effective use of the battery and decreases the cost of recharging.

The NASA automation and robotics technology program

NASA Technical Reports Server (NTRS)

Holcomb, Lee B.; Montemerlo, Melvin D.

1986-01-01

The development and objectives of the NASA automation and robotics technology program are reviewed. The objectives of the program are to utilize AI and robotics to increase the probability of mission success; decrease the cost of ground control; and increase the capability and flexibility of space operations. There is a need for real-time computational capability; an effective man-machine interface; and techniques to validate automated systems. Current programs in the areas of sensing and perception, task planning and reasoning, control execution, operator interface, and system architecture and integration are described. Programs aimed at demonstrating the capabilities of telerobotics and system autonomy are discussed.

Second Generation Novel High Temperature Commercial Receiver & Low Cost High Performance Mirror Collector for Parabolic Solar Trough

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

Stettenheim, Joel

Norwich Technologies (NT) is developing a disruptively superior solar field for trough concentrating solar power (CSP). Troughs are the leading CSP technology (85% of installed capacity), being highly deployable and similar to photovoltaic (PV) systems for siting. NT has developed the SunTrap receiver, a disruptive alternative to vacuum-tube concentrating solar power (CSP) receivers, a market currently dominated by the Schott PTR-70. The SunTrap receiver will (1) operate at higher temperature (T) by using an insulated, recessed radiation-collection system to overcome the energy losses that plague vacuum-tube receivers at high T, (2) decrease acquisition costs via simpler structure, and (3) dramaticallymore » increase reliability by eliminating vacuum. It offers comparable optical efficiency with thermal loss reduction from ≥ 26% (at presently standard T) to ≥ 55% (at high T), lower acquisition costs, and near-zero O&M costs.« less

Passenger aircraft cabin air quality: trends, effects, societal costs, proposals.

PubMed

Hocking, M B

2000-08-01

As aircraft operators have sought to substantially reduce propulsion fuel cost by flying at higher altitudes, the energy cost of providing adequate outside air for ventilation has increased. This has lead to a significant decrease in the amount of outside air provided to the passenger cabin, partly compensated for by recirculation of filtered cabin air. The purpose of this review paper is to assemble the available measured air quality data and some calculated estimates of the air quality for aircraft passenger cabins to highlight the trend of the last 25 years. The influence of filter efficiencies on air quality, and a few medically documented and anecdotal cases of illness transmission aboard aircraft are discussed. Cost information has been collected from the perspective of both the airlines and passengers. Suggestions for air quality improvement are given which should help to result in a net, multistakeholder savings and improved passenger comfort.

Enhancing ultra-high CPV passive cooling using least-material finned heat sinks

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

Micheli, Leonardo, E-mail: lm409@exeter.ac.uk; Mallick, Tapas K., E-mail: T.K.Mallick@exeter.ac.uk; Fernandez, Eduardo F., E-mail: E.Fernandez-Fernandez2@exeter.ac.uk

2015-09-28

Ultra-high concentrating photovoltaic (CPV) systems aim to increase the cost-competiveness of CPV by increasing the concentrations over 2000 suns. In this work, the design of a heat sink for ultra-high concentrating photovoltaic (CPV) applications is presented. For the first time, the least-material approach, widely used in electronics to maximize the thermal dissipation while minimizing the weight of the heat sink, has been applied in CPV. This method has the potential to further decrease the cost of this technology and to keep the multijunction cell within the operative temperature range. The designing procedure is described in the paper and the resultsmore » of a thermal simulation are shown to prove the reliability of the solution. A prediction of the costs is also reported: a cost of 0.151$/W{sub p} is expected for a passive least-material heat sink developed for 4000x applications.« less

Modeled Effectiveness of Ventilation with Contaminant Control Devices on Indoor Air Quality in a Swine Farrowing Facility

PubMed Central

Anthony, T. Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M.

2016-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5°C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s−1 (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures. PMID:24433305

Modeled effectiveness of ventilation with contaminant control devices on indoor air quality in a swine farrowing facility.

PubMed

Anthony, T Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M

2014-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5 °C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s(-1) (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures.

Cost-effectiveness of the stream-gaging program in Kentucky

USGS Publications Warehouse

Ruhl, K.J.

1989-01-01

This report documents the results of a study of the cost-effectiveness of the stream-gaging program in Kentucky. The total surface-water program includes 97 daily-discharge stations , 12 stage-only stations, and 35 crest-stage stations and is operated on a budget of $950,700. One station used for research lacks adequate source of funding and should be discontinued when the research ends. Most stations in the network are multiple-use with 65 stations operated for the purpose of defining hydrologic systems, 48 for project operation, 47 for definition of regional hydrology, and 43 for hydrologic forecasting purposes. Eighteen stations support water quality monitoring activities, one station is used for planning and design, and one station is used for research. The average standard error of estimation of streamflow records was determined only for stations in the Louisville Subdistrict. Under current operating policy, with a budget of $223,500, the average standard error of estimation is 28.5%. Altering the travel routes and measurement frequency to reduce the amount of lost stage record would allow a slight decrease in standard error to 26.9%. The results indicate that the collection of streamflow records in the Louisville Subdistrict is cost effective in its present mode of operation. In the Louisville Subdistrict, a minimum budget of $214,200 is required to operate the current network at an average standard error of 32.7%. A budget less than this does not permit proper service and maintenance of the gages and recorders. The maximum budget analyzed was $268,200, which would result in an average standard error of 16.9% indicating that if the budget was increased by 20%, the percent standard error would be reduced 40 %. (USGS)

Oxygen Production on Mars Using Solid Oxide Electrolysis

NASA Technical Reports Server (NTRS)

Sridhar, K. R.

1997-01-01

If oxygen for propulsion and life support needs were to be extracted from martian resources, significant savings in launch mass and costs could be attained for both manned and unmanned missions. In addition to reduced cost the ability to produce oxygen from martian resources would decrease the risks associated with long duration stays on the surface of Mars. One method of producing the oxygen from the carbon dioxide rich atmosphere of Mars involves solid oxide electrolysis. A brief summary of the theory of operation will be presented followed by a schematic description of a Mars oxygen production pland and a discussion of its power consumption characteristics.

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

PubMed Central

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

2014-01-01

Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health plan beneficiaries, and employers warrants further consideration. PMID:24904218

Low-cost fabrication and performance testing of Polydimethylsiloxane (PDMS) micromixers using an improved print-and-Peel (PAP) method

NASA Astrophysics Data System (ADS)

Abagon, Ma. Victoria; Buendia, Neil Daniel; Jasper Caracas, Corine; July Yap, Kristian

2018-03-01

The research presents different configurations of microfluidic mixers made from polydimethylsiloxane (PDMS) fabricated using an improved, low-cost print-and-peel (PAP) method. Processes, such as mixing, operated in the micro scale allow decreased equipment size-to-production capacity ratio and decreased energy consumption per unit product. In the study, saturated solutions of blue and yellow food dyes were introduced inside the channels using a LEGO® improvised microsyringe pump. Scanning Electron Microscopy (SEM) was used to determine the average depth of the fabricated micromixers which was found to be around 14 ¼m. The flows were observed and images were taken using a light microscope. The color intensities of the images were then measured using MATLAB®. From the relationship between color intensity and concentration, the mixing indices were calculated and found to be 0.9435 to 0.9941, which falls within the standard mixing index range (0.8 - 1.0) regardless of the flow rate and the configuration of the micromixer as verified through the two-way ANOVA. From the cost analysis, the cost of the device fabricated in this study is a hundred-fold less than expenses from standard fabrication procedures. Hence, the fabricated device provides an alternative for micromixers produced from expensive and conventional lithographic methods.

Integrating small satellite communication in an autonomous vehicle network: A case for oceanography

NASA Astrophysics Data System (ADS)

Guerra, André G. C.; Ferreira, António Sérgio; Costa, Maria; Nodar-López, Diego; Aguado Agelet, Fernando

2018-04-01

Small satellites and autonomous vehicles have greatly evolved in the last few decades. Hundreds of small satellites have been launched with increasing functionalities, in the last few years. Likewise, numerous autonomous vehicles have been built, with decreasing costs and form-factor payloads. Here we focus on combining these two multifaceted assets in an incremental way, with an ultimate goal of alleviating the logistical expenses in remote oceanographic operations. The first goal is to create a highly reliable and constantly available communication link for a network of autonomous vehicles, taking advantage of the small satellite lower cost, with respect to conventional spacecraft, and its higher flexibility. We have developed a test platform as a proving ground for this network, by integrating a satellite software defined radio on an unmanned air vehicle, creating a system of systems, and several tests have been run successfully, over land. As soon as the satellite is fully operational, we will start to move towards a cooperative network of autonomous vehicles and small satellites, with application in maritime operations, both in-situ and remote sensing.

Preventative programs for respiratory disease in cow/calf operations.

PubMed

Engelken, T J

1997-11-01

Control of respiratory disease in cow/calf operations presents many challenges. The incidence of disease in the suckling calf is not well documented and the logistics of handling range animals make control programs difficult to implement. Health programs have to be built around normal working patterns, and these patterns may not provide the best "fit" for immune management of the calf. Weaned calves undergo significant disease challenge when they enter typical marketing channels. This provides the potential for high levels of calf morbidity, mortality, medicine costs, and losses from decreased performance as they arrive at a stocker operation or feedyard. If preweaning calf health and preconditioning programs are used, they must be planned so that the producer has an opportunity to obtain a return on their investment. Options for increasing calf weight marketed, certified calf health sales, or retained ownership through the next phase of production should be evaluated carefully. Any potential increase in calf value must be weighed against program costs. This affords the veterinarian an opportunity to build on traditional disease management and prevention skills and expand their influence in overall ranch management.

Dezincing Technology

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

Dudek, F.J.; Daniels, E.J.; Morgan, W.A.

1997-08-01

Half of the steel produced in the US is derived from scrap. With zinc-coated prompt scrap increasing fivefold since 1980, steel-makers are feeling the effect of increased contaminant loads on their operations. The greatest concern is the cost of treatment before disposal of waste dusts and water that arise from remelting zinc-coated scrap. An economic process is needed to strip and recover the zinc from scrap to provide a low residual scrap for steel- and iron-making. Metal Recovery Technologies, Inc., with the assistance of Argonne National Laboratory, have been developing a caustic leach dezincing process for upgrading galvanized stamping plantmore » scrap into clean scrap with recovery of the zinc. With further development the technology could also process galvanized scrap from obsolete automobiles. This paper will review: (1) the status of recent pilot plant operations and plans for a commercial demonstration facility with a dezincing capacity of up to 250,000 tons/year, (2) the economics of caustic dezincing, and (3) benefits of decreased cost of environmental compliance, raw material savings, and improved operations with use of dezinced scrap.« less

Pumpless thermal management of water-cooled high-temperature proton exchange membrane fuel cells

NASA Astrophysics Data System (ADS)

Song, Tae-Won; Choi, Kyoung-Hwan; Kim, Ji-Rae; Yi, Jung S.

2011-05-01

Proton exchange membrane fuel cells (PEMFCs) have been considered for combined heat and power (CHP) applications, but cost reduction has remained an issue for commercialization. Among various types of PEMFC, the high-temperature (HT) PEMFC is gaining more attention due to the simplicity of the system, that will make the total system cost lower. A pumpless cooling concept is introduced to reduce the number of components of a HT PEMFC system even further and also decrease the parasitic power required for operating the system. In this concept, water is used as the coolant, and the buoyancy force caused by the density difference between vapour and liquid when operated above boiling temperate is utilized to circulate the coolant between the stack and the cooling device. In this study, the basic parameters required to design the cooling device are discussed, and the stable operation of the HT PEMFC stack in both the steady-state and during transient periods is demonstrated. It found that the pumpless cooling method provides more uniform temperature distribution within the stack, regardless of the direction of coolant flow.

Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy.

PubMed

Ferreira Laso, Lourdes; López Picado, Amanda; Antoñanzas Villar, Fernando; Lamata de la Orden, Laura; Ceballos Garcia, Mar; Ibañez López, Carolina; Pipaon Ruilope, Lorena; Lamata Hernandez, Felix; Valero Martinez, Cesar; Aizpuru, Felipe; Hernandez Chaves, Roberto

2015-09-01

Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934

Distributed Generation Energy Technology Operations and Maintenance Costs |

Science.gov Websites

Costs Distributed Generation Energy Technology Operations and Maintenance Costs Transparent Cost Database Button The following charts indicate recent operations and maintenance (O&M) cost estimates available national-level cost data from a variety of sources. Costs in your specific location will vary. The

U.S. DOE Progress Towards Developing Low-Cost, High Performance, Durable Polymer Electrolyte Membranes for Fuel Cell Applications

PubMed Central

Houchins, Cassidy; Kleen, Greg J.; Spendelow, Jacob S.; Kopasz, John; Peterson, David; Garland, Nancy L.; Ho, Donna Lee; Marcinkoski, Jason; Martin, Kathi Epping; Tyler, Reginald; Papageorgopoulos, Dimitrios C.

2012-01-01

Low cost, durable, and selective membranes with high ionic conductivity are a priority need for wide-spread adoption of polymer electrolyte membrane fuel cells (PEMFCs) and direct methanol fuel cells (DMFCs). Electrolyte membranes are a major cost component of PEMFC stacks at low production volumes. PEMFC membranes also impose limitations on fuel cell system operating conditions that add system complexity and cost. Reactant gas and fuel permeation through the membrane leads to decreased fuel cell performance, loss of efficiency, and reduced durability in both PEMFCs and DMFCs. To address these challenges, the U.S. Department of Energy (DOE) Fuel Cell Technologies Program, in the Office of Energy Efficiency and Renewable Energy, supports research and development aimed at improving ion exchange membranes for fuel cells. For PEMFCs, efforts are primarily focused on developing materials for higher temperature operation (up to 120 °C) in automotive applications. For DMFCs, efforts are focused on developing membranes with reduced methanol permeability. In this paper, the recently revised DOE membrane targets, strategies, and highlights of DOE-funded projects to develop new, inexpensive membranes that have good performance in hot and dry conditions (PEMFC) and that reduce methanol crossover (DMFC) will be discussed. PMID:24958432

Cost-Benefit Performance of Robotic Surgery Compared with Video-Assisted Thoracoscopic Surgery under the Japanese National Health Insurance System.

PubMed

Kajiwara, Naohiro; Patrick Barron, James; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2015-01-01

Medical economics have significant impact on the entire country. The explosion in surgical techniques has been accompanied by questions regarding actual improvements in outcome and cost-effectiveness, such as the da Vinci(®) Surgical System (dVS) compared with conventional video-assisted thoracic surgery (VATS). To establish a medical fee system for robot-assisted thoracic surgery (RATS), which is a system not yet firmly established in Japan. This study examines the cost benefit performance (CBP) based on medical fees compared with VATS and RATS under the Japanese National Health Insurance System (JNHIS) introduced in 2012. The projected (but as yet undecided) price in the JNHIS would be insufficient if institutions have less than even 200 dVS cases per year. Only institutions which perform more than 300 dVS operations per year would obtain a positive CBP with the projected JNHIS reimbursement. Thus, under the present conditions, it is necessary to perform at least 300 dVS operations per year in each institution with a dVS system to avoid financial deficit with current robotic surgical management. This may hopefully encourage a downward price revision of the dVS equipment by the manufacture which would result in a decrease in the cost per procedure.

Cost effectiveness of the stream-gaging program in North Dakota

USGS Publications Warehouse

Ryan, Gerald L.

1989-01-01

This report documents results of a cost-effectiveness study of the stream-gaging program In North Dakota. It is part of a nationwide evaluation of the stream-gaging program of the U.S. Geological Survey.One phase of evaluating cost effectiveness is to identify less costly alternative methods of simulating streamflow records. Statistical or hydro logic flow-routing methods were used as alternative methods to simulate streamflow records for 21 combinations of gaging stations from the 94-gaging-station network. Accuracy of the alternative methods was sufficient to consider discontinuing only one gaging station.Operation of the gaging-station network was evaluated by using associated uncertainty in streamflow records. The evaluation was limited to the nonwinter operation of 29 gaging stations in eastern North Dakota. The current (1987) travel routes and measurement frequencies require a budget of about $248/000 and result in an average equivalent Gaussian spread in streamflow records of 16.5 percent. Changes in routes and measurement frequencies optimally could reduce the average equivalent Gaussian spread to 14.7 percent.Budgets evaluated ranged from $235,000 to $400,000. A $235,000 budget would increase the optimal average equivalent Gaussian spread from 14.7 to 20.4 percent, and a $400,000 budget could decrease it to 5.8 percent.

Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays.

PubMed

Stockert, Emily Walker; Langerman, Alexander

2014-10-01

Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments. This was a single-site, observational study conducted on the surgical instrumentation at a large academic medical center in Chicago. Data were collected through direct observation by a trained investigator. Operating room instrument use and labor time required for cleaning and repacking instrument trays in central sterile processing (CSP) were analyzed using descriptive statistics and linear regression. Institutional data on volume and expenses were gathered from hospital leadership. Forty-nine procedures and 237 individual trays were observed. Average instrument (±SD)use rates were 13.0% for Otolaryngology (±4.2%), 15.5% for Plastic Surgery (±2.9%), 18.2% for Bariatric Surgery (±5.0%), and 21.9% for Neurosurgery (±1.7%). An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. Using recorded labor time, the cost of cleaning and repackaging an individual instrument was calculated to be $0.10. Adding in CSP operating expenses and instrument depreciation per use, total processing cost per instrument increases to $0.51 or more. Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis.

PubMed

Sabry, Nirmeen; Dawoud, Dalia; Alansary, Adel; Hounsome, Natalia; Baines, Darrin

2015-12-01

Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting. An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis. Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001). A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation. © 2015 John Wiley & Sons, Ltd.

A Comparison of Two Fat Grafting Methods on Operating Room Efficiency and Costs.

PubMed

Gabriel, Allen; Maxwell, G Patrick; Griffin, Leah; Champaneria, Manish C; Parekh, Mousam; Macarios, David

2017-02-01

Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf. Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf. Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc.

Corazon a Corazon: Examining the Philanthropic Motivations, Priorities, and Relational Connectedness of Mexican American, Spanish American and Other Latino/Hispano University Alumni/Alumnae to a Hispanic Serving Institution

ERIC Educational Resources Information Center

Acosta, Sylvia Y.

2010-01-01

Public higher education institutions rely on state funding for a significant percentage of operational costs. In recent years, state contributions to higher education have been substantially reduced due to budget deficits at the state and federal levels. Such budget deficits have resulted in decreased funding for higher education. Universities…

A Robust Design Approach to Cost Estimation: Solar Energy for Marine Corps Expeditionary Operations

DTIC Science & Technology

2014-07-14

solutions in such areas as photovoltaic arrays for power harvesting, light emitting diodes (LED) for decreased energy consumption, and improved battery...generation and conversion system that allows Marines to power systems with solar energy. Each GREENS is comprised of eight photovoltaic array panels...renewable power sources such as photovoltaic arrays and wind turbines. The HOMER model has been utilized for years by organizations and companies

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

PubMed

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of hospital volume on perioperative outcomes and costs of radical cystectomy: analysis of the Maryland Health Services Cost Review Commission database.

PubMed

Gorin, Michael A; Kates, Max; Mullins, Jeffrey K; Pierorazio, Phillip M; Matlaga, Brian R; Schoenberg, Mark P; Bivalacqua, Trinity J

2014-02-01

The objective of this study was to evaluate the impact of hospital case volume on perioperative outcomes and costs of radical cystectomy (RC) after controlling for differences in patient case mix. The Maryland Health Services Cost Review Commission database was queried for patients who underwent an open RC between 2000 and 2011. Patients were divided into tertiles based on hospital case volume. Groups were compared for differences in length of intensive care unit (ICU) stay, length of total hospital stay, rate of in-hospital deaths and procedure-related costs. In total, 1620 patients underwent a RC during the study period. Of these patients, 457 (28.2%) underwent surgery at 37 low volume centers, 465 (28.7%) at six mid volume centers and 698 (43.1%) at a single high volume center. The mean case volume of each group was 1.1, 7.0 and 63.5 RC/center/year, respectively. After controlling for marked differences in patient case mix, having surgery at the single high-volume center was independently associated with a decrease in length of ICU stay (coefficient = -0.41 days, 95% CI -0.78--0.05, p = 0.03), in-hospital mortality (OR 0.18, 95% CI 0.04-0.80, p = 0.02) and total medical costs (coefficient = -2.91k USD, 95% CI -4.15--1.67, p < 0.001). Decreased total costs were driven by reductions in charges associated with the operating room, drugs, radiology tests, labs, supplies and physical/occupational therapy (all p < 0.001). Undergoing RC at a high volume medical center was associated with improved outcomes and reduced costs. These data support the centralization of RC to high volume centers.

Low Computational Signal Acquisition for GNSS Receivers Using a Resampling Strategy and Variable Circular Correlation Time

PubMed Central

Zhang, Yeqing; Wang, Meiling; Li, Yafeng

2018-01-01

For the objective of essentially decreasing computational complexity and time consumption of signal acquisition, this paper explores a resampling strategy and variable circular correlation time strategy specific to broadband multi-frequency GNSS receivers. In broadband GNSS receivers, the resampling strategy is established to work on conventional acquisition algorithms by resampling the main lobe of received broadband signals with a much lower frequency. Variable circular correlation time is designed to adapt to different signal strength conditions and thereby increase the operation flexibility of GNSS signal acquisition. The acquisition threshold is defined as the ratio of the highest and second highest correlation results in the search space of carrier frequency and code phase. Moreover, computational complexity of signal acquisition is formulated by amounts of multiplication and summation operations in the acquisition process. Comparative experiments and performance analysis are conducted on four sets of real GPS L2C signals with different sampling frequencies. The results indicate that the resampling strategy can effectively decrease computation and time cost by nearly 90–94% with just slight loss of acquisition sensitivity. With circular correlation time varying from 10 ms to 20 ms, the time cost of signal acquisition has increased by about 2.7–5.6% per millisecond, with most satellites acquired successfully. PMID:29495301

Low Computational Signal Acquisition for GNSS Receivers Using a Resampling Strategy and Variable Circular Correlation Time.

PubMed

Zhang, Yeqing; Wang, Meiling; Li, Yafeng

2018-02-24

For the objective of essentially decreasing computational complexity and time consumption of signal acquisition, this paper explores a resampling strategy and variable circular correlation time strategy specific to broadband multi-frequency GNSS receivers. In broadband GNSS receivers, the resampling strategy is established to work on conventional acquisition algorithms by resampling the main lobe of received broadband signals with a much lower frequency. Variable circular correlation time is designed to adapt to different signal strength conditions and thereby increase the operation flexibility of GNSS signal acquisition. The acquisition threshold is defined as the ratio of the highest and second highest correlation results in the search space of carrier frequency and code phase. Moreover, computational complexity of signal acquisition is formulated by amounts of multiplication and summation operations in the acquisition process. Comparative experiments and performance analysis are conducted on four sets of real GPS L2C signals with different sampling frequencies. The results indicate that the resampling strategy can effectively decrease computation and time cost by nearly 90-94% with just slight loss of acquisition sensitivity. With circular correlation time varying from 10 ms to 20 ms, the time cost of signal acquisition has increased by about 2.7-5.6% per millisecond, with most satellites acquired successfully.

Cap-and-trade policy: The influence on investments in carbon dioxide reducing technologies in Indiana

NASA Astrophysics Data System (ADS)

Fahie, Monique

With most of the energy produced in the state of Indiana coming from coal, the implementation of policy instruments such as cap-and-trade, which is included in the most recent climate bill, will have significant effects. This thesis provides an analysis of the effects that a cap-and-trade policy might have on the investment decisions for alternative technologies in the power plant sector in Indiana. Two economic models of representative coal-fired power plants, Gallagher (600MW) and Rockport (2600MW), are selected and used to evaluate the repowering decision of a plant for several technologies: integrated gasification combined cycle (IGCC), wind farm combined with natural gas combined cycle (NGCC) and supercritical pulverized coal (SCPC). The firm will make its decisions based on the net present value (NPV) of cost estimates for these CO2 reducing technologies, the cost of purchasing offsets and CO 2 allowances. This model is applied to a base case and three American Clean Energy and Security Act of 2009 cases derived from the Energy Information Administration (EIA, 2009b). A sensitivity analysis is done on the discount rate and capital costs. The results of the study indicate that a SCPC plant without carbon capture and storage (CCS) is the least costly compliance option for both plants under all of the cases while retrofitting the existing plant with CCS is the most expensive. Gallagher's three least expensive options across most scenarios were SCPC without CCS, the operation of the existing plant as is and investment in wind plus NGCC. Rockport's three least expensive compliance options across most scenarios were SCPC without CCS, the operation of the existing plant as is and IGCC without CCS. For both plants, when a 12% discount rate is utilized, NPV of costs are generally lower and the operation of the existing plant technology with the aid of allowances and offsets to be in compliance is the cheapest option. If capital costs were to decrease by 30%, a SCPC without CCS would remain the least costly option to invest in for both plants, but if costs were to increase by 30% operating the existing plant as is becomes the least pricey option.

"Red-Yellow-Green": Effect of an Initiative to Guide Surgeon Choice of Orthopaedic Implants.

PubMed

Okike, Kanu; Pollak, Rachael; O'Toole, Robert V; Pollak, Andrew N

2017-04-05

Orthopaedic procedures are expensive, and devices account for a large proportion of the overall costs. Hospitals have employed a variety of strategies to decrease implant costs, but many center on restricting surgeon choice. At our institution, we developed an implant selection tool that guides surgeons toward more cost-effective implants, while minimally restricting choice. The purpose of this study was to assess the effect of this tool on preferred implant usage rates, vendor attitudes toward pricing structure, and hospital implant expenditures. For 6 commonly used orthopaedic trauma devices, similar constructs were created for the 4 vendors used at our hospital, and the costs were determined. On the basis of these costs, the available options for each device type were categorized as "green" (preferred vendor), "yellow" (midrange), or "red" (used for patient-specific requirements). The "Red-Yellow-Green" chart was posted on the wall of each orthopaedic trauma operating room. To assess the effect of the tool, we compared implant usage patterns before and after implementation of the implant selection tool. We also assessed changes in vendor contract prices, as well as overall savings to our institution. Implant usage changed significantly from 30% "red," 56% "yellow," and 14% "green" prior to the intervention, to 9% "red," 21% "yellow," and 70% "green" after the intervention (p < 0.0001). As a result of price renegotiation with vendors following implementation, we observed average price decreases that ranged from 1.1% to 22.4%. Average expenditures on these 6 implants decreased 20% during the study period, which represented a savings of $216,495 per year. At our institution, we designed and implemented "Red-Yellow-Green," a simple tool that guides surgeons toward the selection of lower-cost implants without violating vendor confidentiality clauses, limiting the implants from which surgeons can choose, or requiring surgeons to discern the prices of complex constructs. Following implementation, hospital implant expenditures decreased as a result of a combination of increased preferred vendor usage by surgeons, as well as increased competition among vendors, which resulted in lower overall prices.

Introduction of an operating room information management system improved overall operating room efficiency.

PubMed

De Deyne, Cathy; Heylen, René

2004-01-01

Operating Room (OR) information systems should manage the OR time, assigned to every surgeon, thereby minimizing the sum of costs of unused OR time and minimizing the costs of elective cases performed outside normal allocated OR time (excess OR-time). The aim of this paper is to illustrate how the introduction of an OR information system influenced daily OR activity performance. Since January 2001, we introduced an OR information system with a visual, airport-like, screen as central part, displaying all scheduled OR activity linked in real-time activity with all OR theatres. For the aim of this paper, we compared all data of OR activity for elective abdominal surgery (EAS) for the first half of 2000 compared to the first half of 2001, after the introduction of our information system. In 2000, 764 elective cases were performed, compared to 815 cases in 2001. For both periods, the total OR time allocated to EAS for this 6 months period was 805 h. For 2000, the total duration of OR activity for EAS was 1044 h 50 min (implicating 239 h 50 min over-time), compared to 1127 h 35 min (implicating 322 h 35 min overtime) for 2001. For 2000, we recorded 147 h 20 min excess time (=exceeding the time limits of OR activity and inducing extra costs) and 46h45min unused OR time. For 2001, we recorded 123 h 04 min excess time and 35 h 21 min unused time. In conclusion, in 2001 we recorded an increase in total OR activity for elective abdominal surgery by 7% in number of procedures and by 8% in total duration. However, in 2001 we recorded a decrease in excess time by 16% (123 h 04 min vs 147 h 20 min), which was for a large part due to a 23% decrease in unused OR time in 2001 compared to 2000 (35 h 21min vs 46 h 45 min). Therefore, the introduction of an OR information system, with a real-time visual display of ongoing OR activity, resulted in a increased performance of OR activity, with more OR procedures performed despite less excess time and less extra costs.

User costs as one of main advantages of precast concrete application in highway construction

NASA Astrophysics Data System (ADS)

Tomek, Radan

2017-09-01

Road user cost primarily refer to the monetized components of road (re)construction impacts, such as the user delay costs, vehicle operating costs, crash costs and emission costs. Objective of this paper is to analyze and appraise the advantages and benefits of the innovative prefabrication approach in contrast to traditional cast-in-place construction method. The goal is to reduce these additional costs borne by motorists and the community at-large as a result of road construction activity to their minimum through application of the prefabrication. Assessing two basic possible approaches to highway infrastructure construction - casting the road pavements and structures either in place or precast off the site - it can be concluded that the initial capital investment costs do not vary much. Substantial differences can be recognized when comparing their life-cycle costs and an extent to which their construction process affects the public, environment and the local economy. Prefabrication of any structure component off-site offers major construction time and user cost savings in comparison with the traditional cast-in-place methods of construction. Precast prestressed road pavements’ technology and precasting bridges’ parts and elements offers dramatic increase in durability, while it also substantially decreases construction time and resulting user costs.

EnergySolution's Clive Disposal Facility Operational Research Model - 13475

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

Nissley, Paul; Berry, Joanne

2013-07-01

EnergySolutions owns and operates a licensed, commercial low-level radioactive waste disposal facility located in Clive, Utah. The Clive site receives low-level radioactive waste from various locations within the United States via bulk truck, containerised truck, enclosed truck, bulk rail-cars, rail boxcars, and rail inter-modals. Waste packages are unloaded, characterized, processed, and disposed of at the Clive site. Examples of low-level radioactive waste arriving at Clive include, but are not limited to, contaminated soil/debris, spent nuclear power plant components, and medical waste. Generators of low-level radioactive waste typically include nuclear power plants, hospitals, national laboratories, and various United States government operatedmore » waste sites. Over the past few years, poor economic conditions have significantly reduced the number of shipments to Clive. With less revenue coming in from processing shipments, Clive needed to keep its expenses down if it was going to maintain past levels of profitability. The Operational Research group of EnergySolutions were asked to develop a simulation model to help identify any improvement opportunities that would increase overall operating efficiency and reduce costs at the Clive Facility. The Clive operations research model simulates the receipt, movement, and processing requirements of shipments arriving at the facility. The model includes shipment schedules, processing times of various waste types, labor requirements, shift schedules, and site equipment availability. The Clive operations research model has been developed using the WITNESS{sup TM} process simulation software, which is developed by the Lanner Group. The major goals of this project were to: - identify processing bottlenecks that could reduce the turnaround time from shipment arrival to disposal; - evaluate the use (or idle time) of labor and equipment; - project future operational requirements under different forecasted scenarios. By identifying processing bottlenecks and unused equipment and/or labor, improvements to operating efficiency could be determined and appropriate cost saving measures implemented. Model runs forecasting various scenarios helped illustrate potential impacts of certain conditions (e.g. 20% decrease in shipments arrived), variables (e.g. 20% decrease in labor), or other possible situations. (authors)« less

[Application of fibrin sealant in patients operated on for differentiated thyroid cancer. What do we improve?].

