Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

34 CFR 300.16 - Excess costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Excess costs. 300.16 Section 300.16 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

34 CFR 300.16 - Excess costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Excess costs. 300.16 Section 300.16 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

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

NASA Astrophysics Data System (ADS)

Sun, Ruoyan

2017-01-01

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

History of Asthma in Patients with Chronic Obstructive Pulmonary Disease. A Comparative Study of Economic Burden.

PubMed

Sadatsafavi, Mohsen; Tavakoli, Hamid; Kendzerska, Tetyana; Gershon, Andrea; To, Teresa; Aaron, Shawn D; FitzGerald, J Mark

2016-02-01

A diagnosis of asthma is considered an independent risk factor for chronic obstructive pulmonary disease (COPD). However, little is known about health service use patterns in patients with COPD who have a history of asthma in comparison with those without such a history, especially regarding comorbid conditions. To estimate the excess costs of COPD in patients with a history of asthma (COPD+asthma) versus those with COPD without such a history (COPD-only); to estimate excess costs attributable to inpatient care, outpatient care, medications, and community care; and to estimate excess costs attributable to comorbid conditions. We used vital statistics, inpatient and outpatient encounters, filled prescription records, and community care data of patients in British Columbia, Canada, from 1997 to 2012 to create propensity score-matched COPD+asthma and COPD-only cohorts. We calculated and compared the excess medical costs (in 2012 Canadian dollars [$]) between the two groups on the basis of billing information. Comorbidities were ascertained from the inpatient and outpatient records and were classified on the basis of major categories of the International Classification of Diseases, 10th Revision. The final sample consisted of 22,565 individuals within each group (mean age at baseline, 67.9 yr; 57.0% female; average follow-up, 4.07 yr). Excess costs of COPD+asthma were $540.7 per patient-year (PY) (95% confidence interval [CI], $301.7-$779.8; P < 0.001). Costs of medications ($657.9/PY; P < 0.001) and outpatient services ($127.6/PY; P < 0.001) were higher in COPD+asthma, but costs of hospitalizations were lower (-$271.0/PY; P = 0.002). Community care costs in the two groups were similar (P = 0.257). The excess cost of respiratory-related conditions was $856.2/PY (P < 0.001), with $552.6/PY being due to respiratory-related medications (P < 0.001); costs of all other conditions combined were lower in COPD+asthma, mainly due to lower costs of cardiovascular diseases (-$201.8/PY; P < 0.001). Patients with COPD with a previous history of asthma consume more health care resources than those with COPD alone, but there are important differences in cost components and costs attributable to comorbid conditions. Further research is required to examine whether the lower costs of cardiovascular disease in these patients is due to lower levels of related risk factors or to intrinsic differences in COPD phenotypes.

10 CFR 765.32 - Reimbursement of excess funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM... additional reimbursement to uranium licensees for costs of remedial action, subject to the availability of... uranium licensee's prorated share will be determined by dividing the total excess funds available by the...

10 CFR 765.32 - Reimbursement of excess funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM... additional reimbursement to uranium licensees for costs of remedial action, subject to the availability of... uranium licensee's prorated share will be determined by dividing the total excess funds available by the...

10 CFR 765.32 - Reimbursement of excess funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM... additional reimbursement to uranium licensees for costs of remedial action, subject to the availability of... uranium licensee's prorated share will be determined by dividing the total excess funds available by the...

10 CFR 765.32 - Reimbursement of excess funds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM... additional reimbursement to uranium licensees for costs of remedial action, subject to the availability of... uranium licensee's prorated share will be determined by dividing the total excess funds available by the...

Health-care costs of underweight, overweight and obesity: Australian population-based study.

PubMed

Clifford, Susan A; Gold, Lisa; Mensah, Fiona K; Jansen, Pauline W; Lucas, Nina; Nicholson, Jan M; Wake, Melissa

2015-12-01

Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. biennial BMI measurements over the same period. Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

34 CFR 668.166 - Excess cash.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the Secretary for the costs the Secretary incurred in providing that excess cash to the institution... 34 Education 3 2010-07-01 2010-07-01 false Excess cash. 668.166 Section 668.166 Education..., DEPARTMENT OF EDUCATION STUDENT ASSISTANCE GENERAL PROVISIONS Cash Management § 668.166 Excess cash. (a...

10 CFR 765.32 - Reimbursement of excess funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Energy DEPARTMENT OF ENERGY REIMBURSEMENT FOR COSTS OF REMEDIAL ACTION AT ACTIVE URANIUM AND THORIUM PROCESSING SITES Additional Reimbursement Procedures § 765.32 Reimbursement of excess funds. (a) No later... total number of Federal-related dry short tons of byproduct material present at the site where costs of...

47 CFR 69.157 - Line port costs in excess of basic, analog service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Line port costs in excess of basic, analog service. 69.157 Section 69.157 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES Computation of Charges for Price Cap Local Exchange Carriers...

34 CFR Appendix to Part 81 - Illustrations of Proportionality

Code of Federal Regulations, 2010 CFR

2010-07-01

... State grant under a Federal vocational education program to pay for the excess cost of vocational... from their intended purposes, and the Federal interest was harmed to that extent. (8) Excess cost requirement. An LEA uses funds reserved for the disadvantaged under a Federal vocational education program to...

41 CFR 102-36.210 - Why must we report excess personal property to GSA?

Code of Federal Regulations, 2011 CFR

2011-01-01

... paid for with taxpayers' money, thus minimizing new procurement costs. Reporting excess personal property to GSA helps assure that the information on available excess personal property is accessible and...

41 CFR 102-36.210 - Why must we report excess personal property to GSA?

Code of Federal Regulations, 2010 CFR

2010-07-01

... paid for with taxpayers' money, thus minimizing new procurement costs. Reporting excess personal property to GSA helps assure that the information on available excess personal property is accessible and...

41 CFR 102-36.210 - Why must we report excess personal property to GSA?

Code of Federal Regulations, 2012 CFR

2012-01-01

... paid for with taxpayers' money, thus minimizing new procurement costs. Reporting excess personal property to GSA helps assure that the information on available excess personal property is accessible and...

41 CFR 102-36.210 - Why must we report excess personal property to GSA?

Code of Federal Regulations, 2014 CFR

2014-01-01

... paid for with taxpayers' money, thus minimizing new procurement costs. Reporting excess personal property to GSA helps assure that the information on available excess personal property is accessible and...

41 CFR 102-36.210 - Why must we report excess personal property to GSA?

Code of Federal Regulations, 2013 CFR

2013-07-01

... paid for with taxpayers' money, thus minimizing new procurement costs. Reporting excess personal property to GSA helps assure that the information on available excess personal property is accessible and...

48 CFR 45.603 - Abandonment, destruction or donation of excess personal property.

Code of Federal Regulations, 2010 CFR

2010-10-01

... or donation of excess personal property. 45.603 Section 45.603 Federal Acquisition Regulations System... Disposal 45.603 Abandonment, destruction or donation of excess personal property. (a) Plant clearance... any of the costs incident to a donation. (d)(1) Before abandoning, destroying, or donating excess...

48 CFR 45.603 - Abandonment, destruction or donation of excess personal property.

Code of Federal Regulations, 2011 CFR

2011-10-01

... or donation of excess personal property. 45.603 Section 45.603 Federal Acquisition Regulations System... Disposal 45.603 Abandonment, destruction or donation of excess personal property. (a) Plant clearance... any of the costs incident to a donation. (d)(1) Before abandoning, destroying, or donating excess...

Burden of Clostridium difficile on the healthcare system.

PubMed

Dubberke, Erik R; Olsen, Margaret A

2012-08-01

There are few high-quality studies of the costs of Clostridium difficile infection (CDI), and the majority of studies focus on the costs of CDI in acute-care facilities. Analysis of the best available data, from 2008, indicates that CDI may have resulted in $4.8 billion in excess costs in US acute-care facilities. Other areas of CDI-attributable excess costs that need to be investigated are costs of increased discharges to long-term care facilities, of CDI with onset in long-term care facilities, of recurrent CDI, and of additional adverse events caused by CDI.

Multiple Chronic Conditions and Healthcare Costs among Adults

PubMed Central

Sambamoorthi, Usha; Tan, Xi; Deb, Arijita

2015-01-01

The prevalence of multiple chronic conditions (MCC) is increasing among individuals of all ages. MCC are associated with poor health outcomes. The presence of MCC has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families. Investigators have used a variety of definitions for MCC to evaluate costs associated with MCC. The objective of this article is to examine the current literature in estimating excess costs associated with MCC among adults. The discussion highlights some of the theoretical and technical merits of various MCC definitions and models used to estimate the excess costs associated with MCC. PMID:26400220

Lifetime indirect cost of childhood overweight and obesity: A decision analytic model.

PubMed

Sonntag, Diana; Ali, Shehzad; De Bock, Freia

2016-01-01

To estimate the indirect lifetime cost of childhood overweight and obesity for Germany. The lifetime cohort model consisted of two parts: (a) Model I used data from the German Interview and Examination Survey for Children on prevalence of BMI categories during childhood to evaluate BMI trajectories before the age of 18; and (b) Model II estimated lifetime excess indirect cost based on the history of childhood BMI. Indirect costs were defined as the opportunity cost of lost productivity due to mortality and morbidity and were identified through a systematic literature review. Our analysis showed that the majority of children with overweight and obesity remained in the same BMI category during their adult life, resulting in significant indirect lifetime costs. We estimated that overweight and obesity during childhood resulted in an excess lifetime cost per person of €4,209 (men) and €2,445 (women). For the current prevalent German population, the excess lifetime cost was €145 billion. Our study showed that childhood obesity results in significant economic burden on the society. Therefore, cost-effective strategies targeted at reducing the prevalence of obesity during the early years of life can significantly reduce both healthcare and nonhealthcare costs over the lifetime. © 2015 The Obesity Society.

17 CFR 210.12-12C - Summary schedule of investments in securities of unaffiliated issuers.

Code of Federal Regulations, 2010 CFR

2010-04-01

...: (a) Aggregate gross unrealized appreciation for all securities in which there is an excess of value over tax cost, (b) the aggregate gross unrealized depreciation for all securities in which there is an excess of tax cost over value, (c) the net unrealized appreciation or depreciation, and (d) the aggregate...

41 CFR 102-36.190 - Must we always pay 25 percent of the original acquisition cost when furnishing excess personal...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Must we always pay 25 percent of the original acquisition cost when furnishing excess personal property to project grantees? 102-36.190 Section 102-36.190 Public Contracts and Property Management Federal Property Management...

Quadrupedal locomotor performance in two species of arboreal squirrels: predicting energy savings of gliding

Treesearch

Elizabeth A. Flaherty; Merav Ben-David; Winston P. Smith

2010-01-01

Gliding allows mammals to exploit canopy habitats of old-growth forests possibly as a means to save energy. To assess costs of quadrupedal locomotion for a gliding arboreal mammal, we used open-flow respirometry and a variable-speed treadmill to measure oxygen consumption and to calculate cost of transport, excess exercise oxygen consumption, and excess post-exercise...

Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency.

PubMed

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

2003-04-01

Determination of operating room (OR) block allocation and case scheduling is often not based on maximizing OR efficiency, but rather on tradition and surgeon convenience. As a result, anesthesiology groups often incur additional labor costs. When negotiating financial support, heads of anesthesiology departments are often challenged to justify the subsidy necessary to offset these additional labor costs. In this study, we describe a method for calculating a statistically sound estimate of the excess labor costs incurred by an anesthesiology group because of inefficient OR allocation and case scheduling. OR information system and anesthesia staffing data for 1 yr were obtained from two university hospitals. Optimal OR allocation for each surgical service was determined by maximizing the efficiency of use of the OR staff. Hourly costs were converted to dollar amounts by using the nationwide median compensation for academic and private-practice anesthesia providers. Differences between actual costs and the optimal OR allocation were determined. For Hospital A, estimated annual excess labor costs were $1.6 million (95% confidence interval, $1.5-$1.7 million) and $2.0 million ($1.89-$2.05 million) when academic and private-practice compensation, respectively, was calculated. For Hospital B, excess labor costs were $1.0 million ($1.08-$1.17 million) and $1.4 million ($1.32-1.43 million) for academic and private-practice compensation, respectively. This study demonstrates a methodology for an anesthesiology group to estimate its excess labor costs. The group can then use these estimates when negotiating for subsidies with its hospital, medical school, or multispecialty medical group. We describe a new application for a previously reported statistical method to calculate operating room (OR) allocations to maximize OR efficiency. When optimal OR allocations and case scheduling are not implemented, the resulting increase in labor costs can be used in negotiations as a statistically sound estimate for the increased labor cost to the anesthesiology department.

Employer-sponsored insurance, health care cost growth, and the economic performance of U.S. Industries.

PubMed

Sood, Neeraj; Ghosh, Arkadipta; Escarce, José J

2009-10-01

To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth ("excess" growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries. We analyzed data from 38 U.S. industries for the period 1987-2005. All data are publicly available from various government agencies. We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation. Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005. Excess growth in health care costs is adversely affecting the economic performance of U.S. industries.

Controlling costs without compromising quality: paying hospitals for total knee replacement.

PubMed

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; χ) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Nursing Home Spending Patterns in the 1990s: The Role of Nursing Home Competition and Excess Demand

PubMed Central

Mukamel, Dana B; Spector, William D; Bajorska, Alina

2005-01-01

Objective To examine nursing home expenditures on clinical, hotel, and administrative activities during the 1990s and to determine the association between nursing home competition and excess demand on expenditures. Data Sources/Study Setting Secondary data sources for 1991, 1996, and 1999 for 500 free-standing nursing homes in New York State. Study Design A retrospective statistical analysis of nursing homes' expenditures. The dependent variables were clinical, hotel, and administrative costs in each year. Independent variables included outputs (inpatient and outpatient), wages, ownership, New York City location, and measures of competition and excess demand. Data Collection/Extraction Method Variables were constructed from annual financial reports submitted by the nursing homes, the Patient Review Instrument and Medicare enrollment data. Principal Findings Clinical and administrative costs have increased over the decade, while hotel expenditures have declined. Increased competition was associated with higher clinical and administrative costs while excess demand was associated with lower clinical and hotel expenditures. Conclusions Nursing home expenditures are sensitive to competition and excess demand conditions. Policies that influence competition in nursing home markets are therefore likely to have an impact on expenditures as well. PMID:16033491

Low excess air burners keep boiler and air cleaner while cutting fuel costs

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

Robinson, H.

1981-11-01

In the 1970s at the Humko Chemical Co., producers of fatty acids used in plastics, soaps, rubber products, and textiles, it was deemed necessary to modify existing boiler equipment to insure an adequate fuel supply and to increase efficienct. Existing equipment operated at an overall average efficiency of 77% and only 6% excess O/sub 2/ could be achieved with number 6 fuel oil and only 2.6% with natural gas. Cleaning the boilers and replacing existing burners with oil and gas firing units led to overall efficiency up to 84% with only 1% excess O/sub 2/. Even though fuel costs havemore » approximately tripled during the ensuing time, Humko's cost of producing steam has only doubled with the more efficienct equipment. (BLM)« less

Health service use and costs associated with excess weight in older adults in Germany.

PubMed

König, Hans-Helmut; Lehnert, Thomas; Brenner, Hermann; Schöttker, Ben; Quinzler, Renate; Haefeli, Walter Emil; Matschinger, Herbert; Heider, Dirk

2015-07-01

excess weight is a risk factor for numerous co-morbidities that predominantly occur in later life. This study's purpose was to analyse the association between excess weight and health service use/costs in the older population in Germany. this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class ≥2 according to BMI. In 42.6%, WHtR was ≥0.6. For normal weight, overweight, obese class 1 and obese class ≥2 individuals, mean costs (3-month period) of outpatient care were 384€, 435€, 475€ and 525€ (P < 0.001), mean costs of inpatient care were 284€, 408€, 333€ and 652€ (P = 0.070) and mean total costs 716€, 891€, 852€ and 1,244€ (P = 0.013). For individuals with WHtR <0.6 versus ≥0.6, outpatient costs were 401€ versus 499€ (P < 0.001), inpatient costs 315€ versus 480€ (P = 0.016) and total costs 755€ versus 1,041€ (P < 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72€; class ≥2: +153€) and total costs (class ≥2: +361€) while the effect of overweight was not significant. WHtR ≥0.6 significantly increased outpatient costs by +79€ and total costs by +189€. excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class ≥2 individuals. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Problems of Excess Capacity

NASA Technical Reports Server (NTRS)

Douglas, G.

1972-01-01

The problems of excess capacity in the airline industry are discussed with focus on the following topics: load factors; fair rate of return on investment; service-quality rivalry among airlines; pricing (fare) policies; aircraft production; and the impacts of excess capacity on operating costs. Also included is a discussion of the interrelationships among these topics.

What are the health costs of uranium mining? A case study of miners in Grants, New Mexico

PubMed Central

Jones, Benjamin A

2014-01-01

Background: Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny. Objectives: This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico. Methods: Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs. Results: Total health costs ranged from $2.2 million to $7.7 million per excess death. This amounts to between $22.4 million and $165.8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185.4 miners per 100 000, with a range of 1419.8–2974.3 per 100 000. Conclusions: Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions. PMID:25224806

What are the health costs of uranium mining? A case study of miners in Grants, New Mexico.

PubMed

Jones, Benjamin A

2014-10-01

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny. This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico. Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs. Total health costs ranged from $2·2 million to $7·7 million per excess death. This amounts to between $22·4 million and $165·8 million in annual health costs over the 1955-1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185·4 miners per 100 000, with a range of 1419·8-2974·3 per 100 000. Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

PubMed Central

Rim, Sun Hee; Guy, Gery P.; Yabroff, K. Robin; McGraw, Kathleen A.; Ekwueme, Donatus U.

2016-01-01

Introduction This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US. Areas covered Twelve published studies were identified. Although studies varied substantially in populations, comorbidities examined, methods, and types of cost reported, costs for cancer survivors with comorbidities generally increased with greater numbers of comorbidities or an increase in comorbidity index score. Survivors with comorbidities incurred significantly more in total medical costs, out-of-pocket costs, and costs by service type compared to cancer survivors without additional comorbidities. Expert commentary Cancer survivors with comorbidities bear significant excess out-of-pocket costs and their care is also more expensive to the healthcare system. On-going evaluation of different payment models, care coordination, and disease management programs for cancer survivors with comorbidities will be important in monitoring impact on healthcare costs. PMID:27649815

Cost-of-illness studies of atrial fibrillation: methodological considerations.

PubMed

Becker, Christian

2014-10-01

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies' methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies' relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts... the base period and the additional amounts paid due to the inappropriate increase of the hospital...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... 42 Public Health 2 2010-10-01 2010-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts...

Outing the costs of civil deference to the military.

PubMed

Hillman, Elizabeth L

2013-01-01

Placing the costs and process of repeal into the framework of U.S. civil governance and military power reveals the faltering state of civilian control over, and understanding of, contemporary military institutions. The excessive delays, repetitive studies, and lack of judicial oversight that characterized the process of repeal expose a military unmoored from the constitutional and democratic constraints of civilian control. The end of Don't Ask, Don't Tell is more than a civil rights triumph. It is also a lesson in the steep costs and troubling consequences of excessive civilian deference to the armed forces.

The association of smoking and the cost of military training

PubMed Central

Klesges, R.; Haddock, C; Chang, C.; Talcott, G; Lando, H.

2001-01-01

OBJECTIVE—To determine if premature discharge from the US Air Force was associated with the smoking status of recruits.
DESIGN AND SETTING—A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged.
MAIN OUTCOME MEASURES—Excess training costs as a result of premature discharge.
RESULTS— In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795).
CONCLUSIONS—Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with $18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over $130 million per year in excess training costs.


Keywords: military; smoking ban; training costs PMID:11226360

24 CFR 941.306 - Maximum project cost.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) project costs that are subject to the TDC limit (i.e., Housing Construction Costs and Community Renewal... project, the actual project cost is determined based upon the amount of public housing capital assistance... Community Renewal Costs in excess of the TDC limit, as determined under paragraph (b)(2) of this section...

24 CFR 941.306 - Maximum project cost.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) project costs that are subject to the TDC limit (i.e., Housing Construction Costs and Community Renewal... project, the actual project cost is determined based upon the amount of public housing capital assistance... Community Renewal Costs in excess of the TDC limit, as determined under paragraph (b)(2) of this section...

The effects of stochastic demand and expense preference behaviour on public hospital costs and excess capacity.

PubMed

Lovell, C A Knox; Rodríguez-Alvarez, Ana; Wall, Alan

2009-02-01

The literature to date on the effect of demand uncertainty on public hospital costs and excess capacity has not taken into account the role of expense preference behaviour. Similarly, the research on expense preference behaviour has not taken demand uncertainty into account. In this paper, we argue that both demand uncertainty and expense preference behaviour may affect public hospital costs and excess capacity and that ignoring either of these effects may lead to biased parameter estimates and misleading inference. To show this, we extend the analysis of Rodríguez-Alvarez and Lovell (Health Econ. 2004; 13: 157-169) by incorporating demand uncertainty into the technology to account for the hospital activity of providing standby capacity or insurance against the unexpected demand. We find that demand uncertainty in Spanish public hospitals affects hospital production decisions and increases costs. Our results also show that overcapitalization in these hospitals can be explained by hospitals providing insurance demand when faced with demand uncertainty. We also find evidence of expense preference behaviour. We conclude that both stochastic demand and expense preference behaviour should be taken into account when analysing hospital costs and production. Copyright (c) 2008 John Wiley & Sons, Ltd.

Projecting excess emergency department visits and associated costs in Brisbane, Australia, under population growth and climate change scenarios

PubMed Central

Toloo, Ghasem (Sam); Hu, Wenbiao; FitzGerald, Gerry; Aitken, Peter; Tong, Shilu

2015-01-01

The direct and indirect health effects of increasingly warmer temperatures are likely to further burden the already overcrowded hospital emergency departments (EDs). Using current trends and estimates in conjunction with future population growth and climate change scenarios, we show that the increased number of hot days in the future can have a considerable impact on EDs, adding to their workload and costs. The excess number of visits in 2030 is projected to range between 98–336 and 42–127 for younger and older groups, respectively. The excess costs in 2012–13 prices are estimated to range between AU$51,000–184,000 (0–64) and AU$27,000–84,000 (65+). By 2060, these estimates will increase to 229–2300 and 145–1188 at a cost of between AU$120,000–1,200,000 and AU$96,000–786,000 for the respective age groups. Improvements in climate change mitigation and adaptation measures are likely to generate synergistic health co-benefits and reduce the impact on frontline health services. PMID:26245139

Metabolic stoichiometry and the fate of excess carbon and nutrients in consumers.