PubMed

Vidal-Pérez, Óscar; Flores-Siguenza, Luis; Valentini, Mauro; Astudillo-Pombo, Emiliano; Fernández-Cruz, Laureano; García-Valdecasas, Juan Carlos

2016-01-01

In recent years, several publications have shown that new adhesives and sealants, like Tissucol(®), applied in thyroid space reduce local complications after thyroidectomies. To demonstrate the effectiveness of fibrin glue Tissucol(®) in reducing the post-operative hospital stay of patients operated on for differentiated thyroid carcinoma in which total thyroidectomy with central and unilateral node neck dissection was performed (due to the debit drains decrease), with consequent cost savings. A prospective randomised study was conducted during the period between May 2009 and October 2013 on patients with differentiated thyroid carcinoma with cervical nodal metastases, and subjected to elective surgery. Two groups were formed: one in which Tissucol(®) was used (case group) and another where it was not used (control group). Patients were operated on by surgeons specifically dedicated to endocrine surgical pathology, using the same surgical technique in all cases. A total of 60 total thyroidectomies with lymph node dissection were performed, with 30 patients in the case group, and 30 patients in control group. No statistically significant differences were observed in most of the studied variables. However, the case group had a shorter hospital stay than the control group with a statistically significant difference (p<0.05). Implementation of Tissucol(®) has statistically and significantly reduced the hospital stay of patients undergoing total thyroidectomy with neck dissection, which represents a significant reduction in hospital costs. This decrease in hospital stay has no influence on the occurrence of major complications related to the intervention. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Assessing the costs of disposable and reusable supplies wasted during surgeries.

PubMed

Chasseigne, V; Leguelinel-Blache, G; Nguyen, T L; de Tayrac, R; Prudhomme, M; Kinowski, J M; Costa, P

2018-05-01

The management of disposable and reusable supplies might have an impact on the cost efficiency of the Operating Room (OR). This study aimed to evaluate the cost and reasons for wasted supplies in the OR during surgical procedures. We conducted an observational and prospective study in a French university hospital. We assessed the cost of wasted supplies in the OR (defined by opened unused devices), the reasons for the wastage, and the circulator retrievals. At the end, we assessed the perception of surgeons and nurses relative to the supply wastage. Fifty routine procedures and five non-scheduled procedures were observed in digestive (n = 20), urologic (n = 20) and gynecologic surgery (n = 15). The median cost [IQR] of open unused devices was €4.1 [0.5; 10.5] per procedure. Wasted supplies represented up to 20.1% of the total cost allocated to surgical supplies. Considering the 8000 surgical procedures performed in these three surgery departments, the potential annual cost savings were 100 000€. The most common reason of wastage was an anticipation of the surgeon's needs. The circulating nurse spent up to 26.3% of operative time outside of the OR, mainly attending to an additional demand from the surgeon (30%). Most of the survey respondents (68%) agreed that knowing supply prices would change their behavior. This study showed the OR is a major source of wasted hospital expenditure and an area wherein an intervention would have a significant impact. Reducing wasted supplies could improve the cost efficiency of the OR and also decrease its ecological impact. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Cost analysis of percutaneous fixation of hand fractures in the main operating room versus the ambulatory setting.

PubMed

Gillis, Joshua A; Williams, Jason G

2017-08-01

To date, there have been no studies identifying the cost differential for performing closed reduction internal fixation (CRIF) of hand fractures in the operating room (OR) versus an ambulatory setting. Our goal was to analyse the cost and efficiency of performing CRIF in these two settings and to investigate current practice trends in Canada. A detailed analysis of the costs involved both directly and indirectly in the CRIF of a hand fracture was conducted. Hospital records were used to calculate efficiency. A survey was distributed to practicing plastic surgeons across Canada regarding their current practice of managing hand fractures. In an eight-hour surgical block we are able to perform five CRIF in the OR versus eight in an ambulatory setting. The costs of performing a CRIF in the OR under local anaesthetic, not including surgeon compensation, is $461.27 Canadian (CAD) compared to $115.59 CAD in the ambulatory setting, a 299% increase. The use of a regional block increases the cost to $665.49 CAD, a 476% increase. The main barrier to performing CRIFs in an outpatient setting is the absence of equipment necessary to perform these cases effectively, based on survey results. The use of the OR for CRIF of hand fractures is associated with a significant increase in cost and hospital resources with decreased efficiency. For appropriately selected hand fractures, CRIF in an ambulatory setting is less costly and more efficient compared to the OR and resources should be allocated to facilitate CRIF in this setting. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A financial analysis of operating room charges for robot-assisted gynaecologic surgery: Efficiency strategies in the operating room for reducing the costs

PubMed Central

Zeybek, Burak; Öge, Tufan; Kılıç, Cemil Hakan; Borahay, Mostafa A.; Kılıç, Gökhan Sami

2014-01-01

Objective To analyse the steps taking place in the operating room (OR) before the console time starts in robot-assisted gynaecologic surgery and to identify potential ways to decrease non-operative time in the OR. Material and Methods Thirteen consecutive robotic cases for benign gynaecologic disease at the Department of Obstetrics and Gynecology at University of Texas Medical Branch (UTMB) were retrospectively reviewed. The collected data included the specific terms ‘Anaesthesia Done’ (step 1), ‘Drape Done’ (step 2), and ‘Trocar In’ (step 3), all of which refer to the time before the actual surgery began and OR charges were evaluated as level 3, 4, and 5 for open abdominal/vaginal hysterectomy, laparoscopic hysterectomy, and robot-assisted hysterectomy, respectively. Results The cost of the OR for 0–30 minutes and each additional 30 minutes were $3,693 and $1,488, $4,961 and $2,426, $5,513 and $2,756 in level 3, 4, and 5 surgeries, respectively. The median time for step 1 was 12.1 min (5.25–23.3), for step 2 was 19 (4.59–44) min, and for step 3 was 25.3 (16.45–45) min. The total median time until the actual operation began was 54.58 min (40–100). The total cost was $6948.7 when the charge was calculated according to level 4 and $7771.1 when the charge was calculated according to level 5. Conclusion Robot-assisted surgery is already ‘cost-expensive’ in the preparation stage of a surgical procedure during anaesthesia induction and draping of the patient because of charging levels. Every effort should be made to shorten the time and reduce the number of instruments used without compromising care. (J Turk Ger Gynecol Assoc 2014; 15: 25–9) PMID:24790513

[Initiating a Robotic Program for Abdominal Surgery - Experiences from a Centre in Germany].

PubMed

Brunner, Maximilian; Matzel, Klaus; Aladashvili, Archil; Krautz, Christian; Grützmann, Robert; Croner, Roland

2018-05-18

Robotic systems are becoming increasingly important in abdominal surgery. We describe the implementation of a robotic program at a German centre for abdominal surgery, with focus on feasibility, safety, patient selection, learning curves, financial aspects and the lessons learned. This retrospective analysis covered data on patient demographics, intra- and postoperative parameters, oncological results and costs of all robotic-assisted abdominal operations performed at our institution between August 2012 to December 2016. It was also evaluated how possible factors for preoperative patient selection might influence intra- or postoperative outcome and learning parameters. 81 operations were performed - mostly colorectal resections (n = 35), ventral mesh rectopexy (n = 23) and liver resections (n = 18). The conversion rate was 7%. All oncological patients underwent R0 resection. Mean postoperative hospitalisation was 8.8 days; mean morbidity was 24%, with major complications (Clavien-Dindo > II) in 7%; mortality was 0%. BMI above 33.5 kg/m 2 was associated with significantly higher morbidity (p = 0.024) and rate of major complications (p = 0.046), as well as a significantly longer hospitalisation (p = 0.009). Patients older than 65 years had significantly higher morbidity (p = 0.025). With increasing numbers of operations, time of surgery decreased (p = 0.001). The average cost of a robot-assisted operation, including hospital stay, was 15,221 €. The costs of robotic sigmoid resections or liver resections were higher (compared to the open approach: 106.8 and 62.8% higher, respectively, compared to the laparoscopic approach 93.5 and 66.5% higher, respectively). Robotic surgery is a safe approach. A crucial factor in the successful and safe performance of robotic assisted operations is proper patient selection, especially during the implementation period. The inevitable learning curve and the higher costs compared to open and laparocopic surgery must be respected and specialisation of the whole team is necessary. Georg Thieme Verlag KG Stuttgart · New York.

The use of 3D planning in facial surgery: preliminary observations.

PubMed

Hoarau, R; Zweifel, D; Simon, C; Broome, M

2014-12-01

Three-dimensional (3D) planning is becoming a more commonly used tool in maxillofacial surgery. At first used only virtually, 3D planning now also enables the creation of useful intraoperative aids such as cutting guides, which decrease the operative difficulty. In our center, we have used 3D planning in various domains of facial surgery and have investigated the advantages of this technique. We have also addressed the difficulties associated with its use. 3D planning increases the accuracy of reconstructive surgery, decreases operating time, whilst maintaining excellent esthetic results. However, its use is restricted to osseous reconstruction at this stage and once planning has been undertaken, it cannot be reversed or altered intraoperatively. Despite the attractive nature of this new tool, its uses and practicalities must be further evaluated. In particular, cost-effectiveness, hospital stay, and patient perceived benefits must be assessed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Effects of the Fuel Price Increase on the Operating Cost of Freight Transport Vehicles

NASA Astrophysics Data System (ADS)

Gohari, Adel; Matori, Nasir; Yusof, Khamaruzaman Wan; Toloue, Iraj; Myint, Kin Cho

2018-03-01

One of the most important criteria in freight modal choices is the transport operating cost in which fuel price changes has a significant effect on it. This paper presents the impact of fuel price increases on the operating cost of the different transport modes for the containerized freight transportation. In this study, an operating cost equation was applied to compare the operating cost of different freight transport vehicles as well as evaluation of the operating cost changes across a range of fuel prices between the current price and one-hundred percent increase. The equation consists of influential parameters such as fuel cost, driver wage and maintenance cost of a vehicle. It has been concluded that the effect of the fuel price increase on the operating cost of different freight transportation modes is not in the same rate. According to equation and effective parameters considered, comparing the results showed that truck has the highest cost, train has the largest increase in price. Finally, the ship is the most influenced vehicle in terms of operating cost percentage increase when the rate of fuel price increase, followed by train and truck.

24 CFR 583.125 - Grants for operating costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Operating costs are those associated with the day-to-day operation of the supportive housing. They also... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Grants for operating costs. 583.125... for operating costs. (a) General. HUD will provide grants to pay a portion (as described in § 583.130...

Simulation of robotic courier deliveries in hospital distribution services.

PubMed

Rossetti, M D; Felder, R A; Kumar, A

2000-06-01

Flexible automation in the form of robotic couriers holds the potential for decreasing operating costs while improving delivery performance in hospital delivery systems. This paper discusses the use of simulation modeling to analyze the costs, benefits, and performance tradeoffs related to the installation and use of a fleet of robotic couriers within hospital facilities. The results of this study enable a better understanding of the delivery and transportation requirements of hospitals. Specifically, we examine how a fleet of robotic couriers can meet the performance requirements of the system while maintaining cost efficiency. We show that for clinical laboratory and pharmaceutical deliveries a fleet of six robotic couriers can achieve significant performance gains in terms of turn-around time and delivery variability over the current system of three human couriers per shift or 13 FTEs. Specifically, the simulation results indicate that using robotic couriers to perform both clinical laboratory and pharmaceutical deliveries would result in a 34% decrease in turn-around time, and a 38% decrease in delivery variability. In addition, a break-even analysis indicated that a positive net present value occurs if nine or more FTEs are eliminated with a resulting ROI of 12%. This analysis demonstrates that simulation can be a valuable tool for examining health care distribution services and indicates that a robotic courier system may yield significant benefits over a traditional courier system in this application.

The financial impact of health information exchange on emergency department care.

PubMed

Frisse, Mark E; Johnson, Kevin B; Nian, Hui; Davison, Coda L; Gadd, Cynthia S; Unertl, Kim M; Turri, Pat A; Chen, Qingxia

2012-01-01

To examine the financial impact health information exchange (HIE) in emergency departments (EDs). We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms. Our estimates employed generalized estimating equations for logistic regression models adjusted for admission type, length of stay, and Charlson co-morbidity index. Marginal probabilities were used to calculate changes in outcome variables and their financial consequences. HIE data were accessed in approximately 6.8% of ED visits across 12 EDs studied. In 11 EDs directly accessing HIE data only through a secure Web browser, access was associated with a decrease in hospital admissions (adjusted odds ratio (OR)=0.27; p<0001). In a 12th ED relying more on print summaries, HIE access was associated with a decrease in hospital admissions (OR=0.48; p<0001) and statistically significant decreases in head CT use, body CT use, and laboratory test ordering. Applied only to the study population, HIE access was associated with an annual cost savings of $1.9 million. Net of annual operating costs, HIE access reduced overall costs by $1.07 million. Hospital admission reductions accounted for 97.6% of total cost reductions. Access to additional clinical data through HIE in emergency department settings is associated with net societal saving.

Operating room waste reduction in plastic and hand surgery.

PubMed

Albert, Mark G; Rothkopf, Douglas M

2015-01-01

Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.

Enhancing Science and Automating Operations using Onboard Autonomy

NASA Technical Reports Server (NTRS)

Sherwood, Robert; Chien, Steve; Tran, Daniel; Davies, Ashley; Castano, Rebecca; Rabideau, Gregg; Mandl, Dan; Szwaczkowski, Joseph; Frye, Stuart; Shulman, Seth

2006-01-01

In this paper, we will describe the evolution of the software from prototype to full time operation onboard Earth Observing One (EO-1). We will quantify the increase in science, decrease in operations cost, and streamlining of operations procedures. Included will be a description of how this software was adapted post-launch to the EO-1 mission, which had very limited computing resources which constrained the autonomy flight software. We will discuss ongoing deployments of this software to the Mars Exploration Rovers and Mars Odyssey Missions as well as a discussion of lessons learned during this project. Finally, we will discuss how the onboard autonomy has been used in conjunction with other satellites and ground sensors to form an autonomous sensor-web to study volcanoes, floods, sea-ice topography, and wild fires. As demonstrated on EO-1, onboard autonomy is a revolutionary advance that will change the operations approach on future NASA missions...

Operation of a sub-terahertz CW gyrotron with an extremely low voltage

NASA Astrophysics Data System (ADS)

Bratman, V. L.; Fedotov, A. E.; Fokin, A. P.; Glyavin, M. Yu.; Manuilov, V. N.; Osharin, I. V.

2017-11-01

Decreasing the operating voltage for medium-power sub-terahertz gyrotrons aimed at industrial and scientific applications is highly attractive, since it allows size and cost reduction of the tubes and power supply units. In this paper, we examine such an opportunity both numerically and experimentally for the fundamental cyclotron resonance operation of an existing gyrotron initially designed for operation at the second cyclotron harmonic with a relatively high voltage. Simulations predict that output power higher than 10 W can be produced at the fundamental harmonic at voltages less than 2 kV. To form a low-voltage helical electron beam with a sufficiently large pitch-factor, a positive voltage was applied to the first anode of the gyrotron three-electrode magnetron-injection gun with a negative voltage at the cathode. CW gyrotron operation at voltages down to 1.5 kV has been demonstrated at a frequency about of 256 GHz.

Association between patient-centered medical home rating and operating cost at federally funded health centers.

PubMed

Nocon, Robert S; Sharma, Ravi; Birnberg, Jonathan M; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H

2012-07-04

Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH). To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27,300; 95% CI, $3047-$57,804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32,731; 95% CI, $1571-$73,670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39,809; 95% CI, $1893-$63,169). According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.

Information systems and human error in the lab.

PubMed

Bissell, Michael G

2004-01-01

Health system costs in clinical laboratories are incurred daily due to human error. Indeed, a major impetus for automating clinical laboratories has always been the opportunity it presents to simultaneously reduce cost and improve quality of operations by decreasing human error. But merely automating these processes is not enough. To the extent that introduction of these systems results in operators having less practice in dealing with unexpected events or becoming deskilled in problemsolving, however new kinds of error will likely appear. Clinical laboratories could potentially benefit by integrating findings on human error from modern behavioral science into their operations. Fully understanding human error requires a deep understanding of human information processing and cognition. Predicting and preventing negative consequences requires application of this understanding to laboratory operations. Although the occurrence of a particular error at a particular instant cannot be absolutely prevented, human error rates can be reduced. The following principles are key: an understanding of the process of learning in relation to error; understanding the origin of errors since this knowledge can be used to reduce their occurrence; optimal systems should be forgiving to the operator by absorbing errors, at least for a time; although much is known by industrial psychologists about how to write operating procedures and instructions in ways that reduce the probability of error, this expertise is hardly ever put to use in the laboratory; and a feedback mechanism must be designed into the system that enables the operator to recognize in real time that an error has occurred.

Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review.

PubMed

Jordan, R W; Smith, N A; Chahal, G S; Casson, C; Reed, M R; Sprowson, A P

2014-12-01

Around 20% of knee replacement have an unsatisfactory outcome. Pre-operative physiotherapy and education have been proposed to improve post-operative outcomes. This systematic review evaluated whether these factors improved length of stay and patient reported outcomes after knee replacement surgery. Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and PEDro were searched on the 1st January 2013. Randomised or quasi-randomised studies assessing either pre-operative education or physiotherapy on patients undergoing a planned total or partial knee replacement were included in the review. Only studies with a control group receiving a defined standard of pre-operative care were included. Eleven studies met the inclusion criteria set. Two studies analysed the effect of pre-operative education, seven pre-operative treatment by a physiotherapist and two studies used both factors. No study found significant differences in validated joint specific patient reported outcome measures. The education studies found a decrease in pre-operative expectation and an improvement in knowledge, flexion and regularity of exercise. Two studies found an improvement in muscle strength in the group treated by a physiotherapist at three months. The combination of education and physiotherapy was shown to reduce patient length of stay and cost in one study. The evidence reviewed is insufficient to support the implementation of either pre-operative education or physiotherapy programmes. The combination of pre-operative education and treatment by a physiotherapist may reduce the medical costs associated with surgery. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Integrated operations/payloads/fleet analysis. Volume 3: System costs. Appendix A: Program direct costs

NASA Technical Reports Server (NTRS)

1971-01-01

Individualized program direct costs for each satellite program are presented. This breakdown provides the activity level dependent costs for each satellite program. The activity level dependent costs, or, more simply, program direct costs, are comprised of the total payload costs (as these costs are strictly program dependent) and the direct launch vehicle costs. Only those incremental launch vehicle costs associated directly with the satellite program are considered. For expendable launch vehicles the direct costs include the vehicle investment hardware costs and the launch operations costs. For the reusable STS vehicles the direct costs include only the launch operations, recovery operations, command and control, vehicle maintenance, and propellant support. The costs associated with amortization of reusable vehicle investment, RDT&E range support, etc., are not included.

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... processing operations performed in the beneficiary developing country. (a) Items included in the direct costs of processing operations. As used in § 10.176, the words “direct costs of processing operations...

Is there value in retrospective 90-day bundle payment models for shoulder arthroplasty procedures?

PubMed

Odum, Susan M; Hamid, Nady; Van Doren, Bryce A; Spector, Leo R

2018-05-01

The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015. The 90-day postacute events included an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH) admissions and readmissions. Expenditures were converted to 2016 dollars using the Consumer Price Index. Wilcoxon tests and multivariate generalized estimating equation were used to assess independent cost-drivers. The median FFS expenditure was $21,157 (interquartile range, $16,894-$30,748) compared with $17,894 (interquartile range, $15,796-$20,894) for BPCI (P < .0001). The BPCI patients had significantly lower rates of SNF admissions (34% FFS vs. 16% BPCI; P < .001), IRF admissions (3% FFS vs. 0.6% BPCI; P = .05), HH utilization (49% FFS vs. 41% BPCI; P = .05), and readmissions (14% FFS vs. 7% BPCI; P = .01). After controlling for postacute events in the multivariate regression model, we found BPCI had a 4% decrease in expenditures (P = .08). All postacute events were independently associated with higher expenditures. Our private practice implemented cost-containment practices, including clinical guidelines, patient navigators, and a BPCI management team. IRF and SNF utilization and the 90-day readmission rate significantly decreased. As a result, we were able to control the postacute spending, which resulted in decreased costs of performing TSA surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Application of neural networks for the prediction of rock fragmentation in Chadormalu iron mine / Zastosowanie sieci neuronowych do prognozowania stopnia rozdrobnienia skał w kopalni rud żelaza w Chadormalu

NASA Astrophysics Data System (ADS)

Monjezi, Masoud; Ahmadi, Zabiholla; Khandelwal, Manoj

2012-12-01

Most open-pit mining operations employ blasting for primary breakage of the in-situ rock mass. Inappropriate blasting techniques can result in excessive damage to the wall rock, decreasing stability and increasing water influx. In addition, it will result in either over and/or under breakage of rocks. The presence of over broken rocks can result in decreased wall stability and require additional excavation. In contrast, the presence of under broken rocks may require secondary blasting and additional crushing. Since blasting is a major cost factor, both cases (under and over breakage) create additional costs reflected in the increase of the operation and maintenance of the machinery. Quick and accurate measurements of fragment size distribution are essential for managing fragmented rock and other materials. Various fragmentation measurement techniques are available and are being used by industry/researchers but most of the methods are time consuming and not precise. An ideally performed blasting operation enormously influences the overall mining cost. This aim can be achieved by proper prediction and attenuation of fragmentation. Prediction of fragmentation is essential for optimizing blasting operation. Poor performance of the empirical models for predicting fragmentation has urged the application of new approaches. In this paper, artificial neural network (ANN) method is implemented to develop a model to predict rock fragmentation size distribution due to blasting in Chadormalu iron mine, Iran. In the development of the proposed ANN model, ten parameters such as UCS, drilling rate, water content, burden, spacing, stemming, hole diameter, bench height, powder factor and charge per delay were incorporated. Training and testing of the model was performed by the back-propagation algorithm using 97 datasets. A four-layer ANN was found to be optimum with architecture of 10-7-5-1. A comparison has made between measured results of fragmentation with predicted results of fragmentation by ANN and multiple regression model. Sensitivity analysis was also performed to understand the effect of each influencing parameters on rock fragmentation.

Materials Advance Chemical Propulsion Technology

NASA Technical Reports Server (NTRS)

2012-01-01

In the future, the Planetary Science Division of NASA's Science Mission Directorate hopes to use better-performing and lower-cost propulsion systems to send rovers, probes, and observers to places like Mars, Jupiter, and Saturn. For such purposes, a new propulsion technology called the Advanced Materials Bipropellant Rocket (AMBR) was developed under NASA's In-Space Propulsion Technology (ISPT) project, located at Glenn Research Center. As an advanced chemical propulsion system, AMBR uses nitrogen tetroxide oxidizer and hydrazine fuel to propel a spacecraft. Based on current research and development efforts, the technology shows great promise for increasing engine operation and engine lifespan, as well as lowering manufacturing costs. In developing AMBR, ISPT has several goals: to decrease the time it takes for a spacecraft to travel to its destination, reduce the cost of making the propulsion system, and lessen the weight of the propulsion system. If goals like these are met, it could result in greater capabilities for in-space science investigations. For example, if the amount (and weight) of propellant required on a spacecraft is reduced, more scientific instruments (and weight) could be added to the spacecraft. To achieve AMBR s maximum potential performance, the engine needed to be capable of operating at extremely high temperatures and pressure. To this end, ISPT required engine chambers made of iridium-coated rhenium (strong, high-temperature metallic elements) that allowed operation at temperatures close to 4,000 F. In addition, ISPT needed an advanced manufacturing technique for better coating methods to increase the strength of the engine chamber without increasing the costs of fabricating the chamber.

Operating cost model for local service airlines

NASA Technical Reports Server (NTRS)

Anderson, J. L.; Andrastek, D. A.

1976-01-01

Several mathematical models now exist which determine the operating economics for a United States trunk airline. These models are valuable in assessing the impact of new aircraft into an airline's fleet. The use of a trunk airline cost model for the local service airline does not result in representative operating costs. A new model is presented which is representative of the operating conditions and resultant costs for the local service airline. The calculated annual direct and indirect operating costs for two multiequipment airlines are compared with their actual operating experience.

Enzymatic corn wet milling: engineering process and cost model

PubMed Central

Ramírez, Edna C; Johnston, David B; McAloon, Andrew J; Singh, Vijay

2009-01-01

Background Enzymatic corn wet milling (E-milling) is a process derived from conventional wet milling for the recovery and purification of starch and co-products using proteases to eliminate the need for sulfites and decrease the steeping time. In 2006, the total starch production in USA by conventional wet milling equaled 23 billion kilograms, including modified starches and starches used for sweeteners and ethanol production [1]. Process engineering and cost models for an E-milling process have been developed for a processing plant with a capacity of 2.54 million kg of corn per day (100,000 bu/day). These models are based on the previously published models for a traditional wet milling plant with the same capacity. The E-milling process includes grain cleaning, pretreatment, enzymatic treatment, germ separation and recovery, fiber separation and recovery, gluten separation and recovery and starch separation. Information for the development of the conventional models was obtained from a variety of technical sources including commercial wet milling companies, industry experts and equipment suppliers. Additional information for the present models was obtained from our own experience with the development of the E-milling process and trials in the laboratory and at the pilot plant scale. The models were developed using process and cost simulation software (SuperPro Designer®) and include processing information such as composition and flow rates of the various process streams, descriptions of the various unit operations and detailed breakdowns of the operating and capital cost of the facility. Results Based on the information from the model, we can estimate the cost of production per kilogram of starch using the input prices for corn, enzyme and other wet milling co-products. The work presented here describes the E-milling process and compares the process, the operation and costs with the conventional process. Conclusion The E-milling process was found to be cost competitive with the conventional process during periods of high corn feedstock costs since the enzymatic process enhances the yields of the products in a corn wet milling process. This model is available upon request from the authors for educational, research and non-commercial uses. PMID:19154623

Don't break the chain: importance of supply chain management in the operating room setting.

PubMed

Bilyk, Candis

2008-09-01

Management of supplies within the operating room (OR) has considerable implications for decreasing healthcare costs while maintaining high-quality patient care. This area of healthcare therefore requires more monitoring by end-users including OR management, physicians, and nursing staff. This article is based on understanding supply chain management in the OR setting. Information provided throughout the article can be applied to small or large health care centers. It defines supply chain management and contains a brief overview of supply chain processes. It reviews the benefits of following these processes. The article also includes recommendations for improving the supply chain in the OR.

State of the NASA Aeropropulsion Discipline Input from the Glenn Research Center

NASA Technical Reports Server (NTRS)

Reddy, D. R.; Schmidt, George

2017-01-01

PROBLEM: Current power turbines are designed for single operating speed, and performance degrades rapidly as power turbine speed decreases. OBJECTIVES: Demonstrate 50 improvement in efficient operational capability using a Variable Speed Power Turbine concept. (Refer to figure lower left, where the goal is to raise efficiency from the current technology line to the green line which represents the AVSPOT VSPT goal.APPROACH: Conduct RD required to advance the technology readiness level of VSPT technology to TRL 4Partner with DoD and leverage DOD AVSPOT contract to share government cost (5050) of contracted efforts to GE and PW for VSPT TRL 45 demonstration.

24 CFR 891.150 - Operating cost standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... through 891.790, the operating cost standard for group homes shall be based on the number of residents... as differences in costs based on location within the field office jurisdiction. The operating cost...

Data systems and computer science: Software Engineering Program

NASA Technical Reports Server (NTRS)

Zygielbaum, Arthur I.

1991-01-01

An external review of the Integrated Technology Plan for the Civil Space Program is presented. This review is specifically concerned with the Software Engineering Program. The goals of the Software Engineering Program are as follows: (1) improve NASA's ability to manage development, operation, and maintenance of complex software systems; (2) decrease NASA's cost and risk in engineering complex software systems; and (3) provide technology to assure safety and reliability of software in mission critical applications.

A Robust Design Approach to Cost Estimation: Solar Energy for Marine Corps Expeditionary Operations

DTIC Science & Technology

2014-04-30

areas as photovoltaic arrays for power harvesting, light emitting diodes (LED) for decreased energy consumption, and improved battery and smart power ...conversion system that allows Marines to power systems with solar energy. Each GREENS is comprised of eight photovoltaic array panels, four high-energy...Brandon Newell conducted an experiment where he assessed the capabilities of the HOMER model in forecasting the power output of a solar panel at the

Quantitative evolutionary design

PubMed Central

Diamond, Jared

2002-01-01

The field of quantitative evolutionary design uses evolutionary reasoning (in terms of natural selection and ultimate causation) to understand the magnitudes of biological reserve capacities, i.e. excesses of capacities over natural loads. Ratios of capacities to loads, defined as safety factors, fall in the range 1.2-10 for most engineered and biological components, even though engineered safety factors are specified intentionally by humans while biological safety factors arise through natural selection. Familiar examples of engineered safety factors include those of buildings, bridges and elevators (lifts), while biological examples include factors of bones and other structural elements, of enzymes and transporters, and of organ metabolic performances. Safety factors serve to minimize the overlap zone (resulting in performance failure) between the low tail of capacity distributions and the high tail of load distributions. Safety factors increase with coefficients of variation of load and capacity, with capacity deterioration with time, and with cost of failure, and decrease with costs of initial construction, maintenance, operation, and opportunity. Adaptive regulation of many biological systems involves capacity increases with increasing load; several quantitative examples suggest sublinear increases, such that safety factors decrease towards 1.0. Unsolved questions include safety factors of series systems, parallel or branched pathways, elements with multiple functions, enzyme reaction chains, and equilibrium enzymes. The modest sizes of safety factors imply the existence of costs that penalize excess capacities. Those costs are likely to involve wasted energy or space for large or expensive components, but opportunity costs of wasted space at the molecular level for minor components. PMID:12122135

A prospective audit on the effect of training and educational workshops on the incidence of urethral catheterization injuries

PubMed Central

Bhatt, Nikita R.; Davis, Niall F.; Quinlan, Mark R.; Flynn, Robert J.; McDermott, T.E.D.; Manecksha, Rustom P.; Thornhill, John A.

2017-01-01

Introduction The incidence of iatrogenic urethral catheterization (UC) injuries is approximately 0.3%. Resultant complications are associated with patient morbidity and unnecessary healthcare costs. Our aim was to investigate whether educational training workshops decreased the incidence of UC-related injuries. Methods A prospective audit was performed to calculate incidence, morbidity, and costs associated with iatrogenic UC injury from January to July 2015. Educational workshops were then conducted with healthcare staff and training modules for junior doctors. UC-related incidence, morbidity, and costs in the subsequent six-month period were recorded prospectively and compared with the previous data. Results The incidence of iatrogenic UC injuries was reduced from 4.3/1000 catheters inserted to 3.8/1000 catheters after the intervention (p=0.59). Morbidity from UC increased in the second half in the form of increase in cumulative additional inpatient hospital stay (22 to 79 days; p=0.25), incidence of urosepsis (n=2 to n=4), and need for operative intervention (n=1 to n=2). The cost of managing UC injuries almost doubled in the period after the training intervention (€50 449 to €90 100). Conclusions Current forms of educational and training interventions for UC did not significantly change morbidity or cost of iatrogenic UC injuries despite a decrease in incidence. Improved and intensive training protocols are necessary for UC to prevent avoidable iatrogenic complications, as well as a safer urethral catheter design. PMID:28761592

Hospital quality choice and market structure in a regulated duopoly.

PubMed

Beitia, Arantza

2003-11-01

This paper analyzes the optimal structure of a regulated health care industry in a model in which the regulator cannot enforce what hospitals do (unverifiable quality of health) or does not know what hospitals know (incomplete information about production costs) or both. We show that if quality is unverifiable the choice between monopoly and duopoly does not change with respect to the verifiable case but, if there are fixed costs (assumed to be quality dependent) and the monopoly is the optimal market structure, the quality level of the operative hospital decreases. Asymmetry of information introduces informational rents that can be reduced by increasing the most efficient hospital's market share. A monopoly is chosen more often.

The use of hydrogen for aircraft propulsion in view of the fuel crisis.

NASA Technical Reports Server (NTRS)

Weiss, S.

1973-01-01

In view of projected decreases in available petroleum fuels, interest has been generated in exploiting the potential of liquid hydrogen (LH2) as an aircraft fuel. Cost studies of LH2 production show it to be more expensive than presently used fuels. Regardless of cost considerations, LH2 is viewed as an attractive aircraft fuel because of the potential performance benefits it offers. Accompanying these benefits, however, are many new problems associated with aircraft design and operations; for example, problems related to fuel system design and the handling of LH2 during ground servicing. Some of the factors influencing LH2 fuel tank design, pumping, heat exchange, and flow regulation are discussed.

A Distributed Parallel Genetic Algorithm of Placement Strategy for Virtual Machines Deployment on Cloud Platform

PubMed Central

Dong, Yu-Shuang; Xu, Gao-Chao; Fu, Xiao-Dong

2014-01-01

The cloud platform provides various services to users. More and more cloud centers provide infrastructure as the main way of operating. To improve the utilization rate of the cloud center and to decrease the operating cost, the cloud center provides services according to requirements of users by sharding the resources with virtualization. Considering both QoS for users and cost saving for cloud computing providers, we try to maximize performance and minimize energy cost as well. In this paper, we propose a distributed parallel genetic algorithm (DPGA) of placement strategy for virtual machines deployment on cloud platform. It executes the genetic algorithm parallelly and distributedly on several selected physical hosts in the first stage. Then it continues to execute the genetic algorithm of the second stage with solutions obtained from the first stage as the initial population. The solution calculated by the genetic algorithm of the second stage is the optimal one of the proposed approach. The experimental results show that the proposed placement strategy of VM deployment can ensure QoS for users and it is more effective and more energy efficient than other placement strategies on the cloud platform. PMID:25097872

A distributed parallel genetic algorithm of placement strategy for virtual machines deployment on cloud platform.

PubMed

Dong, Yu-Shuang; Xu, Gao-Chao; Fu, Xiao-Dong

2014-01-01

The cloud platform provides various services to users. More and more cloud centers provide infrastructure as the main way of operating. To improve the utilization rate of the cloud center and to decrease the operating cost, the cloud center provides services according to requirements of users by sharding the resources with virtualization. Considering both QoS for users and cost saving for cloud computing providers, we try to maximize performance and minimize energy cost as well. In this paper, we propose a distributed parallel genetic algorithm (DPGA) of placement strategy for virtual machines deployment on cloud platform. It executes the genetic algorithm parallelly and distributedly on several selected physical hosts in the first stage. Then it continues to execute the genetic algorithm of the second stage with solutions obtained from the first stage as the initial population. The solution calculated by the genetic algorithm of the second stage is the optimal one of the proposed approach. The experimental results show that the proposed placement strategy of VM deployment can ensure QoS for users and it is more effective and more energy efficient than other placement strategies on the cloud platform.

Simulation of value stream mapping and discrete optimization of energy consumption in modular construction

NASA Astrophysics Data System (ADS)

Chowdhury, Md Mukul

With the increased practice of modularization and prefabrication, the construction industry gained the benefits of quality management, improved completion time, reduced site disruption and vehicular traffic, and improved overall safety and security. Whereas industrialized construction methods, such as modular and manufactured buildings, have evolved over decades, core techniques used in prefabrication plants vary only slightly from those employed in traditional site-built construction. With a focus on energy and cost efficient modular construction, this research presents the development of a simulation, measurement and optimization system for energy consumption in the manufacturing process of modular construction. The system is based on Lean Six Sigma principles and loosely coupled system operation to identify the non-value adding tasks and possible causes of low energy efficiency. The proposed system will also include visualization functions for demonstration of energy consumption in modular construction. The benefits of implementing this system include a reduction in the energy consumption in production cost, decrease of energy cost in the production of lean-modular construction, and increase profit. In addition, the visualization functions will provide detailed information about energy efficiency and operation flexibility in modular construction. A case study is presented to validate the reliability of the system.

Financial and workflow analysis of radiology reporting processes in the planning phase of implementation of a speech recognition system

NASA Astrophysics Data System (ADS)

Whang, Tom; Ratib, Osman M.; Umamoto, Kathleen; Grant, Edward G.; McCoy, Michael J.

2002-05-01

The goal of this study is to determine the financial value and workflow improvements achievable by replacing traditional transcription services with a speech recognition system in a large, university hospital setting. Workflow metrics were measured at two hospitals, one of which exclusively uses a transcription service (UCLA Medical Center), and the other which exclusively uses speech recognition (West Los Angeles VA Hospital). Workflow metrics include time spent per report (the sum of time spent interpreting, dictating, reviewing, and editing), transcription turnaround, and total report turnaround. Compared to traditional transcription, speech recognition resulted in radiologists spending 13-32% more time per report, but it also resulted in reduction of report turnaround time by 22-62% and reduction of marginal cost per report by 94%. The model developed here helps justify the introduction of a speech recognition system by showing that the benefits of reduced operating costs and decreased turnaround time outweigh the cost of increased time spent per report. Whether the ultimate goal is to achieve a financial objective or to improve operational efficiency, it is important to conduct a thorough analysis of workflow before implementation.

41 CFR 102-33.190 - What are the aircraft operations and ownership costs for which we must account?

Code of Federal Regulations, 2010 CFR

2010-07-01

... operations and ownership costs for which we must account? 102-33.190 Section 102-33.190 Public Contracts and... Parts Accounting for the Cost of Government Aircraft § 102-33.190 What are the aircraft operations and ownership costs for which we must account? You must account for the operations and ownership costs of your...

Lessons Learned for Planning and Estimating Operations Support Requirements

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn

2011-01-01

Operations (phase E) costs are typically small compared to the spacecraft development and test costs. This, combined with the long lead time for realizing operations costs, can lead projects to focus on hardware development schedules and costs, de-emphasizing estimation of operations support requirements during proposal, early design, and replan cost exercises. The Discovery and New Frontiers (D&NF) programs comprise small, cost-capped missions supporting scientific exploration of the solar system. Even moderate yearly underestimates of the operations costs can present significant LCC impacts for deep space missions with long operational durations, and any LCC growth can directly impact the programs ability to fund new missions. The D&NF Program Office at Marshall Space Flight Center recently studied cost overruns for 7 D&NF missions related to phase C/D development of operational capabilities and phase E mission operations. The goal was to identify the underlying causes for the overruns and develop practical mitigations to assist the D&NF projects in identifying potential operations risks and controlling the associated impacts to operations development and execution costs. The study found that the drivers behind these overruns include overly optimistic assumptions regarding the savings resulting from the use of heritage technology, late development of operations requirements, inadequate planning for sustaining engineering and the special requirements of long duration missions (e.g., knowledge retention and hardware/software refresh), and delayed completion of ground system development work. This presentation summarizes the study and the results, providing a set of lessons NASA can use to improve early estimation and validation of operations costs.

Understanding Costs of Care in the Operating Room.

PubMed

Childers, Christopher P; Maggard-Gibbons, Melinda

2018-04-18

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20.40; ambulatory, $14.35 of $20.90), with nonbillable supplies accounting for less than 10% of total expenses (inpatient, $2.55 of $37.37; ambulatory, $3.33 of $35.39). From FY2005 to FY2014, expenses in the OR have increased faster than the consumer price index and medical consumer price index. Teaching hospitals had slower growth in costs than nonteaching hospitals. Over time, the proportion of expenses dedicated to indirect costs has increased, while the proportion attributable to salary and supplies has decreased. The mean cost of OR time is $36 to $37 per minute, using financial data from California's short-term general and specialty hospitals in FY2014. These statewide data provide a generalizable benchmark for the value of OR time. Furthermore, understanding the composition of costs will allow those interested in value improvement to identify high-yield targets.

Safety and efficacy of LigaSure usage in pancreaticoduodenectomy.

PubMed

Eng, Oliver S; Goswami, Julie; Moore, Dirk; Chen, Chunxia; Brumbaugh, Jennifer; Gannon, Christopher J; August, David A; Carpizo, Darren R

2013-10-01

Over recent years, use of the LigaSure™ vessel sealing device has increased in major abdominal surgery to include pancreaticoduodenectomy (PD). LigaSure™ use during PD has expanded to include all steps of the procedure, including the division of the uncinate margin. This introduces the potential for thermal major vascular injury or margin positivity. The aim of the present study was to evaluate the safety and efficacy of LigaSure™ usage in PD in comparison to established dissection techniques. One hundred and forty-eight patients who underwent PD from 2007 to 2012 at Robert Wood Johnson University Hospital were identified from a retrospective database. Two groups were recognized: those in which the LigaSure™ device was used (N = 114), and in those it was not (N = 34). Peri-operative outcomes were compared. Vascular intra-operative complications directly caused by thermal injury from LigaSure™ use occurred in 1.8% of patients. Overall vascular intra-operative complications, uncinate margin positivity, blood loss, length of stay, and complication severity were not significantly different between groups. The mean operative time was 77 min less (P < 0.010) in the LigaSure™ group. Savings per case where the LigaSure™ was used amounted to $1776.73. LigaSure™ usage during PD is safe and effective. It is associated with decreased operative times, which may decrease operative costs in PD. © 2013 International Hepato-Pancreato-Biliary Association.

Safety and efficacy of LigaSure usage in pancreaticoduodenectomy

PubMed Central

Eng, Oliver S; Goswami, Julie; Moore, Dirk; Chen, Chunxia; Brumbaugh, Jennifer; Gannon, Christopher J; August, David A; Carpizo, Darren R

2013-01-01

Background Over recent years, use of the LigaSure™ vessel sealing device has increased in major abdominal surgery to include pancreaticoduodenectomy (PD). LigaSure™ use during PD has expanded to include all steps of the procedure, including the division of the uncinate margin. This introduces the potential for thermal major vascular injury or margin positivity. The aim of the present study was to evaluate the safety and efficacy of LigaSure™ usage in PD in comparison to established dissection techniques. Methods One hundred and forty-eight patients who underwent PD from 2007 to 2012 at Robert Wood Johnson University Hospital were identified from a retrospective database. Two groups were recognized: those in which the LigaSure™ device was used (N = 114), and in those it was not (N = 34). Peri-operative outcomes were compared. Results Vascular intra-operative complications directly caused by thermal injury from LigaSure™ use occurred in 1.8% of patients. Overall vascular intra-operative complications, uncinate margin positivity, blood loss, length of stay, and complication severity were not significantly different between groups. The mean operative time was 77 min less (P < 0.010) in the LigaSure™ group. Savings per case where the LigaSure™ was used amounted to $1776.73. Conclusion LigaSure™ usage during PD is safe and effective. It is associated with decreased operative times, which may decrease operative costs in PD. PMID:23782268

Improving HVAC operational efficiency in small-and medium-size commercial buildings

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

Kim, Woohyun; Katipamula, Srinivas; Lutes, Robert

Small- and medium-size (<100,000 sf) commercial buildings (SMBs) represent over 95% of the U.S. commercial building stock and consume over 60% of total site energy consumption. Many of these buildings use rudimentary controls that are mostly manual, with limited scheduling capability, no monitoring, or failure management. Therefore, many of these buildings are operated inefficiently and consume excess energy. SMBs typically use packaged rooftop units (RTUs) that are controlled by an individual thermostat. There is increased urgency to improve the operating efficiency of existing commercial building stock in the United States for many reasons, chief among them being to mitigate themore » climate change impacts. Studies have shown that managing set points and schedules of the RTUs will result in up to 20% energy and cost savings. Another problem associated with RTUs is short cycling, when an RTU goes through ON and OFF cycles too frequently. Excessive cycling can lead to excessive wear and to premature failure of the compressor or its components. Also, short cycling can result in a significantly decreased average efficiency (up to 10%), even if there are no physical failures in the equipment. Ensuring correct use of the zone set points and eliminating frequent cycling of RTUs thereby leading to persistent building operations can significantly increase the operational efficiency of the SMBs. A growing trend is to use low-cost control infrastructure that can enable scalable and cost-effective intelligent building operations. The work reported in this paper describes two algorithms for detecting the zone set point temperature and RTU cycling rate that can be deployed on the low-cost infrastructure. These algorithms only require the zone temperature data for detection. The algorithms have been tested and validated using field data from a number of RTUs from six buildings in different climate locations. Overall, the algorithms were successful in detecting the set points and ON/OFF cycles accurately using the peak detection technique. The paper describes the two algorithms, results from testing the algorithms using field data, how the algorithms can be used to improve SMBs efficiency, and presents related conclusions.« less

Direct methane solid oxide fuel cells and their related applications

NASA Astrophysics Data System (ADS)

Lin, Yuanbo

Solid oxide fuel cells (SOFCs), renowned for their high electrical generation efficiency with low pollutant production, are promising for reducing global energy and environmental concerns. However, there are major barriers for SOFC commercialization. A primary challenge is reducing the capital cost of SOFC power plants to levels that can compete with other generation methods. While the focus of this thesis research was on operation of SOFCs directly with methane fuel, the underlying motivation was to make SOFCs more competitive by reducing their cost. This can be achieved by making SOFCs that reduce the size and complexity of the required "balance of plant". Firstly, direct operation of SOFCs on methane is desirable since it can eliminate the external reformer. However, effective means must be found to suppress deleterious anode coking in methane. In this thesis, the operating conditions under which SOFCs can operate stably and without anode coking were investigated in detail, and the underlying mechanisms of coking and degradation were determined. Furthermore, a novel design utilizing an inert anode barrier layer was developed and shown to substantially improve stability against coking. Secondly, the direct methane SOFCs were investigated for use as electrochemical partial oxidation (EPOx) reactors that can co-generate electricity and synthesis gas (CO+H2) from methane. The results indicated that conventional SOFCs work quite well as methane partial oxidation reactors, producing syngas at relatively high rates. While this approach would not decrease the cost of SOFC power plant, it would improve prospects for commercialization by increasing the value of the power plant, because two products, electricity and syngas, can be sold. Thirdly, SOFCs utilizing thin (La,Sr)(Ga,Mg)O3 electrolytes were demonstrated. This highly conductive material allows lower SOFC operation temperature, leading to the use of lower-cost materials for sealing, interconnection, and balance of plant. Deleterious electrolyte/electrode reactions and electrolyte La loss were avoided during high-temperature co-firing by using thin La-doped ceria barrier layers, allowing very high power densities at moderate operating temperatures. (La,Sr)(Ga,Mg)O3-(La,Sr)(Fe,Co)O3 composite cathodes were investigated and optimal processing parameters that yield low interfacial polarization resistance at intermediate temperature were determined.

INCREASING HEAVY OIL RESERVES IN THE WILMINGTON OIL FIELD THROUGH ADVANCED RESERVOIR CHARACTERIZATION AND THERMAL PRODUCTION TECHNOLOGIES

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

Scott Hara

2001-06-27

The objective of this project is to increase the recoverable heavy oil reserves within sections of the Wilmington Oil Field, near Long Beach, California through the testing and application of advanced reservoir characterization and thermal production technologies. The successful application of these technologies will result in expanding their implementation throughout the Wilmington Field and, through technology transfer, to other slope and basin clastic (SBC) reservoirs. The existing steamflood in the Tar zone of Fault Block II-A (Tar II-A) has been relatively inefficient because of several producibility problems which are common in SBC reservoirs: inadequate characterization of the heterogeneous turbidite sands,more » high permeability thief zones, low gravity oil and non-uniform distribution of the remaining oil. This has resulted in poor sweep efficiency, high steam-oil ratios, and early steam breakthrough. Operational problems related to steam breakthrough, high reservoir pressure, and unconsolidated sands have caused premature well and downhole equipment failures. In aggregate, these reservoir and operational constraints have resulted in increased operating costs and decreased recoverable reserves. A suite of advanced reservoir characterization and thermal production technologies are being applied during the project to improve oil recovery and reduce operating costs.« less

Cooperative optimization of reconfigurable machine tool configurations and production process plan

NASA Astrophysics Data System (ADS)

Xie, Nan; Li, Aiping; Xue, Wei

2012-09-01

The production process plan design and configurations of reconfigurable machine tool (RMT) interact with each other. Reasonable process plans with suitable configurations of RMT help to improve product quality and reduce production cost. Therefore, a cooperative strategy is needed to concurrently solve the above issue. In this paper, the cooperative optimization model for RMT configurations and production process plan is presented. Its objectives take into account both impacts of process and configuration. Moreover, a novel genetic algorithm is also developed to provide optimal or near-optimal solutions: firstly, its chromosome is redesigned which is composed of three parts, operations, process plan and configurations of RMTs, respectively; secondly, its new selection, crossover and mutation operators are also developed to deal with the process constraints from operation processes (OP) graph, otherwise these operators could generate illegal solutions violating the limits; eventually the optimal configurations for RMT under optimal process plan design can be obtained. At last, a manufacturing line case is applied which is composed of three RMTs. It is shown from the case that the optimal process plan and configurations of RMT are concurrently obtained, and the production cost decreases 6.28% and nonmonetary performance increases 22%. The proposed method can figure out both RMT configurations and production process, improve production capacity, functions and equipment utilization for RMT.

Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

PubMed Central

Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.

2013-01-01

Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54–$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893–$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost. PMID:22729481

Cost estimation and analysis using the Sherpa Automated Mine Cost Engineering System

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

Stebbins, P.E.

1993-09-01

The Sherpa Automated Mine Cost Engineering System is a menu-driven software package designed to estimate capital and operating costs for proposed surface mining operations. The program is engineering (as opposed to statistically) based, meaning that all equipment, manpower, and supply requirements are determined from deposit geology, project design and mine production information using standard engineering techniques. These requirements are used in conjunction with equipment, supply, and labor cost databases internal to the program to estimate all associated costs. Because virtually all on-site cost parameters are interrelated within the program, Sherpa provides an efficient means of examining the impact of changesmore » in the equipment mix on total capital and operating costs. If any aspect of the operation is changed, Sherpa immediately adjusts all related aspects as necessary. For instance, if the user wishes to examine the cost ramifications of selecting larger trucks, the program not only considers truck purchase and operation costs, it also automatically and immediately adjusts excavator requirements, operator and mechanic needs, repair facility size, haul road construction and maintenance costs, and ancillary equipment specifications.« less

Geodetic Imaging Lidar: Applications for high-accuracy, large area mapping with NASA's upcoming high-altitude waveform-based airborne laser altimetry Facility

NASA Astrophysics Data System (ADS)

Blair, J. B.; Rabine, D.; Hofton, M. A.; Citrin, E.; Luthcke, S. B.; Misakonis, A.; Wake, S.

2015-12-01

Full waveform laser altimetry has demonstrated its ability to capture highly-accurate surface topography and vertical structure (e.g. vegetation height and structure) even in the most challenging conditions. NASA's high-altitude airborne laser altimeter, LVIS (the Land Vegetation, and Ice Sensor) has produced high-accuracy surface maps over a wide variety of science targets for the last 2 decades. Recently NASA has funded the transition of LVIS into a full-time NASA airborne Facility instrument to increase the amount and quality of the data and to decrease the end-user costs, to expand the utilization and application of this unique sensor capability. Based heavily on the existing LVIS sensor design, the Facility LVIS instrument includes numerous improvements for reliability, resolution, real-time performance monitoring and science products, decreased operational costs, and improved data turnaround time and consistency. The development of this Facility instrument is proceeding well and it is scheduled to begin operations testing in mid-2016. A comprehensive description of the LVIS Facility capability will be presented along with several mission scenarios and science applications examples. The sensor improvements included increased spatial resolution (footprints as small as 5 m), increased range precision (sub-cm single shot range precision), expanded dynamic range, improved detector sensitivity, operational autonomy, real-time flight line tracking, and overall increased reliability and sensor calibration stability. The science customer mission planning and data product interface will be discussed. Science applications of the LVIS Facility include: cryosphere, territorial ecology carbon cycle, hydrology, solid earth and natural hazards, and biodiversity.

Rebasing the Medicare Payment for Dialysis: Rationale, Challenges, and Opportunities

PubMed Central

Johnson, Doug

2014-01-01

After Medicare’s implementation of the bundled payment for dialysis in 2011, there has been a predictable decrease in the use of intravenous drugs included in the bundle. The change in use of erythropoiesis-stimulating agents, which decreased by 37% between 2007, when its allowance in the bundle was calculated, and 2012, was because of both changes in the Food and Drug Administration labeling for erythropoiesis-stimulating agents in 2011 and cost-containment efforts at the facility level. Legislation in 2012 required Medicare to decrease (rebase) the bundled payment for dialysis in 2014 to reflect this decrease in intravenous drug use, which amounted to a cut of 12% or $30 per treatment. Medicare subsequently decided to phase in this decrease in payment over several years to offset the increase in dialysis payment that would otherwise have occurred with inflation. A 3% reduction from the rebasing would offset an approximately 3% increase in the market basket that determines a facility’s costs for 2014 and 2015. Legislation in March of 2014 provides that the rebasing will result in a 1.25% decrease in the market basket adjustment in 2016 and 2017 and a 1% decrease in the market basket adjustment in 2018 for an aggregate rebasing of 9.5% spread over 5 years. Adjusting to this payment decrease in inflation-adjusted dollars will be challenging for many dialysis providers in an industry that operates at an average 3%–4% margin. Closure of facilities, decreases in services, and increased consolidation of the industry are possible scenarios. Newer models of reimbursement, such as ESRD seamless care organizations, offer dialysis providers the opportunity to align incentives between themselves, nephrologists, hospitals, and other health care providers, potentially improving outcomes and saving money, which will be shared between Medicare and the participating providers. PMID:25189926

42 CFR 417.930 - Initial costs of operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Initial costs of operation. 417.930 Section 417.930... PREPAYMENT PLANS Administration of Outstanding Loans and Loan Guarantees § 417.930 Initial costs of operation. Under section 1305 of the PHS, loans and loan guarantees were awarded for initial costs of operation of...

Assistive Device for Efficient Intravitreal Injections.

PubMed

Ullrich, Franziska; Michels, Stephan; Lehmann, Daniel; Pieters, Roel S; Becker, Matthias; Nelson, Bradley J

2016-08-01

Intravitreal therapy is the most common treatment for many chronic ophthalmic diseases, such as age-related macular degeneration. Due to the increasing worldwide demand for intravitreal injections, there exists a need to render this medical procedure more time- and cost-efficient while increasing patient safety. The authors propose a medical assistive device that injects medication intravitreally. Compared to the manual intravitreal injection procedure, an automated device has the potential to increase safety for patients, decrease procedure times, allow for integrated data storage and documentation, and reduce costs for medical staff and expensive operating rooms. This work demonstrates the development of an assistive injection system that is coarsely positioned over the patient's head by the human operator, followed by automatic fine positioning and intravitreal injection through the pars plana. Several safety features, such as continuous eye tracking and iris recognition, have been implemented. The functioning system is demonstrated through ex vivo experiments with porcine eyes. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:752-762.]. Copyright 2016, SLACK Incorporated.

Modelling Wind Turbine Failures based on Weather Conditions

NASA Astrophysics Data System (ADS)

Reder, Maik; Melero, Julio J.

2017-11-01

A large proportion of the overall costs of a wind farm is directly related to operation and maintenance (O&M) tasks. By applying predictive O&M strategies rather than corrective approaches these costs can be decreased significantly. Here, especially wind turbine (WT) failure models can help to understand the components’ degradation processes and enable the operators to anticipate upcoming failures. Usually, these models are based on the age of the systems or components. However, latest research shows that the on-site weather conditions also affect the turbine failure behaviour significantly. This study presents a novel approach to model WT failures based on the environmental conditions to which they are exposed to. The results focus on general WT failures, as well as on four main components: gearbox, generator, pitch and yaw system. A penalised likelihood estimation is used in order to avoid problems due to for example highly correlated input covariates. The relative importance of the model covariates is assessed in order to analyse the effect of each weather parameter on the model output.

Use of Virtual Mission Operations Center Technology to Achieve JPDO's Virtual Tower Vision

NASA Technical Reports Server (NTRS)

Ivancic, William D.; Paulsen, Phillip E.

2006-01-01

The Joint Program Development Office has proposed that the Next Generation Air Transportation System (NGATS) consolidate control centers. NGATS would be managed from a few strategically located facilities with virtual towers and TRACONS. This consolidation is about combining the delivery locations for these services not about decreasing service. By consolidating these locations, cost savings in the order of $500 million have been projected. Evolving to spaced-based communication, navigation, and surveillance offers the opportunity to reduce or eliminate much of the ground-based infrastructure cost. Dynamically adjusted airspace offers the opportunity to reduce the number of sectors and boundary inconsistencies; eliminate or reduce "handoffs;" and eliminate the distinction between Towers, TRACONS, and Enroute Centers. To realize a consolidation vision for air traffic management there must be investment in networking. One technology that holds great potential is the use of Virtual Mission Operations Centers to provide secure, automated, intelligent management of the NGATS. This paper provides a conceptual framework for incorporating VMOC into the NGATS.

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).

Multitasking operating systems for microprocessors

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

Cramer, T.

1981-01-01

Microprocessors, because of their low cost, low power consumption, and small size, have caused an explosion in the number of innovative computer applications. Although there is a great deal of variation in microprocessor applications software, there is relatively little variation in the operating-system-level software from one application to the next. Nonetheless, operating system software, especially when multitasking is involved, can be very time consuming and expensive to develop. The major microprocessor manufacturers have acknowledged the need for operating systems in microprocessor applications and are now supplying real-time multitasking operating system software that is adaptable to a wide variety of usermore » systems. Use of this existing operating system software will decrease the number of redundant operating system development efforts, thus freeing programmers to work on more creative and productive problems. This paper discusses the basic terminology and concepts involved with multitasking operating systems. It is intended to provide a general understanding of the subject, so that the reader will be prepared to evaluate specific operating system software according to his or her needs. 2 references.« less

Modeling Operations Costs for Human Exploration Architectures

NASA Technical Reports Server (NTRS)

Shishko, Robert

2013-01-01

Operations and support (O&S) costs for human spaceflight have not received the same attention in the cost estimating community as have development costs. This is unfortunate as O&S costs typically comprise a majority of life-cycle costs (LCC) in such programs as the International Space Station (ISS) and the now-cancelled Constellation Program. Recognizing this, the Constellation Program and NASA HQs supported the development of an O&S cost model specifically for human spaceflight. This model, known as the Exploration Architectures Operations Cost Model (ExAOCM), provided the operations cost estimates for a variety of alternative human missions to the moon, Mars, and Near-Earth Objects (NEOs) in architectural studies. ExAOCM is philosophically based on the DoD Architecture Framework (DoDAF) concepts of operational nodes, systems, operational functions, and milestones. This paper presents some of the historical background surrounding the development of the model, and discusses the underlying structure, its unusual user interface, and lastly, previous examples of its use in the aforementioned architectural studies.

Estimating airline operating costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

A review was made of the factors affecting commercial aircraft operating and delay costs. From this work, an airline operating cost model was developed which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model, similar in some respects to the standard Air Transport Association of America (ATA) Direct Operating Cost Model, permits estimates of aircraft-related costs not now included in the standard ATA model (e.g., aircraft service, landing fees, flight attendants, and control fees). A study of the cost of aircraft delay was also made and a method for estimating the cost of certain types of airline delay is described.

An open source hydroeconomic model for California's water supply system: PyVIN

NASA Astrophysics Data System (ADS)

Dogan, M. S.; White, E.; Herman, J. D.; Hart, Q.; Merz, J.; Medellin-Azuara, J.; Lund, J. R.

2016-12-01

Models help operators and decision makers explore and compare different management and policy alternatives, better allocate scarce resources, and predict the future behavior of existing or proposed water systems. Hydroeconomic models are useful tools to increase benefits or decrease costs of managing water. Bringing hydrology and economics together, these models provide a framework for different disciplines that share similar objectives. This work proposes a new model to evaluate operation and adaptation strategies under existing and future hydrologic conditions for California's interconnected water system. This model combines the network structure of CALVIN, a statewide optimization model for California's water infrastructure, along with an open source solver written in the Python programming language. With the flexibilities of the model, reservoir operations, including water supply and hydropower, groundwater pumping, and the Delta water operations and requirements can now be better represented. Given time series of hydrologic inputs to the model, typical outputs include urban, agricultural and wildlife refuge water deliveries and shortage costs, conjunctive use of surface and groundwater systems, and insights into policy and management decisions, such as capacity expansion and groundwater management policies. Water market operations also represented in the model, allocating water from lower-valued users to higher-valued users. PyVIN serves as a cross-platform, extensible model to evaluate systemwide water operations. PyVIN separates data from the model structure, enabling model to be easily applied to other parts of the world where water is a scarce resource.

Reducing hospital admissions of healthy children with functional constipation: a quality initiative

PubMed Central

Deneau, Mark; Mutyala, Ramakrishna; Sandweiss, David; Harnsberger, Janet; Varier, Raghu; Pohl, John F; Allen, Lauren; Thackeray, Callie; Zobell, Sarah; Maloney, Christopher

2017-01-01

Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children’s hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC. PMID:29450284

Reducing hospital admissions of healthy children with functional constipation: a quality initiative.