PubMed

Anderson, Thomas R; Hessen, Dag O; Elser, James J; Urabe, Jotaro

2005-01-01

Animals encountering nutritionally imbalanced foods should release elements in excess of requirements in order to maintain overall homeostasis. Quantifying these excesses and predicting their fate is, however, problematic. A new model of the stoichiometry of consumers is formulated that incorporates the separate terms in the metabolic budget, namely, assimilation of ingested substrates and associated costs, protein turnover, other basal costs, such as osmoregulation, and the use of remaining substrates for production. The model indicates that release of excess C and nonlimiting nutrients may often be a significant fraction of the total metabolic budget of animals consuming the nutrient-deficient forages that are common in terrestrial and aquatic systems. The cost of maintenance, in terms of not just C but also N and P, is considerable, such that food quality is important even when intake is low. Many generalist consumers experience short-term and unpredictable fluctuations in their diets. Comparison of model output with data for one such consumer, Daphnia, indicates that mechanisms operating postabsorption in the gut are likely the primary means of regulating excess C, N, and P in these organisms, notably respiration decoupled from biochemical or mechanical work and excretion of carbon and nutrients. This stoichiometrically regulated release may often be in organic rather than inorganic form, with important consequences for the balance of autotrophic and heterotrophic processes in ecosystems.

40 CFR 35.6285 - Recipient payment of response costs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... payment of response costs. The recipient may pay for its share of response costs using cash, services... costs in the form of cash. (b) Services. The recipient may provide equipment and services to satisfy its... CFR part 300). (d) Excess cash cost share contributions/overmatch. The recipient may direct EPA to...

Hospital costs associated with surgical site infections in general and vascular surgery patients.

PubMed

Boltz, Melissa M; Hollenbeak, Christopher S; Julian, Kathleen G; Ortenzi, Gail; Dillon, Peter W

2011-11-01

Although much has been written about excess cost and duration of stay (DOS) associated with surgical site infections (SSIs) after cardiothoracic surgery, less has been reported after vascular and general surgery. We used data from the National Surgical Quality Improvement Program (NSQIP) to estimate the total cost and DOS associated with SSIs in patients undergoing general and vascular surgery. Using standard NSQIP practices, data were collected on patients undergoing general and vascular surgery at a single academic center between 2007 and 2009 and were merged with fully loaded operating costs obtained from the hospital accounting database. Logistic regression was used to determine which patient and preoperative variables influenced the occurrence of SSIs. After adjusting for patient characteristics, costs and DOS were fit to linear regression models to determine the effect of SSIs. Of the 2,250 general and vascular surgery patients sampled, SSIs were observed in 186 inpatients. Predisposing factors of SSIs were male sex, insulin-dependent diabetes, steroid use, wound classification, and operative time (P < .05). After adjusting for those characteristics, the total excess cost and DOS attributable to SSIs were $10,497 (P < .0001) and 4.3 days (P < .0001), respectively. SSIs complicating general and vascular surgical procedures share many risk factors with SSIs after cardiothoracic surgery. Although the excess costs and DOS associated with SSIs after general and vascular surgery are somewhat less, they still represent substantial financial and opportunity costs to hospitals and suggest, along with the implications for patient care, a continuing need for cost-effective quality improvement and programs of infection prevention. Copyright © 2011 Mosby, Inc. All rights reserved.

41 CFR 302-10.207 - Am I responsible for excess or non-allowable charges?

Code of Federal Regulations, 2010 CFR

2010-07-01

... designated in the tariffs as “Special Service;” (c) Cost of storage; and (d) Costs of connecting/disconnecting appliances, equipment, and utilities involved in relocation and costs of converting appliances for...

Estimating the Hospital Delivery Costs Associated With Severe Maternal Morbidity in New York City, 2008-2012.

PubMed

Howland, Renata E; Angley, Meghan; Won, Sang Hee; Wilcox, Wendy; Searing, Hannah; Tsao, Tsu-Yu

2018-02-01

To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors. We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012. Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries with and without severe maternal morbidity remained high ($6,126). Over 5 years, this difference resulted in approximately $83 million in total excess costs (13,502×$6,126). Severe maternal morbidity nearly doubled the cost of delivery above and beyond other drivers of cost, resulting in tens of millions of excess dollars spent in the health care system in New York City. These findings can be used to demonstrate the burden of severe maternal morbidity and evaluate the cost-effectiveness of interventions to improve maternal health.

Excess flow valve benefit/cost analysis.

DOT National Transportation Integrated Search

1994-12-31

The Office of Pipeline Safety (OPS) is adopting regulations requiring the installation of Excess Flow Valves (EFVs) on all new or renewed single-family residential gas services that operate at pressures that are always 10 psig (pounds per square inch...

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study

PubMed Central

2014-01-01

Background Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. Objective To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. Methods A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. Results From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25–41 years) and first (0–16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Conclusions Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients’ lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure. PMID:24954169

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study.

PubMed

Achelrod, Dmitrij; Blankart, Carl Rudolf; Linder, Roland; von Kodolitsch, Yskert; Stargardt, Tom

2014-06-23

Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients' lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure.

Who Would Pay for State Alcohol Tax Increases in the United States?

PubMed Central

Daley, James I.; Xuan, Ziming; Blanchette, Jason G.; Chaloupka, Frank J.; Jernigan, David H.

2016-01-01

Introduction Despite strong evidence that increasing alcohol taxes reduces alcohol-related harm, state alcohol taxes have declined in real terms during the past 3 decades. Opponents of tax increases argue that they are unfair to “responsible” drinkers and those who are financially disadvantaged. The objectives of this study were to assess the impact of hypothetical state alcohol tax increases on the cost of alcohol for adults in the United States on the basis of alcohol consumption and sociodemographic characteristics. Methods The increased net cost of alcohol (ie, product plus tax) from a series of hypothetical state alcohol tax increases was modeled for all 50 states using data from the 2011 Behavioral Risk Factor Surveillance System, IMPACT Databank, and the Alcohol Policy Information System. Costs were assessed by drinking pattern (excessive vs nonexcessive) and by sociodemographic characteristics. Results Among states, excessive drinkers would pay 4.8 to 6.8 times as much as nonexcessive drinkers on a per capita basis and would pay at least 72% of aggregate costs. For nonexcessive drinkers, the annual cost from even the largest hypothetical tax increase ($0.25 per drink) would average less than $10.00. Drinkers with higher household incomes and non-Hispanic white drinkers would pay higher per capita costs than people with lower incomes and racial/ethnic minorities. Conclusion State-specific tax increases would cost more for excessive drinkers, those with higher incomes, and non-Hispanic whites. Costs to nonexcessive drinkers would be modest. Findings are relevant to developing evidence-based public health practice for a leading preventable cause of death. PMID:27197080

Reducing Time-dependent Bias in Estimates of the Attributable Cost of Health Care-associated Methicillin-resistant Staphylococcus aureus Infections: A Comparison of Three Estimation Strategies.

PubMed

Nelson, Richard E; Samore, Matthew H; Jones, Makoto; Greene, Tom; Stevens, Vanessa W; Liu, Chuan-Fen; Graves, Nicholas; Evans, Martin F; Rubin, Michael A

2015-09-01

Previous estimates of the excess costs due to health care-associated infection (HAI) have scarcely addressed the issue of time-dependent bias. We examined time-dependent bias by estimating the health care costs attributable to an HAI due to methicillin-resistant Staphylococcus aureus (MRSA) using a unique dataset in the Department of Veterans Affairs (VA) that makes it possible to distinguish between costs that occurred before and after an HAI. In addition, we compare our results to those from 2 other estimation strategies. Using a historical cohort study design to estimate the excess predischarge costs attributable to MRSA HAIs, we conducted 3 analyses: (1) conventional, in which costs for the entire inpatient stay were compared between patients with and without MRSA HAIs; (2) post-HAI, which included only costs that occurred after an infection; and (3) matched, in which costs for the entire inpatient stay were compared between patients with an MRSA HAI and subset of patients without an MRSA HAI who were matched based on the time to infection. In our post-HAI analysis, estimates of the increase in inpatient costs due to MRSA HAI were $12,559 (P<0.0001) and $24,015 (P<0.0001) for variable and total costs, respectively. The excess variable and total cost estimates were 33.7% and 31.5% higher, respectively, when using the conventional methods and 14.6% and 11.8% higher, respectively, when using matched methods. This is the first study to account for time-dependent bias in the estimation of incremental per-patient health care costs attributable to HAI using a unique dataset in the VA. We found that failure to account for this bias can lead to overestimation of these costs. Matching on the timing of infection can reduce this bias substantially.

44 CFR 206.342 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the relative cost of repairing the damaged facility to the replacement cost of that portion of the... improvement of a structure or facility, that has been damaged in excess of, or the cost of which equals or exceeds, 50 percent of the market value of the structure or placement cost of the facility (including all...

40 CFR 35.6235 - Cost sharing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 35.6285 (c), (d), and (f) regarding credit, excess cash cost share contributions/over match, and... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Cost sharing. 35.6235 Section 35.6235... Cooperative Agreements § 35.6235 Cost sharing. A State must provide at least ten percent of the direct and...

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Impact of chronic ischemic heart disease on the health care costs of COPD patients - An analysis of German claims data.

PubMed

Schwarzkopf, Larissa; Wacker, Margarethe; Ertl, Julia; Hapfelmeier, Jana; Larisch, Katharina; Leidl, Reiner

2016-09-01

Chronic Obstructive Pulmonary Disease (COPD) has a substantial impact on health care systems worldwide. Particularly, cardiovascular diseases such as ischemic heart disease (IHD) are frequent in individuals with COPD, but the economic consequences of combined COPD and IHD are by large unknown. Therefore, our study has the objective to investigate excess costs of IHD in COPD patients. Out of German Statutory Health Insurance claims data we identified 26,318 COPD patients with and 10,287 COPD patients without IHD based on ICD-10 codes (COPD J44; IHD I2[0,1,2,5]) of the year 2011 and matched 9986 of them in a 1:1 ratio based on age and gender. Then, we investigated health care service expenditures in 2012 via Generalized Linear Models. Moreover, we evaluated a potential non-linear association between health care expenditures and age in a gender-stratified Generalized Additive Model. The prevalence of IHD in individuals with COPD increases with rising age up to a share of 50%. COPD patients with IHD cause adjusted mean annual per capita health care service expenditures of ca. €7400 compared with ca. €5800 in COPD patients without IHD. Moreover, excess costs of IHD have an inverse u-shape, peaking in the early (men) respectively late seventies (women). IHD in COPD patients is associated with excess costs of ca. € 1,500, with the exact amount varying age- and gender-dependently. Subgroups with high excess costs indicate medical need that calls for efficient care strategies, considering COPD and IHD together particularly between 70 and 80 years of age. Copyright © 2016 Elsevier Ltd. All rights reserved.

7 CFR 2812.7 - Costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Costs. 2812.7 Section 2812.7 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF OPERATIONS, DEPARTMENT OF AGRICULTURE...) § 2812.7 Costs. Donated excess personal property/equipment is free of charge. However, the donee must pay...

Costs and coverage. Pressures toward health care reform.

PubMed Central

Lee, P R; Soffel, D; Luft, H S

1992-01-01

Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely. PMID:1441510

32 CFR 644.369 - Guidelines for protection and maintenance of excess and surplus real property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... minimize the cost of care, protection and maintenance consistent with these principles. (b) Improvements or... maintenance does not extend to historic places. Historic places in excess or suplus status will be maintained..., preservation and maintenance of historic places. ...

TRADING ALLOWANCES FOR STORMWATER CONTROL: HYDROLOGY AND OPPORTUNITY COSTS

EPA Science Inventory

Excess stormwater runoff is a serious problem in a large number of urban areas, causing flooding, water pollution, groundwater recharge deficits and ecological damage to urban streams. It has been posited that to mitigate the effects of excess stormwater runoff, policy makers...

TRADING ALLOWANCES FOR STORMWATER CONTROL: HYDROLOGY AND OPPORTUNITY COSTS

EPA Science Inventory

Excess stormwater runoff is a serious problem in a large number of urban areas, causing flooding, water pollution, groundwater recharge deficits and ecological damage to urban streams. It has been posited that to mitigate the effects of excess stormwater runoff, policy makers cou...

46 CFR 296.60 - Applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... additional vessel maintenance and repair preparation costs, including costs for additional engineering...” for transit to a U.S. shipyard in excess of the transit period to a foreign shipyard on the same trade...

Does Bertrand's rule apply to macronutrients?

PubMed Central

Raubenheimer, D; Lee, K.P; Simpson, S.J

2005-01-01

It has been known for over a century that the dose–response curve for many micronutrients is non-monotonic, having an initial stage of increasing benefits with increased intake, followed by increasing costs as excesses become toxic. This phenomenon, termed Bertrand's rule, is widely assumed not to apply to caloric macronutrients. To date this assumption has been safe, owing to the considerable methodological challenges involved in coaxing animals to over-ingest macronutrients in a way that enables the effects of specific food components to be isolated. Here we report an experiment which overcomes these difficulties, to test whether the second phase (incurring costs with excessive intake) applies to carbohydrate intake by the generalist-feeding caterpillar Spodoptera littoralis. The results showed that excess carbohydrate intake caused increased mortality, thus extending Bertrand's rule to macronutrients. PMID:16243690

The Cost of Relapse in Schizophrenia.

PubMed

Pennington, Mark; McCrone, Paul

2017-09-01

Schizophrenia is a chronic and debilitating mental illness characterised by periods of relapse that require resource intensive management. Quantifying the cost of relapse is central to the evaluation of the cost effectiveness of treating schizophrenia. We aimed to undertake a comprehensive search of the available literature on the cost of relapse. We performed a search on multiple databases (MEDLINE, Embase, PsycINFO and Health Management Information Consortium) for any study reporting a cost of relapse or data from which such a cost could be calculated. Costs are reported in 2015 international dollars. We found 16 studies reporting costs associated with relapse over a defined period of time and identified a cost associated with hospitalisation for relapse in 43 studies. Eight clinical decision analyses also provided cost estimates. Studies from the US report excess costs of relapse of $6033-$32,753 (2015 Purchasing Power Parity dollars [PPP$]) over periods of 12-15 months. European studies report excess costs of $8665-$18,676 (2015 PPP$) over periods of 6-12 months. Estimates of the cost of hospitalisation for relapse are more diverse, and associated with marked differences in typical length of stay across jurisdictions. Wide ranges in the estimated cost of relapse may reflect differences in sample section and relapse definition as well as practice styles and differences in resource costs. Selection of the most appropriate cost estimate should be guided by the definition of relapse and the analysis setting.

Identification of successful ridesharing strategies.

DOT National Transportation Integrated Search

1989-01-01

Ridesharing offers a relatively low-cost solution to the problems associated with high commuting costs, traffic congestion, unmet parking demands, energy shortages, and excessive air pollutants. Accordingly, it is worthwhile to develop a list of stra...

Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system's TRICARE prime-enrolled population.

PubMed

Dall, Timothy M; Zhang, Yiduo; Chen, Yaozhu J; Wagner, Rachel C Askarinam; Hogan, Paul F; Fagan, Nancy K; Olaiya, Samuel T; Tornberg, David N

2007-01-01

To estimate medical and indirect costs to the Department of Defense (DoD) that are associated with tobacco use, being overweight or obese, and high alcohol consumption. Retrospective, quantitative research. Healthcare provided in military treatment facilities and by providers participating in the military health system. The 4.3 million beneficiaries under age 65 years who were enrolled in the military TRICARE Prime health plan option in 2006. The findings come from a cost-of-disease model developed by combining information from DoD and civilian health surveys and studies; DoD healthcare encounter data for 4.1 million beneficiaries; and epidemiology literature on the increased risk of comorbidities from unhealthy behaviors. DoD spends an estimated $2.1 billion per year for medical care associated with tobacco use ($564 million), excess weight and obesity ($1.1 billion), and high alcohol consumption ($425 million). DoD incurs nonmedical costs related to tobacco use, excess weight and obesity, and high alcohol consumption in excess of $965 million per year. Unhealthy lifestyles are significant contributors to the cost of providing healthcare services to the nation's military personnel, military retirees, and their dependents. The continued rise in healthcare costs could impact other DoD programs and could potentially affect areas related to military capability and readiness. In 2006, DoD initiated Healthy Choices for Life initiatives to address the high cost of unhealthy lifestyles and behaviors, and the DoD continues to monitor lifestyle trends through the DoD Lifestyle Assessment Program.

A case study in electricity regulation: Theory, evidence, and policy

NASA Astrophysics Data System (ADS)

Luk, Stephen Kai Ming

This research provides a thorough empirical analysis of the problem of excess capacity found in the electricity supply industry in Hong Kong. I utilize a cost-function based temporary equilibrium framework to investigate empirically whether the current regulatory scheme encourages the two utilities to overinvest in capital, and how much consumers would have saved if the underutilized capacity is eliminated. The research is divided into two main parts. The first section attempts to find any evidence of over-investment in capital. As a point of departure from traditional analysis, I treat physical capital as quasi-fixed, which implies a restricted cost function to represent the firm's short-run cost structure. Under such specification, the firm minimizes the cost of employing variable factor inputs subject to predetermined levels of quasi-fixed factors. Using a transcendental logarithmic restricted cost function, I estimate the cost-side equivalent of marginal product of capital, or commonly referred to as "shadow values" of capital. The estimation results suggest that the two electric utilities consistently over-invest in generation capacity. The second part of this research focuses on the economies of capital utilization, and the estimation of distortion cost in capital investment. Again, I utilize a translog specification of the cost function to estimate the actual cost of the excess capacity, and to find out how much consumers could have saved if the underutilized generation capacity were brought closer to the international standard. Estimation results indicate that an increase in the utilization rate can significantly reduce the costs of both utilities. And if the current excess capacity were reduced to the international standard, the combined savings in costs for both firms will reach 4.4 billion. This amount of savings, if redistributed to all consumers evenly, will translate into a 650 rebate per capita. Finally, two policy recommendations: a more stringent policy towards capacity expansion and the creation of a reimbursement program, are discussed.

Breast cancer treatment costs in younger, privately insured women.

PubMed

Allaire, Benjamin T; Ekwueme, Donatus U; Poehler, Diana; Thomas, Cheryll C; Guy, Gery P; Subramanian, Sujha; Trogdon, Justin G

2017-07-01

Younger women (under age 45 years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, lower survival rates, and greater financial hardship. The purpose of this study was to estimate breast cancer costs by stage at diagnosis during the first 18 months of treatment for privately insured younger women. We analyzed North Carolina cancer registry data linked to claims data from private insurers from 2003 to 2010. Breast cancer patients were split into two cohorts: a younger and older group aged 21-44 and 45-64 years, respectively. We conducted a cohort study and matched women with and without breast cancer using age, ZIP, and Charlson Comorbidity Index. We calculated mean excess costs between breast cancer and non-breast cancer patients at 6, 12, and 18 months. For younger women, AJCC 6th edition stage II cancer was the most common at diagnosis (40%), followed by stage I (34%). On the other hand, older women had more stage I (46%) cancer followed by stage II (34%). The excess costs for younger and older women at 12 months were $97,486 (95% confidence interval [CI] $93,631-101,341) and $75,737 (95% CI $73,962-77,512), respectively. Younger breast cancer patients had both a higher prevalence of later-stage disease and higher within-stage costs. The study reports high costs of treatment for both younger and older women than a non-cancer comparison group; however, the estimated excess cost was significantly higher for younger women. The financial implications of breast cancer treatment costs for younger women need to be explored in future studies.

Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent.

PubMed

Calhoun, Byron C; Shadigian, Elizabeth; Rooney, Brent

2007-10-01

To investigate the human and monetary cost consequences of preterm delivery as related to induced abortion (IA), with its impact on informed consent and medical malpractice. A review of the literature in English was performed to assess the effect of IA on preterm delivery rates from 24 to 31 6/7 weeks to assess the risk for preterm birth attributable to IA. After calculating preterm birth risk, the increased initial neonatal hospital costs and cerebral palsy (CP) risks related to IA were calculated. IA increased the early preterm delivery rate by 31.5%, with a yearly increase in initial neonatal hospital costs related to IA of > $1.2 billion. The yearly human cost includes 22,917 excess early preterm births (EPB) (< 32 weeks) and 1096 excess CP cases in very-low-birth-weight newborns, <1500 g. IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetric care and abortion should be aware of the risk of preterm birth attributable to induced abortion, with its significant increase in initial neonatal hospital costs and CP cases.

TRADING ALLOWANCES FOR STORMWATER CONTROL: ACCOUNTING FOR CONTINUOUS HYDROLOGY AND OPPORTUNITY COSTS

EPA Science Inventory

Excess stormwater runoff is a serious problem in a large number of urban areas, causing flooding, water pollution, groundwater recharge deficits and ecological damage to urban streams. It has been posited that to mitigate the effects of excess stormwater runoff, policy makers cou...

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

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

Lybarger, J.A.; Spengler, R.F.; Brown, D.R.

1998-10-01

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

Report: City of Elizabeth, New Jersey -Excess Clean Water State Revolving Funds Claimed

EPA Pesticide Factsheets

Report #08-2-0062, January 23, 2008. The grantee claimed and was reimbursed under its Clean Water State Revolving Fund loan in excess of actual costs incurred, contrary to the requirements of Title 40, Code of Federal Regulations, Section 35.3155 (d)(2).

The Costs and Consequences of Excess Credit Hours Policies

ERIC Educational Resources Information Center

Kramer, Dennis A., II; Holcomb, Michael R.; Kelchen, Robert

2018-01-01

The growth of the public discourse on college completion and student debt has pushed policymakers and institutional leaders to implement a variety of policies aimed at incentivizing student completion. This article examines state-adopted excess credit hour (ECH) policies on student completion and median debt outcomes. Using a quasi-experimental…

Caveats, Qualms, and Quibbles: A Revisionist View of Library Automation.

ERIC Educational Resources Information Center

Cart, Michael

1987-01-01

Describes problems in the current state of library automation, including too much jargon, excessive costs, excessive implementation time, and systems that don't work. An example is given of one public library's conservative approach to library automation which husbands resources for the maintenance and expansion of print collections and…

Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change.

PubMed

Lin, Shao; Hsu, Wan-Hsiang; Van Zutphen, Alissa R; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-11-01

Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. The estimated respiratory disease burden attributable to extreme heat at baseline (1991-2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080-2099 based on three different climate scenarios ranged from 206-607 excess hospital admissions, US$26-$76 million in hospitalization costs, and 1,299-3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080-2099 than in 1991-2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.

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.

Ceftazidime dosing in the elderly: economic implications.

PubMed

Vlasses, P H; Bastion, W A; Behal, R; Sirgo, M A

1993-01-01

This study evaluated the prevalence and resulting costs of ceftazidime dosing in excess of product labeling recommendations in elderly hospitalized patients. Ceftazidime is a beta-lactam antibiotic excreted via glomerular filtration. According to product labeling, ceftazidime dosing can frequently be decreased in the elderly because glomerular filtration declines with age. A multicenter, retrospective utilization audit involving 11 US academic medical centers examined 221 medical records of patients 65 years of age or older receiving ceftazidime (any brand, any indication). The creatinine clearance of each patient was estimated using the Cockcroft-Gault formula. Renal insufficiency, defined as an estimated creatinine clearance of less than 50 mL/min, was present in 111 of the patients (50 percent). Ceftazidime dosing in excess of product labeling recommendations was noted in 75 of those 111 (68 percent). The cost of excess ceftazidime dosing for those 75 patients (i.e., extra drug acquisition, preparation, administration) was $13,822.50. Although the dosage of ceftazidime required in a specific patient is based on many factors, ceftazidime is frequently overdosed in the elderly because renal function is not considered. Ceftazidime dose-adjustment in the elderly, based on the estimated creatinine clearance, can lead to cost savings. In the US, where hospital reimbursement by Medicare is based on diagnosis, institutions can realize direct cost savings.