PubMed

Deneau, Mark; Mutyala, Ramakrishna; Sandweiss, David; Harnsberger, Janet; Varier, Raghu; Pohl, John F; Allen, Lauren; Thackeray, Callie; Zobell, Sarah; Maloney, Christopher

2017-01-01

Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children's hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC.

Flat-plate solar array project. Volume 7: Module encapsulation

NASA Astrophysics Data System (ADS)

Cuddihy, E.; Coulbert, C.; Gupta, A.; Liang, R.

1986-10-01

The objective of the Encapsulation Task was to develop, demonstrate, and qualify photovoltaic (PV) module encapsulation systems that would provide 20 year (later decreased to 30 year) life expectancies in terrestrial environments, and which would be compatible with the cost and performance goals of the Flat-Plate Solar Array (FSA) Project. The scope of the Encapsulation Task included the identification, development, and evaluation of material systems and configurations required to support and protect the optically and electrically active solar cell circuit components in the PV module operating environment. Encapsulation material technologies summarized include the development of low cost ultraviolet protection techniques, stable low cost pottants, soiling resistant coatings, electrical isolation criteria, processes for optimum interface bonding, and analytical and experimental tools for evaluating the long term durability and structural adequacy of encapsulated modules. Field testing, accelerated stress testing, and design studies have demonstrated that encapsulation materials, processes, and configurations are available that meet the FSA cost and performance goals.

Flat-plate solar array project. Volume 7: Module encapsulation

NASA Technical Reports Server (NTRS)

Cuddihy, E.; Coulbert, C.; Gupta, A.; Liang, R.

1986-01-01

The objective of the Encapsulation Task was to develop, demonstrate, and qualify photovoltaic (PV) module encapsulation systems that would provide 20 year (later decreased to 30 year) life expectancies in terrestrial environments, and which would be compatible with the cost and performance goals of the Flat-Plate Solar Array (FSA) Project. The scope of the Encapsulation Task included the identification, development, and evaluation of material systems and configurations required to support and protect the optically and electrically active solar cell circuit components in the PV module operating environment. Encapsulation material technologies summarized include the development of low cost ultraviolet protection techniques, stable low cost pottants, soiling resistant coatings, electrical isolation criteria, processes for optimum interface bonding, and analytical and experimental tools for evaluating the long term durability and structural adequacy of encapsulated modules. Field testing, accelerated stress testing, and design studies have demonstrated that encapsulation materials, processes, and configurations are available that meet the FSA cost and performance goals.

Strategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home.

PubMed

Dexter, Franklin; Wachtel, Ruth E

2014-05-01

The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.

Effects of an incinerator project on a healthcare-waste management system.

PubMed

Khammaneechan, Patthanasak; Okanurak, Kamolnetr; Sithisarankul, Pornchai; Tantrakarnapa, Kraichat; Norramit, Poonsup

2011-10-01

This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

A Novel Approach of Battery Energy Storage for Improving Value of Wind Power in Deregulated Markets

NASA Astrophysics Data System (ADS)

Nguyen, Y. Minh; Yoon, Yong Tae

2013-06-01

Wind power producers face many regulation costs in deregulated environment, which remarkably lowers the value of wind power in comparison with the conventional sources. One of these costs is associated with the real-time variation of power output and being paid in frequency control market according to the variation band. In this regard, this paper presents a new approach to the scheduling and operation of battery energy storage installed in wind generation system. This approach depends on the statistic data of wind generation and the prediction of frequency control market prices to determine the optimal charging and discharging of batteries in real-time, which ultimately gives the minimum cost of frequency regulation for wind power producers. The optimization problem is formulated as the trade-off between the decrease in regulation payment and the increase in the cost of using battery energy storage. The approach is illustrated in the case study and the results of simulation show its effectiveness.

Study of short-haul aircraft operating economics. Phase 2: An analysis of the impact of jet modernization on local service airline operating costs

NASA Technical Reports Server (NTRS)

Andrastek, D. A.

1976-01-01

The objectives of this phase of the study were (1) to assess the 10 year operating cost trends of the local service airlines operating in the 1965 through 1974 period, (2) to glean from these trends the technological and operational parameters which were impacted most significantly by the transition to newer pure jet, short haul transports, and effected by changing fuel prices and cost of living indices, and (3) to develop, construct, and evaluate an operating cost forecasting model which would incorporate those factors which best predicted airline total operating cost behavior over that 10-year period.

Implications of Using Computer-Based Training with the AN/SQQ-89(v) Sonar System: Operating and Support Costs

DTIC Science & Technology

2012-06-01

Visibility and Management of Operating and Support Costs (VAMOSC...VAMOSC Visibility and Management of Operating and Support Costs VMA Variant Manning Average WAP Weapons Alternate Processor WCS Work Center...Visibility and Management of Operating and Support Costs (VAMOSC), under Unit Level Consumption and Manhours—Organizational Corrective Maintenance. C

25 CFR 39.201 - Does ISEF reflect the actual cost of school operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Does ISEF reflect the actual cost of school operations... Does ISEF reflect the actual cost of school operations? ISEF does not attempt to assess the actual cost of school operations either at the local school level or in the aggregate nationally. ISEF is a...

25 CFR 39.101 - Does ISEF assess the actual cost of school operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Does ISEF assess the actual cost of school operations? 39... SCHOOL EQUALIZATION PROGRAM Indian School Equalization Formula § 39.101 Does ISEF assess the actual cost of school operations? No. ISEF does not attempt to assess the actual cost of school operations either...

Practicing Surgeons Lead in Quality Care, Safety, and Cost Control

PubMed Central

Shively, Eugene H.; Heine, Michael J.; Schell, Robert H.; Sharpe, J Neal; Garrison, R Neal; Vallance, Steven R.; DeSimone, Kenneth J.S.; Polk, Hiram C.

2004-01-01

Objective: To report the experiences of 66 surgical specialists from 15 different hospitals who performed 43 CPT-based procedures more than 16,000 times. Summary Background Data: Surgeons are under increasing pressure to demonstrate patient safety data as quantitated by objective and subjective outcomes that meet or exceed the standards of benchmark institutions or databases. Methods: Data from 66 surgical specialists on 43 CPT-based procedures were accessioned over a 4-year period. The hospitals vary from a small 30-bed hospital to large teaching hospitals. All reported deaths and complications were verified from hospital and office records and compared with benchmarks. Results: Over a 4-year inclusive period (1999–2002), 16,028 elective operations were accessioned. There was a total 1.4% complication rate and 0.05% death rate. A system has been developed for tracking outcomes. A wide range of improvements have been identified. These include the following: 1) improved classification of indications for systemic prophylactic antibiotic use and reduction in the variety of drugs used, 2) shortened length of stay for standard procedures in different surgical specialties, 3) adherence to strict indicators for selected operative procedures, 4) less use of costly diagnostic procedures, 5) decreased use of expensive home health services, 6) decreased use of very expensive drugs, 7) identification of the unnecessary expense of disposable laparoscopic devices, 8) development of a method to compare a one-surgeon hospital with his peers, and 9) development of unique protocols for interaction of anesthesia and surgery. The system also provides a very good basis for confirmation of patient safety and improvement therein. Conclusions: Since 1998, Quality Surgical Solutions, PLLC, has developed simple physician-authored protocols for delivering high-quality and cost-effective surgery that measure up to benchmark institutions. We have discovered wide areas for improvements in surgery by adherence to simple protocols, minimizing death and complications and clarifying cost issues. PMID:15166954

Evaluation of the cost effectiveness of the 1983 stream-gaging program in Kansas

USGS Publications Warehouse

Medina, K.D.; Geiger, C.O.

1984-01-01

The results of an evaluation of the cost effectiveness of the 1983 stream-gaging program in Kansas are documented. Data uses and funding sources were identified for the 140 complete record streamflow-gaging stations operated in Kansas during 1983 with a budget of $793,780. As a result of the evaluation of the needs and uses of data from the stream-gaging program, it was found that the 140 gaging stations were needed to meet these data requirements. The average standard error of estimation of streamflow records was 20.8 percent, assuming the 1983 budget and operating schedule of 6-week interval visitations and based on 85 of the 140 stations. It was shown that this overall level of accuracy could be improved to 18.9 percent by altering the 1983 schedule of station visitations. A minimum budget of $760 ,000, with a corresponding average error of estimation of 24.9 percent, is required to operate the 1983 program. None of the stations investigated were suitable for the application of alternative methods for simulating discharge records. Improved instrumentation can have a very positive impact on streamflow uncertainties by decreasing lost record. (USGS)

Dairy farm cost efficiency.

PubMed

Tauer, L W; Mishra, A K

2006-12-01

A stochastic cost equation was estimated for US dairy farms using national data from the production year 2000 to determine how farmers might reduce their cost of production. Cost of producing a unit of milk was estimated into separate frontier (efficient) and inefficiency components, with both components estimated as a function of management and causation variables. Variables were entered as impacting the frontier component as well as the efficiency component of the stochastic curve because a priori both components could be impacted. A factor that has an impact on the cost frontier was the number of hours per day the milking facility is used. Using the milking facility for more hours per day decreased frontier costs; however, inefficiency increased with increased hours of milking facility use. Thus, farmers can decrease costs with increased utilization of the milking facility, but only if they are efficient in this strategy. Parlors compared with stanchions used for milking did not decrease frontier costs, but decreased costs because of increased efficiency, as did the use of a nutritionist. Use of rotational grazing decreased frontier costs but also increased inefficiency. Older farmers were less efficient.

Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control.

PubMed

Tepas, Joseph J; Kerwin, Andrew J; Ra, Jin Hee

2014-03-01

We evaluated the impact on coverage and regional cost of trauma care produced by the activation of a Level II center with no preceding needs analysis in an established trauma region with a Level I center. Patient deidentified trauma registry data for years 2010, 2011, and 2012 were analyzed to assess the effect on trauma service volume during a period at the midpoint of which the Level II center was activated. Trends for each year were evaluated by patient volume, mechanism, resource use as reflected in a transfer to the intensive care unit (ICU) and ICU stay, patient severity as defined by Injury Severity Score (ISS), and patient injury profile determined by mean body region Abbreviated Injury Scale (AIS) score. Between 2010 and 2011, during which the Level II opened, overall volume at the Level I center dropped by 3.7%, and blunt volume remained unchanged. From 2011 to 2012, overall Level I volume dropped by 9.4%, and blunt injury fell by 14%. Proportions requiring immediate operating room or ICU care did not change. ISS distribution at the Level I center across the years was similar. Head, chest, and abdominal injuries, as assessed by AIS body region, increased slightly in severity and decreased in volume by 25%, 17%, and 18%, respectively. For 2012, the new center publically reported treating 1,100 patients, which, in concert with the Level I decrease, translates to increasing regional trauma center access by 25% while increasing expense of necessary core personnel by 217%. Addition of a second trauma center in a stable region, in which injury incidence was actually decreasing, doubled the cost of personnel, one of the most expensive components of the trauma system and decreased the volume of injuries necessary for training and education. Trauma system expansion must be based on needs assessment, which assures system survival and controls societal cost. Economic & value-based evaluation, level III.

Estimating Airline Operating Costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

The factors affecting commercial aircraft operating and delay costs were used to develop an airline operating cost model which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model permits estimates of aircraft related costs, i.e., aircraft service, landing fees, flight attendants, and control fees. A method for estimating the costs of certain types of airline delay is also described.

Initial Costs vs. Operational Costs. A Study of Building Improvement Projects in Fourteen Schools in the School District of Greenville County, South Carolina.

ERIC Educational Resources Information Center

Chan, Tak Cheung

To determine whether initial facility improvement costs were paid back by the reduced operational costs resulting from the improvement projects, this study examined the relationship between initial costs and operational costs of fourteen school buildings improved during the 1978-79 school year in Greenville County, South Carolina. With energy…

Economic evaluation of a combined photo-Fenton/MBR process using pesticides as model pollutant. Factors affecting costs.

PubMed

Sánchez Pérez, José Antonio; Román Sánchez, Isabel María; Carra, Irene; Cabrera Reina, Alejandro; Casas López, José Luis; Malato, Sixto

2013-01-15

The aim of this paper is to carry out an economic assessment on a solar photo-Fenton/MBR combined process to treat industrial ecotoxic wastewater. This study focuses on the impact of the contamination present in wastewater, the photochemical oxidation, the use of an MBR as biological process and the plant size on operating and amortization costs. As example of ecotoxic pollutant, a mixture of five commercial pesticides commonly used in the Mediterranean area has been used, ranging from 500 mg/L to 50mg/L, expressed as dissolved organic carbon concentration. The economic evaluation shows that (i) the increase in pollution load does not always involve an increase in photo-Fenton costs because they also depend on organic matter mineralization; (ii) the use of an MBR process permits lower photochemical oxidation requirements than other biological treatments, resulting in approximately 20% photo-Fenton cost reduction for highly polluted wastewater; (iii) when pollution load decreases, the contribution of reactant consumption to the photo-Fenton process costs increase with regard to amortization costs; (iv) 30% total cost reduction can be gained treating higher daily volumes, obtaining competitive costs that vary from 1.1-1.9 €/m(3), depending on the pollution load. Copyright © 2012 Elsevier B.V. All rights reserved.

Assessing Motion Induced Interruptions Using a Motion Platform

DTIC Science & Technology

2013-09-01

same way that cars have shock absorbers to decrease jolt from potholes and bumps in the road, ships may have the potential to be designed to better...Integration (HSI) seeks to assure human performance to reduce operating costs. This thesis seeks to develop a model for ship design in relation to Motion...Induced Interruptions (MII). The model is based on the premise that MIIs affect specific domains of HSI in an adverse way. Future ship design

Cost study : before, during and after AOS implementation (October 1996 - May 1999)

DOT National Transportation Integrated Search

This study compared AATA operating costs over two different time periods: before and during AOS installation. While neither additional operating costs nor operating costs savings were traceable to AOS at this time, the implications of this report, wh...

76 FR 30925 - Information Collection; Submission for OMB Review, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

.../startup): None. Total Burden Cost (operating/maintenance): None. Instrument: Application and Budget.../startup): None. Total Burden Cost (operating/maintenance): None. AmeriCorps\\*\\VISTA Project Progress...,800 hours. Total Burden Cost (capital/startup): None. Total Burden Cost (operating/maintenance): None...

Fuel cell tubes and method of making same

DOEpatents

Borglum, Brian P.

1999-11-30

A method of manufacturing porous ceramic tubes for fuel cells with improved properties and higher manufacturing yield is disclosed. The method involves extruding a closed end fuel cell tube, such as an air electrode of a solid oxide fuel cell, in which the closed end also functions as the sintering support. The resultant fuel cell tube has a superior porosity distribution which allows improved diffusion of oxygen at the closed end of the tube during operation of the fuel cell. Because this region has the highest current density, performance enhancement and improved reliability of the fuel cell tube result. Furthermore, the higher manufacturing yield associated with the present method decreases the overall fuel cell cost. A method of manufacturing porous ceramic tubes for fuel cells with improved properties and higher manufacturing yield is disclosed. The method involves extruding a closed end fuel cell tube, such as an air electrode of a solid oxide fuel cell, in which the closed end also functions as the sintering support. The resultant fuel cell tube has a superior porosity distribution which allows improved diffusion of oxygen at the closed end of the tube during operation of the fuel cell. Because this region has the highest current density, performance enhancement and improved reliability of the fuel cell tube result. Furthermore, the higher manufacturing yield associated with the present method decreases the overall fuel cell cost.

Overseas Contingency Operations: OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term

DTIC Science & Technology

2017-01-01

OVERSEAS CONTINGENCY OPERATIONS OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the... CONTINGENCY OPERATIONS OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term Why GAO...billion in funding for OCO. While DOD’s OCO budget request has included amounts for contingency operations primarily in Iraq and Afghanistan, more

Vehicle operating costs, fuel consumption, and pavement type condition factors

DOT National Transportation Integrated Search

1982-06-01

This report presents updated vehicle operating cost tables which may be used by a highway agency for estimation of vehicle operating costs as a function of operational and roadway variables. These results, partially based on fuel consumption tests on...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

43 CFR 404.40 - What is the non-Federal share of operation, maintenance, and replacement costs?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Cost-Sharing § 404.40 What is the non-Federal share of operation, maintenance, and replacement costs? You are required to pay 100 percent of the operation, maintenance, and replacement costs of any rural... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What is the non-Federal share of operation...

Lean and Green Hand Surgery.

PubMed

Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

2018-02-01

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Influence of design on cost of operating airplanes

NASA Technical Reports Server (NTRS)

Black, Archibald

1922-01-01

The author discusses cost of operating commercial airplanes and endeavors to clear up prevalent misunderstandings. Curves of operating cost for varying duration, speed, reserve horsepower, etc. are developed.

The costs and quality of operative training for residents in tympanoplasty type I.

PubMed

Wang, Mao-Che; Yu, Eric Chen-Hua; Shiao, An-Suey; Liao, Wen-Huei; Liu, Chia-Yu

2009-05-01

A teaching hospital would incur more operation room costs on training surgical residents. To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I. From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004. The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).

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

PubMed

Patiño-Echeverri, Dalia; Hoppock, David C

2012-01-17

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

Segmental Mirroring: Does It Eliminate the Need for Intraoperative Readjustment of the Virtually Pre-Bent Reconstruction Plates and Is It Economically Valuable?

PubMed

Khalifa, Ghada Amin; Abd El Moniem, Nahed Adly; Elsayed, Shadia Abd-ElHameed; Qadry, Yara

2016-03-01

The aim of this study was to compare segmental mirroring with mirroring of the entire unaffected side to determine which method obviates intraoperative readjustment of virtually planned pre-bent plates and to evaluate the effect on costs. Patients eligible for inclusion in this prospective study had unilateral mandibular discontinuity defects. Patients were randomly divided into 2 groups. In group I, models were constructed by mirroring the entire unaffected side of the mandible at the midsagittal plane. In group II, only the resected segments were cut and replaced by the corresponding mirrored healthy segments. The lesions were resected, and their sites were reconstructed using pre-bent reconstruction plates. The need for intraoperative plate readjustment, plate placement time, operation time, and operation costs were reviewed. Fifty patients were enrolled in this study. All but 5 plates in group I required readjustment. In group II, plates were placed without intraoperative handling. Average operating times were 4.20 ± 0.56 hours in group I and 3.186 ± 0.28 hours in group II (P = .00002). Mean times for plate placement were 33.36 ± 8.20 and 21.88 ± 5.73 minutes in groups I and II, respectively. The difference resulted in an average time gain of 11.48 minutes. Average personal costs per minute were US$740.77 for group I and US$560.87 for group II. The difference resulted in an average saving of approximately US$179.90. Segmental mirroring is superior in reflecting the bone anatomy in 3-dimensional models, thus eliminating intraoperative plate readjustment and providing better plate adaptation with better contour. It decreases operating time and costs and thus can be recommended for lesions that do not cross the midline. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Decrease in Urinary Incontinence Management Costs in Women Enrolled in a Clinical Trial of Weight Loss to Treat Urinary Incontinence

PubMed Central

Subak, Leslee L.; Pinto, Angela Marinilli; Wing, Rena R.; Nakagawa, Sanae; Kusek, John W.; Herman, William H.; Kuppermann, Miriam

2012-01-01

Objective To estimate the effect of a decrease in urinary incontinence frequency on urinary incontinence management costs among women enrolled in a clinical trial of a weight loss intervention and to identify factors that predict change in cost. Methods This is a secondary cohort analysis of 338 obese and overweight women with ≥ 10 weekly episodes of urinary incontinence enrolled in an 18-month randomized clinical trial of a weight loss intervention compared to a structured education program to treat urinary incontinence. Quantities of resources used for incontinence management, including pads, additional laundry, and dry cleaning were reported by participants. Direct costs for urinary incontinence management (“cost”) were calculated by multiplying resources used by national resource costs (in 2006 U.S. dollars). Randomized groups were combined to examine the effects of change in incontinence frequency on cost. Possible predictors of change in cost were examined using generalized estimating equations controlling for factors associated with change in cost in univariable analyses. Results Mean (±SD) age was 53±10 years and baseline weight was 97+17 kg. Mean weekly urinary incontinence frequency was 24+18 at baseline and decreased by 37% at 6 months and 60% at 18 months follow-up (both P<0.001). At baseline, adjusted mean cost was $7.76±$14 per week, with costs increasing significantly with greater incontinence frequency. Mean cost decreased by 54% at 6 months and 81% at 18 months (both P<0.001). In multivariable analyses, cost independently decreased by 23% for each decrease of seven urinary incontinence episodes per week and 21% for each 5 kg of weight lost (P<0.001 for both). Conclusion In obese and overweight women enrolled in a clinical trial of weight loss for urinary incontinence, incontinence management cost decreased by 81% at 18 months ($327 per woman per year) and was strongly and independently associated with decreasing incontinence frequency. PMID:22825085

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2014 CFR

2014-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2013 CFR

2013-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2011 CFR

2011-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2010 CFR

2010-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2012 CFR

2012-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

On the Road to Transportation Efficiency (Video)

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

Not Available

2014-03-01

Reducing emissions and oil consumption are crucial worldwide goals. Reducing transportation emissions, in particular, is key to reducing overall emissions. Electric vehicles driving on electrified roadways could be a significant part of the solution. E-roadways offer a variety of benefits: reduce petroleum consumption (electricity is used instead of gasoline), decrease vehicular operating costs (from about 12 cents per mile to 4 cents per mile), and extend the operational range of electric vehicles. Plus, e-roadway power can come from renewable sources. This animation was sponsored by the Clean Transportation Sector Initiative, and interagency effort between the U.S. Department of Transportation andmore » the U.S. Department of Energy.« less

ISHM Implementation for Constellation Systems

NASA Technical Reports Server (NTRS)

Figueroa, Fernando; Holland, Randy; Schmalzel, John; Duncavage, Dan; Crocker, Alan; Alena, Rick

2006-01-01

Integrated System Health Management (ISHM) is a capability that focuses on determining the condition (health) of every element in a complex System (detect anomalies, diagnose causes, prognosis of future anomalies), and provide data, information, and knowledge (DIaK) "not just data" to control systems for safe and effective operation. This capability is currently done by large teams of people, primarily from ground, but needs to be embedded on-board systems to a higher degree to enable NASA's new Exploration Mission (long term travel and stay in space), while increasing safety and decreasing life cycle costs of systems (vehicles; platforms; bases or outposts; and ground test, launch, and processing operations). This viewgraph presentation reviews the use of ISHM for the Constellation system.

Upper-stage space shuttle propulsion by means of separate scramjet and rocket engines

NASA Technical Reports Server (NTRS)

Franciscus, L. C.; Allen, J. L.

1972-01-01

A preliminary mission study of a reusable vehicle from staging to orbit indicates payload advantages for a dual-propulsion system consisting of separate scramjet and rocket engines. In the analysis the scramjet operated continuously and the initiation of rocket operation was varied. For a stage weight of 500,000 lb the payload was 10.4 percent of stage weight or 70 percent greater than that of a comparable all-rocket-powered stage. When compared with a reusable two-state rocket vehicle having 50,000 lb payload, the use of the dual propulsion system for the second stage resulted in significant decreases in lift-off weight and empty weight, indicating possible lower hardware costs.

Long-term impact of highly active antiretroviral therapy on HIV-related health care costs.

PubMed

Keiser, P; Nassar, N; Kvanli, M B; Turner, D; Smith, J W; Skiest, D

2001-05-01

Highly active antiretroviral therapy (HAART) is associated with decreased opportunistic infections, hospitalization, and HIV-related health care costs over relatively short periods of time. We have previously demonstrated that decreases in total HIV cost are proportional to penetration of protease inhibitor therapy in our clinic. To determine the effects of HAART on HIV health care use and costs over 44 months. A comprehensive HIV service within a Veterans Affairs Medical Center. A cost-effectiveness analysis of HAART. The mean monthly number of hospital days, infectious diseases clinic visits, emergency room visits, non-HIV-related outpatient visits, inpatient costs, and antiretroviral treatment costs per patient were determined by dividing these during the period from January 1995 through June 1998 into four intervals. Viral load tests were available from October 1996. Cost-effectiveness of HAART was evaluated by determining the costs of achieving an undetectable viral load over time. Mean monthly hospitalization and associated inpatient costs decreased and remained low 2 years after the introduction of protease inhibitors (37 hospital days per 100 patients). Total cost decreased from $1905 per patient per month during the first quarter to $1090 per patient per month in the third quarter but increased to $1391 per patient per month in the fourth quarter. Antiretroviral treatment costs increased throughout the entire observation period from $79 per patient per month to $518 per patient per month. Hospitalization costs decreased from $1275 per patient per month in the first quarter to less than $500 per patient per month in each of the third and fourth quarters. The percentage of patients with a viral load <500 copies/mL increased from 21% in October 1996 to 47% in June of 1997 (p =.014). The cost of achieving an undetectable viral load decreased from $4438 per patient per month to $2669 per patient per month, but this trend did not reach statistical significance (p =.18). After an initial decrease, there was an increase in the total monthly cost of caring for HIV patients. Cost increases were primarily due to antiretroviral treatment costs, but these costs were offset by a marked decrease in inpatient-related costs. Increases in costs were not related to antiretroviral treatment failures as measured by the proportion of patients with low or undetectable viral loads. The cost of achieving an undetectable viral load remained stable despite increases in the cost of procuring antiretroviral agents.

Performance evaluation of an anaerobic/aerobic landfill-based digester using yard waste for energy and compost production

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

Yazdani, Ramin, E-mail: ryazdani@sbcglobal.net; Civil and Environmental Engineering, University of California, One Shields Avenue, Ghausi Hall, Davis, CA 95616; Barlaz, Morton A., E-mail: barlaz@eos.ncsu.edu

2012-05-15

Highlights: Black-Right-Pointing-Pointer Biochemical methane potential decreased by 83% during the two-stage operation. Black-Right-Pointing-Pointer Net energy produced was 84.3 MWh or 46 kWh per million metric tons (Mg). Black-Right-Pointing-Pointer The average removal efficiency of volatile organic compounds (VOCs) was 96-99%. Black-Right-Pointing-Pointer The average removal efficiency of non-methane organic compounds (NMOCs) was 68-99%. Black-Right-Pointing-Pointer The two-stage batch digester proved to be simple to operate and cost-effective. - Abstract: The objective of this study was to evaluate a new alternative for yard waste management by constructing, operating and monitoring a landfill-based two-stage batch digester (anaerobic/aerobic) with the recovery of energy and compost. Themore » system was initially operated under anaerobic conditions for 366 days, after which the yard waste was aerated for an additional 191 days. Off gas generated from the aerobic stage was treated by biofilters. Net energy recovery was 84.3 MWh, or 46 kWh per million metric tons of wet waste (as received), and the biochemical methane potential of the treated waste decreased by 83% during the two-stage operation. The average removal efficiencies of volatile organic compounds and non-methane organic compounds in the biofilters were 96-99% and 68-99%, respectively.« less

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... Planning and Cost Allocation by Transmission Owning and Operating Public Utilities; Proposed Rule #0;#0...] Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities Issued June 17... Transmission Services by Public Utilities; Recovery of Stranded Costs by Public Utilities and Transmitting...

[12th Annual] Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.; Lane, C. Jerome

1983-01-01

Comparisons are shown between budgeted maintenance and operations costs for 1982-83 and the preceding two years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

13th Annual Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.

1984-01-01

Comparisons are drawn between budgeted maintenance and operations costs for 1983-84 and the preceding 2 years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

Hospital economics of primary total knee arthroplasty at a teaching hospital.

PubMed

Healy, William L; Rana, Adam J; Iorio, Richard

2011-01-01

The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

Thermal and digestive constraints to foraging behaviour in marine mammals.

PubMed

Rosen, David A S; Winship, Arliss J; Hoopes, Lisa A

2007-11-29

While foraging models of terrestrial mammals are concerned primarily with optimizing time/energy budgets, models of foraging behaviour in marine mammals have been primarily concerned with physiological constraints. This has historically centred on calculations of aerobic dive limits. However, other physiological limits are key to forming foraging behaviour, including digestive limitations to food intake and thermoregulation. The ability of an animal to consume sufficient prey to meet its energy requirements is partly determined by its ability to acquire prey (limited by available foraging time, diving capabilities and thermoregulatory costs) and process that prey (limited by maximum digestion capacity and the time devoted to digestion). Failure to consume sufficient prey will have feedback effects on foraging, thermoregulation and digestive capacity through several interacting avenues. Energy deficits will be met through catabolism of tissues, principally the hypodermal lipid layer. Depletion of this blubber layer can affect both buoyancy and gait, increasing the costs and decreasing the efficiency of subsequent foraging attempts. Depletion of the insulative blubber layer may also increase thermoregulatory costs, which will decrease the foraging abilities through higher metabolic overheads. Thus, an energy deficit may lead to a downward spiral of increased tissue catabolism to pay for increased energy costs. Conversely, the heat generated through digestion and foraging activity may help to offset thermoregulatory costs. Finally, the circulatory demands of diving, thermoregulation and digestion may be mutually incompatible. This may force animals to alter time budgets to balance these exclusive demands. Analysis of these interacting processes will lead to a greater understanding of the physiological constraints within which the foraging behaviour must operate.

Experience with physician assistants in a Canadian arthroplasty program.

PubMed

Bohm, Eric R; Dunbar, Michael; Pitman, David; Rhule, Chris; Araneta, Jose

2010-04-01

Recent increases in orthopedic surgical services in Canada have added further demand to an already stretched orthopedic workforce. Various initiatives have been undertaken across Canada to meet this demand. One successful model has been the use of physician assistants (PAs) within the Winnipeg Regional Health Authority (WRHA). This study documents the effect of PAs working in an arthroplasty practice from the perspective of patients and health care providers. We also describe the costs, time savings for surgeons and the effects on surgical throughput and waiting times. We calculated time savings by the use of a daily diary kept by the PAs. Surgeons', residents', nurses' and patients' opinions about PAs were recorded by use of a self administered questionnaire. We calculated costs using forgone general practitioner (GP) surgical assist fees and salary costs for PAs. We obtained information about surgical throughput and wait times from the WRHA waitlist database. In this study, PAs "saved" their supervising physician about 204 hours per year; this time can be used for other clinical, administrative or research duties. Physician assistants are regarded as important members of the health care team by surgeons, nurses, orthopedic residents and patients. When we compared the billing costs with those that would have been generated by the use of GP surgical assists, PAs were essentially cost neutral. Furthermore, they potentially freed GPs from the operating room to spend more time delivering primary care. We found that use of the double operating room model facilitated by PAs increased the surgical throughput of primary hip and knee replacements by 42%, and median wait times decreased from 44 weeks to 30 weeks compared with the preceding year. Physician assistants integrate well into the care team and can increase surgical volumes to reduce wait times in a cost-effective manner.

The Launch Systems Operations Cost Model

NASA Technical Reports Server (NTRS)

Prince, Frank A.; Hamaker, Joseph W. (Technical Monitor)

2001-01-01

One of NASA's primary missions is to reduce the cost of access to space while simultaneously increasing safety. A key component, and one of the least understood, is the recurring operations and support cost for reusable launch systems. In order to predict these costs, NASA, under the leadership of the Independent Program Assessment Office (IPAO), has commissioned the development of a Launch Systems Operations Cost Model (LSOCM). LSOCM is a tool to predict the operations & support (O&S) cost of new and modified reusable (and partially reusable) launch systems. The requirements are to predict the non-recurring cost for the ground infrastructure and the recurring cost of maintaining that infrastructure, performing vehicle logistics, and performing the O&S actions to return the vehicle to flight. In addition, the model must estimate the time required to cycle the vehicle through all of the ground processing activities. The current version of LSOCM is an amalgamation of existing tools, leveraging our understanding of shuttle operations cost with a means of predicting how the maintenance burden will change as the vehicle becomes more aircraft like. The use of the Conceptual Operations Manpower Estimating Tool/Operations Cost Model (COMET/OCM) provides a solid point of departure based on shuttle and expendable launch vehicle (ELV) experience. The incorporation of the Reliability and Maintainability Analysis Tool (RMAT) as expressed by a set of response surface model equations gives a method for estimating how changing launch system characteristics affects cost and cycle time as compared to today's shuttle system. Plans are being made to improve the model. The development team will be spending the next few months devising a structured methodology that will enable verified and validated algorithms to give accurate cost estimates. To assist in this endeavor the LSOCM team is part of an Agency wide effort to combine resources with other cost and operations professionals to support models, databases, and operations assessments.

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization.

PubMed

McCray, Devina K S; Grobmyer, Stephen R; Pederson, Holly J

2017-02-01

Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; P<0.001; 95% CI: 1.94-3.94) or 2015 (OR: 4.14; P<0.001; 95% CI: 2.51-6.83). There was a significant decrease in pre-operative MRI utilization between 2012 and 2014 (P<0.001) after adjustment for pre-operative MRIs ordered for care path indications. Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs.

SO 2-Resistant Immobilized Amine Sorbents for CO 2 Capture

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

Tumuluri, Uma

2014-01-01

The solid amine sorbent for CO 2 capture process has advantages of simplicity and low operating cost compared to the MEA (monoethanolamine) process. Solid amine sorbents reported so far suffered from either low CO 2 capture capacity or low stability in the flue gas environment. This project is aimed at developing a SO 2-resistant solid amine sorbent for capturing CO 2 from coal–fired power plants with SCR/FGD which emits SO 2ranging from 15 to 30 ppm and NO ranging from 5 to 10 ppm. The amine sorbent we developed in a previous project degraded rapidly with 65% decrease in themore » initial capture capacity in presence of 1% SO 2. This amine sorbent was further modified by coating with polyethyleneglycol (PEG) to increase the SO 2-resistance. Polyethylene glycol (PEG) was found to decrease the SO 2-amine interaction, resulting in the decrease in the maximum SO desorption temperature (Tmax ) of amine sorbent. The PEG-coated amine sorbent exhibited higher stability with only 40% decrease in the initial capture capacity compared to un-coated amine sorbents. The cost of the solid amine sorbent developed in this project is estimated to be less than $7.00/lb; the sorbent exhibited CO 2 capture capacity more than 2.3 mmol/g. The results of this study provided the scientific basis for further development of SO 2-resistant sorbents.« less

A Study of the Optimal Planning Model for Reservoir Sustainable Management- A Case Study of Shihmen Reservoir

NASA Astrophysics Data System (ADS)

Chen, Y. Y.; Ho, C. C.; Chang, L. C.

2017-12-01

The reservoir management in Taiwan faces lots of challenge. Massive sediment caused by landslide were flushed into reservoir, which will decrease capacity, rise the turbidity, and increase supply risk. Sediment usually accompanies nutrition that will cause eutrophication problem. Moreover, the unevenly distribution of rainfall cause water supply instability. Hence, how to ensure sustainable use of reservoirs has become an important task in reservoir management. The purpose of the study is developing an optimal planning model for reservoir sustainable management to find out an optimal operation rules of reservoir flood control and sediment sluicing. The model applies Genetic Algorithms to combine with the artificial neural network of hydraulic analysis and reservoir sediment movement. The main objective of operation rules in this study is to prevent reservoir outflow caused downstream overflow, minimum the gap between initial and last water level of reservoir, and maximum sluicing sediment efficiency. A case of Shihmen reservoir was used to explore the different between optimal operating rule and the current operation of the reservoir. The results indicate optimal operating rules tended to open desilting tunnel early and extend open duration during flood discharge period. The results also show the sluicing sediment efficiency of optimal operating rule is 36%, 44%, 54% during Typhoon Jangmi, Typhoon Fung-Wong, and Typhoon Sinlaku respectively. The results demonstrate the optimal operation rules do play a role in extending the service life of Shihmen reservoir and protecting the safety of downstream. The study introduces a low cost strategy, alteration of operation reservoir rules, into reservoir sustainable management instead of pump dredger in order to improve the problem of elimination of reservoir sediment and high cost.

Robotic laparoscopic surgery: cost and training.

PubMed

Amodeo, A; Linares Quevedo, A; Joseph, J V; Belgrano, E; Patel, H R H

2009-06-01

The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for developing a robotic surgical program: it is very important to show that robotics will add a dimension that will benefit the hospital, the patient care and institutional recognition. Another essential task to overcome is the important education of the operating room nursing staff, a significant difference between this modality and traditional surgery. Without operating room environment support, most surgeons will revert to traditional methods even after a few successful robotics cases. As the field of robotic surgery continues to grow, graduate medical education and continuing medical education programs that address the surgical robotic learning needs of residents and practicing surgeons need to be developed.

A practitioner's perspective on the application and research needs of membrane bioreactors for municipal wastewater treatment.

PubMed

Kraemer, Jeremy T; Menniti, Adrienne L; Erdal, Zeynep K; Constantine, Timothy A; Johnson, Bruce R; Daigger, Glen T; Crawford, George V

2012-10-01

The application of membrane bioreactors (MBRs) for municipal wastewater treatment has increased dramatically over the last decade. From a practitioner's perspective, design practice has evolved over five "generations" in the areas of biological process optimization, separating process design from equipment supply, and reliability/redundancy thereby facilitating "large" MBRs (e.g. 150,000 m(3)/day). MBR advantages and disadvantages, and process design to accommodate biological nutrient removal, high mixed liquor suspended solids concentrations, operation and maintenance, peak flows, and procurement are reviewed from the design practitioner's perspective. Finally, four knowledge areas are identified as important to practitioners meriting further research and development: (i) membrane design and performance such as improving peak flow characteristics and decreasing operating costs; (ii) process design and performance such as managing the fluid properties of the biological solids, disinfection, and microcontaminant removal; (iii) facility design such as equipment standardization and decreasing mechanical complexity; and (iv) sustainability such as anaerobic MBRs. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cost Experience of Automated Guideway Transit Systems. (Supplement V) Costs and Trends for the Period 1976-1982.

DOT National Transportation Integrated Search

1984-04-01

This report summarizes the cost experiences and trends of sixteen domestic AGT systems. Capital costs, operation and maintenance costs, system characteristics, operational statistics, and unit cost measures are presented to provide useful information...

Microgravity

NASA Image and Video Library

1998-10-21

The Glenn Research Center (GRC) Telescience Support Center (TSC) is a NASA telescience ground facility that provides the capability to execute ground support operations of on-orbit International Space Station (ISS) and Space Shuttle payloads. This capability is provided with the coordination with the Marshall Space Flight Center (MSFC) Huntsville Operations Support Center (HOSC), the Johnson Space Center (JSC) Mission Control Center in Houston (MCC-H) and other remote ground control facilities. The concept of telescience is a result of NASA's vision to provide worldwide distributed ISS ground operations that will enable payload developers and scientists to control and monitor their on-board payloads from any location -- not necessarily a NASA site. This concept enhances the quality of scientific and technological data while decreasing operation costs of long-term support activities by providing ground operation services to a Principal Investigator and Engineering Team at their home site. The TSC acts as a hub in which users can either locate their operations staff within the walls of the TSC or request the TSC operation capabilities be extended to a location more convenient such as a university.

Spacelab Mission Implementation Cost Assessment (SMICA)

NASA Technical Reports Server (NTRS)

Guynes, B. V.

1984-01-01

A total savings of approximately 20 percent is attainable if: (1) mission management and ground processing schedules are compressed; (2) the equipping, staffing, and operating of the Payload Operations Control Center is revised, and (3) methods of working with experiment developers are changed. The development of a new mission implementation technique, which includes mission definition, experiment development, and mission integration/operations, is examined. The Payload Operations Control Center is to relocate and utilize new computer equipment to produce cost savings. Methods of reducing costs by minimizing the Spacelab and payload processing time during pre- and post-mission operation at KSC are analyzed. The changes required to reduce costs in the analytical integration process are studied. The influence of time, requirements accountability, and risk on costs is discussed. Recommendation for cost reductions developed by the Spacelab Mission Implementation Cost Assessment study are listed.

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

PubMed Central

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults <30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

Memory and Energy Optimization Strategies for Multithreaded Operating System on the Resource-Constrained Wireless Sensor Node

PubMed Central

Liu, Xing; Hou, Kun Mean; de Vaulx, Christophe; Xu, Jun; Yang, Jianfeng; Zhou, Haiying; Shi, Hongling; Zhou, Peng

2015-01-01

Memory and energy optimization strategies are essential for the resource-constrained wireless sensor network (WSN) nodes. In this article, a new memory-optimized and energy-optimized multithreaded WSN operating system (OS) LiveOS is designed and implemented. Memory cost of LiveOS is optimized by using the stack-shifting hybrid scheduling approach. Different from the traditional multithreaded OS in which thread stacks are allocated statically by the pre-reservation, thread stacks in LiveOS are allocated dynamically by using the stack-shifting technique. As a result, memory waste problems caused by the static pre-reservation can be avoided. In addition to the stack-shifting dynamic allocation approach, the hybrid scheduling mechanism which can decrease both the thread scheduling overhead and the thread stack number is also implemented in LiveOS. With these mechanisms, the stack memory cost of LiveOS can be reduced more than 50% if compared to that of a traditional multithreaded OS. Not is memory cost optimized, but also the energy cost is optimized in LiveOS, and this is achieved by using the multi-core “context aware” and multi-core “power-off/wakeup” energy conservation approaches. By using these approaches, energy cost of LiveOS can be reduced more than 30% when compared to the single-core WSN system. Memory and energy optimization strategies in LiveOS not only prolong the lifetime of WSN nodes, but also make the multithreaded OS feasible to run on the memory-constrained WSN nodes. PMID:25545264

A Field Investigation and Facility Review of Eight Modular Starved-Air Heat Recovery Incinerator Systems.

DTIC Science & Technology

1984-10-01

are shared with the production facility. I Capital Costs: $260,000 (1976) plus $45,000 for the building. Operating and Maintenance Costs: O&M costs are...agricultural product processing plant. Operation: Three shifts, 5.5 days/week, 52 weeks/year. Capital Costs: Total capital cost S1,400,000 (1981...which makes their operating and maintenance costs, waste tonnages, ; and steam production readily available. Sample Data (All Numbers Rounded) 1st

Simulation of air quality and operational cost to ventilate swine farrowing facilities in Midwest U.S. during winter

PubMed Central

Park, Jae Hong; Peters, Thomas M.; Altmaier, Ralph; Jones, Samuel M.; Gassman, Richard; Anthony, T. Renée

2017-01-01

We have developed a time-dependent simulation model to estimate in-room concentrations of multiple contaminants [ammonia (NH3), carbon dioxide (CO2), carbon monoxide (CO) and dust] as a function of increased ventilation with filtered recirculation for swine farrowing facilities. Energy and mass balance equations were used to simulate the indoor air quality (IAQ) and operational cost for a variety of ventilation conditions over a 3-month winter period for a facility located in the Midwest U.S., using simplified and real-time production parameters, comparing results to field data. A revised model was improved by minimizing the sum of squared errors (SSE) between modeled and measured NH3 and CO2. After optimizing NH3 and CO2, other IAQ results from the simulation were compared to field measurements using linear regression. For NH3, the coefficient of determination (R2) for simulation results and field measurements improved from 0.02 with the original model to 0.37 with the new model. For CO2, the R2 for simulation results and field measurements was 0.49 with the new model. When the makeup air was matched to hallway air CO2 concentrations (1,500 ppm), simulation results showed the smallest SSE. With the new model, the R2 for other contaminants were 0.34 for inhalable dust, 0.36 for respirable dust, and 0.26 for CO. Operation of the air cleaner decreased inhalable dust by 35% and respirable dust concentrations by 33%, while having no effect on NH3, CO2, in agreement with field data, and increasing operational cost by $860 (58%) for the three-month period. PMID:28775911

An activity-based methodology for operations cost analysis

NASA Technical Reports Server (NTRS)

Korsmeyer, David; Bilby, Curt; Frizzell, R. A.

1991-01-01

This report describes an activity-based cost estimation method, proposed for the Space Exploration Initiative (SEI), as an alternative to NASA's traditional mass-based cost estimation method. A case study demonstrates how the activity-based cost estimation technique can be used to identify the operations that have a significant impact on costs over the life cycle of the SEI. The case study yielded an operations cost of $101 billion for the 20-year span of the lunar surface operations for the Option 5a program architecture. In addition, the results indicated that the support and training costs for the missions were the greatest contributors to the annual cost estimates. A cost-sensitivity analysis of the cultural and architectural drivers determined that the length of training and the amount of support associated with the ground support personnel for mission activities are the most significant cost contributors.

Acquisition-Management Program

NASA Technical Reports Server (NTRS)

Avery, Don E.; Vann, A. Vernon; Jones, Richard H.; Rew, William E.

1987-01-01

NASA Acquisition Management Subsystem (AMS) program integrated NASA-wide standard automated-procurement-system program developed in 1985. Designed to provide each NASA installation with procurement data-base concept with on-line terminals for managing, tracking, reporting, and controlling contractual actions and associated procurement data. Subsystem provides control, status, and reporting for various procurement areas. Purpose of standardization is to decrease costs of procurement and operation of automatic data processing; increases procurement productivity; furnishes accurate, on-line management information and improves customer support. Written in the ADABAS NATURAL.

LERC power system autonomy program 1990 demonstration

NASA Technical Reports Server (NTRS)

Faymon, Karl A.; Sundberg, Gale R.; Bercaw, Robert R.; Weeks, David J.

1987-01-01

The NASA Lewis Research Center has undertaken a program for the development of space systems automation, with a view to increased reliability, safety, payload capability, and decreased operational costs. The NASA Space Station is a primary area of application for the techniques thus developed. Attention is presently given to the activities associated with the Power Systems Autonomy Demonstration Project, which has a projected demonstration date in 1990 and will integrate knowledge-based systems into a real-time environment. Two coordinated systems under expert system control will be demonstrated.

Cell Growth Enhancement

NASA Technical Reports Server (NTRS)

1992-01-01

Exogene Corporation uses advanced technologies to enhance production of bio-processed substances like proteins, antibiotics and amino acids. Among them are genetic modification and a genetic switch. They originated in research for Jet Propulsion Laboratory. Extensive experiments in cell growth through production of hemoglobin to improve oxygen supply to cells were performed. By improving efficiency of oxygen use by cells, major operational expenses can be reduced. Greater product yields result in decreased raw material costs and more efficient use of equipment. A broad range of applications is cited.

The Cost of Deploying a Role 2 Medical Asset to Afghanistan.

PubMed

Childers, Richard; Parker, Paul

2015-11-01

The costs of military assets, including medical resources, are necessary for military planners when determining their force make up. The monetary cost of operating a Role 3 unit, the most comprehensive medical asset in the combat theater, has been determined. The cost of operating a Role 2 (R2) facility-the less comprehensive but more common asset-has not been assessed. Here we estimate the cost of operating an R2 medical asset in Afghanistan. Personnel costs were assessed by combining the U.S. Department of Defense estimate for personnel cost with the replacement costs for deployed staff. Manning was for a U.S. Marine Corps Shock Trauma Platoon and Forward Resuscitative Surgical System. It costs $2,956,873 a month to operate an R2 medical facility in Afghanistan. It also takes the place of a rifle platoon and disrupts the domestic military health care mission. The costs of operating an R2 medical facility are significant and should be considered when the medical benefits of an R2 are unclear. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Operations Analysis of the 2nd Generation Reusable Launch Vehicle

NASA Technical Reports Server (NTRS)

Noneman, Steven R.; Smith, C. A. (Technical Monitor)

2002-01-01

The Space Launch Initiative (SLI) program is developing a second-generation reusable launch vehicle. The program goals include lowering the risk of loss of crew to 1 in 10,000 and reducing annual operations cost to one third of the cost of the Space Shuttle. The SLI missions include NASA, military and commercial satellite launches and crew and cargo launches to the space station. The SLI operations analyses provide an assessment of the operational support and infrastructure needed to operate candidate system architectures. Measures of the operability are estimated (i.e. system dependability, responsiveness, and efficiency). Operations analysis is used to determine the impact of specific technologies on operations. A conceptual path to reducing annual operations costs by two thirds is based on key design characteristics, such as reusability, and improved processes lowering labor costs. New operations risks can be expected to emerge. They can be mitigated with effective risk management with careful identification, assignment, tracking, and closure. SLI design characteristics such as nearly full reusability, high reliability, advanced automation, and lowered maintenance and servicing coupled with improved processes are contributors to operability and large operating cost reductions.

Comparative technoeconomic analysis of a softwood ethanol process featuring posthydrolysis sugars concentration operations and continuous fermentation with cell recycle.

PubMed

Schneiderman, Steven J; Gurram, Raghu N; Menkhaus, Todd J; Gilcrease, Patrick C

2015-01-01

Economical production of second generation ethanol from Ponderosa pine is of interest due to widespread mountain pine beetle infestation in the western United States and Canada. The conversion process is limited by low glucose and high inhibitor concentrations resulting from conventional low-solids dilute acid pretreatment and enzymatic hydrolysis. Inhibited fermentations require larger fermentors (due to reduced volumetric productivity) and low sugars lead to low ethanol titers, increasing distillation costs. In this work, multiple effect evaporation (MEE) and nanofiltration (NF) were evaluated to concentrate the hydrolysate from 30 g/l to 100, 150, or 200 g/l glucose. To ferment this high gravity, inhibitor containing stream, traditional batch fermentation was compared with continuous stirred tank fermentation (CSTF) and continuous fermentation with cell recycle (CSTF-CR). Equivalent annual operating cost (EAOC = amortized capital + yearly operating expenses) was used to compare these potential improvements for a local-scale 5 MGY ethanol production facility. Hydrolysate concentration via evaporation increased EAOC over the base process due to the capital and energy intensive nature of evaporating a very dilute sugar stream; however, concentration via NF decreased EAOC for several of the cases (by 2 to 15%). NF concentration to 100 g/l glucose with a CSTF-CR was the most economical option, reducing EAOC by $0.15 per gallon ethanol produced. Sensitivity analyses on NF options showed that EAOC improvement over the base case could still be realized for even higher solids removal requirements (up to two times higher centrifuge requirement for the best case) or decreased NF performance. © 2015 American Institute of Chemical Engineers.

Environmental Assessment for Toxecon Retrofit for Mercury and Multi-Pollutant Control, Presque Isle Power Plant, Marquette, Michigan

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

N /A

This Environmental Assessment (EA) evaluates environmental issues associated with constructing and operating an integrated emissions control system proposed by We Energies and its project partners with cost-shared funding support by DOE. The proposed project would be demonstrated at the existing 90-MW Units 7, 8, and 9 of We Energies' coal-fired Presque Isle Power Plant in Marquette, Michigan. The commercial-scale demonstrate would allow utilities to make decisions regarding the integrated emissions control system as a viable commercial option. DOE's share of the funding for the 5-year demonstration project would be about $25 million, while $25 million would also be provided bymore » We Energies and its project partners. This project was selected by DOE under the Clean Coal Power Initiative (CCPI) for negotiation of a cooperative agreement to demonstrate the integration of technologies to reduce emissions of mercury (Hg) and particulate matter, as well as potentially control sulfur dioxide (SO{sub 2}), oxides of nitrogen (NO{sub x}) and hydrochloric acid (HCl) emissions. DOE's decision is whether or not to fund the project. The EA evaluates the principal environmental issues, including air quality, waste management, and traffic, that could result from construction and operation of the proposed project. The EA also considers two reasonably foreseeable scenarios that could result from the no-action alternative in which DOE would not provide cost-shared funding for the proposed project. Key findings include that potential air quality impacts resulting from the proposed project would generally be beneficial because plantwide air emissions would decrease or continue at the same level. The decrease in stack exit temperature would decrease the plume rise, which could result in increased downwind ground-level concentrations of those air pollutants experience little or no decrease in stack emissions. However, results of air dispersion modeling indicated that no major impacts would be expected relative to Prevention of Significant Deterioration increments and National Ambient Air Quality Standards.« less

Planning and Estimation of Operations Support Requirements

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn E.; Barley, Bryan; Bacskay, Allen; Clardy, Dennon

2010-01-01

Life Cycle Cost (LCC) estimates during the proposal and early design phases, as well as project replans during the development phase, are heavily focused on hardware development schedules and costs. Operations (phase E) costs are typically small compared to the spacecraft development and test costs. This, combined with the long lead time for realizing operations costs, can lead to de-emphasizing estimation of operations support requirements during proposal, early design, and replan cost exercises. The Discovery and New Frontiers (D&NF) programs comprise small, cost-capped missions supporting scientific exploration of the solar system. Any LCC growth can directly impact the programs' ability to fund new missions, and even moderate yearly underestimates of the operations costs can present significant LCC impacts for deep space missions with long operational durations. The National Aeronautics and Space Administration (NASA) D&NF Program Office at Marshall Space Flight Center (MSFC) recently studied cost overruns and schedule delays for 5 missions. The goal was to identify the underlying causes for the overruns and delays, and to develop practical mitigations to assist the D&NF projects in identifying potential risks and controlling the associated impacts to proposed mission costs and schedules. The study found that 4 out of the 5 missions studied had significant overruns at or after launch due to underestimation of the complexity and supporting requirements for operations activities; the fifth mission had not launched at the time of the mission. The drivers behind these overruns include overly optimistic assumptions regarding the savings resulting from the use of heritage technology, late development of operations requirements, inadequate planning for sustaining engineering and the special requirements of long duration missions (e.g., knowledge retention and hardware/software refresh), and delayed completion of ground system development work. This paper updates the D&NF LCC study, looking at the operations (phase E) cost drivers in more detail and extending the study to include 2 additional missions and identifies areas for increased emphasis by project management in order to improve the fidelity of operations estimates.

Techno-economic performance evaluation of solar tower plants with integrated multi-layered PCM thermocline thermal energy storage - A comparative study to conventional two-tank storage systems

NASA Astrophysics Data System (ADS)

Guedéz, Rafael; Ferruzza, Davide; Arnaudo, Monica; Rodríguez, Ivette; Perez-Segarra, Carlos D.; Hassar, Zhor; Laumert, Björn

2016-05-01

Solar Tower Power Plants with thermal energy storage are a promising technology for dispatchable renewable energy in the near future. Storage integration makes possible to shift the electricity production to more profitable peak hours. Usually two tanks are used to store cold and hot fluids, but this means both higher investment costs and difficulties during the operation of the variable volume tanks. Instead, another solution can be a single tank thermocline storage in a multi-layered configuration. In such tank both latent and sensible fillers are employed to decrease the related cost up to 30% and maintain high efficiencies. This paper analyses a multi-layered solid PCM storage tank concept for solar tower applications, and describes a comprehensive methodology to determine under which market structures such devices can outperform the more conventional two tank storage systems. A detail model of the tank has been developed and introduced in an existing techno-economic tool developed by the authors (DYESOPT). The results show that under current cost estimates and technical limitations the multi-layered solid PCM storage concept is a better solution when peaking operating strategies are desired, as it is the case for the two-tier South African tariff scheme.

Virtualization and cloud computing in dentistry.

PubMed

Chow, Frank; Muftu, Ali; Shorter, Richard

2014-01-01

The use of virtualization and cloud computing has changed the way we use computers. Virtualization is a method of placing software called a hypervisor on the hardware of a computer or a host operating system. It allows a guest operating system to run on top of the physical computer with a virtual machine (i.e., virtual computer). Virtualization allows multiple virtual computers to run on top of one physical computer and to share its hardware resources, such as printers, scanners, and modems. This increases the efficient use of the computer by decreasing costs (e.g., hardware, electricity administration, and management) since only one physical computer is needed and running. This virtualization platform is the basis for cloud computing. It has expanded into areas of server and storage virtualization. One of the commonly used dental storage systems is cloud storage. Patient information is encrypted as required by the Health Insurance Portability and Accountability Act (HIPAA) and stored on off-site private cloud services for a monthly service fee. As computer costs continue to increase, so too will the need for more storage and processing power. Virtual and cloud computing will be a method for dentists to minimize costs and maximize computer efficiency in the near future. This article will provide some useful information on current uses of cloud computing.

Balancing Hydronic Systems in Multifamily Buildings

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

Ruch, Russell; Ludwig, Peter; Maurer, Tessa

2014-07-01

In multifamily hydronic systems, temperature imbalance may be caused by undersized piping, improperly adjusted balancing valves, inefficient water temperature and flow levels, and owner/occupant interaction with the boilers, distribution, and controls. The imbalance leads to tenant discomfort, higher energy use intensity, and inefficient building operation. This research, conducted by Building America team Partnership for Advanced Residential Retrofit, explores cost-effective distribution upgrades and balancing measures in multifamily hydronic systems, providing a resource to contractors, auditors, and building owners on best practices to improve tenant comfort and lower operating costs. The team surveyed existing knowledge on cost-effective retrofits for optimizing distribution inmore » typical multifamily hydronic systems, with the aim of identifying common situations and solutions, and then conducted case studies on two Chicago area buildings with known balancing issues in order to quantify the extent of temperature imbalance. At one of these buildings a booster pump was installed on a loop to an underheated wing of the building. This study found that unit temperature in a multifamily hydronic building can vary as much as 61°F, particularly if windows are opened or tenants use intermittent supplemental heating sources like oven ranges. Average temperature spread at the building as a result of this retrofit decreased from 22.1°F to 15.5°F.« less

Clinical and economic impact of etanercept in real-life: a prospective, non-interventional study of etanercept in the treatment of patients with moderate to severe plaque psoriasis in private dermatologist settings (ESTHER).

PubMed

Larsen, Christian Grønhøj; Andersen, Peter Hundevadt; Lorentzen, Henrik; Zachariae, Claus; Huldt-Nystrøm, Theis; Dotterud, Lars Kåre; Lindkvist, Rose-Marie; Qvitzau, Susanne

2013-01-01

Real-life data on the therapeutic effectiveness and costs of etanercept are scarce. To assess the clinical and economic impact of etanercept in patients with psoriasis in Denmark and Norway. This prospective, non-interventional study in a private dermatologist care setting in Denmark and Norway included patients ≥18 years with moderate to severe plaque psoriasis, selected for treatment with etanercept. Assessments during 1 year from etanercept initiation included Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI) and adverse events. Direct and indirect costs were calculated. 163 subjects were enrolled. Baseline mean SAPASI was 19.1 . Proportion of patients with ≥50% decrease in SAPASI from baseline was 85% and 81% at weeks 24 and 52. DLQI decreased significantly from 11.4 (7.0) to 3.2 (4.3) and 3.7 (4.6) at weeks 24 and 52. Total annual costs increased from 78,000 to 286,000 DKK (p<0.0001), mainly due to the cost of etanercept. Outpatient-care costs and loss-of-productivity costs decreased from 9,500 to 5,000 (p = 0.0002), and from 33,000 to 18,000 DKK (p = 0.0105), respectively. The decrease in costs was more pronounced in patients who also had psoriatic arthritis. Cost increase was greatest during the first 6 months. Etanercept treatment was associated with decreased psoriasis severity and improved quality of life. Cost increase was driven by medication, while costs of outpatient care and loss-of-productivity decreased. Maintained improved quality of life was accompanied by decreasing cost during the second 6 month period of etanercept treatment. There were no new safety signals reported.

75 FR 7411 - Schedule of Water Charges

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-19

... sale revenues, while the costs of reservoir maintenance and operations, contractual services and..., ``including debt service, operation, maintenance, replacement, reserves, and associated administrative costs... holds funds dedicated to pay the costs of project construction, operation, maintenance, and replacement...

Improving Operating Room Efficiency: First Case On-Time Start Project.

PubMed

Phieffer, Laura; Hefner, Jennifer L; Rahmanian, Armin; Swartz, Jason; Ellison, Christopher E; Harter, Ronald; Lumbley, Joshua; Moffatt-Bruce, Susan D

Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011. The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback. By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department. Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.

Ambulatory patient classifications and the regressive nature of Medicare reform: is the reduction in outpatient health care reimbursement worth the price?

PubMed

Borgelt, B B; Stone, C

1999-10-01

To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare mix hospital-based radiation oncology departments to continue to deliver their current level of care could be compromised. APC reform may carry monetary and opportunity costs which far outweigh its apparent savings. As payment systems continue to place pressure on operating margins, it becomes even more critical that both academic and community radiation oncology practices know the cost of providing services.

PREMChlor: Probabilistic Remediation Evaluation Model for Chlorinated Solvents

DTIC Science & Technology

2010-03-01

Council O&M Operation & Management PAT pump-and-treat PCE tetrachloroethylene PDFs Probability density functions PRBs Permeable reactive barriers...includes a one-time capital cost and a total operation & management (O&M) cost in present net value (NPV) for a certain remediation period. The...Generally, the costs of plume treatment include the capital cost (treatment volume multiply by the unit cost) and the annual operation & Management (O&M

Entanglement cost under positive-partial-transpose-preserving operations.

PubMed

Audenaert, K; Plenio, M B; Eisert, J

2003-01-17

We study the entanglement cost under quantum operations preserving the positivity of the partial transpose (PPT operations). We demonstrate that this cost is directly related to the logarithmic negativity, thereby providing the operational interpretation for this entanglement measure. As examples we discuss general Werner states and arbitrary bipartite Gaussian states. Then we prove that for the antisymmetric Werner state PPT cost and PPT entanglement of distillation coincide. This is the first example of a truly mixed state for which entanglement manipulation is asymptotically reversible, which points towards a unique entanglement measure under PPT operations.

Effect of facility on the operative costs of distal radius fractures.