12 CFR 404.9 - Schedule of fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... attempt to conduct searches in the most efficient manner to minimize costs for both Ex-Im Bank and the... as follows: (1) Commercial use requesters. Ex-Im Bank shall charge the full costs for search, review... shall charge only for the cost of duplication in excess of 100 pages. No fee will be charged for search...

12 CFR 404.9 - Schedule of fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... attempt to conduct searches in the most efficient manner to minimize costs for both Ex-Im Bank and the... as follows: (1) Commercial use requesters. Ex-Im Bank shall charge the full costs for search, review... shall charge only for the cost of duplication in excess of 100 pages. No fee will be charged for search...

12 CFR 404.9 - Schedule of fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... attempt to conduct searches in the most efficient manner to minimize costs for both Ex-Im Bank and the... as follows: (1) Commercial use requesters. Ex-Im Bank shall charge the full costs for search, review... shall charge only for the cost of duplication in excess of 100 pages. No fee will be charged for search...

12 CFR 404.9 - Schedule of fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... attempt to conduct searches in the most efficient manner to minimize costs for both Ex-Im Bank and the... as follows: (1) Commercial use requesters. Ex-Im Bank shall charge the full costs for search, review... shall charge only for the cost of duplication in excess of 100 pages. No fee will be charged for search...

76 FR 72666 - Pipeline Safety: Expanding the Use of Excess Flow Valves in Gas Distribution Systems to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

... technical feasibility and cost of the installation of such valves; (D) The public safety benefits of the... public comment regarding the technical challenges, and the potential costs and the potential benefits of... a cost-benefit perspective. DATES: Persons interested in submitting written comments on this ANPRM...

The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention.

PubMed

Becker, Christian; Holle, Rolf; Stollenwerk, Björn

2015-06-01

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€-36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An economic analysis of adherence engineering to improve use of best practices during central line maintenance procedures.

PubMed

Nelson, Richard E; Angelovic, Aaron W; Nelson, Scott D; Gleed, Jeremy R; Drews, Frank A

2015-05-01

Adherence engineering applies human factors principles to examine non-adherence within a specific task and to guide the development of materials or equipment to increase protocol adherence and reduce human error. Central line maintenance (CLM) for intensive care unit (ICU) patients is a task through which error or non-adherence to protocols can cause central line-associated bloodstream infections (CLABSIs). We conducted an economic analysis of an adherence engineering CLM kit designed to improve the CLM task and reduce the risk of CLABSI. We constructed a Markov model to compare the cost-effectiveness of the CLM kit, which contains each of the 27 items necessary for performing the CLM procedure, compared with the standard care procedure for CLM, in which each item for dressing maintenance is gathered separately. We estimated the model using the cost of CLABSI overall ($45,685) as well as the excess LOS (6.9 excess ICU days, 3.5 excess general ward days). Assuming the CLM kit reduces the risk of CLABSI by 100% and 50%, this strategy was less costly (cost savings between $306 and $860) and more effective (between 0.05 and 0.13 more quality-adjusted life-years) compared with not using the pre-packaged kit. We identified threshold values for the effectiveness of the kit in reducing CLABSI for which the kit strategy was no longer less costly. An adherence engineering-based intervention to streamline the CLM process can improve patient outcomes and lower costs. Patient safety can be improved by adopting new approaches that are based on human factors principles.

Estimating the energetic cost of feeding excess dietary nitrogen to dairy cows

USDA-ARS?s Scientific Manuscript database

Feeding N in excess of requirements could require the use of additional energy to synthesize and excrete urea, however, the amount energy required is unclear. Little progress has been made on this topic in recent decades so an extension of work published in 1970 was conducted to quantify the effect ...

Healthcare Costs Among Patients with Excessive Sleepiness Associated with Obstructive Sleep Apnea, Shift Work Disorder, or Narcolepsy

PubMed Central

Carlton, Rashad; Lunacsek, Orsolya; Regan, Timothy; Carroll, Cathryn A.

2014-01-01

Background Excessive daytime sleepiness affects nearly 20% of the general population and is associated with many medical conditions, including shift work disorder (SWD), obstructive sleep apnea (OSA), and narcolepsy. Excessive sleepiness imposes a significant clinical, quality-of-life, safety, and economic burden on society. Objective To compare healthcare costs for patients receiving initial therapy with armodafinil or with modafinil for the treatment of excessive sleepiness associated with OSA, SWD, or narcolepsy. Methods A retrospective cohort analysis of medical and pharmacy claims was conducted using the IMS LifeLink Health Plan Claims Database. Patients aged ≥18 years who had a pharmacy claim for armodafinil or for modafinil between June 1, 2009, and February 28, 2012, and had 6 months of continuous eligibility before the index prescription date, as well as International Classification of Diseases, Ninth Revision diagnosis for either OSA (327.23), SWD (327.36), or narcolepsy (347.0x) were included in the study. Patients were placed into 1 of 2 treatment cohorts based on their index prescription and followed for 1 month minimum and 34 months maximum. The annualized all-cause costs were calculated by multiplying the average per-month medical and pharmacy costs for each patient by 12 months. The daily average consumption (DACON) for armodafinil or for modafinil was calculated by dividing the total units dispensed of either drug by the prescription days supply. Results A total of 5693 patients receiving armodafinil and 9212 patients receiving modafinil were included in this study. A lower DACON was observed for armodafinil (1.04) compared with modafinil (1.47). The postindex mean medical costs were significantly lower for the armodafinil cohort compared with the modafinil cohort after adjusting for baseline differences ($11,363 vs $13,775, respectively; P = .005). The mean monthly drug-specific pharmacy costs were lower for the armodafinil cohort compared with the modafinil cohort ($166 vs $326, respectively; P <.001). In addition, lower total healthcare costs were observed for the armodafinil cohort compared with the modafinil cohort after correcting for baseline differences ($18,309 vs $23,530, respectively; P <.001). Conclusion As shown in this analysis, armodafinil may have real-world DACON advantages and may be associated with lower overall healthcare costs compared with modafinil. PMID:25558302

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

Sargent, S.A.; Pierson, T.R.; Steffe, J.F.

Apple juice processors generating up to 100 ton/day (90,718 kg/day) of pomace and incurring no disposal costs could not economically invest in a pile burning, fluidized-bed or suspension-fired system at present fossil fuel costs. Cost analysis is warranted for situations in which disposal costs are greater than $9.15/ton ($8.30/1000 kg) or in which fossil fuel price increases are expected in excess of 25%.

Biological sludge solubilisation for reduction of excess sludge production in wastewater treatment process.

PubMed

Yamaguchi, T; Yao, Y; Kihara, Y

2006-01-01

A novel sludge disintegration system (JFE-SD system) was developed for the reduction of excess sludge production in wastewater treatment plants. Chemical and biological treatments were applied to disintegrate excess sludge. At the first step, to enhance biological disintegration, the sludge was pretreated with alkali. At the second step, the sludge was disintegrated by biological treatment. Many kinds of sludge degrading microorganisms integrated the sludge. The efficiency of the new sludge disintegration system was confirmed in a full-scale experiment. The JFE-SD system reduced excess sludge production by approximately 50% during the experimental period. The quality of effluent was kept at quite a good level. Economic analysis revealed that this system could significantly decrease the excess sludge treatment cost.

Applying cost analyses to drive policy that protects children. Mercury as a case study

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

Leonardo Trasande; Clyde Schechter; Karla A. Haynes

2006-09-15

Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging frommore » 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually. $1.3 billion of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 excess cases of mental retardation annually. This number accounts for 3.2% of MR cases in the United States. If the lifetime excess cost of a case of MR is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually. Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.« less

Programmes for tobacco and alcohol users in Australian work-places.

PubMed

Richmond, R; Heather, N; Holt, P

1996-12-01

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life-style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work-place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one-quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.

The clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial

PubMed Central

Crawford, Mike J; Sanatinia, Rahil; Barrett, Barbara; Byford, Sarah; Dean, Madeleine; Green, John; Jones, Rachael; Leurent, Baptiste; Sweeting, Michael J; Touquet, Robin; Greene, Linda; Tyrer, Peter; Ward, Helen; Lingford-Hughes, Anne

2015-01-01

Objectives To examine the clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people who attend sexual health clinics. Methods Two-arm, parallel group, assessor blind, pragmatic, randomised controlled trial. 802 people aged 19 years or over who attended one of three sexual health clinics and were drinking excessively were randomised to either brief advice or control treatment. Brief advice consisted of feedback on alcohol and health, written information and an offer of an appointment with an Alcohol Health Worker. Control participants received a leaflet on health and lifestyle. The primary outcome was mean weekly alcohol consumption during the previous 90 days measured 6 months after randomisation. The main secondary outcome was unprotected sex during this period. Results Among the 402 randomised to brief advice, 397 (99%) received it. The adjusted mean difference in alcohol consumption at 6 months was −2.33 units per week (95% CI −4.69 to 0.03, p=0.053) among those in the active compared to the control arm of the trial. Unprotected sex was reported by 154 (53%) of those who received brief advice, and 178 (59%) controls (adjusted OR=0.89, 95% CI 0.63 to 1.25, p=0.496). There were no significant differences in costs between study groups at 6 months. Conclusions Introduction of universal screening and brief advice for excessive alcohol use among people attending sexual health clinics does not result in clinically important reductions in alcohol consumption or provide a cost-effective use of resources. Trial registration number Current Controlled Trials ISRCTN 99963322. PMID:24936090

The Treatment of Capital Costs in Educational Projects

ERIC Educational Resources Information Center

Bezeau, Lawrence

1975-01-01

Failure to account for the cost and depreciation of capital leads to suboptimal investments in education, specifically to excessively capital intensive instructional technologies. This type of error, which is particularly serious when planning for developing countries, can be easily avoided. (Author)

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

PubMed Central

Hsu, Wan-Hsiang; Van Zutphen, Alissa R.; Saha, Shubhayu; Luber, George; Hwang, Syni-An

2012-01-01

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change. Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata. Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation. Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics. Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial. PMID:22922791

Impact of the Volkswagen emissions control defeat device on US public health

NASA Astrophysics Data System (ADS)

Barrett, Steven R. H.; Speth, Raymond L.; Eastham, Sebastian D.; Dedoussi, Irene C.; Ashok, Akshay; Malina, Robert; Keith, David W.

2015-11-01

The US Environmental Protection Agency (EPA) has alleged that Volkswagen Group of America (VW) violated the Clean Air Act (CAA) by developing and installing emissions control system ‘defeat devices’ (software) in model year 2009-2015 vehicles with 2.0 litre diesel engines. VW has admitted the inclusion of defeat devices. On-road emissions testing suggests that in-use NOx emissions for these vehicles are a factor of 10 to 40 above the EPA standard. In this paper we quantify the human health impacts and associated costs of the excess emissions. We propagate uncertainties throughout the analysis. A distribution function for excess emissions is estimated based on available in-use NOx emissions measurements. We then use vehicle sales data and the STEP vehicle fleet model to estimate vehicle distance traveled per year for the fleet. The excess NOx emissions are allocated on a 50 km grid using an EPA estimate of the light duty diesel vehicle NOx emissions distribution. We apply a GEOS-Chem adjoint-based rapid air pollution exposure model to produce estimates of particulate matter and ozone exposure due to the spatially resolved excess NOx emissions. A set of concentration-response functions is applied to estimate mortality and morbidity outcomes. Integrated over the sales period (2008-2015) we estimate that the excess emissions will cause 59 (95% CI: 10 to 150) early deaths in the US. When monetizing premature mortality using EPA-recommended data, we find a social cost of ˜450m over the sales period. For the current fleet, we estimate that a return to compliance for all affected vehicles by the end of 2016 will avert ˜130 early deaths and avoid ˜840m in social costs compared to a counterfactual case without recall.

34 CFR 300.202 - Use of amounts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... this part; (2) Must be used only to pay the excess costs of providing special education and related... B of the Act to pay for all of the costs directly attributable to the education of a child with a... prevent an LEA from using Part B funds to pay for all of the costs directly attributable to the education...

34 CFR 300.202 - Use of amounts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... this part; (2) Must be used only to pay the excess costs of providing special education and related... B of the Act to pay for all of the costs directly attributable to the education of a child with a... prevent an LEA from using Part B funds to pay for all of the costs directly attributable to the education...

Economic burden associated with alcohol dependence in a German primary care sample: a bottom-up study.

PubMed

Manthey, Jakob; Laramée, Philippe; Parrott, Steve; Rehm, Jürgen

2016-08-31

A considerable economic burden has been repeatedly associated with alcohol dependence (AD) - mostly calculated using aggregate data and alcohol-attributable fractions (top-down approach). However, this approach is limited by a number of assumptions, which are hard to test. Thus, cost estimates should ideally be validated with studies using individual data to estimate the same costs (bottom-up approach). However, bottom-up studies on the economic burden associated with AD are lacking. Our study aimed to fill this gap using the bottom-up approach to examine costs for AD, and also stratified the results by the following subgroups: sex, age, diagnostic approach and severity of AD, as relevant variations could be expected by these factors. 1356 primary health care patients, representative for two German regions. AD was diagnosed by a standardized instrument and treating physicians. Individual costs were calculated by combining resource use and productivity data representing a period of six months prior to the time of interview, with unit costs derived from the literature or official statistics. The economic burden associated with AD was determined via excess costs by comparing utilization of various health care resources and impaired productivity between people with and without AD, controlling for relevant confounders. Additional analyses for several AD characteristics were performed. Mean costs among alcohol dependent patients were 50 % higher compared to the remaining patients, resulting in 1836 € excess costs per alcohol dependent patient in 6 months. More than half of these excess costs incurred through increased productivity loss among alcohol dependent patients. Treatment for alcohol problems represents only 6 % of these costs. The economic burden associated with AD incurred mainly among males and among 30 to 49 year old patients. Both diagnostic approaches were significantly related to the economic burden, while costs increased with alcohol use disorder severity but not with other AD severity indicators. Our study confirms previous studies using top-down approaches to estimate the economic burden associated with AD. Further, we highlight the need for efforts aimed at preventing adverse outcomes for health and occupational situation associated with alcohol dependence based on factors associated with particularly high economic burden.

Middle-Aged Thinking.

ERIC Educational Resources Information Center

Nixon, Charles W.

1998-01-01

Examines renovation issues involving 30- and 40-year-old school facilities. Explores ways a school district can renovate old buildings to first-class cost-effective facilities while avoiding excessive transition costs. Discussions include installation of new technology and the resulting wiring demands, and developing more energy-efficient heating…

Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals.

PubMed

Schweizer, Marin L; Cullen, Joseph J; Perencevich, Eli N; Vaughan Sarrazin, Mary S

2014-06-01

Surgical site infections (SSIs) are potentially preventable complications that are associated with excess morbidity and mortality. To determine the excess costs associated with total, deep, and superficial SSIs among all operations and for high-volume surgical specialties. Surgical patients from 129 Veterans Affairs (VA) hospitals were included. The Veterans Health Administration Decision Support System and VA Surgical Quality Improvement Program databases were used to assess costs associated with SSIs among VA patients who underwent surgery in fiscal year 2010. Linear mixed-effects models were used to evaluate incremental costs associated with SSIs, controlling for patient risk factors, surgical risk factors, and hospital-level variation in costs. Costs of the index hospitalization and subsequent 30-day readmissions were included. Additional analysis determined potential cost savings of quality improvement programs to reduce SSI rates at hospitals with the highest risk-adjusted SSI rates. Among 54,233 VA patients who underwent surgery, 1756 (3.2%) experienced an SSI. Overall, 0.8% of the cohort had a deep SSI, and 2.4% had a superficial SSI. The mean unadjusted costs were $31,580 and $52,620 for patients without and with an SSI, respectively. In the risk-adjusted analyses, the relative costs were 1.43 times greater for patients with an SSI than for patients without an SSI (95% CI, 1.34-1.52; difference, $11,876). Deep SSIs were associated with 1.93 times greater costs (95% CI, 1.71-2.18; difference, $25,721), and superficial SSIs were associated with 1.25 times greater costs (95% CI, 1.17-1.35; difference, $7003). Among the highest-volume specialties, the greatest mean cost attributable to SSIs was $23,755 among patients undergoing neurosurgery, followed by patients undergoing orthopedic surgery, general surgery, peripheral vascular surgery, and urologic surgery. If hospitals in the highest 10th percentile (ie, the worst hospitals) reduced their SSI rates to the rates of the hospitals in the 50th percentile, the Veterans Health Administration would save approximately $6.7 million per year. Surgical site infections are associated with significant excess costs. Among analyzed surgery types, deep SSIs and SSIs among neurosurgery patients are associated with the highest risk-adjusted costs. Large potential savings per year may be achieved by decreasing SSI rates.

The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study.

PubMed

White, Barry A B; Dea, Nicolas; Street, John T; Cheng, Christiana L; Rivers, Carly S; Attabib, Najmedden; Kwon, Brian K; Fisher, Charles G; Dvorak, Marcel F

2017-10-15

Secondary complications of spinal cord injury (SCI) are a burden to affected individuals and the rest of society. There is limited evidence of the economic burden or cost of complications in SCI populations in Canada, however, which is necessary for comparative economic analyses and decision analytic modeling of possible solutions to these common health problems. Comparative economic analyses can inform resource allocation decisions, but the outputs are only as good as the inputs. In this article, new evidence of the excess or incremental costs of urinary tract infection (UTI) and pressure ulceration (PU) in acute traumatic SCI from an exploratory case series analysis of admissions to a Level I specialized Canadian spine facility (2008-2013) is presented. Participants in a national SCI registry were case-control matched (1:1) on the predicted probability of experiencing UTI or PU during initial acute SCI admission. The excess costs of UTI and PU are estimated as the mean of the differences in total direct acute SCI admission costs (length of stay, accommodation, nursing, pharmacy) from the perspective of the admitting facility between participants matched or paired on demographic and SCI characteristics. Even relatively minor UTI and PU, respectively, added an average of $7,790 (standard deviation [SD] $6,267) and $18,758 (SD $27,574) to the direct cost of acute SCI admission in 2013 Canadian dollars (CAD). This case series analysis established evidence of the excess costs of UTI and PU in acute SCI admissions, which will support decision-informing analyses in SCI.

Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs.

PubMed

Song, Xiaoyan; Srinivasan, Arjun; Plaut, David; Perl, Trish M

2003-04-01

To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it. A population-based, matched, historical cohort study. A 1,025-bed, university-based teaching facility and referral hospital. Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000. The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, dollars 77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and dollars 81,208, respectively. Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

Regional Public Health Cost Estimates of Contaminated Coastal Waters: A Case Study of Gastroenteritis at Southern California Beaches

NASA Astrophysics Data System (ADS)

Given, S.; Pendleton, L.; Boehm, A.

2007-05-01

We present estimates of annual public health impacts, both illnesses and cost of illness,attributable to excess gastrointestinal illnesses caused by swimming in contaminated coastal waters at beaches in southern California, USA. Beach-specific enterococci densities are used as inputs to two epidemiological dose-response models to predict the risk of gastrointestinal illness at 28 beaches spanning 160 km of coastline in Los Angeles and Orange Counties. We use attendance data along with the health cost of gastrointestinal illness to estimate the number of illnesses among swimmers . We estimate that between 627,800 and 1,479,200 excess gastrointestinal illnesses occur at beaches in Los Angeles and Orange Counties each year. Using a conservative health cost of gastroenteritis, this corresponds to an annual economic loss of 21 or 51 million depending upon the underlying epidemiological model used (in year 2000 dollars). Results demonstrate that improving coastal water quality could result in a reduction of gastrointestinal illnesses locally and a concurrent savings in expenditures on related health care costs.

Excess costs of dementia disorders and the role of age and gender - an analysis of German health and long-term care insurance claims data

PubMed Central

2012-01-01

Background Demographic ageing is associated with an increasing number of dementia patients, who reportedly incur higher costs of care than individuals without dementia. Regarding Germany, evidence on these excess costs is scarce. Adopting a payer perspective, our study aimed to quantify the additional yearly expenditures per dementia patient for various health and long-term care services. Additionally, we sought to identify gender-specific cost patterns and to describe age-dependent cost profiles. Methods The analyses used 2006 claims data from the AOK Bavaria Statutory Health Insurance fund of 9,147 dementia patients and 29,741 age- and gender-matched control subjects. Cost predictions based on two-part regression models adjusted for age and gender and excess costs of dementia care refer to the difference in model-estimated means between both groups. Corresponding analyses were performed stratified for gender. Finally, a potentially non-linear association between age and costs was investigated within a generalized additive model. Results Yearly spending within the social security system was circa €12,300 per dementia patient and circa €4,000 per non-demented control subject. About two-thirds of the additional expenditure for dementia patients occurred in the long-term care sector. Within our study sample, male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age. Conclusions Dementia poses a substantial additional burden to the German social security system, with the long-term care sector being more seriously challenged than the health care sector. Our results suggest that female dementia patients need to be seen as a key target group for health services research in an ageing society. It seems clear that strategies enabling community-based care for this vulnerable population might contribute to lowering the financial burden caused by dementia. This would allow for the sustaining of comprehensive dementia care within the social security system. PMID:22713212

Long-term economic consequences of child maltreatment: a population-based study.

PubMed

Thielen, Frederick W; Ten Have, Margreet; de Graaf, Ron; Cuijpers, Pim; Beekman, Aartjan; Evers, Silvia; Smit, Filip

2016-12-01

Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.

26 CFR 1.936-4 - Intangible property income in the absence of an election out.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 1, 1983, to use the cost-plus method of pricing without reflecting a return from intangibles, but... and its affiliates do not make an election under either the cost sharing or 50/50 profit split option... disposition of any product or from the rendering of a service which is in excess of the reasonable costs it...

48 CFR 9903.201-1 - CAS applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST... contracts. (2) Negotiated contracts and subcontracts not in excess of $650,000. For purposes of this... price adjustment (provided that price adjustment is not based on actual costs incurred), time-and...

Effect of deflocculation on the efficiency of disperser induced dairy waste activated sludge disintegration and treatment cost.

PubMed

Devi, T Poornima; Ebenezer, A Vimala; Kumar, S Adish; Kaliappan, S; Banu, J Rajesh

2014-09-01

Excess sludge disintegration by energy intensive processes like mechanical pretreatment is considered to be high in cost. In this study, an attempt has been made to disintegrate excess sludge by disperser in a cost effective manner by deflocculating the sludge using sodium dodecyl sulphate (SDS) at a concentration of 0.04 g/g SS. The disperser pretreatment was effective at a specific energy input of 5013 kJ/kg TS where deflocculated sludge showed higher chemical oxygen demand solubilisation and suspended solids reduction of 26% and 22.9% than flocculated sludge and was found to be 18.8% and 18.6% for former and latter respectively. Higher accumulation of volatile fatty acid (700 mg/L) in deflocculated sludge indicates better hydrolysis of sludge by proposed method. The anaerobic biodegradability resulted in higher biogas production potential of 0.522 L/(g VS) for deflocculated sludge. Cost analysis of the study showed 43% net energy saving in deflocculated sludge. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pyrimethanil degradation by photo-Fenton process: Influence of iron and irradiance level on treatment cost.

PubMed

Cabrera Reina, A; Miralles-Cuevas, S; Casas López, J L; Sánchez Pérez, J A

2017-12-15

This study evaluates the combined effect of photo-catalyst concentration and irradiance level on photo-Fenton efficiency when this treatment is applied to industrial wastewater decontamination. Three levels of irradiance (18, 32 and 46W/m 2 ) and three iron concentrations (8, 20 and 32mg/L) were selected and their influence over the process studied using a raceway pond reactor placed inside a solar box. For 8mg/L, it was found that there was a lack of catalyst to make use of all the available photons. For 20mg/L, the treatment always improved with irradiance indicating that the process was photo-limited. For 32mg/L, the excess of iron caused an excess of radicals production which proved to be counter-productive for the overall process efficiency. The economic assessment showed that acquisition and maintenance costs represent the lowest relative values. The highest cost was found to be the cost of the reagents consumed. Both sulfuric acid and sodium hydroxide are negligible in terms of costs. Iron cost percentages were also very low and never higher than 10.5% while the highest cost was always that of hydrogen peroxide, representing at least 85% of the reagent costs. Thus, the total costs were between 0.76 and 1.39€/m 3 . Copyright © 2017 Elsevier B.V. All rights reserved.

DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status.

PubMed

Sonntag, Diana; Jarczok, Marc N; Ali, Shehzad

2017-09-01

The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups. © 2017 The Obesity Society.

Scrutinizing data helps team target high-cost DRGs, improve costly tracheostomy care.

PubMed

1997-10-01

Targeting high-cost DRGs using data collection, analysis: A hospital team analyzed DRGs with the highest excess charges and found DRG 483 (tracheostomy) had astronomical charges. Here's the step-by-step story of how they analyzed individual physician resource utilization, care progression through the hospital, and admission source to identify areas for clinical improvement, plus their findings and how they're putting them to use to improve care and reduce costs.

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.

Application of kaolin-based catalysts in biodiesel production via transesterification of vegetable oils in excess methanol.

PubMed

Dang, Tan Hiep; Chen, Bing-Hung; Lee, Duu-Jong

2013-10-01

Biodiesel production from transesterification of vegetable oils in excess methanol was performed by using as-prepared catalyst from low-cost kaolin clay. This effective heterogeneous catalyst was successfully prepared from natural kaolin firstly by dehydroxylation at 800°C for 10h and, subsequently, by NaOH-activation hydrothermally at 90°C for 24h and calcined again at 500°C for 6h. The as-obtained catalytic material was characterized with instruments, including FT-IR, XRD, SEM, and porosimeter (BET/BJH analysis). The as-prepared catalyst was advantageous not only for its easy preparation, but also for its cost-efficiency and superior catalysis in transesterification of vegetable oils in excess methanol to produce fatty acid methyl esters (FAMEs). Conversion efficiencies of soybean and palm oils to biodiesel over the as-prepared catalysts reached 97.0±3.0% and 95.4±3.7%, respectively, under optimal conditions. Activation energies of transesterification reactions of soybean and palm oils in excess methanol using these catalysts are 14.09 kJ/mol and 48.87 kJ/mol, respectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

Treating catfish diseases: walking the line between excess and moderation

USDA-ARS?s Scientific Manuscript database

Cost savings by using a cheaper disease treatment will increase profitability of any catfish farm. This invited producer presentation will discuss costs savings using copper sulfate in catfish production and a summation of our research, specifically in the hatchery. Copper sulfate is not approved ...

The complications of trauma and their associated costs in a level I trauma center.

PubMed

O'Keefe, G E; Maier, R V; Diehr, P; Grossman, D; Jurkovich, G J; Conrad, D

1997-08-01

To estimate the expected costs for acute trauma care, to quantify the costs associated with the development of complications in injury victims, and to determine the deficit incurred by patients in whom complications develop. A retrospective, cohort design. A referral trauma center. A total of 12,088 patients admitted to a single regional trauma center during a period of 5 years. This is an observational study, and no interventions specific to this study are included in the design. (1) The expected costs for injury victims based on readily available clinical data. (2) The costs associated with the most important complications of trauma. (3) The effect of complications on inadequate reimbursement for trauma care. The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14,567, and the observed costs averaged $15,032. Six complications were important predictors of cost. These included adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23,266 and the observed costs averaged $47,457. The mean excess costs for a single complication ranged from $6669 to $18,052. Multiple complications led to greater increases in excess cost, averaging $110,007 for the 62 patients with 3 or more complications. Costs exceeded reimbursement to a much greater degree in those in whom any of the 6 complications developed. Expected hospital costs can be estimated using admission clinical data. Each of 6 complications was associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.

The development of multi-objective optimization model for excess bagasse utilization: A case study for Thailand

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

Buddadee, Bancha; Wirojanagud, Wanpen; Watts, Daniel J.

In this paper, a multi-objective optimization model is proposed as a tool to assist in deciding for the proper utilization scheme of excess bagasse produced in sugarcane industry. Two major scenarios for excess bagasse utilization are considered in the optimization. The first scenario is the typical situation when excess bagasse is used for the onsite electricity production. In case of the second scenario, excess bagasse is processed for the offsite ethanol production. Then the ethanol is blended with an octane rating of 91 gasoline by a portion of 10% and 90% by volume respectively and the mixture is used asmore » alternative fuel for gasoline vehicles in Thailand. The model proposed in this paper called 'Environmental System Optimization' comprises the life cycle impact assessment of global warming potential (GWP) and the associated cost followed by the multi-objective optimization which facilitates in finding out the optimal proportion of the excess bagasse processed in each scenario. Basic mathematical expressions for indicating the GWP and cost of the entire process of excess bagasse utilization are taken into account in the model formulation and optimization. The outcome of this study is the methodology developed for decision-making concerning the excess bagasse utilization available in Thailand in view of the GWP and economic effects. A demonstration example is presented to illustrate the advantage of the methodology which may be used by the policy maker. The methodology developed is successfully performed to satisfy both environmental and economic objectives over the whole life cycle of the system. It is shown in the demonstration example that the first scenario results in positive GWP while the second scenario results in negative GWP. The combination of these two scenario results in positive or negative GWP depending on the preference of the weighting given to each objective. The results on economics of all scenarios show the satisfied outcomes.« less

Employer-Sponsored Insurance, Health Care Cost Growth, and the Economic Performance of U.S. Industries

PubMed Central

Sood, Neeraj; Ghosh, Arkadipta; Escarce, José J

2009-01-01

Objective To estimate the effect of growth in health care costs that outpaces gross domestic product (GDP) growth (“excess” growth in health care costs) on employment, gross output, and value added to GDP of U.S. industries. Study Setting We analyzed data from 38 U.S. industries for the period 1987–2005. All data are publicly available from various government agencies. Study Design We estimated bivariate and multivariate regressions. To develop the regression models, we assumed that rapid growth in health care costs has a larger effect on economic performance for industries where large percentages of workers receive employer-sponsored health insurance (ESI). We used the estimated regression coefficients to simulate economic outcomes under alternative scenarios of health care cost inflation. Results Faster growth in health care costs had greater adverse effects on economic outcomes for industries with larger percentages of workers who had ESI. We found that a 10 percent increase in excess growth in health care costs would have resulted in 120,803 fewer jobs, US$28,022 million in lost gross output, and US$14,082 million in lost value added in 2005. These declines represent 0.17 to 0.18 percent of employment, gross output, and value added in 2005. Conclusion Excess growth in health care costs is adversely affecting the economic performance of U.S. industries. PMID:19500165

48 CFR 2834.002 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., although by virtue of the life cycle costs, it would otherwise be identified as “major” in response to OMB... information system. Within the Department of Justice, a major automated information system is one whose life-cycle cost is in excess of $100 million. (b) Major real property system. (1) By purchase, when the...

48 CFR 2834.002 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., although by virtue of the life cycle costs, it would otherwise be identified as “major” in response to OMB... information system. Within the Department of Justice, a major automated information system is one whose life-cycle cost is in excess of $100 million. (b) Major real property system. (1) By purchase, when the...

48 CFR 31.205-48 - Research and development costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Research and development... Organizations 31.205-48 Research and development costs. Research and development, as used in this subsection... grant for research and development effort, the excess is unallowable under any other Government contract...

48 CFR 31.205-48 - Research and development costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Research and development... Organizations 31.205-48 Research and development costs. Research and development, as used in this subsection... grant for research and development effort, the excess is unallowable under any other Government contract...

Reductions in High-End Imaging Utilization With Radiology Review and Consultation.

PubMed

Ingraham, Bailey; Miller, Kristen; Iaia, Alberto; Sneider, Michael B; Naqvi, Shabbir; Evans, Kimberly; Gheyi, Vinay; Anzilotti, Kert

2016-09-01

Following the uptake of value-based purchasing in concert with health care reform in the United States, providers, insurers, and patients are looking for ways to reduce excessive, dangerous, and/or inappropriate high-end imaging utilization (HEIU). Inappropriate HEIU is associated with patient safety risks due to unnecessary exposure to radiation, misappropriation of scarce equipment resources and staff, complications to clinical care, and needless, excessive costs for the patient, hospital, and payer. This paper presents a cost-effective radiology-initiated improvement program piloted in the Christiana Hospital Coordinated Care Network. The pilot demonstrated the effectiveness of regulating high-end imaging orders through radiologists' review of requests of the order as part of the consult process. Over the 2014-2015 fiscal year, 2,177 high-end imaging orders were reviewed by 26 radiologists for approval, rejection, or recommendation of an alternate examination. Of the orders, 86.7% (1887) were approved, 4.0% (87) were rejected, and 9.3% (203) received recommendation for an alternate examination. Based on improved patient safety, cost savings, and appropriate resource use, these findings suggest that radiologists' review can effectively reduce excessive HEIU. This method, with an appropriate algorithm to assist with handling a larger volume of orders, would be ideal to implement systemwide to manage HEIU cost efficiency, simultaneously providing radiologists with more control in their area of expertise and positively impacting quality, safety, and value-based purchasing goals. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation.

PubMed

Ben Ameur, Amal; Ridde, Valéry; Bado, Aristide R; Ingabire, Marie-Gloriose; Queuille, Ludovic

2012-11-21

In 2006, the Parliament of Burkina Faso passed a policy to reduce the direct costs of obstetric services and neonatal care in the country's health centres, aiming to lower the country's high national maternal mortality and morbidity rates. Implementation was via a "partial exemption" covering 80% of the costs. In 2008 the German NGO HELP launched a pilot project in two health districts to eliminate the remaining 20% of user fees. Regardless of any exemptions, women giving birth in Burkina Faso's health centres face additional expenses that often represent an additional barrier to accessing health services. We compared the total cost of giving birth in health centres offering partial exemption versus those with full exemption to assess the impact on additional out-of-pocket fees. A case-control study was performed to compare medical expenses. Case subjects were women who gave birth in 12 health centres located in the Dori and Sebba districts, where HELP provided full fee exemption for obstetric services and neonatal care. Controls were from six health centres in the neighbouring Djibo district where a partial fee exemption was in place. A random sample of approximately 50 women per health centre was selected for a total of 870 women. There was an implementation gap regarding the full exemption for obstetric services and neonatal care. Only 1.1% of the sample from Sebba but 17.5% of the group from Dori had excessive spending on birth related costs, indicating that women who delivered in Sebba were much less exposed to excessive medical expenses than women from Dori. Additional out-of-pocket fees in the full exemption health districts took into account household ability to pay, with poorer women generally paying less. We found that the elimination of fees for facility-based births benefits especially the poorest households. The existence of excessive spending related to direct costs of giving birth is of concern, making it urgent for the government to remove all direct fees for obstetric and neonatal care. However, the policy of completely abolishing user fees is insufficient; the implementation process must have a thorough monitoring system to reduce implementation gaps.

The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

PubMed

Croker, Richard; Smyth, Darren; Walker, Alex J; Goldacre, Ben

2018-06-07

Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. English primary care. English general practices. Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Medicare program; Medicare hospital reimbursement reforms: limitations on reimbursable costs and the rate of hospital cost increases--HCFA. Interim final rule with comment period.

PubMed

1982-09-30

These rules implement section 1886 of the Social Security Act (established by section 101 of the Tax Equity and Fiscal Responsibility Act of 1982). These rules amend current regulations on hospital cost limits, providing for new exemptions and exceptions. These amendments make exceptions available to hospitals consistent with the new cost limits published elsewhere in this issue of the Federal Register, and specifically exempt from those cost limits rural hospitals with less than 50 beds in existence as of the enactment of the law. These rules also set forth new regulations establishing a three-year ceiling on the allowable annual rate of increase in operating costs per case for inpatient hospital services. This ceiling takes the form of a target amount of cost per case against which a hospital's incurred cost per case will be compared. Hospitals are provided incentives to keep their cost increases below the target rate. A hospital that has costs per case less than the target amount will be paid a portion of the difference between actual cost and the target amount. A hospital that has costs per case that are greater than the target amount will be paid the target amount plus 25 percent of its costs in excess of the target for the first two years of the ceiling, and none of the excess in the third year. However, payment to a hospital under these new target rate regulations will not be greater than the amount determined under the new schedule of limits on hospital inpatient operating costs published elsewhere in this issue of the Federal Register.

Construction of VLCC marine oil storage cost index system

NASA Astrophysics Data System (ADS)

Li, Yuan; Li, Yule; Lu, Jinshu; Wu, Wenfeng; Zhu, Faxin; Chen, Tian; Qin, Beichen

2018-04-01

VLCC as the research object, the basic knowledge of VLCC is summarized. According to the phenomenon that VLCC is applied to offshore oil storage gradually, this paper applies the theoretical analysis method to analyze the excess capacity from VLCC, the drop of oil price, the aging VLCC is more suitable for offshore storage The paper analyzes the reason of VLCC offshore oil storage from three aspects, analyzes the cost of VLCC offshore storage from the aspects of manpower cost and shipping cost, and constructs the cost index system of VLCC offshore oil storage.

The Costs and Risks of Medical Care

PubMed Central

McPhee, Stephen J.; Myers, Lois P.; Schroeder, Steven A.

1982-01-01

Understanding the costs and risks of medical care, as well as the benefits, is essential to good medical practice. The literature on this topic transcends disciplines, making it a challenge for clinicians and medical educators to compile information on costs and risks for use in patient care. This annotated bibliography presents summaries of pertinent references on (1) financial costs of care, (2) excessive use of medical services, (3) clinical risks of care, (4) decision analysis, (5) cost-benefit analyses, (6) factors affecting physician use of services and (7) strategies to improve physician ordering patterns. PMID:6814071

Implications of comorbidity on costs for patients with Alzheimer disease.

PubMed

Kuo, Tzu-Chun; Zhao, Yang; Weir, Sharada; Kramer, Marilyn Schlein; Ash, Arlene S

2008-08-01

No prior studies have used a comprehensive clinical classification system to examine the effect of differences in overall illness burden and the presence of other diseases on costs for patients with Alzheimer disease (AD) when compared with demographically matched nondemented controls. Of a total of 627,775 enrollees who were eligible for medical and pharmacy benefits for 2003 and 2004 in the MarketScan Medicare Supplemental and Coordination of Benefits Database, we found 25,109 AD patients. For each case, 3 demographically matched nondemented controls were selected using propensity scores. Applying the diagnostic cost groups (DCGs) model to all enrollees, 2003 diagnoses were used to estimate prospective relative risk scores (RRSs) that predict 2004 costs from all illness other than AD. RRSs were then used to control for illness burden to estimate AD's independent effect on costs. Compared with the control group, the AD cohort has more comorbid conditions (8.1 vs. 6.5) and higher illness burden (1.23 vs. 1.04). Individuals with AD are more likely to have mental health conditions, neurologic conditions, cognitive disorders, cerebrovascular disease, diabetes with acute complications, and injuries. Annual costs for AD patients are $3567 (34%) higher than for controls. Excess costs attributable to AD, after controlling for non-AD illness burden, are estimated at $2307 per year with outpatient pharmacy being the key driver ($1711 in excess costs). AD patients are sicker and more expensive than demographically matched controls. Even after adjusting for differences in illness burden, costs remain higher for AD patients.

Applying cost analyses to drive policy that protects children: mercury as a case study.

PubMed

Trasande, Leonardo; Schechter, Clyde; Haynes, Karla A; Landrigan, Philip J

2006-09-01

Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually (range: $0.7-$13.9 billion, 2000 dollars). $1.3 billion (range: $51 million-$2.0 billion) of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 (range: 115-2675) excess cases of mental retardation (MR defined as IQ < 70) annually. This number accounts for 3.2% (range: 0.2-5.4%) of MR cases in the United States. If the lifetime excess cost of a case of MR (excluding individual productivity losses) is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually (range: $143 million-$3.3 billion). Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.

Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia.

PubMed

Reyes, J F; Wood, J G; Beutels, P; Macartney, K; McIntyre, P; Menzies, R; Mealing, N; Newall, A T

2017-01-05

Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction. We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations. Relative to the baseline period (1997-2006), over the 6years (2007-2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program. The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted bypre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs. Copyright © 2016. Published by Elsevier Ltd.

Estimating local costs associated with Clostridium difficile infection using machine learning and electronic medical records

PubMed Central

Pak, Theodore R.; Chacko, Kieran; O’Donnell, Timothy; Huprikar, Shirish; van Bakel, Harm; Kasarskis, Andrew; Scott, Erick R.

2018-01-01

Background Reported per-patient costs of Clostridium difficile infection (CDI) vary by two orders of magnitude among different hospitals, implying that infection control officers need precise, local analyses to guide rational decision-making between interventions. Objective We sought to comprehensively estimate changes in length of stay (LOS) attributable to CDI at one urban tertiary-care facility using only data automatically extractable from the electronic medical record (EMR). Methods We performed a retrospective cohort study of 171,938 visits spanning a 7-year period. 23,968 variables were extracted from EMR data recorded within 24 hours of admission to train elastic net regularized logistic regression models for propensity score matching. To address time-dependent bias (reverse causation), we separately stratified comparisons by time-of-infection and fit multistate models. Results The estimated difference in median LOS for propensity-matched cohorts varied from 3.1 days (95% CI, 2.2–3.9) to 10.1 days (95% CI, 7.3–12.2) depending on the case definition; however, dependency of the estimate on time-to-infection was observed. Stratification by time to first positive toxin assay, excluding probable community-acquired infections, showed a minimum excess LOS of 3.1 days (95% CI, 1.7–4.4). Under the same case definition, the multistate model averaged an excess LOS of 3.3 days (95% CI, 2.6–4.0). Conclusions Two independent time-to-infection adjusted methods converged on similar excess LOS estimates. Changes in LOS can be extrapolated to a marginal dollar costs by multiplying by average costs of an inpatient-day. Infection control officers can leverage automatically extractable EMR data to estimate costs of CDI at their own institution. PMID:29103378

Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment.

PubMed

Frick, Kevin D; Clark, Melissa A; Steinwachs, Donald M; Langenberg, Patricia; Stovall, Dale; Munro, Malcolm G; Dickersin, Kay

2009-01-01

In this study, we sought to 1) describe elements of the financial and quality-of-life burden of dysfunctional uterine bleeding (DUB) from the perspective of women who agreed to obtain surgical treatment; 2) explore associations between DUB symptom characteristics and the financial and quality-of-life burden; 3) estimate the annual dollar value of the financial burden; and 4) estimate the most that could be spent on surgery to eliminate DUB symptoms for which medical treatment has been unsuccessful that would result in a $50,000/quality-adjusted life-year incremental cost-effectiveness ratio. We collected baseline data on DUB symptoms and aspects of the financial and quality-of-life burden for 237 women agreeing to surgery for DUB in a randomized trial comparing hysterectomy with endometrial ablation. Measures included out-of-pocket pharmaceutical expenditures, excess expenditures on pads or tampons, the value of time missed from paid work and home management activities, and health utility. We used chi2 and t tests to assess the statistical significance of associations between DUB characteristics and the financial and quality-of-life burden. The annual financial burden was estimated. Pelvic pain and cramps were associated with activity limitations and tiredness was associated with a lower health utility. Excess pharmaceutical and pad and tampon costs were $333 per patient per year (95% confidence interval [CI], $263-$403). Excess paid work and home management loss costs were $2,291 per patient per year (95% CI, $1847-$2752). Effective surgical treatment costing $40,000 would be cost-effective compared with unsuccessful medical treatment. The financial and quality-of-life effects of DUB represent a substantial burden.

Public health impacts of excess NOx emissions from Volkswagen diesel passenger vehicles in Germany

NASA Astrophysics Data System (ADS)

Chossière, Guillaume P.; Malina, Robert; Ashok, Akshay; Dedoussi, Irene C.; Eastham, Sebastian D.; Speth, Raymond L.; Barrett, Steven R. H.

2017-03-01

In September 2015, the Volkswagen Group (VW) admitted the use of ‘defeat devices’ designed to lower emissions measured during VW vehicle testing for regulatory purposes. Globally, 11 million cars sold between 2008 and 2015 are affected, including about 2.6 million in Germany. On-road emissions tests have yielded mean on-road NOx emissions for these cars of 0.85 g km-1, over four times the applicable European limit of 0.18 g km-1. This study estimates the human health impacts and costs associated with excess emissions from VW cars driven in Germany. A distribution of on-road emissions factors is derived from existing measurements and combined with sales data and a vehicle fleet model to estimate total excess NOx emissions. These emissions are distributed on a 25 by 28 km grid covering Europe, using the German Federal Environmental Protection Agency’s (UBA) estimate of the spatial distribution of NOx emissions from passenger cars in Germany. We use the GEOS-Chem chemistry-transport model to predict the corresponding increase in population exposure to fine particulate matter and ozone in the European Union, Switzerland, and Norway, and a set of concentration-response functions to estimate mortality outcomes in terms of early deaths and of life-years lost. Integrated over the sales period (2008-2015), we estimate median mortality impacts from VW excess emissions in Germany to be 1200 premature deaths in Europe, corresponding to 13 000 life-years lost and 1.9 billion EUR in costs associated with life-years lost. Approximately 60% of mortality costs occur outside Germany. For the current fleet, we estimate that if on-road emissions for all affected VW vehicles in Germany are reduced to the applicable European emission standard by the end of 2017, this would avert 29 000 life-years lost and 4.1 billion 2015 EUR in health costs (median estimates) relative to a counterfactual case with no recall.