PubMed

Mather, Richard C; Wysocki, Robert W; Mack Aldridge, J; Pietrobon, Ricardo; Nunley, James A

2011-07-01

The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. Economic and Decisional Analysis III. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Community Microgrid Scheduling Considering Network Operational Constraints and Building Thermal Dynamics

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

Liu, Guodong; Ollis, Thomas B.; Xiao, Bailu

Here, this paper proposes a Mixed Integer Conic Programming (MICP) model for community microgrids considering the network operational constraints and building thermal dynamics. The proposed optimization model optimizes not only the operating cost, including fuel cost, purchasing cost, battery degradation cost, voluntary load shedding cost and the cost associated with customer discomfort due to room temperature deviation from the set point, but also several performance indices, including voltage deviation, network power loss and power factor at the Point of Common Coupling (PCC). In particular, the detailed thermal dynamic model of buildings is integrated into the distribution optimal power flow (D-OPF)more » model for the optimal operation of community microgrids. The heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently to reduce the electricity cost while maintaining the indoor temperature in the comfort range set by customers. Numerical simulation results show the effectiveness of the proposed model and significant saving in electricity cost could be achieved with network operational constraints satisfied.« less

Community Microgrid Scheduling Considering Network Operational Constraints and Building Thermal Dynamics

DOE PAGES

Liu, Guodong; Ollis, Thomas B.; Xiao, Bailu; ...

2017-10-10

Here, this paper proposes a Mixed Integer Conic Programming (MICP) model for community microgrids considering the network operational constraints and building thermal dynamics. The proposed optimization model optimizes not only the operating cost, including fuel cost, purchasing cost, battery degradation cost, voluntary load shedding cost and the cost associated with customer discomfort due to room temperature deviation from the set point, but also several performance indices, including voltage deviation, network power loss and power factor at the Point of Common Coupling (PCC). In particular, the detailed thermal dynamic model of buildings is integrated into the distribution optimal power flow (D-OPF)more » model for the optimal operation of community microgrids. The heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently to reduce the electricity cost while maintaining the indoor temperature in the comfort range set by customers. Numerical simulation results show the effectiveness of the proposed model and significant saving in electricity cost could be achieved with network operational constraints satisfied.« less

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

Cost and risk assessment for spacecraft operation decisions caused by the space debris environment

NASA Astrophysics Data System (ADS)

Schaub, Hanspeter; Jasper, Lee E. Z.; Anderson, Paul V.; McKnight, Darren S.

2015-08-01

Space debris is a topic of concern among many in the space community. Most forecasting analyses look centuries into the future to attempt to predict how severe debris densities and fluxes will become in orbit regimes of interest. Conversely, space operators currently do not treat space debris as a major mission hazard. This survey paper outlines the range of cost and risk evaluations a space operator must consider when determining a debris-related response. Beyond the typical direct costs of performing an avoidance maneuver, the total cost including indirect costs, political costs and space environmental costs are discussed. The weights on these costs can vary drastically across mission types and orbit regimes flown. The operator response options during a mission are grouped into four categories: no action, perform debris dodging, follow stricter mitigation, and employ ADR. Current space operations are only considering the no action and debris dodging options, but increasing debris risk will eventually force the stricter mitigation and ADR options. Debris response equilibria where debris-related risks and costs settle on a steady-state solution are hypothesized.

Cost effectiveness of stream-gaging program in Michigan

USGS Publications Warehouse

Holtschlag, D.J.

1985-01-01

This report documents the results of a study of the cost effectiveness of the stream-gaging program in Michigan. Data uses and funding sources were identified for the 129 continuous gaging stations being operated in Michigan as of 1984. One gaging station was identified as having insufficient reason to continue its operation. Several stations were identified for reactivation, should funds become available, because of insufficiencies in the data network. Alternative methods of developing streamflow information based on routing and regression analyses were investigated for 10 stations. However, no station records were reproduced with sufficient accuracy to replace conventional gaging practices. A cost-effectiveness analysis of the data-collection procedure for the ice-free season was conducted using a Kalman-filter analysis. To define missing-record characteristics, cross-correlation coefficients and coefficients of variation were computed at stations on the basis of daily mean discharge. Discharge-measurement data were used to describe the gage/discharge rating stability at each station. The results of the cost-effectiveness analysis for a 9-month ice-free season show that the current policy of visiting most stations on a fixed servicing schedule once every 6 weeks results in an average standard error of 12.1 percent for the current $718,100 budget. By adopting a flexible servicing schedule, the average standard error could be reduced to 11.1 percent. Alternatively, the budget could be reduced to $700,200 while maintaining the current level of accuracy. A minimum budget of $680,200 is needed to operate the 129-gaging-station program; a budget less than this would not permit proper service and maintenance of stations. At the minimum budget, the average standard error would be 14.4 percent. A budget of $789,900 (the maximum analyzed) would result in a decrease in the average standard error to 9.07 percent. Owing to continual changes in the composition of the network and the changes in the uncertainties of streamflow accuracy at individual stations, the cost-effectiveness analysis will need to be updated regularly if it is to be used as a management tool. Cost of these updates need to be considered in decisions concerning the feasibility of flexible servicing schedules.

Comparative Analysis of Length of Stay and Inpatient Costs for Orthopedic Surgery Patients Treated with IV Acetaminophen and IV Opioids vs. IV Opioids Alone for Post-Operative Pain.

PubMed

Hansen, Ryan N; Pham, An; Strassels, Scott A; Balaban, Stela; Wan, George J

2016-09-01

Recovery from orthopedic surgery is oriented towards restoring functional health outcomes while reducing hospital length of stay (LOS) and medical expenditures. Optimal pain management is a key to reaching these objectives. We sought to compare orthopedic surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia to those who received IV opioids alone and compared the two groups on LOS and hospitalization costs. We performed a retrospective analysis of the Premier Database (Premier, Inc.; between January 2009 and June 2015) comparing orthopedic surgery patients who received post-operative pain management with combination IV acetaminophen and IV opioids to those who received only IV opioids starting on the day of surgery and continuing up to the second post-operative day. The quarterly rate of IV acetaminophen use for all hospitalizations by hospital served as the instrumental variable in two-stage least squares regressions controlling for patient and hospital covariates to compare the LOS and hospitalization costs of IV acetaminophen recipients to opioid monotherapy patients. We identified 4,85,895 orthopedic surgery patients with 1,74,805 (36%) who had received IV acetaminophen. Study subjects averaged 64 years of age and were predominantly non-Hispanic Caucasians (78%) and female (58%). The mean unadjusted LOS for IV acetaminophen patients was 3.2 days [standard deviation (SD) 2.6] compared to 3.9 days (SD 3.9) with only IV opioids (P < 0.0001). Average unadjusted hospitalization costs were $19,024.9 (SD $13,113.7) for IV acetaminophen patients and $19,927.6 (SD $19,578.8) for IV opioid patients (P < 0.0001). These differences remained statistically significant in our instrumental variable models, with IV acetaminophen associated with 0.51 days shorter hospitalization [95% confidence interval (CI) -0.58 to -0.44, P < 0.0001] and $634.8 lower hospitalization costs (95% CI -$1032.5 to -$237.1, P = 0.0018). Compared to opioids alone, managing post-orthopedic surgery pain with the addition of IV acetaminophen is associated with shorter LOS and decreased hospitalization costs. Mallinckrodt Pharmaceuticals.

Utility of de-escalatory confidence-building measures

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

Nation, J.

1989-06-01

This paper evaluates the utility of specific confidence-building de-escalatory measures and pays special attention to the evaluation of measures which place restrictions on or establish procedures for strategic forces. Some measures appear more promising than others. Potentially useful confidence-building measures largely satisfy defined criteria and include the phased return of strategic nuclear forces to peacetime bases and operations, the termination of interference with communications and NTMs (National Technical Means) and the termination of civil defense preparations. Less-promising CBMs include the standing down of supplemental early warning systems, the establishment of SSBN keep-out zones, and decreases in bomber alert rates. Establishmentmore » of SSBN keep-out zones and reduction in bomber rates are difficult to verify, while the standing-down of early warning systems provides little benefit at potentially large costs. Particular confidence-building measures (CBMs) may be most useful in building superpower confidence at specific points in the crisis termination phase. For example, a decrease in strategic bomber alert rates may provide some decrease in perception of the likelihood of war, but its potential costs, particularly in increasing bomber vulnerability, may limit its utility and implementation to the final crisis stages when the risks of re-escalation and surprise attack are lower.« less

Cost of phosphate removal in municipal wastewater treatment plants

NASA Technical Reports Server (NTRS)

Schuessler, H.

1983-01-01

Construction and operating costs of advanced wastewater treatment for phosphate removal at municipal wastewater treatment plants have been investigated on orders from the Federal Environmental Bureau in Berlin. Particular attention has been paid to applicable kinds of precipitants for pre-, simultaneous and post-precipitation as well as to different phosphate influent and effluent concentrations. The article offers detailed comments on determination of technical data, investments, capital costs, operating costs and annual costs as well as potential cost reductions resulting from precipitation. Selected results of the cost investigation are shown in graphical form as specific investments, operating and annual costs depending on wastewater flow.

Telescience Operations on International Space Station

NASA Technical Reports Server (NTRS)

Schubert, Kathleen E.

1999-01-01

This paper describes the concept of telescience operations for the International Space Station (ISS). The extended duration microgravity environment of the ISS will enable microgravity science research to enter into a new era of increased scientific and technological data return. The National Aeronautics and Space Administration (NASA) has a vision of distributed ground operations which enables the Principal Investigator direct interaction with his/her on-board experiment from his/her home location. This is the concept of telescience and is essential for maximizing the use of the long duration science environment that ISS provides. The goal of telescience is to provide the capability to fully tele-operate an experiment from any ground location in such a way as to increase the amount and quality of scientific and technological data return and decrease the operations cost of an individual experiment relative to the era of Space Shuttle experiments. This paper also describes the NASA Lewis Research Center (LeRC) implementation approach for the LeRC Telescience Support Center (TSC) and Principal Investigator Science Operations Sites (SOS) which will fully meet the concept of telescience as prescribed by the Agency.

Integrating Solar Power onto the Electric Grid - Bridging the Gap between Atmospheric Science, Engineering and Economics

NASA Astrophysics Data System (ADS)

Ghonima, M. S.; Yang, H.; Zhong, X.; Ozge, B.; Sahu, D. K.; Kim, C. K.; Babacan, O.; Hanna, R.; Kurtz, B.; Mejia, F. A.; Nguyen, A.; Urquhart, B.; Chow, C. W.; Mathiesen, P.; Bosch, J.; Wang, G.

2015-12-01

One of the main obstacles to high penetrations of solar power is the variable nature of solar power generation. To mitigate variability, grid operators have to schedule additional reliability resources, at considerable expense, to ensure that load requirements are met by generation. Thus despite the cost of solar PV decreasing, the cost of integrating solar power will increase as penetration of solar resources onto the electric grid increases. There are three principal tools currently available to mitigate variability impacts: (i) flexible generation, (ii) storage, either virtual (demand response) or physical devices and (iii) solar forecasting. Storage devices are a powerful tool capable of ensuring smooth power output from renewable resources. However, the high cost of storage is prohibitive and markets are still being designed to leverage their full potential and mitigate their limitation (e.g. empty storage). Solar forecasting provides valuable information on the daily net load profile and upcoming ramps (increasing or decreasing solar power output) thereby providing the grid advance warning to schedule ancillary generation more accurately, or curtail solar power output. In order to develop solar forecasting as a tool that can be utilized by the grid operators we identified two focus areas: (i) develop solar forecast technology and improve solar forecast accuracy and (ii) develop forecasts that can be incorporated within existing grid planning and operation infrastructure. The first issue required atmospheric science and engineering research, while the second required detailed knowledge of energy markets, and power engineering. Motivated by this background we will emphasize area (i) in this talk and provide an overview of recent advancements in solar forecasting especially in two areas: (a) Numerical modeling tools for coastal stratocumulus to improve scheduling in the day-ahead California energy market. (b) Development of a sky imager to provide short term forecasts (0-20 min ahead) to improve optimization and control of equipment on distribution feeders with high penetration of solar. Leveraging such tools that have seen extensive use in the atmospheric sciences supports the development of accurate physics-based solar forecast models. Directions for future research are also provided.

eHCM: Resources Reduction & Demand Increase, cover the gap by a managerial approach powered by an IT solutions.

PubMed

Buccioli, Matteo; Agnoletti, Vanni; Padovani, Emanuele; Perger, Peter

2014-01-01

The economic and financial crisis has also had an important impact on the healthcare sector. Available resources have decreased, while at the same time costs as well as demand for healthcare services are on the rise. This coalescing negative impact on availability of healthcare resources is exacerbated even further by a widespread ignorance of management accounting matters. Little knowledge about costs is a strong source of costs augmentation. Although it is broadly recognized that cost accounting has a positive impact on healthcare organizations, it is not widespread adopted. Hospitals are essential components in providing overall healthcare. Operating rooms are critical hospital units not only in patient safety terms but also in expenditure terms. Understanding OR procedures in the hospital provides important information about how health care resources are used. There have been several scientific studies on management accounting in healthcare environments and more than ever there is a need for innovation, particularly by connecting business administration research findings to modern IT tools. IT adoption constitutes one of the most important innovation fields within the healthcare sector, with beneficial effects on the decision making processes. The e-HCM (e-Healthcare Cost Management) project consists of a cost calculation model which is applicable to Business Intelligence. The cost calculation approach comprises elements from both traditional cost accounting and activity-based costing. Direct costs for all surgical procedures can be calculated through a seven step implementation process.

47 CFR 54.305 - Sale or transfer of exchanges.

Code of Federal Regulations, 2010 CFR

2010-10-01

... following the transfer of exchanges. For the first year of operation, a loop cost expense adjustment, using... operation shall be determined using cost data for the first year of operation of the transferred exchanges. Such cost data for the first year of operation shall be calculated in accordance with §§ 36.611, 36.612...

Urinary incontinence management costs are reduced following Burch or sling surgery for stress incontinence.

PubMed

Subak, Leslee L; Goode, Patricia S; Brubaker, Linda; Kusek, John W; Schembri, Michael; Lukacz, Emily S; Kraus, Stephen R; Chai, Toby C; Norton, Peggy; Tennstedt, Sharon L

2014-08-01

The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. At baseline mean (±SD) age of participants was 53 ± 10 years, and the frequency of weekly UI episodes was 23 ± 21. Weekly UI episodes decreased by 86% at 24 months (P < .001). The mean weekly cost was $16.60 ± $27.00 (median $9.39) at baseline and $4.57 ± $15.00 (median $0.10) at 24 months (P < .001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 ± $0.77 per week for each decrease of 1 UI episode per day (P < .001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P < .001) and decreased 24-hour pad weight (P < .02). Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures. Copyright © 2014. Published by Mosby, Inc.

Delay banking for air traffic management

NASA Technical Reports Server (NTRS)

Green, Steven M. (Inventor)

2007-01-01

A method and associated system for time delay banking for aircraft arrival time, aircraft departure time and/or en route flight position. The delay credit value for a given flight may decrease with passage of time and may be transferred to or traded with other flights having the same or a different user (airline owner or operator). The delay credit value for a given aircraft flight depends upon an initial delay credit value, which is determined by a central system and depends upon one or more other flight characteristics. Optionally, the delay credit value decreases with passage of time. Optionally, a transaction cost is assessed against a delay credit value that is used on behalf of another flight with the same user or is traded with a different user.

Source, use and disposition of freshwater in Puerto Rico, 2010

USGS Publications Warehouse

Molina, Wanda L.

2015-07-29

From 2000 to 2010, the population of Puerto Rico decreased 2.6 percent, from 3.8 to 3.7 million residents (U.S. Census Bureau, 2011), and this decrease in population reduced the demand for freshwater. Factors that contributed to a reduction in domestic per capita water use in Puerto Rico include water-rate cost increases, the implementation of low-flow fixture, and domestic conservation programs. Almost 99 percent of the residents in Puerto Rico were served by public-supply water systems in 2010. Public-supply water is provided by the Puerto Rico Aqueduct and Sewer Authority (PRASA) and by non-PRASA systems. Non-PRASA systems include community-operated water systems (water systems that serve rural or suburban housing areas).

IUS/TUG orbital operations and mission support study. Volume 5: Cost estimates

NASA Technical Reports Server (NTRS)

1975-01-01

The costing approach, methodology, and rationale utilized for generating cost data for composite IUS and space tug orbital operations are discussed. Summary cost estimates are given along with cost data initially derived for the IUS program and space tug program individually, and cost estimates for each work breakdown structure element.

Comparative Evaluation of Cutting Methods of Activated Concrete from Nuclear Power Plant Decommissioning - 13548

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

Kim, HakSoo; Chung, SungHwan; Maeng, SungJun

2013-07-01

The amount of radioactive wastes from decommissioning of a nuclear power plant varies greatly depending on factors such as type and size of the plant, operation history, decommissioning options, and waste treatment and volume reduction methods. There are many methods to decrease the amount of decommissioning radioactive wastes including minimization of waste generation, waste reclassification through decontamination and cutting methods to remove the contaminated areas. According to OECD/NEA, it is known that the radioactive waste treatment and disposal cost accounts for about 40 percentage of the total decommissioning cost. In Korea, it is needed to reduce amount of decommissioning radioactivemore » waste due to high disposal cost, about $7,000 (as of 2010) per a 200 liter drum for the low- and intermediate-level radioactive waste (LILW). In this paper, cutting methods to minimize the radioactive waste of activated concrete were investigated and associated decommissioning cost impact was assessed. The cutting methods considered are cylindrical and volume reductive cuttings. The study showed that the volume reductive cutting is more cost-effective than the cylindrical cutting. Therefore, the volume reductive cutting method can be effectively applied to the activated bio-shield concrete. (authors)« less

Analyses on Cost Reduction and CO2 Mitigation by Penetration of Fuel Cells to Residential Houses

NASA Astrophysics Data System (ADS)

Aki, Hirohisa; Yamamoto, Shigeo; Kondoh, Junji; Murata, Akinobu; Ishii, Itaru; Maeda, Tetsuhiko

This paper presents analyses on the penetration of polymer electrolyte fuel cells (PEFC) into a group of 10 residential houses and its effects of CO2 emission mitigation and consumers’ cost reduction in next 30 years. The price is considered to be reduced as the penetration progress which is expected to begin in near future. An experimental curve is assumed to express the decrease of the price. Installation of energy interchange systems which involve electricity, gas and hydrogen between a house which has a FC and contiguous houses is assumed to utilize both electricity and heat more efficiently, and to avoid start-stop operation of fuel processor (reformer) as much as possible. A multi-objective model which considers CO2 mitigation and consumers’ cost reduction is constructed and provided a Pareto optimum solution. A solution which simultaneously realizes both CO2 mitigation and consumers’ cost reduction appeared in the Pareto optimum solution. Strategies to reduce CO2 emission and consumers’ cost are suggested from the results of the analyses. The analyses also revealed that the energy interchange systems are effective especially in the early stage of the penetration.

Space tug economic analysis study. Volume 3: Cost estimates

NASA Technical Reports Server (NTRS)

1972-01-01

Cost estimates for the space tug operation are presented. The subjects discussed are: (1) research and development costs, (2) investment costs, (3) operations costs, and (4) funding requirements. The emphasis is placed on the single stage tug configuration using various types of liquid propellants.

Life Cycle Costing.

ERIC Educational Resources Information Center

McCraley, Thomas L.

1985-01-01

Life cycle costing establishes a realistic comparison of the cost of owning and operating products. The formula of initial cost plus maintenance plus operation divided by useful life identifies the best price over the lifetime of the product purchased. (MLF)

43 CFR 426.23 - Recovery of operation and maintenance (O&M) costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Recovery of operation and maintenance (O&M... operation and maintenance (O&M) costs. (a) General. All new, amended, and renewed contracts shall provide for payment of O&M costs as specified in this section. (b) Amount of O&M costs a district must pay if...

Space Costing: Who Should Pay for the Use of College Space? A Report.

ERIC Educational Resources Information Center

Zacher, Sy

The costs of owning and operating physical facilities are consuming an increasing share of the budgets of colleges and universities. In the past, academic and operating units of colleges have viewed their space as a free commodity and often used it extravagantly. Space costing is a method of cost accounting the space and operating and maintenance…

41 CFR 102-33.190 - What are the aircraft operations and ownership costs for which we must account?

Code of Federal Regulations, 2011 CFR

2011-01-01

... Parts Accounting for the Cost of Government Aircraft § 102-33.190 What are the aircraft operations and... Government aircraft as described in the “Government Aircraft Cost Accounting Guide” (CAG), which follows OMB... operations and ownership costs for which we must account? 102-33.190 Section 102-33.190 Public Contracts and...

Quality control process improvement of flexible printed circuit board by FMEA

NASA Astrophysics Data System (ADS)

Krasaephol, Siwaporn; Chutima, Parames

2018-02-01

This research focuses on the quality control process improvement of Flexible Printed Circuit Board (FPCB), centred around model 7-Flex, by using Failure Mode and Effect Analysis (FMEA) method to decrease proportion of defective finished goods that are found at the final inspection process. Due to a number of defective units that were found at the final inspection process, high scraps may be escaped to customers. The problem comes from poor quality control process which is not efficient enough to filter defective products from in-process because there is no In-Process Quality Control (IPQC) or sampling inspection in the process. Therefore, the quality control process has to be improved by setting inspection gates and IPCQs at critical processes in order to filter the defective products. The critical processes are analysed by the FMEA method. IPQC is used for detecting defective products and reducing chances of defective finished goods escaped to the customers. Reducing proportion of defective finished goods also decreases scrap cost because finished goods incur higher scrap cost than work in-process. Moreover, defective products that are found during process can reflect the abnormal processes; therefore, engineers and operators should timely solve the problems. Improved quality control was implemented for 7-Flex production lines from July 2017 to September 2017. The result shows decreasing of the average proportion of defective finished goods and the average of Customer Manufacturers Lot Reject Rate (%LRR of CMs) equal to 4.5% and 4.1% respectively. Furthermore, cost saving of this quality control process equals to 100K Baht.

The Impact of Biomass Feedstock Supply Variability on the Delivered Price to a Biorefinery in the Peace River Region of Alberta, Canada

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

Stephen, Jamie; Sokhansanj, Shahabaddine; Bi, X.T.

2010-01-01

Agricultural residue feedstock availability in a given region can vary significantly over the 20 25 year lifetime of a biorefinery. Since delivered price of biomass feedstock to a biorefinery is related to the distance travelled and equipment optimization, and transportation distance increases as productivity decreases, productivity is a primary determinant of feedstock price. Using the Integrated Biomass Supply Analysis and Logistics (IBSAL) modeling environment and a standard round bale harvest and delivery scenario, harvest and delivery price were modelled for minimum, average, and maximum yields at four potential biorefinery sites in the Peace River region of Alberta, Canada. Biorefinery capacitiesmore » ranged from 50,000 to 500,000 tonnes per year. Delivery cost is a linear function of transportation distance and can be combined with a polynomial harvest function to create a generalized delivered cost function for agricultural residues. The range in delivered cost is substantial and is an important consideration for the operating costs of a biorefinery.« less

25 CFR 39.1200 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... School Operation and Maintenance Fund § 39.1200 Definitions. Contract school operation and maintenance costs for fiscal year 1979 means the sum of costs for custodial salaries and fringe benefits, related supplies and equipment and equipment repair, insurance, and school operation utilities costs, where such...

Using backup generators for meeting peak electricity demand: a sensitivity analysis on emission controls, location, and health endpoints.

PubMed

Gilmore, Elisabeth A; Adams, Peter J; Lave, Lester B

2010-05-01

Generators installed for backup power during blackouts could help satisfy peak electricity demand; however, many are diesel generators with nonnegligible air emissions that may damage air quality and human health. The full (private and social) cost of using diesel generators with and without emission control retrofits for fine particulate matter (PM2.5) and nitrogen oxides (NOx) were compared with a new natural gas turbine peaking plant. Lower private costs were found for the backup generators because the capital costs are mostly ascribed to reliability. To estimate the social costs from air quality, the changes in ambient concentrations of ozone (O3) and PM2.5 were modeled using the Particulate Matter Comprehensive Air Quality Model with extensions (PMCAMx) chemical transport model. These air quality changes were translated to their equivalent human health effects using concentration-response functions and then into dollars using estimates of "willingness-to-pay" to avoid ill health. As a case study, 1000 MW of backup generation operating for 12 hr/day for 6 days in each of four eastern U.S. cities (Atlanta, Chicago, Dallas, and New York) was modeled. In all cities, modeled PM2.5 concentrations increased (up to 5 microg/m3) due mainly to primary emissions. Smaller increases and decreases were observed for secondary PM2.5 with more variation between cities. Increases in NOx, emissions resulted in significant nitrate formation (up to 1 microg/m3) in Atlanta and Chicago. The NOx emissions also caused O3 decreases in the urban centers and increases in the surrounding areas. For PM2.5, a social cost of approximately $2/kWh was calculated for uncontrolled diesel generators in highly populated cities but was under 10 cent/kWh with PM2.5 and NOx controls. On a full cost basis, it was found that properly controlled diesel generators are cost-effective for meeting peak electricity demand. The authors recommend NOx and PM2.5 controls.

Methodology for Calculating Cost-per-Mile for Current and Future Vehicle Powertrain Technologies, with Projections to 2024: Preprint

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

Ruth, M.; Timbario, T. A.; Timbario, T. J.

2011-01-01

Currently, several cost-per-mile calculators exist that can provide estimates of acquisition and operating costs for consumers and fleets. However, these calculators are limited in their ability to determine the difference in cost per mile for consumer versus fleet ownership, to calculate the costs beyond one ownership period, to show the sensitivity of the cost per mile to the annual vehicle miles traveled (VMT), and to estimate future increases in operating and ownership costs. Oftentimes, these tools apply a constant percentage increase over the time period of vehicle operation, or in some cases, no increase in direct costs at all overmore » time. A more accurate cost-per-mile calculator has been developed that allows the user to analyze these costs for both consumers and fleets. The calculator was developed to allow simultaneous comparisons of conventional light-duty internal combustion engine (ICE) vehicles, mild and full hybrid electric vehicles (HEVs), and fuel cell vehicles (FCVs). This paper is a summary of the development by the authors of a more accurate cost-per-mile calculator that allows the user to analyze vehicle acquisition and operating costs for both consumer and fleets. Cost-per-mile results are reported for consumer-operated vehicles travelling 15,000 miles per year and for fleets travelling 25,000 miles per year.« less

AEMS implementation cost study for Boeing 727

NASA Technical Reports Server (NTRS)

Allison, R. L.

1977-01-01

Costs for airline operational implementation of a NASA-developed approach energy management system (AEMS) concept, as applied to the 727 airplane, were determined. Estimated costs are provided for airplane retrofit and for installation of the required DME ground stations. Operational costs and fuel cost savings are presented in a cost-of-ownership study. The potential return on the equipment investment is evaluated using a net present value method. Scheduled 727 traffic and existing VASI, ILS, and collocated DME ground station facilities are summarized for domestic airports used by 727 operators.

Economic value of angling on the Colorado River at Lees Ferry: Using secondary data to estimate the influence of seasonality

USGS Publications Warehouse

Bair, Lucas S.; Rogowski, David L.; Neher, Christopher

2016-01-01

Glen Canyon Dam (GCD) on the Colorado River in northern Arizona provides water storage, flood control, and power system benefits to approximately 40 million people who rely on water and energy resources in the Colorado River basin. Downstream resources (e.g., angling, whitewater floating) in Glen Canyon National Recreation Area (GCNRA) and Grand Canyon National Park are impacted by the operation of GCD. The GCD Adaptive Management Program was established in 1997 to monitor and research the effects of dam operations on the downstream environment. We utilized secondary survey data and an individual observation travel cost model to estimate the net economic benefit of angling in GCNRA for each season and each type of angler. As expected, the demand for angling decreased with increasing travel cost; the annual value of angling at Lees Ferry totaled US$2.7 million at 2014 visitation levels. Demand for angling was also affected by season, with per-trip values of $210 in the summer, $237 in the spring, $261 in the fall, and $399 in the winter. This information provides insight into the ways in which anglers are potentially impacted by seasonal GCD operations and adaptive management experiments aimed at improving downstream resource conditions.

An electronic flight bag for NextGen avionics

NASA Astrophysics Data System (ADS)

Zelazo, D. Eyton

2012-06-01

The introduction of the Next Generation Air Transportation System (NextGen) initiative by the Federal Aviation Administration (FAA) will impose new requirements for cockpit avionics. A similar program is also taking place in Europe by the European Organisation for the Safety of Air Navigation (Eurocontrol) called the Single European Sky Air Traffic Management Research (SESAR) initiative. NextGen will require aircraft to utilize Automatic Dependent Surveillance-Broadcast (ADS-B) in/out technology, requiring substantial changes to existing cockpit display systems. There are two ways that aircraft operators can upgrade their aircraft in order to utilize ADS-B technology. The first is to replace existing primary flight displays with new displays that are ADS-B compatible. The second, less costly approach is to install an advanced Class 3 Electronic Flight Bag (EFB) system. The installation of Class 3 EFBs in the cockpit will allow aircraft operators to utilize ADS-B technology in a lesser amount of time with a decreased cost of implementation and will provide additional benefits to the operator. This paper describes a Class 3 EFB, the NexisTM Flight-Intelligence System, which has been designed to allow users a direct interface with NextGen avionics sensors while additionally providing the pilot with all the necessary information to meet NextGen requirements.

The Application of Architecture Frameworks to Modelling Exploration Operations Costs

NASA Technical Reports Server (NTRS)

Shishko, Robert

2006-01-01

Developments in architectural frameworks and system-of-systems thinking have provided useful constructs for systems engineering. DoDAF concepts, language, and formalisms, in particular, provide a natural way of conceptualizing an operations cost model applicable to NASA's space exploration vision. Not all DoDAF products have meaning or apply to a DoDAF inspired operations cost model, but this paper describes how such DoDAF concepts as nodes, systems, and operational activities relate to the development of a model to estimate exploration operations costs. The paper discusses the specific implementation to the Mission Operations Directorate (MOD) operational functions/activities currently being developed and presents an overview of how this powerful representation can apply to robotic space missions as well.

Contrast in low-cost operational concepts for orbiting satellites

NASA Astrophysics Data System (ADS)

Walyus, Keith D.; Reis, James; Bradley, Arthur J.

2002-12-01

Older spacecraft missions, especially those in low Earth orbit with telemetry intensive requirements, required round-the-clock control center staffing. The state of technology relied on control center personnel to continually examine data, make decisions, resolve anomalies, and file reports. Hubble Space Telescope (HST) is a prime example of this description. Technological advancements in hardware and software over the last decade have yielded increases in productivity and operational efficiency, which result in lower cost. The re-engineering effort of HST, which has recently concluded, utilized emerging technology to reduce cost and increase productivity. New missions, of which NASA's Transition Region and Coronal Explorer Satellite (TRACE) is an example, have benefited from recent technological advancements and are more cost-effective than when HST was first launched. During its launch (1998) and early orbit phase, the TRACE Flight Operations Team (FOT) employed continually staffed operations. Yet once the mission entered its nominal phase, the FOT reduced their staffing to standard weekday business hours. Operations were still conducted at night and during the weekends, but these operations occurred autonomously without compromising their high standards for data collections. For the HST, which launched in 1990, reduced cost operations will employ a different operational concept, when the spacecraft enters its low-cost phase after its final servicing mission in 2004. Primarily due to the spacecraft"s design, the HST Project has determined that single-shift operations will introduce unacceptable risks for the amount of dollars saved. More importantly, significant cost-savings can still be achieved by changing the operational concept for the FOT, while still maintaining round-the-clock staffing. It"s important to note that the low-cost solutions obtained for one satellite may not be applicable for other satellites. This paper will contrast the differences between low-cost operational concepts for a satellite launched in 1998 versus a satellite launched in 1990.