Increased decision thresholds enhance information gathering performance in juvenile Obsessive-Compulsive Disorder (OCD)

PubMed Central

Iannaccone, Reto; Brem, Silvia; Walitza, Susanne

2017-01-01

Patients with obsessive-compulsive disorder (OCD) can be described as cautious and hesitant, manifesting an excessive indecisiveness that hinders efficient decision making. However, excess caution in decision making may also lead to better performance in specific situations where the cost of extended deliberation is small. We compared 16 juvenile OCD patients with 16 matched healthy controls whilst they performed a sequential information gathering task under different external cost conditions. We found that patients with OCD outperformed healthy controls, winning significantly more points. The groups also differed in the number of draws required prior to committing to a decision, but not in decision accuracy. A novel Bayesian computational model revealed that subjective sampling costs arose as a non-linear function of sampling, closely resembling an escalating urgency signal. Group difference in performance was best explained by a later emergence of these subjective costs in the OCD group, also evident in an increased decision threshold. Our findings present a novel computational model and suggest that enhanced information gathering in OCD can be accounted for by a higher decision threshold arising out of an altered perception of costs that, in some specific contexts, may be advantageous. PMID:28403139

34 CFR Appendix A to Part 300 - Excess Costs Calculation

Code of Federal Regulations, 2013 CFR

2013-07-01

... students from all sources—local, State, and Federal (including Part B)—in the preceding school year. Only... are those costs for the education of an elementary school or secondary school student with a... school year for an elementary school or secondary school student, as may be appropriate. An LEA must...

34 CFR Appendix A to Part 300 - Excess Costs Calculation

Code of Federal Regulations, 2014 CFR

2014-07-01

... students from all sources—local, State, and Federal (including Part B)—in the preceding school year. Only... are those costs for the education of an elementary school or secondary school student with a... school year for an elementary school or secondary school student, as may be appropriate. An LEA must...

34 CFR Appendix A to Part 300 - Excess Costs Calculation

Code of Federal Regulations, 2012 CFR

2012-07-01

... students from all sources—local, State, and Federal (including Part B)—in the preceding school year. Only... are those costs for the education of an elementary school or secondary school student with a... school year for an elementary school or secondary school student, as may be appropriate. An LEA must...

26 CFR 1.1471-1 - Recovery of excessive profits on government contracts.

Code of Federal Regulations, 2012 CFR

2012-04-01

... determining the true total contract price of such contract or subcontract. § 16.8 Cost of performing a... subcontract, as for instance, payments of royalties and amortization of the cost of designs purchased and patent rights over their useful life; and “deferred” or “unliquidated” experimental and development...

26 CFR 1.1471-1 - Recovery of excessive profits on government contracts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... determining the true total contract price of such contract or subcontract. § 16.8 Cost of performing a... subcontract, as for instance, payments of royalties and amortization of the cost of designs purchased and patent rights over their useful life; and “deferred” or “unliquidated” experimental and development...

26 CFR 1.1471-1 - Recovery of excessive profits on government contracts.

Code of Federal Regulations, 2011 CFR

2011-04-01

... determining the true total contract price of such contract or subcontract. § 16.8 Cost of performing a... subcontract, as for instance, payments of royalties and amortization of the cost of designs purchased and patent rights over their useful life; and “deferred” or “unliquidated” experimental and development...

Perinatal Health Belief Scales: A Cost Effective Technique for Predicting Prenatal Appointment Keeping Rates amongst Pregnant Teenagers.

ERIC Educational Resources Information Center

Wells, Robert D.; And Others

Prenatal appointment keeping is an important predictor of birth outcomes, yet many pregnant adolescents miss an excessive number of appointments. Since effective strategies for increasing appointment keeping require costly staff time, methods to predict relative risk for noncompliance with appointments might help delineate a circumscribed…

14 CFR 1260.67 - Equipment and other property under grants with commercial firms.

Code of Federal Regulations, 2012 CFR

2012-01-01

... conduct of research. Acquisition of special purpose equipment costing in excess of $5,000 and not included... purchase, as a direct cost to the grant, items of general purpose equipment, examples of which include but... Government shall have title to equipment and other personal property acquired with Government funds. Such...

14 CFR 1260.67 - Equipment and other property under grants with commercial firms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... conduct of research. Acquisition of special purpose equipment costing in excess of $5,000 and not included... purchase, as a direct cost to the grant, items of general purpose equipment, examples of which include but... Government shall have title to equipment and other personal property acquired with Government funds. Such...

Assessment of microbial biomass carbon and nitrogen of native and non-native perennial pasture soils using hyperspectral data

USDA-ARS?s Scientific Manuscript database

Soil microbial biomass carbon (MBC) and nitrogen (MBN) are integral parts to soil organic matter. Increased production costs and chemical runoff can result from excessive application of fertilizer if these measurements are not used in total nutrient calculations. More timely and cost-effective me...

Utah | Midmarket Solar Policies in the United States | Solar Research |

Science.gov Websites

Credit: Net excess generation is credited at the retail rate for residential and small commercial customers; large commercial and industrial customers with demand charge may choose between valuing net cost) for residential taxpayers; $50,000 (or 10% of system cost) for commercial taxpayers. Renewable

An inexpensive laparoscopy system for female sterilization.

PubMed

Wheeless, C R

1975-12-01

Laparoscopy has become an established procedure for female sterilization. The cost of the equipment remains excessively high, thereby reducing its availability to all physicians and patients who desire and need it. We have described an inexpensive--but highly effective--female sterilization system utilizing equipment that should cost in the range of $400.00.

48 CFR 2834.002 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MAJOR SYSTEM ACQUISITION General 2834.002 Policy. In accordance with Pub. L. 98-577, the Small Business...-cycle cost is in excess of $100 million. (b) Major real property system. (1) By purchase, when the..., although by virtue of the life cycle costs, it would otherwise be identified as “major” in response to OMB...

Carbon source recovery from excess sludge by mechanical disintegration for biological denitrification.

PubMed

Zubrowska-Sudol, M

2018-04-01

The goal of the study was to evaluate the possibility of carbon source recovery from excess sludge by mechanical disintegration for biological denitrification. The total efficiency of denitrification, unit demand for organic compounds for denitrification, unit volume of disintegrated sludge and unit cost of nitrogen removal as a function of energy density used for excess sludge disintegration (70, 140 and 210 kJ/L) were analyzed. In the study a full-scale disc disintegrator was used (motor power: 30 kWh, motor speed: 2,950 rpm). It was shown that the amounts of organic compounds released from the activated sludge flocs at all tested levels of energy density are high enough to be used to intensify the removal of nitrogen compounds from wastewater. It was also documented that the energy density provided during process of disintegration was an important factor determining the characteristics of organic compounds obtained under the disintegration for their use in order to intensify the process of denitrification. The highest value of total efficiency of denitrification (50.5 ± 3.1 mg N/L) was obtained for carbon source recovery from excess sludge at 70 kJ/L, but the lowest unit cost of nitrogen removal occurred for 140 kJ/L (0.0019 ± 0.0011 EUR/g N).

Cognitive behavioural anger management intervention for people with intellectual disabilities: costs of intervention and impact on health and social care resource use.

PubMed

Felce, D; Cohen, D; Willner, P; Rose, J; Kroese, B; Rose, N; Shead, J; Jahoda, A; MacMahon, P; Lammie, C; Stimpson, A; Woodgate, C; Gillespie, D; Townson, J; Nuttall, J; Hood, K

2015-01-01

Anger and aggression among adults with intellectual disability (ID) are associated with a range of adverse consequences for their well-being and that of their family or staff carers. The aims were to evaluate the effectiveness of an anger management intervention for adults with mild to moderate ID and to evaluate the costs of the intervention and its impact on health and social care resource use. This paper is concerned with the latter aim. A cluster-randomised controlled trial was conducted involving day services for adults with ID in Scotland, England and Wales. Incremental costs of delivering the intervention and its impact on subsequent total health and social care package costs were calculated. Full data comparing costs between baseline and follow-up 10 months later were collected for 67 participants in the intervention arm and 62 participants in the control arm. Cost differences between the groups at follow-up, adjusted for baseline levels, were calculated using non-parametric bootstrapping controlling for clustering. The mean hourly excess cost of intervention over treatment as usual was £12.34. A mean adjusted cost difference of £22.46 per person per week in favour of the intervention group was found but this was not statistically significant. The baseline-adjusted cost difference at follow-up would result in a fairly immediate compensation for the excess costs of intervention, provided the difference is not a statistical artefact. Further research is needed to clarify the extent to which it might represent a real saving in service support costs. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

48 CFR 26.403 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of the executive agency shall not assume responsibility for the costs and logistics of collecting, transporting, maintaining the safety of, or distributing excess, apparently wholesome food to food-insecure...

24 CFR 248.157 - Voluntary sale of housing not in excess of Federal cost limit.

Code of Federal Regulations, 2010 CFR

2010-04-01

... costs; (5) Receive a distribution equal to an 8 percent annual return on any actual cash investment made... by a priority purchaser seeking to make an offer during either 6-month priority purchaser marketing...-based nonprofit and the offer is submitted within the marketing period established in paragraph (c)(1...

Systems Engineering

DTIC Science & Technology

1989-05-01

Faced with complaints about lengthy and costly developments , rapid obsolescence, and excessive costs of ownership, we have all heard the following...microwave integrated circuits raises similar system and sub-system issues. Microprocessor developments raise new questions regarding the trade-offs between...imply the need for and utilization of more specialists, but future avionics developments will also require systems-oriented engineess. By definition

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... section applies to payments made to health care providers that are operated by units of government as...) of the Act. (a) General rules. (1) All health care providers that are operated by units of government are limited to reimbursement not in excess of the individual health care provider's cost of providing...

Save money by understanding variance and tolerancing.

PubMed

Stuart, K

2007-01-01

Manufacturing processes are inherently variable, which results in component and assembly variance. Unless process capability, variance and tolerancing are fully understood, incorrect design tolerances may be applied, which will lead to more expensive tooling, inflated production costs, high reject rates, product recalls and excessive warranty costs. A methodology is described for correctly allocating tolerances and performing appropriate analyses.

Course Presentation of the Joint-Products Problem with Costs Associated with Dumping

ERIC Educational Resources Information Center

Borland, Melvin V.; Howsen, Roy M.

2009-01-01

The typical profit-maximization solution for the joint-production problem found in intermediate texts, managerial texts, and other texts concerned with optimal pricing is oversimplified and inconsistent with profit maximization, unless there is either no excess of any of the joint products or no costs associated with dumping. However, it is an…

14 CFR § 1260.67 - Equipment and other property under grants with commercial firms.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the conduct of research. Acquisition of special purpose equipment costing in excess of $5,000 and not... purchase, as a direct cost to the grant, items of general purpose equipment, examples of which include but... Government shall have title to equipment and other personal property acquired with Government funds. Such...

Evolutionary stability of mutualism: interspecific population regulation as an evolutionarily stable strategy.

PubMed

Holland, J Nathaniel; DeAngelis, Donald L; Schultz, Stewart T

2004-09-07

Interspecific mutualisms are often vulnerable to instability because low benefit : cost ratios can rapidly lead to extinction or to the conversion of mutualism to parasite-host or predator-prey interactions. We hypothesize that the evolutionary stability of mutualism can depend on how benefits and costs to one mutualist vary with the population density of its partner, and that stability can be maintained if a mutualist can influence demographic rates and regulate the population density of its partner. We test this hypothesis in a model of mutualism with key features of senita cactus (Pachycereus schottii)-senita moth (Upiga virescens) interactions, in which benefits of pollination and costs of larval seed consumption to plant fitness depend on pollinator density. We show that plants can maximize their fitness by allocating resources to the production of excess flowers at the expense of fruit. Fruit abortion resulting from excess flower production reduces pre-adult survival of the pollinating seed-consumer, and maintains its density beneath a threshold that would destabilize the mutualism. Such a strategy of excess flower production and fruit abortion is convergent and evolutionarily stable against invasion by cheater plants that produce few flowers and abort few to no fruit. This novel mechanism of achieving evolutionarily stable mutualism, namely interspecific population regulation, is qualitatively different from other mechanisms invoking partner choice or selective rewards, and may be a general process that helps to preserve mutualistic interactions in nature.

Efficient design of clinical trials and epidemiological research: is it possible?

PubMed

Lauer, Michael S; Gordon, David; Wei, Gina; Pearson, Gail

2017-08-01

Randomized clinical trials and large-scale, cohort studies continue to have a critical role in generating evidence in cardiovascular medicine; however, the increasing concern is that ballooning costs threaten the clinical trial enterprise. In this Perspectives article, we discuss the changing landscape of clinical research, and clinical trials in particular, focusing on reasons for the increasing costs and inefficiencies. These reasons include excessively complex design, overly restrictive inclusion and exclusion criteria, burdensome regulations, excessive source-data verification, and concerns about the effect of clinical research conduct on workflow. Thought leaders have called on the clinical research community to consider alternative, transformative business models, including those models that focus on simplicity and leveraging of digital resources. We present some examples of innovative approaches by which some investigators have successfully conducted large-scale, clinical trials at relatively low cost. These examples include randomized registry trials, cluster-randomized trials, adaptive trials, and trials that are fully embedded within digital clinical care or administrative platforms.

Public Health Impacts of Excess NOX Emissions from Volkswagen Diesel Passenger Vehicles: a comparison between Germany and the United States

NASA Astrophysics Data System (ADS)

Chossiere, G.; Barrett, S. R. H.; Malina, R.; Dedoussi, I. C.; Eastham, S. D.; Ashok, A.

2016-12-01

In September 2015, the Volkswagen Group admitted the use of an illegal emissions control system that activates during vehicle testing for regulatory purposes. Globally, 11 million diesel cars sold between 2008 and 2015 are affected, including about 2.6 million in Germany and 480,000 in the United States. On-road tests suggest that NOx emissions for these cars amount to 0.85 g/km on average, over four times the applicable European limit of 0.18 g/km and more than 20 times the corresponding EPA standard. This study quantifies and compares the human health impacts and costs associated with excess emissions from VW cars driven in Germany and in the United States. A distribution of emissions factors built from existing on-road measurements is combined with sales data and a vehicle fleet model to estimate total excess NOx emissions in each country. In Europe, we used the GEOS-Chem chemistry-transport model to predict the increase in population exposure to fine particulate matter and ozone due to the excess NOx emissions in Germany. The corresponding quantities in the US case were obtained using an adjoint-based air pollution model derived from the GEOS-Chem model. A set of concentration-response functions allowed us to estimate mortality outcomes in terms of early deaths in the US and in Europe. Integrated over the sales period (2008 - 2015), we estimate median mortality impacts from VW excess emissions in Germany to be 1,100 (95% CI: 0 to 3,000) early deaths in Europe, corresponding to 3.9 billion EUR (95% CI: 0 to 10 billion) in associated costs. Another 59 (95% CI: 10 to 150) early deaths is expected in the US as a result of excess emissions released in the country, corresponding to 450 million USD in social costs. We find that excess NOx emissions in Europe have 5 times greater health impacts per kilogram than those in the US due to the higher population density and more NOx-sensitive background conditions in Europe. The gas ratios in the two regions support this finding and highlight the greater availability of free ammonia in Europe than in the US, resulting in more NOx being converted into ammonium nitrate aerosol, and greater concentrations of PM2.5. Conversely, increased NOx emissions result in a decrease in ozone concentrations over Europe, whereas increase in ozone concentration is a driver of early deaths in the US.

Estimating the energetic cost of feeding excess dietary nitrogen to dairy cows.

PubMed

Reed, K F; Bonfá, H C; Dijkstra, J; Casper, D P; Kebreab, E

2017-09-01

Feeding N in excess of requirement could require the use of additional energy to metabolize excess protein, and to synthesize and excrete urea; however, the amount and fate of this energy is unknown. Little progress has been made on this topic in recent decades, so an extension of work published in 1970 was conducted to quantify the effect of excess N on ruminant energetics. In part 1 of this study, the results of previous work were replicated using a simple linear regression to estimate the effect of excess N on energy balance. In part 2, mixed model methodology and a larger data set were used to improve upon the previously reported linear regression methods. In part 3, heat production, retained energy, and milk energy replaced the composite energy balance variable previously proposed as the dependent variable to narrow the effect of excess N. In addition, rumen degradable and undegradable protein intakes were estimated using table values and included as covariates in part 3. Excess N had opposite and approximately equal effects on heat production (+4.1 to +7.6 kcal/g of excess N) and retained energy (-4.2 to -6.6 kcal/g of excess N) but had a larger negative effect on milk gross energy (-52 to -68 kcal/g of excess N). The results suggest that feeding excess N increases heat production, but more investigation is required to determine why excess N has such a large effect on milk gross energy production. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The cost effectiveness of laparoscopic versus open gastric bypass surgery.

PubMed

Paxton, James H; Matthews, Jeffrey B

2005-01-01

Over the last decade, laparoscopic gastric bypass (LGBP) has been proven to be a safe and well-tolerated approach to the Roux-en-Y gastric bypass, despite its increased cost when compared to the open approach (OGBP). This increased expense has led many to question whether LGBP is a cost effective alternative to OGBP. The aim of this study is to determine which approach is most cost effective, considering costs associated with the operation itself, perioperative complications, and income lost during convalescence. A PubMed search of the National Library of Medicine online journal database was conducted. Studies that met predetermined criteria for selection were included in the analyses of patient demographics, perioperative complications, length of hospital stay, excess weight loss, and time to recovery. Data on 6,425 OGBP and 5,867 LGBP patients were used to compare the outcomes associated with each approach. Significant differences were found in the perioperative complication profiles, time to recovery, and overall expense of the two approaches. OGBP was associated with an increased incidence of major perioperative complications, especially extraintestinal complications, and greater perioperative mortality. LGBP was associated with shorter hospital stays, increased incidence of intestinal complications, and a 2.25% incidence of conversion to OGBP. Patient demographics and percent excess weight loss (%EWL) at 3 years follow-up were found to be similar with both OGBP and LGBP. LGBP is a cost effective alternative to OGBP for surgical weight loss. Despite the increased cost of LGBP, patients suffer fewer expensive and lifethreatening perioperative complications.

Employer Health and Productivity Roadmap™ strategy.

PubMed

Parkinson, Michael D

2013-12-01

The National Institute for Occupational Safety and Health Total Worker Health™ Program defines essential elements of an integrated health protection and health promotion model to improve the health, safety, and performance of employers and employees. The lack of a clear strategy to address the core drivers of poor health, excessive medical costs, and lost productivity has deterred a comprehensive, integrated, and proactive approach to meet these challenges. The Employer Health and Productivity Roadmap™, comprising six interrelated and integrated core elements, creates a framework of shared accountability for both employers and their health and productivity partners to implement and monitor actionable measures that improve health, maximize productivity, and reduce excessive costs. The strategy is most effective when linked to a financially incentivized health management program or consumer-directed health plan insurance benefit design.

United States petroleum pipelines: An empirical analysis of pipeline sizing

NASA Astrophysics Data System (ADS)

Coburn, L. L.

1980-12-01

The undersizing theory hypothesizes that integrated oil companies have a strong economic incentive to size the petroleum pipelines they own and ship over in a way that means that some of the demand must utilize higher cost alternatives. The DOJ theory posits that excess or monopoly profits are earned due to the natural monopoly characteristics of petroleum pipelines and the existence of market power in some pipelines at either the upstream or downstream market. The theory holds that independent petroleum pipelines owned by companies not otherwise affiliated with the petroleum industry (independent pipelines) do not have these incentives and all the efficiencies of pipeline transportation are passed to the ultimate consumer. Integrated oil companies on the other hand, keep these cost efficiencies for themselves in the form of excess profits.

A modified oxic-settling-anaerobic activated sludge process using gravity thickening for excess sludge reduction

NASA Astrophysics Data System (ADS)

Wang, Jun; Li, Shi-Yu; Jiang, Feng; Wu, Ke; Liu, Guang-Li; Lu, Hui; Chen, Guang-Hao

2015-09-01

Oxic-settling-anaerobic process (OSA) was known as a cost-effective way to reduce the excess sludge production with simple upgrade of conventional activated sludge process (CAS). A low oxidation-reduction potential (ORP) level was the key factor to sludge decay and lysis in the sludge holding tank of the OSA process. However, the ORP control with nitrogen purge or chemical dosing in the OSA process would induce extra expense and complicate the operation. Hence, in this study, a sludge holding tank using gravity thickening was applied to OSA process to reduce the excess sludge production without any ORP control. Results showed that the modified OSA process not only reduced the excess sludge production effectively but also improved the sludge settleability without affected the treatment capacity. The reduction of the excess sludge production in the modified OSA process resulted from interactions among lots of factors. The key element of the process was the gravity thickening sludge holding tank.

The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis.

PubMed

Bartick, Melissa; Reinhold, Arnold

2010-05-01

A 2001 study revealed that $3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality. Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars. If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.

Valuing mortality impacts of smoke exposure from major southern California wildfires

Treesearch

Ikuho Kochi; Patricia A. Champ; John B. Loomis; Geoffrey H. Donovan

2012-01-01

While the mortality impacts of urban air pollution have been well addressed in the literature, very little is known about the mortality impacts and associated social cost from wildfire-smoke exposure (Kochi et al., 2010; U.S. Environmental Protection Agency, 2004). In an attempt to address this knowledge gap, we estimate the social cost associated with excess mortality...

76 FR 35781 - Fisheries of the Exclusive Economic Zone Off Alaska; Bering Sea and Aleutian Islands Crab...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... operational costs. NMFS also issued processor quota share (PQS) under the Program. Each year, PQS yields an... requirements. The RIR/FRFA prepared for this action describes the costs and benefits of Amendment 37 (see... person or company that holds in excess of 20 percent of the West-designated WAG QS; (2) any person or...

Big plans.

PubMed

Fitch, Kevin F; Doyle, James F

2005-09-01

In Elmhurst Memorial Healthcare's capital planning method: Future replacement costs of assets are estimated by inflating their historical cost over their lives. A balanced model is created initially based on the assumption that rates of revenue growth, inflation, investment income, and interest expense are all equal. Numbers then can be adjusted to account for possible variations, such as excesses or shortages in investment or debt balances.

Valuing morbidity effects of wildfire smoke exposure from the 2007 Southern California wildfires

Treesearch

Ikuho Kochi; Patricia A. Champ; John B. Loomis; Geoffrey H. Donovan

2016-01-01

This study estimated the economic costs associated with morbidity from the wildfires that occurred in 2007 in southern California. We used the excess number of hospital admissions and emergency department visits to quantify the morbidity effects and used medical costs to estimate the economic impact. With data from 187 hospital facilities and 140 emergency departments...

78 FR 66413 - Cost-of-Living Increase and Other Determinations for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

... Act for certain World War II veterans will be $540.75 for 2014; (3) The student earned income... attaining NRA in the year, we withhold $1 in benefits for every $3 of earnings in excess of the annual... Social Security Act (Act), there will be a 1.5 percent cost-of-living increase in Social Security...

Cost-effective control of nitrogen loadings in Long Island Sound

NASA Astrophysics Data System (ADS)

Bennett, Lynne L.; Thorpe, Steven G.; Guse, A. Joseph

2000-12-01

Long Island Sound is plagued by conditions of severe hypoxia (low levels of dissolved oxygen) during the summer months because of the existence of excessive amounts of nitrogen. A new proposal that would allow sewage treatment plants to buy or sell nitrogen discharge credits is currently being evaluated by the states of Connecticut and New York. Existing theory suggests that a trading program for nitrogen emissions would be a cost-effective means of addressing the problem. We estimate the costs associated with several trading scenarios and find that the potential for cost savings is substantial and that cost savings rise as the scope of trading expands.

Workplace smoking related absenteeism and productivity costs in Taiwan

PubMed Central

Tsai, S; Wen, C; Hu, S; Cheng, T; Huang, S

2005-01-01

Objective: To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. Methods: The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. Results: Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost US$178 million per annum for males and US$6 million for females at a total cost of US$184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of US$733 million. Increased sick leave costs due to passive smoking were approximately US$81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be US$34 million. Conclusions: Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately US$1032 million. PMID:15923446

Workplace smoking related absenteeism and productivity costs in Taiwan.

PubMed

Tsai, S P; Wen, C P; Hu, S C; Cheng, T Y; Huang, S J

2005-06-01

To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost USD 178 million per annum for males and USD 6 million for females at a total cost of USD 184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of USD 733 million. Increased sick leave costs due to passive smoking were approximately USD 81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be USD 34 million. Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately USD 1032 million.

The health-related, social, and economic consequences of parkinsonism: a controlled national study.

PubMed

Jennum, Poul; Zoetmulder, Marielle; Korbo, Lise; Kjellberg, Jakob

2011-08-01

Parkinson's disease (PD) and atypical parkinsonism (AP) cause a significant socioeconomic burden, but there is insufficient information about the total disease burden at a national level. Thus, the goal of this study was to estimate the excess direct and indirect costs of PD and AP in a national sample. Using records from the Danish National Patient Registry (1997-2007), 13,400 PD and 647 AP patients were identified and compared with, respectively, 53,600 and 2,588 control cases randomly selected with respect to age, gender, civil status, and geographic location. Direct costs including frequencies of primary and sector contacts and procedures, and medication from primary and secondary sectors were obtained from the Danish Ministry of Health, the Danish Medicines Agency, and the National Health Security. Indirect costs, which included labor supply and social transfer payments, were based on income data derived from the Coherent Social Statistics. Patients with PD and AP had significantly higher rates of health-related contact and medication use and a higher socioeconomic cost. Furthermore, they had very low employment rates, and those in employment had a lower income level than employed control subjects. The annual mean excess health-related cost was 6,500 ($8,975/£5,543) and 9,771 ($13,491/£8,332) for each patient with PD and AP, respectively. In addition, the patients with PD and AP received an annual mean excess social transfer income of 324 (£276/$447) and 844 (£719/$1,165), respectively. The employment- and health-related consequences could be identified up to 8 years before the first diagnosis and increased with disease advancement. PD and AP have major socioeconomic consequences for patients and society. The health effects are present for up to more than 8 years before a diagnosis of PD/AP.

7 CFR 91.41 - Charges for demonstrations and courses of instruction.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED... demonstrations and courses of instruction. Charges, not in excess of the cost thereof and as approved by the...

Potential for ag residue collection, economics and environmental benefits

NASA Astrophysics Data System (ADS)

Hettenhaus, J. R.

2003-12-01

Removing excess corn stover and cereal straws after erosion requirements have been satisfied offers much potential as a renewable feedstock for initial biorefineries, producing fuels, chemicals and materials while reducing crop inputs, increasing farm income and offsetting greenhouse gas emissions. Two biorefinery site studies are presented for the production of fuel ethanol: SW Nebraska and Western Oklahoma. Results include excess available, delivered cost, net income to the farmer, improved SOM from move to no-till and GHG reduction from fossil fuel offset

Robot Drills Holes To Relieve Excess Tire Pressures

NASA Technical Reports Server (NTRS)

Carrott, David T.

1996-01-01

Small, relatively inexpensive, remotely controlled robot called "tire assault vehicle" (TAV) developed to relieve excess tire pressures to protect ground crew, aircraft equipment, and nearby vehicles engaged in landing tests of CV-990 Landing System Research Aircraft. Reduces costs and saves time in training, maintenance, and setup related to "yellow" and "red" tire conditions. Adapted to any heavy-aircraft environment in which ground-crew safety at risk because of potential for tire explosions. Also ideal as scout vehicle for performing inspections in hazardous locations.

Use of anaerobic hydrolysis pretreatment to enhance ultrasonic disintegration of excess sludge.

PubMed

Li, Xianjin; Zhu, Tong; Shen, Yang; Chai, Tianyu; Xie, Yuanhua; You, Meiyan; Wang, Youzhao

2016-01-01

To improve the excess sludge disintegration efficiency, reduce the sludge disintegration cost, and increase sludge biodegradability, a combined pretreatment of anaerobic hydrolysis (AH) and ultrasonic treatment (UT) was proposed for excess sludge. Results showed that AH had an advantage in dissolving flocs, modifying sludge characteristics, and reducing the difficulty of sludge disintegration, whereas UT was advantageous in damaging cell walls, releasing intracellular substances, and decomposing macromolecular material. The combined AH-UT process was an efficient method for excess sludge pretreatment. The optimized solution involved AH for 3 days, followed by UT for 10 min. After treatment, chemical oxygen demand, protein, and peptidoglycan concentrations reached 3,949.5 mg O2/L, 752.5 mg/L and 619.1 mg/L, respectively. This work has great significance for further engineering applications, namely, reducing energy consumption, increasing the sludge disintegration rate, and improving the biochemical properties of sludge.

The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective.

PubMed

Effertz, Tobias; Engel, Susanne; Verheyen, Frank; Linder, Roland

2016-12-01

With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.

Costs associated with low birth weight in a rural area of Southern Mozambique.

PubMed

Sicuri, Elisa; Bardají, Azucena; Sigauque, Betuel; Maixenchs, Maria; Nhacolo, Ariel; Nhalungo, Delino; Macete, Eusebio; Alonso, Pedro L; Menéndez, Clara

2011-01-01

Low Birth Weight (LBW) is prevalent in low-income countries. Even though the economic evaluation of interventions to reduce this burden is essential to guide health policies, data on costs associated with LBW are scarce. This study aims to estimate the costs to the health system and to the household and the Disability Adjusted Life Years (DALYs) arising from infant deaths associated with LBW in Southern Mozambique. Costs incurred by the households were collected through exit surveys. Health system costs were gathered from data obtained onsite and from published information. DALYs due to death of LBW babies were based on local estimates of prevalence of LBW (12%), very low birth weight (VLBW) (1%) and of case fatality rates compared to non-LBW weight babies [for LBW (12%) and VLBW (80%)]. Costs associated with LBW excess morbidity were calculated on the incremental number of hospital admissions in LBW babies compared to non-LBW weight babies. Direct and indirect household costs for routine health care were 24.12 US$ (CI 95% 21.51; 26.26). An increase in birth weight of 100 grams would lead to a 53% decrease in these costs. Direct and indirect household costs for hospital admissions were 8.50 US$ (CI 95% 6.33; 10.72). Of the 3,322 live births that occurred in one year in the study area, health system costs associated to LBW (routine health care and excess morbidity) and DALYs were 169,957.61 US$ (CI 95% 144,900.00; 195,500.00) and 2,746.06, respectively. This first cost evaluation of LBW in a low-income country shows that reducing the prevalence of LBW would translate into important cost savings to the health system and the household. These results are of relevance for similar settings and should serve to promote interventions aimed at improving maternal care.

The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study.

PubMed

Wacker, Margarethe; Holle, Rolf; Heinrich, Joachim; Ladwig, Karl-Heinz; Peters, Annette; Leidl, Reiner; Menn, Petra

2013-07-17

Smoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers. Using a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity. Average annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively. Results indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest.

18 CFR 154.305 - Tax normalization.

Code of Federal Regulations, 2010 CFR

2010-04-01

... State (including franchise taxes). (4) Income tax component means that part of the cost-of-service that... deferred taxes becomes deficient in, or in excess of, amounts necessary to meet future tax liabilities. (2...

Estimating the Economic Value of Ice Climbing in Hyalite Canyon: An Application of Travel Cost Count Data Models that Account for Excess Zeros*

PubMed Central

Anderson, D. Mark

2009-01-01

Recently, the sport of ice climbing has seen a drastic increase in popularity. This paper uses the travel cost method to estimate the demand for ice climbing in Hyalite Canyon, Montana, one of the premier ice climbing venues in North America. Access to Hyalite and other ice climbing destinations have been put at risk due to liability issues, public land management agendas, and winter road conditions. To this point, there has been no analysis on the economic benefits of ice climbing. In addition to the novel outdoor recreation application, this study applies econometric methods designed to deal with “excess zeros” in the data. Depending upon model specification, per person per trip values are estimated to be in the range of $76 to $135. PMID:20044202

Optimal system sizing in grid-connected photovoltaic applications

NASA Astrophysics Data System (ADS)

Simoens, H. M.; Baert, D. H.; de Mey, G.

A costs/benefits analysis for optimizing the combination of photovoltaic (PV) panels, batteries and an inverter for grid interconnected systems at a 500 W/day Belgian residence is presented. It is assumed that some power purchases from the grid will always be necessary, and that excess PV power can be fed into the grid. A minimal value for the cost divided by the performance is defined for economic optimization. Shortages and excesses are calculated for PV panels of 0.5-10 kWp output, with consideration given to the advantages of a battery back-up. The minimal economic value is found to increase with the magnitude of PV output, and an inverter should never be rated at more than half the array maximum output. A maximum panel size for the Belgian residence is projected to be 6 kWp.

Evolutionary stability of mutualism: interspecific population regulation as an evolutionarily stable strategy

USGS Publications Warehouse

Holland, J. Nathaniel; DeAngelis, Donald L.; Schultz, Stewart T.

2004-01-01

Interspecific mutualisms are often vulnerable to instability because low benefit : cost ratios can rapidly lead to extinction or to the conversion of mutualism to parasite–host or predator–prey interactions. We hypothesize that the evolutionary stability of mutualism can depend on how benefits and costs to one mutualist vary with the population density of its partner, and that stability can be maintained if a mutualist can influence demographic rates and regulate the population density of its partner. We test this hypothesis in a model of mutualism with key features of senita cactus (Pachycereus schottii) – senita moth (Upiga virescens) interactions, in which benefits of pollination and costs of larval seed consumption to plant fitness depend on pollinator density. We show that plants can maximize their fitness by allocating resources to the production of excess flowers at the expense of fruit. Fruit abortion resulting from excess flower production reduces pre–adult survival of the pollinating seed–consumer, and maintains its density beneath a threshold that would destabilize the mutualism. Such a strategy of excess flower production and fruit abortion is convergent and evolutionarily stable against invasion by cheater plants that produce few flowers and abort few to no fruit. This novel mechanism of achieving evolutionarily stable mutualism, namely interspecific population regulation, is qualitatively different from other mechanisms invoking partner choice or selective rewards, and may be a general process that helps to preserve mutualistic interactions in nature.

Excess Length of Stay Attributable to Clostridium difficile Infection (CDI) in the Acute Care Setting: A Multistate Model.

PubMed

Stevens, Vanessa W; Khader, Karim; Nelson, Richard E; Jones, Makoto; Rubin, Michael A; Brown, Kevin A; Evans, Martin E; Greene, Tom; Slade, Eric; Samore, Matthew H

2015-09-01

Standard estimates of the impact of Clostridium difficile infections (CDI) on inpatient lengths of stay (LOS) may overstate inpatient care costs attributable to CDI. In this study, we used multistate modeling (MSM) of CDI timing to reduce bias in estimates of excess LOS. A retrospective cohort study of all hospitalizations at any of 120 acute care facilities within the US Department of Veterans Affairs (VA) between 2005 and 2012 was conducted. We estimated the excess LOS attributable to CDI using an MSM to address time-dependent bias. Bootstrapping was used to generate 95% confidence intervals (CI). These estimates were compared to unadjusted differences in mean LOS for hospitalizations with and without CDI. During the study period, there were 3.96 million hospitalizations and 43,540 CDIs. A comparison of unadjusted means suggested an excess LOS of 14.0 days (19.4 vs 5.4 days). In contrast, the MSM estimated an attributable LOS of only 2.27 days (95% CI, 2.14-2.40). The excess LOS for mild-to-moderate CDI was 0.75 days (95% CI, 0.59-0.89), and for severe CDI, it was 4.11 days (95% CI, 3.90-4.32). Substantial variation across the Veteran Integrated Services Networks (VISN) was observed. CDI significantly contributes to LOS, but the magnitude of its estimated impact is smaller when methods are used that account for the time-varying nature of infection. The greatest impact on LOS occurred among patients with severe CDI. Significant geographic variability was observed. MSM is a useful tool for obtaining more accurate estimates of the inpatient care costs of CDI.

Optimal fault-tolerant control strategy of a solid oxide fuel cell system

NASA Astrophysics Data System (ADS)

Wu, Xiaojuan; Gao, Danhui

2017-10-01

For solid oxide fuel cell (SOFC) development, load tracking, heat management, air excess ratio constraint, high efficiency, low cost and fault diagnosis are six key issues. However, no literature studies the control techniques combining optimization and fault diagnosis for the SOFC system. An optimal fault-tolerant control strategy is presented in this paper, which involves four parts: a fault diagnosis module, a switching module, two backup optimizers and a controller loop. The fault diagnosis part is presented to identify the SOFC current fault type, and the switching module is used to select the appropriate backup optimizer based on the diagnosis result. NSGA-II and TOPSIS are employed to design the two backup optimizers under normal and air compressor fault states. PID algorithm is proposed to design the control loop, which includes a power tracking controller, an anode inlet temperature controller, a cathode inlet temperature controller and an air excess ratio controller. The simulation results show the proposed optimal fault-tolerant control method can track the power, temperature and air excess ratio at the desired values, simultaneously achieving the maximum efficiency and the minimum unit cost in the case of SOFC normal and even in the air compressor fault.

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

PubMed

Ekwaru, John Paul; Ohinmaa, Arto; Tran, Bach Xuan; Setayeshgar, Solmaz; Johnson, Jeffrey A; Veugelers, Paul J

2017-01-01

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach. We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach

PubMed Central

2017-01-01

Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a “best practice” in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project’s cost-effectiveness following a life-course approach. Methods We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system’s cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. Results The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER

Evidence of Dietary Improvement and Preventable Costs of Cardiovascular Disease.

PubMed

Zhang, Donglan; Cogswell, Mary E; Wang, Guijing; Bowman, Barbara A

2017-11-01

We conducted a review to summarize preventable medical costs of cardiovascular disease (CVD) associated with improved diet, as defined by the 2020 Strategic Impact Goal of the American Heart Association. We searched databases of PubMed, Embase, CINAHL and ABI/INFORM to identify population-based studies published from January 1995 to December 2015 on CVD medical costs related to excess intake of salt/sodium or sugar-sweetened beverages, and inadequate intake of fruits and vegetables, fish/fish oils/omega-3 fatty acids, or whole grains/fiber/dietary fiber. Based on the American Heart Association's secondary dietary metrics, we also searched the literature on inadequate intake of nuts and excess intake of processed meat and saturated fat. For each component, we evaluated the CVD cost savings if consumption levels were changed. The cost savings were adjusted into 2013 US dollars. Among 330 studies focusing on diet and economic consequences, 16 studies evaluated CVD costs associated with 1 or more dietary components: salt/sodium (n = 13), fruits and vegetables (n = 1), meat (n = 1), and saturated fat (n = 3). In the United States, reducing individual sodium intake to 2,300 mg/day from the current level could potentially save $1,990.9/person per year for hypertension treatment, based on a simulation study. Increasing consumption of fruits and vegetables from <0.5 cup/day to >1.5 cups/day could save $1,568.0/person per year in treatment costs for CVD, based on a cohort study. Potential CVD cost savings associated with diet improvement are substantial. Interventions for reducing sodium intake and increasing fruit and vegetable consumption could be viable means to alleviate the increasing national medical expenditures. Published by Elsevier Inc.

Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's.

PubMed

Zhao, Yang; Kuo, Tzu-Chun; Weir, Sharada; Kramer, Marilyn S; Ash, Arlene S

2008-05-22

Alzheimer's disease (AD) is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER) visits and inpatient admissions. Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003-2004 MEDSTAT MarketScan Medicare Supplemental and Coordination of Benefits (COB) Database were examined: 1) 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2) 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs), a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324). Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p < 0.05). In particular, AD patients were far more likely to be hospitalized for infections, pneumonia and falls (hip fracture, syncope, collapse). Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.

Open fermentative production of L-lactic acid with high optical purity by thermophilic Bacillus coagulans using excess sludge as nutrient.

PubMed

Ma, Kedong; Maeda, Toshinari; You, Huiyan; Shirai, Yoshihito

2014-01-01

The development of a low-cost polymer-grade L-lactic acid production process was achieved in this study. Excess sludge hydrolyzate (ESH) was chosen as nutrient source for the objective of reducing nutrient cost in lactic acid production. 1% of ESH had high performance in lactic acid production relative to 2g/l yeast extract (YE) while the production cost of ESH was much lower than that of YE, indicating ESH was a promising substitute of YE. By employing a thermophilic strain of Bacillus coagulans (NBRC 12583), non-sterilized batch and repeated batch L-lactic acid fermentation was successfully performed, and the optical purity of L-lactic acid accumulated was more than 99%. Moreover, the factors associated with cell growth and lactic acid fermentation was investigated through a two-stage lactic acid production strategy. Oxygen played an important role in cell growth, and the optimal condition for cell growth and fermentation was pH 7.0 and 50°C. Copyright © 2013 Elsevier Ltd. All rights reserved.

Measuring drug effectiveness by default: the case of Bendectin.

PubMed

Neutel, C I; Johansen, H L

1995-01-01

In 1983, Bendectin was voluntarily removed from the market by Merrell Dow Pharmaceuticals Inc. because of the many product liability suits pending. Earlier, 10 to 25% of pregnancies were exposed to Bendectin and over the years the drug was used in as many as 33 million pregnancies. The scientific evidence available pointed to the safety of Bendectin. This article considers some of the effects of the withdrawal of the drug. In 1983, hospital admissions for excessive vomiting in pregnancy per thousand live births rose by 37% over 1980-82 ratios and by 50% in 1984. In the United States, hospitalization rose by similar amounts. A rough estimate of excess hospital costs over the years 1983-87 is $16 million for Canada and $73 million for the U.S. Such estimates do not take into consideration other costs, such as extra physician visits, increased absenteeism from work, and the effect on quality of life of the pregnant woman and her family. No decrease in rates of congenital malformations could be shown to offset this increased cost to society.

Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model.

PubMed

Bleibler, Florian; Rapp, Kilian; Jaensch, Andrea; Becker, Clemens; König, Hans-Helmut

2014-06-30

Osteoporotic fractures cause a large health burden and substantial costs. This study estimated the expected fracture numbers and costs for the remaining lifetime of postmenopausal women in Germany. A discrete event simulation (DES) model which tracks changes in fracture risk due to osteoporosis, a previous fracture or institutionalization in a nursing home was developed. Expected lifetime fracture numbers and costs per capita were estimated for postmenopausal women (aged 50 and older) at average osteoporosis risk (AOR) and for those never suffering from osteoporosis. Direct and indirect costs were modeled. Deterministic univariate and probabilistic sensitivity analyses were conducted. The expected fracture numbers over the remaining lifetime of a 50 year old woman with AOR for each fracture type (% attributable to osteoporosis) were: hip 0.282 (57.9%), wrist 0.229 (18.2%), clinical vertebral 0.206 (39.2%), humerus 0.147 (43.5%), pelvis 0.105 (47.5%), and other femur 0.033 (52.1%). Expected discounted fracture lifetime costs (excess cost attributable to osteoporosis) per 50 year old woman with AOR amounted to € 4,479 (€ 1,995). Most costs were accrued in the hospital € 1,743 (€ 751) and long-term care sectors € 1,210 (€ 620). Univariate sensitivity analysis resulted in percentage changes between -48.4% (if fracture rates decreased by 2% per year) and +83.5% (if fracture rates increased by 2% per year) compared to base case excess costs. Costs for women with osteoporosis were about 3.3 times of those never getting osteoporosis (€ 7,463 vs. € 2,247), and were markedly increased for women with a previous fracture. The results of this study indicate that osteoporosis causes a substantial share of fracture costs in postmenopausal women, which strongly increase with age and previous fractures.

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

PubMed Central

Draper, Brian; Berry, Helen; Karmel, Rosemary; Goss, John

2018-01-01

Background Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. Method To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data. Results For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001). Discussion Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective. Conclusions Complications and dementia were found to cost more than other kinds of inpatient complexity. PMID:29474407

Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model

PubMed Central

2014-01-01

Background Osteoporotic fractures cause a large health burden and substantial costs. This study estimated the expected fracture numbers and costs for the remaining lifetime of postmenopausal women in Germany. Methods A discrete event simulation (DES) model which tracks changes in fracture risk due to osteoporosis, a previous fracture or institutionalization in a nursing home was developed. Expected lifetime fracture numbers and costs per capita were estimated for postmenopausal women (aged 50 and older) at average osteoporosis risk (AOR) and for those never suffering from osteoporosis. Direct and indirect costs were modeled. Deterministic univariate and probabilistic sensitivity analyses were conducted. Results The expected fracture numbers over the remaining lifetime of a 50 year old woman with AOR for each fracture type (% attributable to osteoporosis) were: hip 0.282 (57.9%), wrist 0.229 (18.2%), clinical vertebral 0.206 (39.2%), humerus 0.147 (43.5%), pelvis 0.105 (47.5%), and other femur 0.033 (52.1%). Expected discounted fracture lifetime costs (excess cost attributable to osteoporosis) per 50 year old woman with AOR amounted to €4,479 (€1,995). Most costs were accrued in the hospital €1,743 (€751) and long-term care sectors €1,210 (€620). Univariate sensitivity analysis resulted in percentage changes between -48.4% (if fracture rates decreased by 2% per year) and +83.5% (if fracture rates increased by 2% per year) compared to base case excess costs. Costs for women with osteoporosis were about 3.3 times of those never getting osteoporosis (€7,463 vs. €2,247), and were markedly increased for women with a previous fracture. Conclusion The results of this study indicate that osteoporosis causes a substantial share of fracture costs in postmenopausal women, which strongly increase with age and previous fractures. PMID:24981316

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications.

PubMed

Bail, Kasia; Draper, Brian; Berry, Helen; Karmel, Rosemary; Goss, John

2018-01-01

Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data. For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001). Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective. Complications and dementia were found to cost more than other kinds of inpatient complexity.

Traffic load spectra development for the 2002 AASHTO design guide.

DOT National Transportation Integrated Search

2004-12-30

Accurate knowledge of traffic volumes and loading is essential to structural pavement design and performance. : Underestimation of design traffic can result in premature pavement failures and excessive rehabilitation costs. : Overestimation can resul...

Somatic symptom disorder

MedlinePlus

... and work Poor health An increased risk for depression and suicide Money problems due to the cost of excess office visits and tests SSD is a long-term (chronic) condition. ... treatment plan is important for managing with this disorder.