Detoxification of sugarcane-derived hemicellulosic hydrolysate using a lactic acid producing strain.

PubMed

Alves de Oliveira, Regiane; Vaz Rossell, Carlos Eduardo; Venus, Joachim; Cândida Rabelo, Sarita; Maciel Filho, Rubens

2018-07-20

Furfural and HMF are known for a negative impact in different bioprocesses, including lactic acid fermentation. There are already some methods described to remove these inhibitory compounds from the hydrolysates. However, these methods also reduce the yield of sugars from the hydrolysis and increase the process costs. In this work, the detoxification of sugarcane-derived hemicellulosic hydrolysate was performed by Lactobacillus plantarum during the fermentation time. At the end of the fermentation, a decrease of 98% of furfural and 86% of HMF and was observed, with a final lactic acid titer of 34.5 g/L. The simultaneous fermentation and bio-detoxification simplify the process and reduce operational costs, leading to economic competitiveness of second-generation feedstock for lactic acid production. Copyright © 2018 Elsevier B.V. All rights reserved.

Space processing economics

NASA Technical Reports Server (NTRS)

Bredt, J. H.

1974-01-01

Two types of space processing operations may be considered economically justified; they are manufacturing operations that make profits and experiment operations that provide needed applied research results at lower costs than those of alternative methods. Some examples from the Skylab experiments suggest that applied research should become cost effective soon after the space shuttle and Spacelab become operational. In space manufacturing, the total cost of space operations required to process materials must be repaid by the value added to the materials by the processing. Accurate estimates of profitability are not yet possible because shuttle operational costs are not firmly established and the markets for future products are difficult to estimate. However, approximate calculations show that semiconductor products and biological preparations may be processed on a scale consistent with market requirements and at costs that are at least compatible with profitability using the Shuttle/Spacelab system.

Investments and costs of oral health care for Family Health Care

PubMed Central

Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

2016-01-01

ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team’s operational cost. PMID:27463254

Membrane treatment of liquid wastes from radiological decontamination operations.

PubMed

Svittsov, A A; Khubetsov, S B; Volchek, K

2011-01-01

The paper focuses on the evaluation of membrane filtration for the treatment of liquid radioactive streams generated in area decontamination operations. In this work, semi-permeable membranes were demonstrated to be effective reducing the volume of wastewater containing cesium and cobalt by two orders of a magnitude. The efficiency of membrane separation was enhanced by employing additives that enlarged the size of target radionuclide species and improved their rejection by the membranes. This was achieved by chelation with synthetic water-soluble polymers and by adsorption on micro particles of adsorbent coupled with micelle formation. The effect of wastewater composition and that of the radionuclide-binding additives on the volume reduction was investigated. Membrane treatment is expected to help simplify further processing and decrease disposal costs.

Model Checking Satellite Operational Procedures

NASA Astrophysics Data System (ADS)

Cavaliere, Federico; Mari, Federico; Melatti, Igor; Minei, Giovanni; Salvo, Ivano; Tronci, Enrico; Verzino, Giovanni; Yushtein, Yuri

2011-08-01

We present a model checking approach for the automatic verification of satellite operational procedures (OPs). Building a model for a complex system as a satellite is a hard task. We overcome this obstruction by using a suitable simulator (SIMSAT) for the satellite. Our approach aims at improving OP quality assurance by automatic exhaustive exploration of all possible simulation scenarios. Moreover, our solution decreases OP verification costs by using a model checker (CMurphi) to automatically drive the simulator. We model OPs as user-executed programs observing the simulator telemetries and sending telecommands to the simulator. In order to assess feasibility of our approach we present experimental results on a simple meaningful scenario. Our results show that we can save up to 90% of verification time.

A white paper: Operational efficiency. New approaches to future propulsion systems

NASA Technical Reports Server (NTRS)

Rhodes, Russel; Wong, George

1991-01-01

Advanced launch systems for the next generation of space transportation systems (1995 to 2010) must deliver large payloads (125,000 to 500,000 lbs) to low earth orbit (LEO) at one tenth of today's cost, or 300 to 400 $/lb of payload. This cost represents an order of magnitude reduction from the Titan unmanned vehicle cost of delivering payload to orbit. To achieve this sizable reduction, the operations cost as well as the engine cost must both be lower than current engine system. The Advanced Launch System (ALS) is studying advanced engine designs, such as the Space Transportation Main Engine (STME), which has achieved notable reduction in cost. The results are presented of a current study wherein another level of cost reduction can be achieved by designing the propulsion module utilizing these advanced engines for enhanced operations efficiency and reduced operations cost.

Analysis of an inventory model for both linearly decreasing demand and holding cost

NASA Astrophysics Data System (ADS)

Malik, A. K.; Singh, Parth Raj; Tomar, Ajay; Kumar, Satish; Yadav, S. K.

2016-03-01

This study proposes the analysis of an inventory model for linearly decreasing demand and holding cost for non-instantaneous deteriorating items. The inventory model focuses on commodities having linearly decreasing demand without shortages. The holding cost doesn't remain uniform with time due to any form of variation in the time value of money. Here we consider that the holding cost decreases with respect to time. The optimal time interval for the total profit and the optimal order quantity are determined. The developed inventory model is pointed up through a numerical example. It also includes the sensitivity analysis.

Efficient operation of a multi-purpose reservoir in Chile: Tradeoffs between irrigation and hydropower production

NASA Astrophysics Data System (ADS)

Gonzalez Cabrera, J. M., Sr.; Olivares, M. A.

2015-12-01

This study proposes a method to develop efficient operational policies for a reservoir the southern Chile. The main water uses in this system are hydropower and irrigation, with conflicting seasonal demands. The conflict between these two uses is currently managed through a so-called "irrigation agreement" which defines a series of operational conditions on the reservoir by restricting volumes used for power production depending on reservoir storage level. Other than that, the reservoir operation is driven by cost-minimization over the power grid. Recent evidence shows an increasing degree of conflict in this basin, which suggests that the static approach of irrigation agreements, might no longer be appropriate. Moreover, this agreement could be revised in light of decreased water availability. This problem poses a challenge related to the spatial scope of analysis. Thus, irrigation benefits are driven by decisions made within the basin, whereas hydropower benefits depend on the operation of the entire power grid. Exploring the tradeoffs between these two water uses involves modeling both scales. The proposed methodology integrates information from both a grid-wide power operations model and a basin-wide agro-economic model into a decision model for optimal reservoir operation. The first model, a hydrothermal coordination tool, schedules power production by each plant in the grid, and allows capturing technical and economic aspects to the operation of hydropower reservoirs. The agro-economic model incorporates economic features of irrigation in the basin, and allows obtaining irrigation water demand functions. Finally, the results of both models are integrated into a single model for optimal reservoir operation considering the tradeoffs between the two uses. The result of the joint operation of water resources, show a flexible coordination of uses, revealing the opportunity cost of irrigation, which it gives the possibility of negotiating transfers of water to hydropower in dry years, with the aim of obtaining greater benefits from water use in the basin

Operations and support cost modeling of conceptual space vehicles

NASA Technical Reports Server (NTRS)

Ebeling, Charles

1994-01-01

The University of Dayton is pleased to submit this annual report to the National Aeronautics and Space Administration (NASA) Langley Research Center which documents the development of an operations and support (O&S) cost model as part of a larger life cycle cost (LCC) structure. It is intended for use during the conceptual design of new launch vehicles and spacecraft. This research is being conducted under NASA Research Grant NAG-1-1327. This research effort changes the focus from that of the first two years in which a reliability and maintainability model was developed to the initial development of an operations and support life cycle cost model. Cost categories were initially patterned after NASA's three axis work breakdown structure consisting of a configuration axis (vehicle), a function axis, and a cost axis. A revised cost element structure (CES), which is currently under study by NASA, was used to established the basic cost elements used in the model. While the focus of the effort was on operations and maintenance costs and other recurring costs, the computerized model allowed for other cost categories such as RDT&E and production costs to be addressed. Secondary tasks performed concurrent with the development of the costing model included support and upgrades to the reliability and maintainability (R&M) model. The primary result of the current research has been a methodology and a computer implementation of the methodology to provide for timely operations and support cost analysis during the conceptual design activities.

A cost evaluation methodology for surgical technologies.

PubMed

Ismail, Imad; Wolff, Sandrine; Gronfier, Agnes; Mutter, Didier; Swanström, Lee L; Swantröm, Lee L

2015-08-01

To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room's medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.

Effect of present technology on airship capabilities

NASA Technical Reports Server (NTRS)

Madden, R. T.

1975-01-01

The effect is presented of updating past airship designs using current materials and propulsion systems to determine new airship performance and productivity capabilities. New materials and power plants permit reductions in the empty weights and increases in the useful load capabilities of past airship designs. The increased useful load capability results in increased productivity for a given range, i.e., either increased payload at the same operating speed or increased operating speed for the same payload weight or combinations of both. Estimated investment costs and operating costs are presented to indicate the significant cost parameters in estimating transportation costs of payloads in cents per ton mile. Investment costs are presented considering production lots of 1, 10 and 100 units. Operating costs are presented considering flight speeds and ranges.

An agent-based model evaluation of economic control strategies for paratuberculosis in a dairy herd.

PubMed

Verteramo Chiu, Leslie J; Tauer, Loren W; Al-Mamun, Mohammad A; Kaniyamattam, Karun; Smith, Rebecca L; Grohn, Yrjo T

2018-04-25

This paper uses an agent-based simulation model to estimate the costs associated with Mycobacterium avium ssp. paratuberculosis (MAP), or Johne's disease, in a milking herd, and to determine the net benefits of implementing various control strategies. The net present value (NPV) of a 1,000-cow milking herd is calculated over 20 yr, parametrized to a representative US commercial herd. The revenues of the herd are generated from sales of milk and culled animals. The costs include all variable and fixed costs necessary to operate a representative 1,000-cow milking herd. We estimate the NPV of the herd with no MAP infection, under an expected endemic infection distribution with no controls, and under an expected endemic infection distribution with various controls. The initial number of cows in a herd with an endemic MAP infection is distributed as 75% susceptible, 13% latent, 9% low MAP shedding, and 3% high MAP shedding. Control strategies include testing using ELISA and fecal culture tests and culling of cows that test positive, and culling based on observable milk production decrease. Results show that culling cows based on test results does not increase the herd's NPV and in most cases decreases NPV due to test costs as well as false positives and negatives with their associated costs (e.g., culling healthy cows and keeping infected cows). Culling consistently low producing cows when MAP is believed to be present in the herd produces higher NPV over the strategy of testing and culling MAP infected animals, and over the case of no MAP control. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Payload analysis for space shuttle applications (study 2.2). Volume 3: Payload system operations analysis (task 2.2.1). [payload system operations analysis for shuttles and space tugs

NASA Technical Reports Server (NTRS)

1972-01-01

The technical and cost analysis that was performed for the payload system operations analysis is presented. The technical analysis consists of the operations for the payload/shuttle and payload/tug, and the spacecraft analysis which includes sortie, automated, and large observatory type payloads. The cost analysis includes the costing tradeoffs of the various payload design concepts and traffic models. The overall objectives of this effort were to identify payload design and operational concepts for the shuttle which will result in low cost design, and to examine the low cost design concepts to identify applicable design guidelines. The operations analysis examined several past and current NASA and DoD satellite programs to establish a shuttle operations model. From this model the analysis examined the payload/shuttle flow and determined facility concepts necessary for effective payload/shuttle ground operations. The study of the payload/tug operations was an examination of the various flight timelines for missions requiring the tug.

The learning curve and the cost of heart transplantation.

PubMed

Woods, J R; Saywell, R M; Nyhuis, A W; Jay, S J; Lohrman, R G; Halbrook, H G

1992-06-01

The effect of learning on hospital outcomes such as mortality or adverse events (the so-called "practice makes perfect" hypothesis) has been studied by numerous investigators. The effect of learning on hospital cost, however, has received much less attention. This article reports the results of a multiple regression model demonstrating a nonlinear, decreasing trend in operative and postoperative hospital costs over time in a consecutive series of 71 heart transplant patients, all treated in the same institution. The cost trend is shown to persist even after controlling for various preoperative demographic and clinical risk factors and the specific experience of individual surgeons. Using a reference case, the model predicts a cost of $81,297 for the first heart transplant procedure performed at the hospital. If this same patient had been the tenth case rather than the first, with the hospital having benefited from the experience gained in nine previous cases, the model predicts the cost would now be only $48,431, or approximately 60 percent of the cost of the first case. Had this patient been the twenty-fifth case, the predicted cost would be $35,352 (43 percent of the original cost), and had this been the fiftieth case, the cost would be $25,458 (31 percent of the original cost). The longitudinal study design used in this analysis greatly reduces the likelihood that the observed cost reduction is due to economies of scale rather than learning. The results have implications for a policy of regionalization as a tactic for containing hospital cost. Whereas others have pointed to a volume-cost relationship as an argument for the regionalization of expensive and complex hospital procedures, the present data isolate a learning-cost relationship as a separate argument for regionalization.

Cost awareness decreases total percutaneous coronary intervention procedural cost: The SHOPPING (Show How Options in Price for Procedures Can Be Influenced Greatly) trial.

PubMed

Asher, Elad; Mansour, John; Wheeler, Adam; Kendrick, Daniel; Cunningham, Michael; Parikh, Sahil; Zidar, David; Harford, Todd; Simon, Daniel I; Kashyap, Vikram S

2017-06-01

We initiated the SHOPPING Trial (Show How Options in Price for Procedures can be InflueNced Greatly) to see if percutaneous coronary intervention (PCI) procedures can be performed at a lower cost in a single institution. Procedural practice variability is associated with inefficiency and increased cost. We hypothesized that announcing costs for all supplies during a catheterization procedure and reporting individual operator cost relative to peers would spur cost reduction without affecting clinical outcomes. Baseline costs of 10 consecutive PCI procedures performed by 9 interventional cardiologists were documented during a 90-day interval. Costs were reassessed after instituting cost announcing and peer reporting the next quarter. The intervention involved labeling of all endovascular supplies, equipment, devices, and disposables in the catheterization laboratory and announcement of the unit price for each piece when requested. For each interventionalist, procedure time and costs were measured and analyzed prior to and after the intervention. We found that total PCI procedural cost was significantly reduced by an average of $234.77 (P = 0.01), equating to a total savings of $21,129.30 over the course of 90 PCI procedures. Major Adverse Cardiac and Cerebrovascular Event (MACCE) rates were similar during both periods (2.3% vs. 3.5%, P = NS). Announcing costs in the catheterization laboratory during single vessel PCI and peer reporting leads to cost reduction without affecting clinical outcomes. This intervention may have a role in more complex coronary and peripheral interventional procedures, and in other procedural areas where multiple equipment and device alternatives with variable costs are available. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Autonomous Flight Rules Concept: User Implementation Costs and Strategies

NASA Technical Reports Server (NTRS)

Cotton, William B.; Hilb, Robert

2014-01-01

The costs to implement Autonomous Flight Rules (AFR) were examined for estimates in acquisition, installation, training and operations. The user categories were airlines, fractional operators, general aviation and unmanned aircraft systems. Transition strategies to minimize costs while maximizing operational benefits were also analyzed. The primary cost category was found to be the avionics acquisition. Cost ranges for AFR equipment were given to reflect the uncertainty of the certification level for the equipment and the extent of existing compatible avionics in the aircraft to be modified.

Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

PubMed

Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

2017-10-01

The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P < 0.001). The difference was due to higher costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

CleanFleet final report. Volume 8, fleet economics

DOT National Transportation Integrated Search

1995-12-01

The costs that face a fleet operator in implementing alternative motor fuels : into fleet operations are examined. The cost assessment is built upon a list of thirteen cost factors grouped into the three catagories: infrastructure costs, vehicle owni...

Development and application of a model for the analysis of trades between space launch system operations and acquisition costs

NASA Astrophysics Data System (ADS)

Nix, Michael B.

2005-12-01

Early design decisions in the development of space launch systems determine the costs to acquire and operate launch systems. Some sources indicate that as much as 90% of life cycle costs are fixed by the end of the critical design review phase. System characteristics determined by these early decisions are major factors in the acquisition cost of flight hardware elements and facilities and influence operations costs through the amount of maintenance and support labor required to sustain system function. Operations costs are also dependent on post-development management decisions regarding how much labor will be deployed to meet requirements of market demand and ownership profit. The ability to perform early trade-offs between these costs is vital to the development of systems that have the necessary capacity to provide service and are profitable to operate. An Excel-based prototype model was developed for making early analyses of trade-offs between the costs to operate a space launch system and to acquire the necessary assets to meet a given set of operational requirements. The model, integrating input from existing models and adding missing capability, allows the user to make such trade-offs across a range of operations concepts (required flight rates, staffing levels, shifts per workday, workdays per week and per year, unreliability, wearout and depot maintenance) and the number, type and capability of assets (flight hardware elements, processing and supporting facilities and infrastructure). The costs and capabilities of hypothetical launch systems can be modeled as a function of interrelated turnaround times and labor resource levels, and asset loss and retirement. The number of flight components and facilities required can be calculated and the operations and acquisition costs compared for a specified scenario. Findings, based on the analysis of a hypothetical two stage to orbit, reusable, unmanned launch system, indicate that the model is suitable for the trade-off analyses desired. The minimum turnaround time/maximum labor allocation for specific hardware configurations and characteristics and corresponding asset requirements can be estimated. Either turnaround time or resources can be varied and the resulting operations and acquisition costs can be compared. Asset reliability, wearout and depot maintenance intervals and durations can be varied as well to analyze the effects on costs. Likewise, the effects on operations and acquisitions costs of the introduction of alternative technologies that affect reliability, maintainability and supportability in various hardware configurations can be evaluated.

19 CFR 10.206 - Value content requirement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... countries, plus the direct costs of processing operations performed in a beneficiary country or countries...)(1) of this part. Any cost or value of materials or direct costs of processing operations...) combining or packaging operations, or mere dilution with water or mere dilution with another substance that...

40 CFR 610.23 - Operator interaction effects.

Code of Federal Regulations, 2010 CFR

2010-07-01

... degree of sensitivity of device effectiveness to variances in installation, operation and maintenance; (b..., operation and maintenance; (c) The extent to which device installation or use, or the effects of such... between total cost of ownership of the device (purchase price plus maintenance costs) and the cost savings...

Operations analysis (study 2.1): Shuttle upper stage software requirements

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1974-01-01

An investigation of software costs related to space shuttle upper stage operations with emphasis on the additional costs attributable to space servicing was conducted. The questions and problem areas include the following: (1) the key parameters involved with software costs; (2) historical data for extrapolation of future costs; (3) elements of the basic software development effort that are applicable to servicing functions; (4) effect of multiple servicing on complexity of the operation; and (5) are recurring software costs significant. The results address these questions and provide a foundation for estimating software costs based on the costs of similar programs and a series of empirical factors.

The combined value of wind and solar power forecasting improvements and electricity storage

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

Hodge, Bri-Mathias; Brancucci Martinez-Anido, Carlo; Wang, Qin

As the penetration rates of variable renewable energy increase, the value of power systems operation flexibility technology options, such as renewable energy forecasting improvements and electricity storage, is also assumed to increase. In this work, we examine the value of these two technologies, when used independently and concurrently, for two real case studies that represent the generation mixes for the California and Midcontinent Independent System Operators (CAISO and MISO). Since both technologies provide additional system flexibility they reduce operational costs and renewable curtailment for both generation mixes under study. Interestingly, the relative impacts are quite similar when both technologies aremore » used together. Though both flexibility options can solve some of the same issues that arise with high penetration levels of renewables, they do not seem to significantly increase or decrease the economic potential of the other technology.« less

The combined value of wind and solar power forecasting improvements and electricity storage

DOE PAGES

Hodge, Bri-Mathias; Brancucci Martinez-Anido, Carlo; Wang, Qin; ...

2018-02-12

As the penetration rates of variable renewable energy increase, the value of power systems operation flexibility technology options, such as renewable energy forecasting improvements and electricity storage, is also assumed to increase. In this work, we examine the value of these two technologies, when used independently and concurrently, for two real case studies that represent the generation mixes for the California and Midcontinent Independent System Operators (CAISO and MISO). Since both technologies provide additional system flexibility they reduce operational costs and renewable curtailment for both generation mixes under study. Interestingly, the relative impacts are quite similar when both technologies aremore » used together. Though both flexibility options can solve some of the same issues that arise with high penetration levels of renewables, they do not seem to significantly increase or decrease the economic potential of the other technology.« less

Cryogenics Testbed Laboratory Flange Baseline Configuration

NASA Technical Reports Server (NTRS)

Acuna, Marie Lei Ysabel D.

2013-01-01

As an intern at Kennedy Space Center (KSC), I was involved in research for the Fluids and Propulsion Division of the NASA Engineering (NE) Directorate. I was immersed in the Integrated Ground Operations Demonstration Units (IGODU) project for the majority of my time at KSC, primarily with the Ground Operations Demonstration Unit Liquid Oxygen (GODU L02) branch of IGODU. This project was established to develop advancements in cryogenic systems as a part of KSC's Advanced Exploration Systems (AES) program. The vision of AES is to develop new approaches for human exploration, and operations in and beyond low Earth orbit. Advanced cryogenic systems are crucial to minimize the consumable losses of cryogenic propellants, develop higher performance launch vehicles, and decrease operations cost for future launch programs. During my internship, I conducted a flange torque tracking study that established a baseline configuration for the flanges in the Simulated Propellant Loading System (SPLS) at the KSC Cryogenics Test Laboratory (CTL) - the testing environment for GODU L02.

High-sensitivity operation of single-beam optically pumped magnetometer in a kHz frequency range

DOE PAGES

Savukov, Igor Mykhaylovich; Kim, Y. J.; Shah, V.; ...

2017-02-02

Here, optically pumped magnetometers (OPM) can be used in various applications, from magnetoencephalography to magnetic resonance imaging and nuclear quadrupole resonance (NQR). OPMs provide high sensitivity and have the significant advantage of non-cryogenic operation. To date, many magnetometers have been demonstrated with sensitivity close to 1 fT, but most devices are not commercialized. Most recently, QuSpin developed a model of OPM that is low cost, high sensitivity, and convenient for users, which operates in a single-beam configuration. Here we developed a theory of single-beam (or parallel two-beam) magnetometers and showed that it is possible to achieve good sensitivity beyond theirmore » usual frequency range by tuning the magnetic field. Experimentally we have tested and optimized a QuSpin OPM for operation in the frequency range from DC to 1.7 kHz, and found that the performance was only slightly inferior despite the expected decrease due to deviation from the spin-exchange relaxation-free regime.« less

High-sensitivity operation of single-beam optically pumped magnetometer in a kHz frequency range

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

Savukov, Igor Mykhaylovich; Kim, Y. J.; Shah, V.

Here, optically pumped magnetometers (OPM) can be used in various applications, from magnetoencephalography to magnetic resonance imaging and nuclear quadrupole resonance (NQR). OPMs provide high sensitivity and have the significant advantage of non-cryogenic operation. To date, many magnetometers have been demonstrated with sensitivity close to 1 fT, but most devices are not commercialized. Most recently, QuSpin developed a model of OPM that is low cost, high sensitivity, and convenient for users, which operates in a single-beam configuration. Here we developed a theory of single-beam (or parallel two-beam) magnetometers and showed that it is possible to achieve good sensitivity beyond theirmore » usual frequency range by tuning the magnetic field. Experimentally we have tested and optimized a QuSpin OPM for operation in the frequency range from DC to 1.7 kHz, and found that the performance was only slightly inferior despite the expected decrease due to deviation from the spin-exchange relaxation-free regime.« less

Estimating the costs of drug-related hospital separations in Australia.

PubMed

Riddell, Steven; Shanahan, Marian; Degenhardt, Louisa; Roxburgh, Amanda

2008-04-01

To estimate the total hospital costs of drug-related separations in Australia from 1999/2000 to 2004/05, and separate costs for the following illicit drug classes: opioids, amphetamine, cannabis and cocaine. Australian hospital separations between 1999/2000 to 2004/05 from the National Hospital Morbidity Dataset (NHMD) with a principal diagnosis of opioids, amphetamine, cannabis or cocaine were included, as were indirect estimates of additional 'drug-caused' separations using aetiological fractions. The costs were estimated using the year-specific case weights and costs for each respective Diagnostic Related Group (DRG). Total constant costs decreased from $50.8 million in 1999/2000 to $43.8 million in 2002/03 then increased to $46.7 million in 2004/05. The initial decrease was driven by a decline in numbers of opioid-related separations (with costs decreasing by $11.5 million) between 1999/2000 and 2001/02. Decreases were evident in separations within the opioid use, dependence and poisoning DRGs. Increases in costs were observed between 1999/00 and 2004/05 for amphetamine (an increase of $2.4 million), cannabis ($1.8 million) and cocaine ($330,000) related separations. Several uncommon but very expensive drug-related separations constituted 12.7% of the total drug-related separations. Overall, the costs of drug-related hospital separations have decreased by $4.1 million between 1999 and 2005, which is primarily attributable to fewer opioid-related separations. Small reductions in the number of costly separations through harm reduction strategies have the potential to significantly reduce drug-related hospital costs.

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

Lower, Mark D; Christopher, Timothy W; Oland, C Barry

The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPImore » program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL reduce its overall utility costs by decreasing the amount of fuel used to generate steam. Reduced fuel consumption also decreased air emissions. These improvements also helped lower the risk of burn injuries to workers and helped prevent shrapnel injuries resulting from missiles produced by pressurized component failures. In most cases, the economic benefit and cost effectiveness of the SPRS Safety and Energy Efficiency Improvement Project is reflected in payback periods of 1 year or less.« less

Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Cost Analysis of 57 Operations in a 10-year Experience at a Major Deformity Center.

PubMed

Theologis, Alexander A; Miller, Liane; Callahan, Matt; Lau, Darryl; Zygourakis, Corinna; Scheer, Justin K; Burch, Shane; Pekmezci, Murat; Chou, Dean; Tay, Bobby; Mummaneni, Praveen; Berven, Sigurd; Deviren, Vedat; Ames, Christopher P

2016-08-15

Retrospective cohort analysis. To evaluate the economic impact of revision surgery for proximal junctional failures (PJF) after thoracolumbar fusions for adult spinal deformity (ASD). PJF after fusions for ASD is a major cause of disability. Although clinical sequelae are described, PJF-revision operation costs are incompletely defined. Consecutive adults who underwent thoracolumbar fusions for ASD (August, 2003 to January, 2013) were evaluated. Inclusion criteria include construct from pelvis to L2 or above and minimum 6 months follow-up after the index ASD operation. Direct costs (surgical supplies/implants, room/care, pharmacy, services) were identified from medical billing data and calculated for index ASD operations and subsequent surgeries for PJF. Not included in direct cost data were indirect costs, charges, surgeon fees, or revision operations for indications other than PJF (i.e., pseudarthrosis). Patients were compared based on the construct's upper-instrumented vertebra: upper thoracic (UT: T1-6) versus thoracolumbar junction (TLjxn: T9-L2). Of 501 patients, 382 met inclusion criteria. Fifty-one patients [UT:14; TLjxn: 40 at index; average follow-up 32.6 months (6-92 months)] had revisions for PJF, which summed to $3.2 million total direct cost. Average direct cost of index operations for the cohort ($68,294) was significantly greater than PJF-revisions ($55,547). Compared with TLjxn, UT had a significantly higher average cost for index operations ($79,860 vs. $65,868). However, PJF-revision cases were similar in average cost (UT:$60,103; TLjxn:$53,920; P = 0.09). Costs of PJF amounted to an additional 12.1% of the total index surgical cost in 382 patients. Revision operations for PJF after long thoracolumbar fusions for ASD are associated with an average direct cost of $55,547 per case. Revision costs for PJF are similar based on the index procedure's upper-instrumented vertebra level. At a major tertiary center over a 10-year period, PJF came at a very significant economic expense amounting to $3.2 million for 57 cases. 3.

Operational and financial impact of physician screening in the ED.

PubMed

Soremekun, Olanrewaju A; Biddinger, Paul D; White, Benjamin A; Sinclair, Julia R; Chang, Yuchiao; Carignan, Sarah B; Brown, David F M

2012-05-01

Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center. We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS. During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%. In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact. Copyright © 2012 Elsevier Inc. All rights reserved.

Thermal Management and Reliability of Power Electronics and Electric Machines

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

Narumanchi, Sreekant

2016-09-19

Increasing the number of electric-drive vehicles (EDVs) on America's roads has been identified as a strategy with near-term potential for dramatically decreasing the nation's dependence on oil - by the U.S. Department of Energy, the federal cross-agency EV-Everywhere Challenge, and the automotive industry. Mass-market deployment will rely on meeting aggressive technical targets, including improved efficiency and reduced size, weight, and cost. Many of these advances will depend on optimization of thermal management. Effective thermal management is critical to improving the performance and ensuring the reliability of EDVs. Efficient heat removal makes higher power densities and lower operating temperatures possible, andmore » in turn enables cost and size reductions. The National Renewable Energy Laboratory (NREL), along with DOE and industry partners is working to develop cost-effective thermal management solutions to increase device and component power densities. In this presentation, the activities in recent years related to thermal management and reliability of automotive power electronics and electric machines are presented.« less

Optimization of A(2)O BNR processes using ASM and EAWAG Bio-P models: model performance.

PubMed

El Shorbagy, Walid E; Radif, Nawras N; Droste, Ronald L

2013-12-01

This paper presents the performance of an optimization model for a biological nutrient removal (BNR) system using the anaerobic-anoxic-oxic (A(2)O) process. The formulated model simulates removal of organics, nitrogen, and phosphorus using a reduced International Water Association (IWA) Activated Sludge Model #3 (ASM3) model and a Swiss Federal Institute for Environmental Science and Technology (EAWAG) Bio-P module. Optimal sizing is attained considering capital and operational costs. Process performance is evaluated against the effect of influent conditions, effluent limits, and selected parameters of various optimal solutions with the following results: an increase of influent temperature from 10 degrees C to 25 degrees C decreases the annual cost by about 8.5%, an increase of influent flow from 500 to 2500 m(3)/h triples the annual cost, the A(2)O BNR system is more sensitive to variations in influent ammonia than phosphorus concentration and the maximum growth rate of autotrophic biomass was the most sensitive kinetic parameter in the optimization model.

Low-Cost and Durable Bipolar Plates for Proton Exchange Membrane Electrolyzers

NASA Astrophysics Data System (ADS)

Lettenmeier, P.; Wang, R.; Abouatallah, R.; Saruhan, B.; Freitag, O.; Gazdzicki, P.; Morawietz, T.; Hiesgen, R.; Gago, A. S.; Friedrich, K. A.