Laser Balancing

NASA Technical Reports Server (NTRS)

1981-01-01

Mechanical Technology, Incorporated developed a fully automatic laser machining process that allows more precise balancing removes metal faster, eliminates excess metal removal and other operator induced inaccuracies, and provides significant reduction in balancing time. Manufacturing costs are reduced as a result.

Improving Freight Crash Incident Management : Research Project Capsule

DOT National Transportation Integrated Search

2012-10-01

Excessive delay, cost, : and adverse public : safety result from : major incidents that : occur along critical : segments of the : interstate system. : There is a high likelihood these types of incidents involve a commercial : vehicle. Several recent...

An investigation of promotional mix considerations for mail-order prescriptions: facilitating the market's acceptance of a partial health care-cost remedy.

PubMed

Strutton, D; Pelton, L E; True, S L

1993-01-01

While the U.S. health care system is confronted by a daunting assortment of problems, the foremost crisis almost certainly involves the excessive costs of health care. Mail-order prescriptions offer a modest, albeit worthwhile, measure of relief from high health care costs. This study investigates the information search behaviors and product perceptions that characterize current users and nonusers of mail-order prescriptions. Implications and recommendations concerned with the development of promotional strategies for mail-order prescriptions are derived from the findings.

Hurricane risk assessment to rollback or ride out a cost versus loss decision making approach

NASA Technical Reports Server (NTRS)

Wohlman, Richard A.

1992-01-01

The potential exists that a hurricane striking the Kennedy Space Center while a Space Shuttle is on the pad. Winds in excess of 74.5 knots could cause the failure of the holddown bolts bringing about the catastrophic loss of the entire vehicle. Current plans call for the rollback of the shuttle when winds of that magnitude are forecast to strike the center. As this is costly, a new objective method for making rollback/rideout decisions based upon Bayesian Analysis and economic cost versus loss is presented.

Selling solar energy as a cash crop

NASA Technical Reports Server (NTRS)

Brantley, L. W.

1978-01-01

The paper considers solar energy equipment which, besides supplying energy for farmstead needs, would convert excess energy to a transportable form to sell to a power company. It is suggested that a concentrating two-axis tracking spheroidal collector would cost as little as $5/sq ft if mass produced. The proposed system uses 7854 sq ft of collector area (set in about one acre of land), and the cost payback is estimated.

Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision-Making Abilities and the Amount of Information in Their Choice Environment

PubMed Central

Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas

2015-01-01

Objective To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace. Study Setting Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161). Study Design We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available). Data Collection Primary data were collected using an online questionnaire. Principal Findings Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available. Conclusions Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces. PMID:24779769

How Big is Too Big for Hubs: Marginal Profitability in Hub-and-Spoke Networks

NASA Technical Reports Server (NTRS)

Ross, Leola B.; Schmidt, Stephen J.

1997-01-01

Increasing the scale of hub operations at major airports has led to concerns about congestion at excessively large hubs. In this paper, we estimate the marginal cost of adding spokes to an existing hub network. We observe entry/non-entry decisions on potential spokes from existing hubs, and estimate both a variable profit function for providing service in markets using that spoke as well as the fixed costs of providing service to the spoke. We let the fixed costs depend upon the scale of operations at the hub, and find the hub size at which spoke service costs are minimized.

Traffic load spectra development for the 2002 AASHTO pavement design guide

DOT National Transportation Integrated Search

2004-12-30

Accurate knowledge of traffic volumes and loading is essential to structural pavement design and performance. Underestimation of design traffic can result in premature pavement failures and excessive rehabilitation costs. Overestimation can result in...

Integrating Residential Photovoltaics With Power Lines

NASA Technical Reports Server (NTRS)

Borden, C. S.

1985-01-01

Report finds rooftop solar-cell arrays feed excess power to electric-utility grid for fee are potentially attractive large-scale application of photovoltaic technology. Presents assessment of breakeven costs of these arrays under variety of technological and economic assumptions.

Academic Library Buildings in 1980.

ERIC Educational Resources Information Center

Livingston, Barbara; And Others

1980-01-01

Reports a trend toward the inclusion of academic libraries in building complexes and shared space. Only a handful of construction and remodeling projects completed in the year ending June 30, 1980, have costs in excess of $1 million. (RAA)

18 CFR 35.24 - Tax normalization for public utilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... provision for deferred taxes becomes deficient in or in excess of amounts necessary to meet future tax... subdivision of a State (including franchise taxes). (5) Income tax component means that part of the cost of...

Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

PubMed

Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

2013-05-01

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Estimating the economic value of ice climbing in Hyalite Canyon: An application of travel cost count data models that account for excess zeros.

PubMed

Anderson, D Mark

2010-01-01

Recently, the sport of ice climbing has seen a dramatic increase in popularity. This paper uses the travel cost method to estimate the demand for ice climbing in Hyalite Canyon, Montana, one of the premier ice climbing venues in North America. Access to Hyalite and other ice climbing destinations have been put at risk due to liability issues, public land management agendas, and winter road conditions. To this point, there has been no analysis on the economic benefits of ice climbing. In addition to the novel outdoor recreation application, this study applies econometric methods designed to deal with "excess zeros" in the data. Depending upon model specification, per person per trip values are estimated to be in the range of $76 to $135. Copyright 2009 Elsevier Ltd. All rights reserved.

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants.

PubMed

Colaizy, Tarah T; Bartick, Melissa C; Jegier, Briana J; Green, Brittany D; Reinhold, Arnold G; Schaefer, Andrew J; Bogen, Debra L; Schwarz, Eleanor Bimla; Stuebe, Alison M

2016-08-01

To estimate risk of necrotizing enterocolitis (NEC) for extremely low birth weight (ELBW) infants as a function of preterm formula (PF) and maternal milk intake and calculate the impact of suboptimal feeding on the incidence and costs of NEC. We used aORs derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared with a theoretical cohort in which 90% of infants received at least 98% human milk. NEC incidence among infants receiving ≥98% human milk was 1.3%; 11.1% among infants fed only PF; and 8.2% among infants fed a mixed diet (P = .002). In adjusted models, compared with infants fed predominantly human milk, we found an increased risk of NEC associated with exclusive PF (aOR = 12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥98% human milk. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563 655 (CI $476 191, $599 069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death. Among ELBW infants, not being fed predominantly human milk is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs. Copyright © 2016 Elsevier Inc. All rights reserved.

Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling.

PubMed

McLeod, Melissa; Blakely, Tony; Kvizhinadze, Giorgi; Harris, Ricci

2014-01-01

A critical first step toward incorporating equity into cost-effectiveness analyses is to appropriately model interventions by population subgroups. In this paper we use a standardized treatment intervention to examine the impact of using ethnic-specific (Māori and non-Māori) data in cost-utility analyses for three cancers. We estimate gains in health-adjusted life years (HALYs) for a simple intervention (20% reduction in excess cancer mortality) for lung, female breast, and colon cancers, using Markov modeling. Base models include ethnic-specific cancer incidence with other parameters either turned off or set to non-Māori levels for both groups. Subsequent models add ethnic-specific cancer survival, morbidity, and life expectancy. Costs include intervention and downstream health system costs. For the three cancers, including existing inequalities in background parameters (population mortality and comorbidities) for Māori attributes less value to a year of life saved compared to non-Māori and lowers the relative health gains for Māori. In contrast, ethnic inequalities in cancer parameters have less predictable effects. Despite Māori having higher excess mortality from all three cancers, modeled health gains for Māori were less from the lung cancer intervention than for non-Māori but higher for the breast and colon interventions. Cost-effectiveness modeling is a useful tool in the prioritization of health services. But there are important (and sometimes counterintuitive) implications of including ethnic-specific background and disease parameters. In order to avoid perpetuating existing ethnic inequalities in health, such analyses should be undertaken with care.

The socioeconomic consequences of optic neuritis with and without multiple sclerosis: a controlled national study.

PubMed

Jennum, P; Frederiksen, J L; Wanscher, B; Kjellberg, J

2013-04-01

Optic neuritis (ON) often precedes multiple sclerosis (MS). MS is associated with a significant socioeconomic burden. However, the burden of ON with and without MS before and after its diagnosis has never been calculated. Using complete national records from the Danish National Patient Registry (1998-2006), we identified 1677 patients with ON and compared them with 6708 randomly selected citizens matched for age, sex and geography. A societal perspective is taken towards the cost analyses. Costs included in the analysis are those of the health sector, including all contacts with primary and secondary sectors, and the use and costs of drugs. Productivity losses included labour supply and income. All social transfer payments were also calculated. Patients with ON had higher rates of contact with healthcare services, medication use and income from employment, all of which incurred a higher socioeconomic cost. Employed patients had lower income than control subjects. The total annual excess costs relative to matched controls were €3501 for ON patients and €9215 for patients with a dual diagnosis of ON and MS. The ON and ON+MS patients received an annual mean excess social transfer income of €1175 and €4619. ON/ON+MS patients presented social and economic consequences up to 8 years before diagnosis, and these increased after the diagnosis was established. ON, especially if combined with a diagnosis of MS, has a significant socioeconomic consequence for the individual patient and for society. Productivity losses are a far more important economic factor than health sector costs. © 2012 John Wiley & Sons A/S.

Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling

PubMed Central

2014-01-01

Background A critical first step toward incorporating equity into cost-effectiveness analyses is to appropriately model interventions by population subgroups. In this paper we use a standardized treatment intervention to examine the impact of using ethnic-specific (Māori and non-Māori) data in cost-utility analyses for three cancers. Methods We estimate gains in health-adjusted life years (HALYs) for a simple intervention (20% reduction in excess cancer mortality) for lung, female breast, and colon cancers, using Markov modeling. Base models include ethnic-specific cancer incidence with other parameters either turned off or set to non-Māori levels for both groups. Subsequent models add ethnic-specific cancer survival, morbidity, and life expectancy. Costs include intervention and downstream health system costs. Results For the three cancers, including existing inequalities in background parameters (population mortality and comorbidities) for Māori attributes less value to a year of life saved compared to non-Māori and lowers the relative health gains for Māori. In contrast, ethnic inequalities in cancer parameters have less predictable effects. Despite Māori having higher excess mortality from all three cancers, modeled health gains for Māori were less from the lung cancer intervention than for non-Māori but higher for the breast and colon interventions. Conclusions Cost-effectiveness modeling is a useful tool in the prioritization of health services. But there are important (and sometimes counterintuitive) implications of including ethnic-specific background and disease parameters. In order to avoid perpetuating existing ethnic inequalities in health, such analyses should be undertaken with care. PMID:24910540

Cost containment for the public health.

PubMed

Eastaugh, Steven R

2006-01-01

The U.S. health care system has major problems with respect to patient access and cost control. Trimming excess hospital expenses and expanding public health activities are cost effective. By budgeting well, with global budgets set for the high cost sectors, the United States might emerge with lower tax hikes, a healthier population, better facilities, and enhanced access to service. Nations with global budgets have better health statistics, and lower costs, compared to the United States. With global budgets, these countries employ 75 to 85 percent fewer employees in administration and regulation, but patient satisfaction is almost double the rate in the United States. Implement a global budget for health care, or substantially raise taxes, is the basic choice faced in this country. Key words: global budget control cost containment.

22 CFR 226.81 - Prohibition against profit.

Code of Federal Regulations, 2010 CFR

2010-04-01

....81 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Additional Provisions For Awards to Commercial Organizations § 226.81... organization. Profit is any amount in excess of allowable direct and indirect costs. ...

34 CFR Appendix A to Part 300 - Excess Costs Calculation

Code of Federal Regulations, 2010 CFR

2010-07-01

... total expenditures amounts spent for: (1) IDEA, Part B allocation, (2) ESEA, Title I, Part A allocation... last year: (1) From funds under IDEA, Part B allocation $ 200,000 (2) From funds under ESEA, Title I...

34 CFR Appendix A to Part 300 - Excess Costs Calculation

Code of Federal Regulations, 2011 CFR

2011-07-01

... total expenditures amounts spent for: (1) IDEA, Part B allocation, (2) ESEA, Title I, Part A allocation... last year: (1) From funds under IDEA, Part B allocation $ 200,000 (2) From funds under ESEA, Title I...

A Cost Estimation Analysis of U.S. Navy Ship Fuel-Savings Techniques and Technologies

DTIC Science & Technology

2009-09-01

readings to the boiler operator. The PLC will provide constant automatic trimming of the excess oxygen based upon real time SGA readings. An SCD...the author): The Aegis Combat System is controlled by an advanced, automatic detect-and-track, multi-function three-dimensional passive...subsequently offloaded. An Online Wash System would reduce these maintenance costs and improve fuel efficiency of these engines by keeping the engines

[Rehabilitation in geriatric patients after ischemic stroke--a comparison of 2 organisational systems in Germany using claims data of a statutory health insurance fund].

PubMed

Abbas, S; Ihle, P; Hein, R; Schubert, I

2013-12-01

Due to historical aspects in some federal states in Germany rehabilitation of geriatric patients is organized in geriatric departments in hospitals (§ 109 SGB V). In other states rehabilitation of these patients is mainly realized in geriatric rehabilitation facilities outside hospital care after approval by the health insurance (§ 111 SGB V). Thus, it is of interest to compare both types of health care with respect to differences in population characteristics, resource utilization and outcome parameters (i.e., excess costs, rehospitalization, fracture risk and mortality) using a common geriatric indication, the ischemic stroke, as an example. Claims data of the AOK (Local Health Care Fund) from seven federal states in Germany were used. Insured persons with a documented hospital stay with discharge diagnosis cerebral infarction/stroke (ICD-10 I63, I64, below denoted by "ischemic stroke") in 2007 (N=39,887) were included and allocated to the respective form of rehabilitative health care via the OPS (German procedure classification for inpatient procedures) procedure 8-550 (§ 109, N=1,272) or via admission to a geriatric rehabilitation unit within 1 month after hospital discharge (§ 111, N=2,200). All direct costs were ascertained and presented with and without costs of long-term care. Excess costs were calculated as the difference of costs between the first year after insult and the costs in the previous year. Excess costs in the 2 types of care were compared using multivariate quantile regression analysis. Risk of hospitalization (due to ischemic stroke or fracture) and risk of death in a 1-year follow-up was analysed using multivariate cox regression. Insured members treated according to health care type § 109 were somewhat older (mean: 81 vs. 80 years of age), more frequently female (72 vs. 67%), more often receiving long-term care (27 vs. 19%) and had more often documented sequelae after insult (>=4 diseases 39 vs. 28%). No significant differences in excess costs between both types of care were observed (quantile regression: 25%-percentile-comparison: p=0.49 and 0.11; median-comparison: p=0.99 and 0.13; 75%-percentile-comparison: p=0.13 and 0.30, with and without costs of long-term care, respectively). Moreover, no significant differences were observed related to the outcomes 'rehospitalization due to ischemic stroke' (hazard ratio - HR [95% confidence interval - CI])=1.12 [0.85-1.48], p=0.43) and death (HR [95% CI]=1.03 [0.88-1.20], p=0.75) in the multivariate model (reference: health care type § 111). Insured members in health care type § 109 had a significant lower risk of rehospitalization due to fracture (HR [95% CI]=0.61 [0.40-0.93], p=0.02). According to health care type § 109 and § 111, geriatric patients differ in certain characteristics such as gender, statutory care and documented sequelae after insult. Except for the outcome 'fracture', no significant differences between both types of care have been observed in the selected outcomes. Primary studies with more differentiated data collection may focus on specific treatment and on aims and achievements of rehabilitation. © Georg Thieme Verlag KG Stuttgart · New York.

A comparison of alternative strategies for cost-effective water quality management in lakes.

PubMed

Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

2006-09-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

NASA Astrophysics Data System (ADS)

Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

2006-09-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

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

The structural robustness of geographical networks against regional failure and their pre-optimization

NASA Astrophysics Data System (ADS)

Li, Yixiao; Zhang, Lin; Huang, Chaogeng; Shen, Bin

2016-06-01

Failures of real-world infrastructure networks due to natural disasters often originate in a certain region, but this feature has seldom been considered in theoretical models. In this article, we introduce a possible failure pattern of geographical networks-;regional failure;-by which nodes and edges within a region malfunction. Based on a previous spatial network model (Louf et al., 2013), we study the robustness of geographical networks against regional failure, which is measured by the fraction of nodes that remain in the largest connected component, via simulations. A small-area failure results in a large reduction of their robustness measure. Furthermore, we investigate two pre-deployed mechanisms to enhance their robustness: One is to extend the cost-benefit growth mechanism of the original network model by adding more than one link in a growth step, and the other is to strengthen the interconnection of hubs in generated networks. We measure the robustness-enhancing effects of both mechanisms on the basis of their costs, i.e., the amount of excessive links and the induced geographical length. The latter mechanism is better than the former one if a normal level of costs is considered. When costs exceed a certain level, the former has an advantage. Because the costs of excessive links affect the investment decision of real-world infrastructure networks, it is practical to enhance their robustness by adding more links between hubs. These results might help design robust geographical networks economically.

Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals.

PubMed

Hauck, Katharina D; Wang, Shaolin; Vincent, Charles; Smith, Peter C

2017-02-01

There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.

Pneumonia and influenza hospitalizations among children under 5 years of age in Suzhou, China, 2005-2011.

PubMed

Zhang, Xiyan; Zhang, Jun; Chen, Liling; Feng, Luzhao; Yu, Hongjie; Zhao, Genming; Zhang, Tao

2017-01-01

The disease burden of influenza among children in China has not been well described. To estimate the influenza-associated excess hospitalization rate and compare the hospitalization length and costs between pneumonia and influenza (P&I) and other community-acquired diseases (CAD) in Suzhou, China. We retrospectively collected hospital discharge data on pediatric patients' discharge diagnosis, hospital costs, and length of hospital stay in Suzhou. P&I hospitalization was defined as a primary discharge diagnosis of pneumonia and influenza disease (ICD-10 codes J09-J18). Other CAD were common community-acquired diseases among children. Negative binomial regression models were used to estimate the weekly P&I hospitalizations in Suzhou. Excess P&I hospitalizations due to influenza were calculated as the difference in P&I hospitalizations between the epidemic period and the baseline period. Baseline was defined as when the influenza-positive rates were <5% for two consecutive weeks. From October 2005 to September 2011, we identified a total of 180 091 all-cause hospitalizations among children <5 years of age in Suzhou City. The rates of P&I and influenza-associated excess hospitalizations were highest in the 2009-2010 pandemic and 2010-2011 post-pandemic seasons. Infants <6 months of age had the highest P&I hospitalization rates, the longest hospital stays (7.5-8.0 days), and the highest hospitalization costs for P&I. Compared with other CAD, children admitted for P&I had longer hospital stays and higher hospitalization costs. The influenza-associated P&I hospitalization rates and economic burden were high among children. Targeted influenza prevention and control strategies for young children in Suzhou may reduce the influenza-associated hospitalizations in this age group. © 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Policy analysis for prenatal genetic diagnosis.

PubMed

Thompson, M; Milunsky, A

1979-01-01

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

High Efficiency, High Density Terrestrial Panel. [for solar cell modules

NASA Technical Reports Server (NTRS)

Wohlgemuth, J.; Wihl, M.; Rosenfield, T.

1979-01-01

Terrestrial panels were fabricated using rectangular cells. Packing densities in excess of 90% with panel conversion efficiencies greater than 13% were obtained. Higher density panels can be produced on a cost competitive basis with the standard salami panels.

43 CFR 426.13 - Excess land appraisals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... cost methods, as applicable. Reclamation will consider nonproject water supply factors as provided in... standard appraisal procedures. (c) Appraisals of nonproject water supplies. (1) The appraiser will consider nonproject water supply factors, where appropriate, including: (i) Ground water pumping lift; (ii) Surface...

Pharmacoeconomic evaluations of antifungal therapies.

PubMed

Hennen, Cynthia R

2009-07-01

Invasive fungal infections are a growing source of morbidity and mortality in the United States and are associated with excess hospital stay and costs. Although clinicians now have more effective and safe treatment options for invasive candidiasis, evidence confirming the pharmacoeconomic benefits of newer treatment options such as the echinocandins is scarce as few rigorous pharmacoeconomic studies have been completed in the arena of invasive fungal infections. Beyond the cost of drug acquisition, costs associated with ineffective treatment and significant drug-related side-effects must be factored into pharmacoeconomic analysis. Additional administrative costs may need to be considered when a formulary medication switch is undertaken, including those involved with re-education of clinicians unfamiliar with the newer product.

Better Cash Management Can Reduce the Cost of the National Direct Student Loan Program. Report to the Congress by the Comptroller General of the United States.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

The Office of Education has allowed schools participating in the National Direct Student Loan Program to hold more than an annual average of $63 million in federal funds in excess of their 30-day needs. The General Accounting Office estimates that if the Treasury had this money it could save the government interest costs of as much as $4 million,…

Airships for transporting highly volatile commodities

NASA Technical Reports Server (NTRS)

Sonstegaard, M.

1975-01-01

Large airships may prove feasible as carriers of commodities that move as gases or cryogenic liquids; buoyant gaseous cargo could be ballasted with liquid cargo. Airships are compact in shape, operate in a rarified medium, and hence can be fast and perhaps economic carriers of costly cryogenic tanks. The high-pressure gas pipeline has excessive surface area when carrying hydrogen and excessive fluid density when carrying natural gas, while the cryogenic ocean tanker runs in a dense medium and makes gravity waves. But the airship, despite its fluid dynamic advantages, faces problems of safety, weather, and altitude control.

77 FR 59702 - Promoting U.S. EC Regulatory Compatibility

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-28

... TRADE REPRESENTATIVE Promoting U.S. EC Regulatory Compatibility AGENCY: Office of the United... and European Commission (EC) share the goal of reducing excessive regulatory costs, unjustified..., safety, welfare, and the environment. Promoting this goal will help businesses to grow, create jobs, and...

Evaluation of alternative snow plow cutting edges.

DOT National Transportation Integrated Search

2009-05-01

With approximately 450 snow plow trucks, the Maine Department of Transportation (MaineDOT) uses in : excess of 10,000 linear feet of plow cutting edges each winter season. Using the 2008-2009 cost per linear : foot of $48.32, the Departments total co...

OPPORTUNITY COSTS OF RESIDENTIAL BEST MANAGEMENT PRACTICES FOR STORMWATER RUNOFF CONTROL

EPA Science Inventory

Excess stormwater runoff is a serious problem in a large number of urban areas, causing flooding, water pollution, groundwater recharge deficits and ecological damage to urban streams. Solutions currently proposed to deal with this problem often involve large centralized infrastr...

Costs of Clostridium difficile infection in pediatric operations: A propensity score-matching analysis.