2017-03-01

Cost reduction and high efficiency are the mayor challenges for sustainable H2 production via proton exchange membrane (PEM) electrolysis. Titanium-based components such as bipolar plates (BPP) have the largest contribution to the capital cost. This work proposes the use of stainless steel BPPs coated with Nb and Ti by magnetron sputtering physical vapor deposition (PVD) and vacuum plasma spraying (VPS), respectively. The physical properties of the coatings are thoroughly characterized by scanning electron, atomic force microscopies (SEM, AFM); and X-ray diffraction, photoelectron spectroscopies (XRD, XPS). The Ti coating (50 μm) protects the stainless steel substrate against corrosion, while a 50-fold thinner layer of Nb decreases the contact resistance by almost one order of magnitude. The Nb/Ti-coated stainless steel bipolar BPPs endure the harsh environment of the anode for more than 1000 h of operation under nominal conditions, showing a potential use in PEM electrolyzers for large-scale H2 production from renewables.

Preceptorship planning is essential to perioperative nursing retention: matching teaching and learning styles.

PubMed

Willemsen-McBride, Tara

2010-03-01

Current nursing shortages along with unsuccessful nursing orientation programs have been a major concern for the past decade because they result in poor retention, reduced quality of patient care, decreased job satisfaction and high financial costs to the organization. Specialty areas, such as the Operating Room (OR), are even more vulnerable due to the stressful working environment and critical care skill set. It has been estimated that approximately 35-65% of new graduates will leave their work place within the first year of employment, lending to the 55% nursing turnover rate. The cost of orientating a new nurse to the perioperative role is estimated to cost between $50,000 and $59,000 U.S. Thus, it is imperative to improve the orientation experience for both new and senior perioperative nurses. Matching preceptor/preceptee learning styles is one way to enhance job satisfaction levels. This paper revisits the literature on preceptorship and provides suggestions on how to enhance existing orientation programs.

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

Narumanchi, Sreekant

Increasing the number of electric-drive vehicles (EDVs) on America's roads has been identified as a strategy with near-term potential for dramatically decreasing the nation's dependence on oil - by the U.S. Department of Energy, the federal cross-agency EV-Everywhere Challenge, and the automotive industry. Mass-market deployment will rely on meeting aggressive technical targets, including improved efficiency and reduced size, weight, and cost. Many of these advances will depend on optimization of thermal management. Effective thermal management is critical to improving the performance and ensuring the reliability of EDVs. Efficient heat removal makes higher power densities and lower operating temperatures possible, andmore » in turn enables cost and size reductions. The National Renewable Energy Laboratory (NREL), along with DOE and industry partners is working to develop cost-effective thermal management solutions to increase device and component power densities. In this presentation, the activities in recent years related to thermal management and reliability of automotive power electronics and electric machines are presented.« less

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

Narumanchi, Sreekant

Increasing the number of electric-drive vehicles (EDVs) on America's roads has been identified as a strategy with near-term potential for dramatically decreasing the nation's dependence on oil -- by the U.S. Department of Energy, the federal cross-agency EV-Everywhere Challenge, and the automotive industry. Mass-market deployment will rely on meeting aggressive technical targets, including improved efficiency and reduced size, weight, and cost. Many of these advances will depend on optimization of thermal management. Effective thermal management is critical to improving the performance and ensuring the reliability of EDVs. Efficient heat removal makes higher power densities and lower operating temperatures possible, andmore » in turn enables cost and size reductions. The National Renewable Energy Laboratory (NREL), along with DOE and industry partners is working to develop cost-effective thermal management solutions to increase device and component power densities. In this presentation, the activities in recent years related to thermal management and reliability of automotive power electronics and electric machines will be presented.« less

Low-Cost and Durable Bipolar Plates for Proton Exchange Membrane Electrolyzers

PubMed Central

Lettenmeier, P.; Wang, R.; Abouatallah, R.; Saruhan, B.; Freitag, O.; Gazdzicki, P.; Morawietz, T.; Hiesgen, R.; Gago, A. S.; Friedrich, K. A.

2017-01-01

Cost reduction and high efficiency are the mayor challenges for sustainable H2 production via proton exchange membrane (PEM) electrolysis. Titanium-based components such as bipolar plates (BPP) have the largest contribution to the capital cost. This work proposes the use of stainless steel BPPs coated with Nb and Ti by magnetron sputtering physical vapor deposition (PVD) and vacuum plasma spraying (VPS), respectively. The physical properties of the coatings are thoroughly characterized by scanning electron, atomic force microscopies (SEM, AFM); and X-ray diffraction, photoelectron spectroscopies (XRD, XPS). The Ti coating (50 μm) protects the stainless steel substrate against corrosion, while a 50-fold thinner layer of Nb decreases the contact resistance by almost one order of magnitude. The Nb/Ti-coated stainless steel bipolar BPPs endure the harsh environment of the anode for more than 1000 h of operation under nominal conditions, showing a potential use in PEM electrolyzers for large-scale H2 production from renewables. PMID:28294119

Sludge digestion instead of aerobic stabilisation - a cost benefit analysis based on experiences in Germany.

PubMed

Gretzschel, Oliver; Schmitt, Theo G; Hansen, Joachim; Siekmann, Klaus; Jakob, Jürgen

2014-01-01

As a consequence of a worldwide increase of energy costs, the efficient use of sewage sludge as a renewable energy resource must be considered, even for smaller wastewater treatment plants (WWTPs) with design capacities between 10,000 and 50,000 population equivalent (PE). To find the lower limit for an economical conversion of an aerobic stabilisation plant into an anaerobic stabilisation plant, we derived cost functions for specific capital costs and operating cost savings. With these tools, it is possible to evaluate if it would be promising to further investigate refitting aerobic plants into plants that produce biogas. By comparing capital costs with operation cost savings, a break-even point for process conversion could be determined. The break-even point varies depending on project specific constraints and assumptions related to future energy and operation costs and variable interest rates. A 5% increase of energy and operation costs leads to a cost efficient conversion for plants above 7,500 PE. A conversion of WWTPs results in different positive effects on energy generation and plant operations: increased efficiency, energy savings, and on-site renewable power generation by digester gas which can be used in the plant. Also, the optimisation of energy efficiency results in a reduction of primary energy consumption.

Quality politics: an immaterial investment for companies in (micro)electronics

NASA Astrophysics Data System (ADS)

Bacivarov, I. C.; Lupan, R.; Robledo, C.; Bacivarov, Angelica

2010-11-01

With the globalization of the markets and the growth of competitiveness in the manufacturing sector, quality has become a key factor of success. Quality is particularly important for the companies which activate in the micro(electronics) field. The quality management system holds a vital place in the company's structure. Implementing such a system requires important operating costs. These costs are known as Quality Obtaining Costs (QOC) and may be considered as an investment. Planning an investment, means evaluating its return in order to see if it is profitable or not. Measuring the return of quality politics investment raise some delicate problems. We may calculate some aspects of the return of investment by measuring the shape of non-quality costs. An eventual decrease of these costs could be synonym with a profitable investment. But the advantages of good quality politics cannot be measured only by taking into consideration the non-quality costs (even if they include direct and indirect costs). There are also intangible advantages (like mark image, competences, polyvalence, client's satisfaction...) that derive from quality approaches. How to evaluate this type of consequences / advantages? The idea developed in this article is to considerate the quality politics like un immaterial/intelligent investment. Therefore could it be advantageous / possible to use the immaterial investment's measuring and evaluation techniques for studying the quality politics return of investment?

Economics of image guidance and navigation in spine surgery.

PubMed

Al-Khouja, Lutfi; Shweikeh, Faris; Pashman, Robert; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2015-01-01

Image-guidance and navigation in spinal surgery is becoming more widely utilized. Several studies have shown the use of this technology to increase accuracy of pedicle screw placement, decrease the rates of revision surgery, and minimize radiation exposure. In this paper, the authors analyze the economics of image-guided surgery (IGS) and navigation in spine surgery. A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database. Each article was screened for inclusion and exclusion criteria, including costs, reoperation, readmission rates, operating room time, and length of stay. Thirteen studies were included in the analysis. Six studies were identified to meet the inclusion criteria for reporting costs and seven met the criteria for analysis of efficacy. Average costs ranged from $17,650 to $39,643. Pedicle screw misplacement rates using IGS ranged from 1.20% to 15.07% while reoperation rates ranged from 0% to 7.42%. There is currently an insufficient amount of studies reporting on the economics of spinal navigation to accurately conclude on its cost-effectiveness in clinical practice. Although a few of these studies showed less costs associated with intraoperative imaging, none were able to establish a statistically significant difference. Preliminary findings drawn from this study indicate a possible cost-effectiveness advantage with IGS, but more comprehensive data on costs need to be reported in order to validate its utilization.

Decrease Hospital Spending: There's an App for That! A Retrospective Analysis of Implementation of a Mobile Resident Handbook on Hospital Costs and Disposition.

PubMed

Holtkamp, Matthew D

2017-10-01

Patient care involves time sensitive decisions. Matching a patient's presenting condition with possible diagnoses requires proper assessment and diagnostic tests. Timely access to necessary information leads to improved patient care, better outcomes, and decreased costs. This study evaluated objective outcomes of the implementation of a novel Resident Handbook Application (RHAP) for smart phones. The RHAP included tools necessary to make proper assessments and to order appropriate tests. The RHAPs effectiveness was accessed using the Military Health System Military Mart database. This database includes patient specific aggregate data, including diagnosis, patient demographics, itemized cost, hospital days, and disposition status. Multivariable analysis was used to compare before and after RHAP implementation, controlling for patient demographics and diagnosis. Internal medicine admission data were used as a control group. There was a statistically significant decrease in laboratory costs and a strong trend toward statistically significant decreases in the cost of radiology performed after implementation of RHAP (p value of <0.02 and <0.07, respectively). There was also a decrease in hospital days (3.66-3.30 days), in total cost per admission ($18,866-$16,305), and in cost per hospital day per patient ($5,140-$4,936). During the same time period a Control group had no change or increases in these areas. The use of the RHAP resulted in decreases in costs in a variety of areas and a decrease in hospital bed days without any apparent negative effect upon patient outcomes or disposition status.

Solar energy system economic evaluation for Wormser Columbia, South Carolina

NASA Technical Reports Server (NTRS)

1980-01-01

The Solar Energy System is not economically beneficial under the assumed economic conditions at the sites considered. Economic benefits from this system depend on decreasing the initial investment and the continued increase in the cost of conventional energy. Decreasing the cost depends on favorable tax treatment and continuing development of solar energy technology. Fuel cost would have to increase drastically while the cost of the system would have to remain constant or decrease for the system to become economically feasible.

The Economics of Air Cargo

NASA Technical Reports Server (NTRS)

Kersey, J. W.

1972-01-01

The economic factors involved in air cargo operations and air cargo marketing development are discussed. Specific steps which are followed by various airports to reduce operating costs are described. The economics of cargo handling within an airline are analyzed with respect to: (1) paperwork costs, (2) terminal costs, (3) line haul costs, and (4) claims costs.

Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

PubMed

Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

2018-02-01

To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p < 0.001). The mean operating theatre time, surgeon procedure time and length of stay were all significantly lower under local anaesthesia compared to general anaesthesia. Time variables such as operating theatre time and length of stay were the most significant predictors of the total costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

A mixed integer linear programming model for operational planning of a biodiesel supply chain network from used cooking oil

NASA Astrophysics Data System (ADS)

Jonrinaldi, Hadiguna, Rika Ampuh; Salastino, Rades

2017-11-01

Environmental consciousness has paid many attention nowadays. It is not only about how to recycle, remanufacture or reuse used end products but it is also how to optimize the operations of the reverse system. A previous research has proposed a design of reverse supply chain of biodiesel network from used cooking oil. However, the research focused on the design of the supply chain strategy not the operations of the supply chain. It only decided how to design the structure of the supply chain in the next few years, and the process of each stage will be conducted in the supply chain system in general. The supply chain system has not considered operational policies to be conducted by the companies in the supply chain. Companies need a policy for each stage of the supply chain operations to be conducted so as to produce the optimal supply chain system, including how to use all the resources that have been designed in order to achieve the objectives of the supply chain system. Therefore, this paper proposes a model to optimize the operational planning of a biodiesel supply chain network from used cooking oil. A mixed integer linear programming is developed to model the operational planning of biodiesel supply chain in order to minimize the total operational cost of the supply chain. Based on the implementation of the model developed, the total operational cost of the biodiesel supply chain incurred by the system is less than the total operational cost of supply chain based on the previous research during seven days of operational planning about amount of 2,743,470.00 or 0.186%. Production costs contributed to 74.6 % of total operational cost and the cost of purchasing the used cooking oil contributed to 24.1 % of total operational cost. So, the system should pay more attention to these two aspects as changes in the value of these aspects will cause significant effects to the change in the total operational cost of the supply chain.

Irrigation of Abdomen With Imipenem Solution Decreases Surgical Site Infections in Patients With Perforated Appendicitis: A Randomized Clinical Trial

PubMed Central

Hesami, Mohammad Ali; Alipour, Hamid; Nikoupour Daylami, Hamed; Alipour, Bijan; Bazargan-Hejazi, Shahrzad; Ahmadi, Alireza

2014-01-01

Background: Perforated appendicitis is one of the most common causes of acute abdomen requiring emergent surgery for immediate appendectomy and peritoneal cavity irrigation; however, the efficacy of irrigation with antibiotic solutions is controversial. Objectives: The aim of this study was to assess the efficacy of imipenem solution irrigation on post-operative surgical site infections (SSIs), hospital length of stay, and hospital costs. We hypothesized that there would be lower rate of SSIs, a shorter hospital stay, and lower hospital cost in patients with perforated appendicitis who received peritoneal cavity irrigation with imipenem solution in comparison to their counterparts who received irrigation with normal saline. Patients and Methods: In this randomized single-blind parallel-group clinical trial, we enrolled 90 patients with perforated appendicitis with 12-50 years of age and randomly allocated them into experimental group (n = 45) and control group (n = 45). The control group received peritoneal irrigation with normal saline (0.9%) and experimental group underwent peritoneal irrigation with imipenem solution (1 mg/mL). All surgical procedures were performed in Imam Reza Hospital of Kermanshah University of Medical Sciences. The study primary outcome was surgical site infections (including wound infection and abdominal abscess) and the secondary outcomes were length of hospital stay and hospital cost. Chi-squared and t-tests were used to analyze the study data. Results: Imipenem solution irrigation was associated with significant clinical improvement at one-month follow-up. The experimental group presented with significantly lower rate of SSIs and shorter length of hospital stay. The experimental group had lower rate of SSIs compared to the control group (4.4% vs. 22.2%, respectively) (p= 0.013). The duration of hospital stay was nearly one day longer in control group (5.84 ± 2.58 days) vs. experimental group (4.91 ± 1.29 days) (P = 0.034), and hospital costs were $50 lower in experimental group ($500 ± $292) vs. control group ($450 ± $170) (P = 0.281). Conclusions: The study findings revealed that peritoneal lavage with imipenem solution (1 mg/mL) decreases the rate of post-operative SSIs in patients with perforated appendicitis in comparison to patients irrigated with normal saline alone. These patients also had shorter hospital stay, and lower hospital costs. PMID:24910794

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

PubMed

Taniguchi, Yu; Kitamura, Akihiko; Nofuji, Yu; Ishizaki, Tatsuro; Seino, Satoshi; Yokoyama, Yuri; Shinozaki, Tomohiro; Murayama, Hiroshi; Mitsutake, Seigo; Amano, Hidenori; Nishi, Mariko; Matsuyama, Yutaka; Fujiwara, Yoshinori; Shinkai, Shoji

2018-03-26

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Introducing the productive operating theatre programme in urology theatre suites.

PubMed

Ahmed, Kamran; Khan, Nuzhath; Anderson, Deirdre; Watkiss, Jonathan; Challacombe, Ben; Khan, Mohammed Shamim; Dasgupta, Prokar; Cahill, Declan

2013-01-01

The Productive Operating Theatre (TPOT) is a theatre improvement programme designed by the UK National Health Service. The aim of this study was to evaluate the implementation of TPOT in urology operating theatres and identify obstacles to running an ideal operating list. TPOT was introduced in two urology operating theatres in September 2010. A multidisciplinary team identified and audited obstacles to the running of an ideal operating list. A brief/debrief system was introduced and patient satisfaction was recorded via a structured questionnaire. The primary outcome measure was the effect of TPOT on start and overrun times. Start times: 39-41% increase in operating lists starting on time from September 2010 to June 2011, involving 1,365 cases. Overrun times: Declined by 832 min between March 2010 and March 2011. The cost of monthly overrun decreased from September 2010 to June 2011 by GBP 510-3,030. Patient experience: A high degree of satisfaction regarding level of care (77%), staff hygiene (71%) and information provided (72%), while negative comments regarding staff shortages and environment/facilities were recorded. TPOT has helped identify key obstacles and shown improvements in efficiency measures such as start/overrun times. Copyright © 2013 S. Karger AG, Basel.

The "Guidewire-Coil"-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy.

PubMed

Dreger, Nici Markus; von Rundstedt, Friedrich Carl; Roth, Stephan; Brandt, Alexander Sascha; Degener, Stephan

2017-01-05

Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion. We retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram. The study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the "Guidewire-Coil-Technique", the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting. The "Guidewire-Coil-Technique" is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.

Drivers and applications of integrated clean-up technologies for surfactant-enhanced remediation of environments contaminated with polycyclic aromatic hydrocarbons (PAHs).

PubMed

Liang, Xujun; Guo, Chuling; Liao, Changjun; Liu, Shasha; Wick, Lukas Y; Peng, Dan; Yi, Xiaoyun; Lu, Guining; Yin, Hua; Lin, Zhang; Dang, Zhi

2017-06-01

Surfactant-enhanced remediation (SER) is considered as a promising and efficient remediation approach. This review summarizes and discusses main drivers on the application of SER in removing polycyclic aromatic hydrocarbons (PAHs) from contaminated soil and water. The effect of PAH-PAH interactions on SER efficiency is, for the first time, illustrated in an SER review. Interactions between mixed PAHs could enhance, decrease, or have no impact on surfactants' solubilization power towards PAHs, thus affecting the optimal usage of surfactants for SER. Although SER can transfer PAHs from soil/non-aqueous phase liquids to the aqueous phase, the harmful impact of PAHs still exists. To decrease the level of PAHs in SER solutions, a series of SER-based integrated cleanup technologies have been developed including surfactant-enhanced bioremediation (SEBR), surfactant-enhanced phytoremediation (SEPR) and SER-advanced oxidation processes (SER-AOPs). In this review, the general considerations and corresponding applications of the integrated cleanup technologies are summarized and discussed. Compared with SER-AOPs, SEBR and SEPR need less operation cost, yet require more treatment time. To successfully achieve the field application of surfactant-based technologies, massive production of the cost-effective green surfactants (i.e. biosurfactants) and comprehensive evaluation of the drivers and the global cost of SER-based cleanup technologies need to be performed in the future. Copyright © 2017. Published by Elsevier Ltd.

Effects of acuity-adaptable rooms on flow of patients and delivery of care.

PubMed

Hendrich, Ann L; Fay, Joy; Sorrells, Amy K

2004-01-01

Delayed transfers of patients between nursing units and lack of available beds are significant problems that increase costs and decrease quality of care and satisfaction among patients and staff. To test whether use of acuity-adaptable rooms helps solve problems with transfers of patients, satisfaction levels, and medical errors. A pre-post method was used to compare the effects of environmental design on various clinical and financial measures. Twelve outcome-based questions were formulated as the basis for inquiry. Two years of baseline data were collected before the unit moved and were compared with 3 years of data collected after the move. Significant improvements in quality and operational cost occurred after the move, including a large reduction in clinician handoffs and transfers; reductions in medication error and patient fall indexes; improvements in predictive indicators of patients' satisfaction; decrease in budgeted nursing hours per patient day and increased available nursing time for direct care without added cost; increase in patient days per bed, with a smaller bed base (number of beds per patient days). Some staff turnover occurred during the first year; turnover stabilized thereafter. Data in 5 key areas (flow of patients and hospital capacity, patients' dissatisfaction, sentinel events, mean length of stay, and allocation of nursing productivity) appear to be sufficient to test the business case for future investment in partial or complete replication of this model with appropriate populations of patients.

A hybrid meta-heuristic algorithm for the vehicle routing problem with stochastic travel times considering the driver's satisfaction

NASA Astrophysics Data System (ADS)

Tavakkoli-Moghaddam, Reza; Alinaghian, Mehdi; Salamat-Bakhsh, Alireza; Norouzi, Narges

2012-05-01

A vehicle routing problem is a significant problem that has attracted great attention from researchers in recent years. The main objectives of the vehicle routing problem are to minimize the traveled distance, total traveling time, number of vehicles and cost function of transportation. Reducing these variables leads to decreasing the total cost and increasing the driver's satisfaction level. On the other hand, this satisfaction, which will decrease by increasing the service time, is considered as an important logistic problem for a company. The stochastic time dominated by a probability variable leads to variation of the service time, while it is ignored in classical routing problems. This paper investigates the problem of the increasing service time by using the stochastic time for each tour such that the total traveling time of the vehicles is limited to a specific limit based on a defined probability. Since exact solutions of the vehicle routing problem that belong to the category of NP-hard problems are not practical in a large scale, a hybrid algorithm based on simulated annealing with genetic operators was proposed to obtain an efficient solution with reasonable computational cost and time. Finally, for some small cases, the related results of the proposed algorithm were compared with results obtained by the Lingo 8 software. The obtained results indicate the efficiency of the proposed hybrid simulated annealing algorithm.

Low Earth Orbit Raider (LER) winged air launch vehicle concept

NASA Technical Reports Server (NTRS)

Feaux, Karl; Jordan, William; Killough, Graham; Miller, Robert; Plunk, Vonn

1989-01-01

The need to launch small payloads into low earth orbit has increased dramatically during the past several years. The Low Earth orbit Raider (LER) is an answer to this need. The LER is an air-launched, winged vehicle designed to carry a 1500 pound payload into a 250 nautical mile orbit. The LER is launched from the back of a 747-100B at 35,000 feet and a Mach number of 0.8. Three staged solid propellant motors offer safe ground and flight handling, reliable operation, and decreased fabrication cost. The wing provides lift for 747 separation and during the first stage burn. Also, aerodynamic controls are provided to simplify first stage maneuvers. The air-launch concept offers many advantages to the consumer compared to conventional methods. Launching at 35,000 feet lowers atmospheric drag and other loads on the vehicle considerably. Since the 747 is a mobile launch pad, flexibility in orbit selection and launch time is unparalleled. Even polar orbits are accessible with a decreased payload. Most importantly, the LER launch service can come to the customer, satellites and experiments need not be transported to ground based launch facilities. The LER is designed to offer increased consumer freedom at a lower cost over existing launch systems. Simplistic design emphasizing reliability at low cost allows for the light payloads of the LER.

Trends in health care resource utilization and pharmacological management of COPD in Taiwan from 2004 to 2010.

PubMed

Tsai, Ying-Huang; Yang, Tsung-Ming; Lin, Chieh-Mo; Huang, Shu-Yi; Wen, Yu-Wen

2017-01-01

COPD has attracted widespread attention worldwide. The prevalence of COPD in Taiwan has been reported, but little is known about trends in health care resource utilization and pharmacologic management in COPD treatment. The objective of this article was to study trends in health care resource utilization, pharmacologic management, and medical costs of COPD treatment in Taiwan. Reimbursement claims in the Taiwan National Health Insurance System from 2004 to 2010 were collected. The disease burden of COPD, including health care resource utilization and medical costs, was evaluated. The pharmacy cost of COPD increased from 2004 to 2010 due to the increased utilization of long-acting muscarinic antagonist (LAMA) and fixed-dose combination of long-acting β2-agonist and inhaled corticosteroid (LABA/ICS), whereas the cost of all other COPD-related medications decreased. The average outpatient department (OPD) cost per patient increased 29.3% from 1,070 USD in 2004 to 1,383 USD in 2010. The highest average total medical cost per patient was 3,434 USD in 2005, and it decreased 12.4% to 3,008 USD in 2010. There was no significant difference in the average number of OPD visits and emergency department visits per patient. The highest average number of hospital admissions was 0.81 in 2005, and it decreased to 0.65 in 2010. The average number of intensive care unit (ICU) admissions decreased from 0.52 in 2005 to 0.31 in 2010. From 2004 to 2010, the average total medical cost per patient of COPD was slightly decreased because of the decreased average number of hospital admissions and ICU admissions. The costs of both LAMA and LABA/ICS increased, while the cost for all other COPD-related medications decreased. These findings suggest that the increased utilization of LAMA and LABA/ICS may have contributed to the decreased average number of hospital admissions and ICU admissions in COPD patients from 2004 to 2010.

Sample preparation and detection device for infectious agents

DOEpatents

Miles, Robin R.; Wang, Amy W.; Fuller, Christopher K.; Lemoff, Asuncion V.; Bettencourt, Kerry A.; Yu, June

2003-06-10

A sample preparation and analysis device which incorporates both immunoassays and PCR assays in one compact, field-portable microchip. The device provides new capabilities in fluid and particle control which allows the building of a fluidic chip with no moving parts, thus decreasing fabrication cost and increasing the robustness of the device. The device can operate in a true continuous (not batch) mode. The device incorporates magnetohydrodynamic (MHD) pumps to move the fluid through the system, acoustic mixing and fractionation, dielectropheretic (DEP) sample concentration and purification, and on-chip optical detection capabilities.

Evolution of INMARSAT systems and applications: The land mobile experience

NASA Technical Reports Server (NTRS)

Staffa, Eugene; Subramaniam, Ram

1993-01-01

Inmarsat has provided mobile satellite communication services for land mobile applications for well over a decade. Having started with the Inmarsat-A voice and telex system, Inmarsat is committed to the evolution of services towards a global personal, handheld satellite communicator. Over the years, users have benefitted from the evolution of technologies, increased user friendliness and portability of terminals and ever decreasing cost of operations. This paper describes the various present systems, their characteristics and applications, and outlines their contributions in the evolution towards the personal global communicator.

Equipment upgrades for the Pu-238 program

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

Congdon, J.W.; Stephens, W.D.; Marra, J.E.

1990-02-14

Much of the equipment and instrumentation in the Pu-238 production facilities is more than 15 years old. Significant improvements have been made in the available instrumentation, in particular, due to the application of microprocessors and lasers. The Actinide Technology Section of SRL has selected and is in the process of evaluating several state-of-the-art instruments which have potential applications in the Pu-238 program. The ease of operation and the accuracy of the instruments have been improved and, in most cases, the cost of the instruments have decreased. 5 refs.

Payload accommodations. Avionics payload support architecture

NASA Technical Reports Server (NTRS)

Creasy, Susan L.; Levy, C. D.

1990-01-01

Concepts for vehicle and payload avionics architectures for future NASA programs, including the Assured Shuttle Access program, Space Station Freedom (SSF), Shuttle-C, Advanced Manned Launch System (AMLS), and the Lunar/Mars programs are discussed. Emphasis is on the potential available to increase payload services which will be required in the future, while decreasing the operational cost/complexity by utilizing state of the art advanced avionics systems and a distributed processing architecture. Also addressed are the trade studies required to determine the optimal degree of vehicle (NASA) to payload (customer) separation and the ramifications of these decisions.

Towards a New Paradigm of Software Development: an Ambassador Driven Process in Distributed Software Companies

NASA Astrophysics Data System (ADS)

Kumlander, Deniss

The globalization of companies operations and competitor between software vendors demand improving quality of delivered software and decreasing the overall cost. The same in fact introduce a lot of problem into software development process as produce distributed organization breaking the co-location rule of modern software development methodologies. Here we propose a reformulation of the ambassador position increasing its productivity in order to bridge communication and workflow gap by managing the entire communication process rather than concentrating purely on the communication result.

Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. A study of opportunity cost based on meta-analysis

PubMed Central

GIRABENT-FARRÉS, M.

2018-01-01

Background We aimed to calculate the opportunity cost of the operating time to demonstrate that single incision laparoscopic cholecystectomy (SILC) is more expensive than classic laparoscopic cholecystectomy (CLC). Methods We identified studies comparing use of both techniques during the period 2008–2016, and to calculate the opportunity cost, we performed another search in the same period of time with an economic evaluation of classic laparoscopy. We performed a meta-analysis of the items selected in the first review considering the cost of surgery and surgical time, and we analyzed their differences. We subsequently calculated the opportunity cost of these time differences based on the design of a cost/time variable using the data from the second literature review. Results Twenty-seven articles were selected from the first review: 26 for operating time (3.138 patients) and 3 for the cost of surgery (831 patients), and 3 articles from the second review. Both techniques have similar operating costs. Single incision laparoscopy surgery takes longer (16.90min) to perform (p <0.00001) and this difference represents an opportunity cost of 755.97 € (cost/time unit factor of 44.73 €/min). Conclusions SILC costs the same as CLC, but the surgery takes longer to perform, and this difference involves an opportunity cost that increases the total cost of SILC. The value of the opportunity cost of the operating time can vary the total cost of a surgical technique and it should be included in the economic evaluation to support the decision to adopt a new surgical technique. PMID:29549678

Identification of Flights for Cost-Efficient Climate Impact Reduction

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Kirschen, Philippe G.; Sridhar, Banavar; Ng, Hok K.

2014-01-01

The aircraft-induced climate impact has drawn attention in recent years. Aviation operations affect the environment mainly through the release of carbon-dioxide, nitrogen-oxides, and by the formation of contrails. Recent research has shown that altering trajectories can reduce aviation environmental cost by reducing Absolute Global Temperature Change Potential, a climate assessment metric that adapts a linear system for modeling the global temperature response to aviation emissions and contrails. However, these methods will increase fuel consumption that leads to higher fuel costs imposed on airlines. The goal of this work is to identify ights for which the environmental cost of climate impact reduction outweighs the increase in operational cost on an individual aircraft basis. Environmental cost is quanti ed using the monetary social cost of carbon. The increase in operational cost is considering cost of additional fuel usage only. For this paper, an algorithm has been developed that modi es the trajectories of ights to evaluate the e ect of environ- mental cost and operational cost of ights in the United States National Airspace System. The algorithm identi es ights for which the environmental cost of climate impact can be reduced and modi es their trajectories to achieve maximum environmental net bene t, which is the di erence between reduction in environmental cost and additional operational cost. The result shows on a selected day, 16% of the ights among eight major airlines, or 2,043 ights, can achieve environmental net bene t using weather forecast data, resulting in net bene t of around $500,000. The result also suggests that the long-haul ights would be better candidates for cost-ecient climate impact reduction than the short haul ights. The algorithm will help to identify the characteristics of ights that are capable of applying cost-ecient climate impact reduction strategy.

Effects of housing system on the costs of commercial egg production1

PubMed Central

Matthews, W. A.; Sumner, D. A.

2014-01-01

This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. PMID:25480736

Effects of housing system on the costs of commercial egg production.

PubMed

Matthews, W A; Sumner, D A

2015-03-01

This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. © The Author 2015. Published by Oxford University Press on behalf of Poultry Science Association.