PubMed

Kulaylat, Afif N; Rocourt, Dorothy V; Podany, Abigail B; Engbrecht, Brett W; Twilley, Marianne; Santos, Mary C; Cilley, Robert E; Hollenbeak, Christopher S; Dillon, Peter W

2017-05-01

The purpose of this analysis was to assess the burden of Clostridium difficile infection in the hospitalized pediatric surgical population and to characterize its influence on the costs of care. There were 313,664 patients age 1-18 years who underwent a general thoracic or abdominal procedure in the Kids' Inpatient Database during 2003, 2006, 2009, and 2012. Logistic regression was used to model factors associated with the development of C difficile infection. A propensity score-matching analysis was performed to evaluate the influence of C difficile infection on mortality, duration of stay, and costs in similar patient cohorts. Population weights were used to estimate the national excess burden of C difficile infection on these outcomes. The overall prevalence of C difficile infection in the sampled cohort was 0.30%, with an increasing trend of C difficile infection over time in non-children's hospitals (P < .001). C difficile infection was associated with younger age, nonelective procedures, increasing comorbidities, and urban teaching hospital status (P < .001). An estimated 1,438 children developed C difficile infection after operation. After propensity score matching, the mean excess duration of stay and costs attributable to C difficile infection were 5.8 days and $12,801 (P < .001), accounting for 8,295 days spent in the hospital and $18.4 million (2012 USD) in spending annually. C difficile infection is a relatively uncommon but costly complication after pediatric operative procedures. Given the increasing trend of C difficile infection among hospitalized surgical patients, there is substantial opportunity for reduction of inpatient burden and associated costs in this potentially preventable nosocomial infection. Copyright © 2016 Elsevier Inc. All rights reserved.

Multifluid geo-energy systems: Using geologic CO 2 storage for geothermal energy production and grid-scale energy storage in sedimentary basins

DOE PAGES

Buscheck, Thomas A.; Bielicki, Jeffrey M.; Edmunds, Thomas A.; ...

2016-05-05

We present an approach that uses the huge fluid and thermal storage capacity of the subsurface, together with geologic carbon dioxide (CO 2) storage, to harvest, store, and dispatch energy from subsurface (geothermal) and surface (solar, nuclear, fossil) thermal resources, as well as excess energy on electric grids. Captured CO 2 is injected into saline aquifers to store pressure, generate artesian flow of brine, and provide a supplemental working fluid for efficient heat extraction and power conversion. Concentric rings of injection and production wells create a hydraulic mound to store pressure, CO 2, and thermal energy. This energy storage canmore » take excess power from the grid and excess/waste thermal energy, and dispatch that energy when it is demanded and thus enable higher penetration of variable renewable energy technologies (e.g., wind, solar). CO 2 stored in the subsurface functions as a cushion gas to provide enormous pressure-storage capacity and displace large quantities of brine, some of which can be treated for a variety of beneficial uses. Geothermal power and energy-storage applications may generate enough revenues to compensate for CO 2 capture costs. While our approach can use nitrogen (N 2), in addition to CO 2, as a supplemental fluid, and store thermal energy, this study focuses using CO 2 for geothermal energy production and grid-scale energy storage. We conduct a techno-economic assessment to determine the levelized cost of electricity of using this approach to generate geothermal power. We present a reservoir pressure-management strategy that diverts a small portion of the produced brine for beneficial consumptive use to reduce the pumping cost of fluid recirculation, while reducing the risk of seismicity, caprock fracture, and CO 2 leakage.« less

Estimating a Change from TRICARE to Commercial Insurance Plans.

PubMed

Murray, Carla T; Schmit, Matthew

2018-03-14

We estimate the effect on health care spending of an option to change TRICARE. Under the option, which is based on a proposal made by the Military Compensation and Retirement Modernization Commission (MCRMC), most beneficiaries could choose from a range of commercial health networks instead of the current TRICARE plans. Military treatment facilities would become network providers under the commercial plans. We used data from the Department of Defense (DoD) to estimate the cost of providing the current health care benefit to working-age retirees and their dependents and survivors, and active duty family members. We then adjusted those data to estimate what the private insurance premiums would be for those groups. Greater details about the methodology can be found in earlier work by the Congressional Budget Office. Because payments by TRICARE to physicians and hospitals are tied to payments made by Medicare, we used the information from studies that compare Medicare payment rates to rates paid to doctors and hospitals by private insurance to estimate what it would cost private insurers to provide approximately the same level of care, with adjustments to account for the higher out-of-pocket costs that beneficiaries would pay under the option. We also made adjustments to account for the possibility that many beneficiaries would decrease their use of the MTFs in favor of private providers, which could increase the overall costs of DoD. We then estimated that increasing the cost sharing to a level found in popular civilian plans would lower overall demand for services by about 10% for military retiree households and about 18% for active duty family members. We estimated that DoD would pay subsidies to retain about half of the excess capacity created by beneficiaries switching their care from MTFs to the private sector. Evaluated at the midpoint of the ranges, the net effect on DoD's budget would be approximately $0, we estimate, but costs could fall in a likely range from about $3 billion in annual savings to about $3 billion in annual costs. Thus, the MCRMC estimate of $3.2 billion implicitly assumed that no excess capacity would be retained by MTFs. In 2031, under current law, the average retiree family is expected to cost the federal government about $24,100 (in 2017 dollars) and that family's out-of-pocket costs are expected to amount to about $1,900. The option would reduce the government's costs for the average retiree family to $23,500, but retiree families could see their out-of-pocket costs rise to $7,500 per year. This article outlined a method of identifying two particular sources of that uncertainty: the extent to which people will receive care outside of MTFs and the extent to which the MTFs can adjust to reductions in demand. For one particular option, we demonstrate that the potential savings from changing the system depends on increasing the share of costs paid by beneficiaries - particularly working-age retirees - and on DoD's ability to reduce excess capacity in the system.

Excess post-exercise oxygen consumption in adult sockeye (Oncorhynchus nerka) and coho (O. kisutch) salmon following critical speed swimming.

PubMed

Lee, C G; Farrell, A P; Lotto, A; Hinch, S G; Healey, M C

2003-09-01

The present study measured the excess post-exercise oxygen cost (EPOC) following tests at critical swimming speed (Ucrit) in three stocks of adult, wild, Pacific salmon (Oncorhynchus sp.) and used EPOC to estimate the time required to return to their routine level of oxygen consumption (recovery time) and the total oxygen cost of swimming to Ucrit. Following exhaustion at Ucrit, recovery time was 42-78 min, depending upon the fish stock. The recovery times are several-fold shorter than previously reported for juvenile, hatchery-raised salmonids. EPOC varied fivefold among the fish stocks, being greatest for Gates Creek sockeye salmon (O. nerka), which was the salmon stock that had the longest in-river migration, experienced the warmest temperature and achieved the highest maximum oxygen consumption compared with the other salmon stocks that were studied. EPOC was related to Ucrit, which in turn was directly influenced by ambient test temperature. The non-aerobic cost of swimming to Ucrit was estimated to add an additional 21.4-50.5% to the oxygen consumption measured at Ucrit. While these non-aerobic contributions to swimming did not affect the minimum cost of transport, they were up to three times higher than the value used previously for an energetic model of salmon migration in the Fraser River, BC, Canada. As such, the underestimate of non-aerobic swimming costs may require a reevaluation of the importance of how in-river barriers like rapids and bypass facilities at dams, and year-to-year changes in river flows and temperatures, affect energy use and hence migration success.

Cost analysis of an ammonia dry cooling system with a Chicago Bridge and Iron peak shaving system

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

Drost, M.K.; Johnson, B.M.

1980-12-01

A study was performed to determine the potential for reducing the cost associated with dry cooling by using an ammonia dry cooling system augmented with the Chicago Bridge and Iron (CP and I) peak shaving system. The cost analysis of an all-dry ammonia cooling system operating in conjunction with a peak shaving system is documented. The peak shaving system utilizes the excess cooling capability available at night to cool water to be used for supplemental cooling during the following day. The analysis consisted of determining the incremental cost of cooling for the CB and I system and comparing this costmore » to the incremental cost of cooling for both dry and wet/dry systems for a consistent set of design conditions and assumptions. The wet/dry systems were analyzed over a range of water usages. The basis of the comparisons was a cooling system designed for installations with a 650 mWe (gross) coal-fired power plant. From results of the study it was concluded that: the CB and I system shows a substantial economic advantage when compared with an all-dry cooling system; the CB and I system appears to be competitive with wet/dry cooling systems using about 2 to 3% water; and the CB and I system demonstrates a clear economic advantage when compared to both dry and wet/dry concepts for a winter peaking utility where the excess generation is assumed to displace both base-loaded coal-fired power generation and oil-fired gas turbine peaking units.« less

41 CFR 102-75.230 - Who is responsible for property protection and maintenance costs while the request for exception...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 102-75.230 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 75-REAL PROPERTY DISPOSAL Utilization of Excess Real... landholding agency at that time. ...

NPY family genes respond negatively to alternative feedstuffs in channel catfish diets

USDA-ARS?s Scientific Manuscript database

Of considerable importance in fish nutrition is the development of aquafeeds using alternative dietary ingredients which will allow aquaculture to grow globally, without putting excessive pressure on natural fisheries or adding considerable cost to production, while also addressing and maintaining t...

Recovery of proteins and phosphorus from manure

USDA-ARS?s Scientific Manuscript database

The recovery of phosphorus and proteins from manure could be advantageous to both offset costs and to improve and lessen the environmental impacts of manure storage and treatment. Phosphorous in manure can contaminate rivers, lakes, and bays through runoff, if applied onto a cropland excessively. Th...

Recovery of amino acids and phosphorus from manure

USDA-ARS?s Scientific Manuscript database

Background & Objectives: The recovery of phosphorus and proteins from manure could be advantageous to both offset costs and to improve and lessen the environmental impacts of manure. Phosphorous in manure can contaminate rivers, lakes, and bays through runoff, if applied onto a cropland excessively....

43 CFR 426.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... entitlements mean the ownership and nonfull-cost entitlements. Acreage limitation provisions mean the ownership... land means nonexempt land that is in excess of a landowner's maximum ownership entitlement under the... economic risk and the use or possession of the lessor's land is partially or wholly transferred to the...

"Wrapping Up" Your Construction Insurance.

ERIC Educational Resources Information Center

Ferraro, Mark

1998-01-01

School facility managers are beginning to use a special insurance-management technique called wrap-up. The project owner purchases a bulk construction insurance policy consisting of general liability, excess liability, workers' compensation, and builders' risk insurance. Wrap-ups ensure competitive pricing, safety incentives, lower claims costs,…

7 CFR 29.127 - Demonstrations and courses of instruction.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 29.127 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE COMMODITY STANDARDS AND STANDARD... instruction. Charges, not in excess of the cost thereof, as may be approved by the Director, may be made for...

47 CFR 32.1170 - Receivables.

Code of Federal Regulations, 2010 CFR

2010-10-01

... process of collection. (b) Collections in excess of amounts charged to this account may be credited to and carried in this account until applied against charges for services rendered or until refunded. (c) Cost of... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS...

Potential of activated sludge disintegration.

PubMed

Boehler, M; Siegrist, H

2006-01-01

The disposal of sewage sludge and the agricultural use of stabilised sludge are decreasing due to more stringent regulations in Europe. An increasing fraction of sewage sludge must therefore be dewatered, dried, incinerated and the ashes disposed of in landfills. These processes are cost-intensive and also lead to the loss of valuable phosphate resources incorporated in the sludge ash. The implementation of processes that could reduce excess sludge production and recycle phosphate is therefore recommended. Disintegration of biological sludge by mechanical, thermal and physical methods could significantly reduce excess sludge production, improve the settling properties of the sludge and reduce bulking and scumming. The solubilised COD could also improve denitrification if the treated sludge is recycled to the anoxic zone. However, disintegration partly inhibits and kills nitrifiers and could therefore shorten their effective solid retention time, thus reducing the safety of the nitrification. This paper discusses the potential of disintegration on sludge reduction, the operating stability of nitrification, the improvement of denitrification and also presents an energy and cost evaluation.

A fast, programmable hardware architecture for the processing of spaceborne SAR data

NASA Technical Reports Server (NTRS)

Bennett, J. R.; Cumming, I. G.; Lim, J.; Wedding, R. M.

1984-01-01

The development of high-throughput SAR processors (HTSPs) for the spaceborne SARs being planned by NASA, ESA, DFVLR, NASDA, and the Canadian Radarsat Project is discussed. The basic parameters and data-processing requirements of the SARs are listed in tables, and the principal problems are identified as real-operations rates in excess of 2 x 10 to the 9th/sec, I/O rates in excess of 8 x 10 to the 6th samples/sec, and control computation loads (as for range cell migration correction) as high as 1.4 x 10 to the 6th instructions/sec. A number of possible HTSP architectures are reviewed; host/array-processor (H/AP) and distributed-control/data-path (DCDP) architectures are examined in detail and illustrated with block diagrams; and a cost/speed comparison of these two architectures is presented. The H/AP approach is found to be adequate and economical for speeds below 1/200 of real time, while DCDP is more cost-effective above 1/50 of real time.

Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults.

PubMed

Karki, Surendra; Newall, Anthony T; MacIntyre, C Raina; Heywood, Anita E; McIntyre, Peter; Banks, Emily; Liu, Bette

2016-01-01

Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age. In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population. Per HZ case, there was an average of 0.06 (95% CI 0.04-0.08) excess hospitalisations, 1.61 (95% CI 1.51-1.69) excess general practitioner visits, 1.96 (95% CI 1.86-2.15) excess prescriptions filled and 0.11 (95% CI 0.09-0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719-2767); GP visits was highest in those 60-69 years (N = 50567, 95%CI 39958-61105), prescriptions and ED visits were highest in 70-79 years (N = 50524, 95%CI 40634-60471 and N = 2891, 95%CI 2319-3449 respectively). This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted.

Audit of Sandia Corporation`s pension plans and other prefunded benefits

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

Not Available

1994-04-06

The audit disclosed that Sandia`s pension plans had $588.9 million in excess assets as of December 31, 1990, on a current value basis. If plan terminations and spin-offs occurred, at least $408.8 million of this amount could be returned to the Government without affecting the pension benefits that Sandia employees and retirees have earned. We recommended that Albuquerque take the necessary action to reduce the excess assets in the pension plans and recover the Government`s share. However, Albuquerque disagreed with the recommendation. Albuquerque justified leaving the excess assets in the pension plans to fund future plan amendments; to avoid futuremore » funding contributions; to avoid the costs and time-consuming administrative steps associated with taking action; and to prevent damaging effects on employee morale. We analyzed these points, and concluded that they should not prevent the Department from initiating action to return excess assets to the Government. Actuarial analysis of the pension plans showed that, even if certain plan adjustments were made, the plans were overfunded by $256 million as of December 31, 1991 (on an actuarial value basis).« less

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

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

Not Available

1977-12-01

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

Development of variable-rate precision spraying systems for tree crop production

USDA-ARS?s Scientific Manuscript database

Excessive pesticides are often applied to target and non-target areas in orchards and nurseries, resulting in greater production costs, worker exposure to unnecessary pesticide risks, and adverse contamination of the environment. To improve spray application efficiency, two types of variable-rate pr...

45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

Code of Federal Regulations, 2014 CFR

2014-10-01

... Companion is provided with the Corporation-specified minimum levels of insurance as follows: (1) Accident insurance. Accident insurance covers Senior Companions for personal injury during travel between their homes... provided by other insurance. It does not include professional liability coverage. (3) Excess automobile...

45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Companion is provided with the Corporation-specified minimum levels of insurance as follows: (1) Accident insurance. Accident insurance covers Senior Companions for personal injury during travel between their homes... provided by other insurance. It does not include professional liability coverage. (3) Excess automobile...

45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

Code of Federal Regulations, 2013 CFR

2013-10-01

... Companion is provided with the Corporation-specified minimum levels of insurance as follows: (1) Accident insurance. Accident insurance covers Senior Companions for personal injury during travel between their homes... provided by other insurance. It does not include professional liability coverage. (3) Excess automobile...

48 CFR 922.103-4 - Approvals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost to the Government may be affected, approval of hours of work in excess of the normal workweek is... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Approvals. 922.103-4 Section 922.103-4 Federal Acquisition Regulations System DEPARTMENT OF ENERGY SOCIOECONOMIC PROGRAMS...

Not Another Budget Cut! Money-Saving Ideas for Campus Organizations.

ERIC Educational Resources Information Center

Oxendine, W. H. "Butch," Jr.

1997-01-01

Twenty ideas for reducing program costs are offered to campus activities programmers. They include using technology wisely, avoiding excess outlay of funds, trading for services, seeking donations and sponsors, co-sponsoring events, buying supplies in bulk, requesting discounts, avoiding unnecessary sales taxes, using telephone services…

Climate Strategy Impact on Nitrogen Deposition in the USA

EPA Science Inventory

Nitrogen (N) leakage to the environment in the United States costs an estimated $210 billion per year, equivalent to 1-3% of the national GDP, in part due to atmospheric N pollution. Excess N deteriorates ecosystems via eutrophication in water bodies, causing fish kills and addi...

Tunnel Cost-Estimating Methods.

DTIC Science & Technology

1981-10-01

wears down the bit very quickly; stratified rock or mixed face results in uneven thrust and excessive bearing wear and can cause large rocks to jam ...of Reclamation (USBIJREC) Strawberry Aqueduct System, is approximately 3-1/4 miles long and 13 ft in diameter. It was moled through hard sandstone and

47 CFR 69.4 - Charges to be filed.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES... shall include charges for the End User Common Line element, and for line port costs in excess of basic... each of the following elements: (1) [Reserved] (2) Carrier common line, provided that after June 30...

Parental smoking and respiratory tract infections in children.

PubMed

Peat, J K; Keena, V; Harakeh, Z; Marks, G

2001-09-01

The adverse health consequences of exposing children to tobacco smoke have been well documented. Re-calculation of the data available from cohort and cross-sectional studies worldwide shows that between 500-2500 excess hospitalisations and between 1000 to 5000 excess diagnoses per 100 000 young children as result from respiratory infections can be directly attributed to parental smoking. Results of published meta-analyses support these figures, which are probably under-estimated because of the effects of non-differential misclassification bias. These excess infections are a source of preventable morbidity and have a high cost to the community. They also have important long-term consequences because children who have respiratory infections in early life are at an increased risk of developing asthma in later childhood. More effective strategies that prevent smoking in young people before they become parents have the potential to lead to reductions in these high rates of unnecessary morbidity in the next generation of children.

Direct oxygen uptake from air by novel glycogen accumulating organism dominated biofilm minimizes excess sludge production.

PubMed

Hossain, Md Iqbal; Paparini, Andrea; Cord-Ruwisch, Ralf

2018-05-29

The cost associated with treatment and disposal of excess sludge produced is one of the greatest operational expenses in wastewater treatment plants. In this study, we quantify and explain greatly reduced excess sludge production in the novel glycogen accumulating organism (GAO) dominated drained biofilm system previously shown to be capable of extremely energy efficient removal of organic carbon (biological oxygen demand or BOD) from wastewater. The average excess sludge production rate was 0.05 g VSS g -1 BOD (acetate) removed, which is about 9-times lower than that of comparative studies using the same acetate based synthetic wastewater. The substantially lower sludge yield was attributed to a number of features such as the high oxygen consumption facilitated by direct oxygen uptake from air, high biomass content (21.41 g VSS L -1 of reactor), the predominance of the GAO (Candidatus competibacter) with a low growth yield and the overwhelming presence of the predatory protozoa (Tetramitus) in the biofilm. Overall, the combination of low-energy requirement for air supply (no compressed air supply) and the low excess sludge production rate, could make this novel "GAO drained biofilm" process one of the most economical ways of biological organic carbon removal from wastewater. Copyright © 2018. Published by Elsevier B.V.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

PubMed Central

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI ± $437). CONCLUSIONS Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability. PMID:11251744

Food and processing residues in California: resource assessment and potential for power generation.

PubMed

Matteson, Gary C; Jenkins, B M

2007-11-01

The California agricultural industry produces more than 350 commodities with a combined yearly value in excess of $28 billion. The processing of many of these crops results in the production of residue streams, and the food processing industry faces increasing regulatory pressure to reduce environmental impacts and provide for sustainable management and use. Surveys of food and other processing and waste management sectors combined with published state data yield a total resource in excess of 4 million metric tons of dry matter, with nearly half of this likely to be available for utilization. About two-thirds of the available resource is produced as high-moisture residues that could support 134 MWe of power generation by anaerobic digestion and other conversion techniques. The other third is generated as low-moisture materials, many of which are already employed as fuel in direct combustion biomass power plants. The cost of energy conversion remains high for biochemical systems, with tipping or disposal fees of the order of $30-50Mg(-1) required to align power costs with current market prices. Identifying ways to reduce capital and operating costs of energy conversion, extending operating seasons to increase capacity factors through centralizing facilities, combining resource streams, and monetizing environmental benefits remain important goals for restructuring food and processing waste management in the state.

Corrosion resistant positive electrode for high-temperature, secondary electrochemical cell

DOEpatents

Otto, Neil C.; Warner, Barry T.; Smaga, John A.; Battles, James E.

1983-01-01

The corrosion rate of low carbon steel within a positive electrode of a high-temperature, secondary electrochemical cell that includes FeS as active material is substantially reduced by incorporating therein finely divided iron powder in stoichiometric excess to the amount required to form FeS in the fully charged electrode. The cell typically includes an alkali metal or alkaline earth metal as negative electrode active material and a molten metal halide salt as electrolyte. The excess iron permits use of inexpensive carbon steel alloys that are substantially free of the costly corrosion resistant elements chromium, nickel and molybdenum while avoiding shorten cell life resulting from high corrosion rates.

Corrosion resistant positive electrode for high-temperature, secondary electrochemical cell

DOEpatents

Otto, N.C.; Warner, B.T.; Smaga, J.A.; Battles, J.E.

1982-07-07

The corrosion rate of low carbon steel within a positive electrode of a high-temperature, secondary electrochemical cell that includes FeS as active material is substantially reduced by incorporating therein finely divided iron powder in stoichiometric excess to the amount required to form FeS in the fully charged electrode. The cell typically includes an alkali metal or alkaline earth metal as negative electrode active material and a molten metal halide salt as electrolyte. The excess iron permits use of inexpensive carbon steel alloys that are substantially free of the costly corrosion resistant elements chromium, nickel and molybdenum while avoiding shorten cell life resulting from high corrosion rates.

Contracts and supply assurance in the UK health care market.

PubMed

Fenn, P; Rickman, N; McGuire, A

1994-07-01

We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract.

Preventable hospitalizations, barriers to care, and disability.

PubMed

Pezzin, Liliana E; Bogner, Hillary R; Kurichi, Jibby E; Kwong, Pui L; Streim, Joel E; Xie, Dawei; Na, Ling; Hennessy, Sean

2018-05-01

The AHRQ's Prevention Quality Indicators assume inpatient hospitalizations for certain conditions, referred as ambulatory-care sensitive (ACS) conditions, are potentially preventable and may indicate reduced access to and a lower quality of ambulatory care. Using a cohort drawn from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims, we examined the extent to which barriers to healthcare are associated with ACS hospitalizations and related costs, and whether these associations differ by beneficiaries' disability status. Our results indicate that the regression-adjusted cost of ACS hospitalizations for elderly Medicare beneficiaries with no disabilities was $799. This cost increased six-fold, by $5148, among beneficiaries with mild disability, by $9045 for beneficiaries with moderate disability, by $5513 for those with severe disability, and by $8557 for persons with complete disability (P < 0.001). Persons reporting having foregone or delayed needed medical care because of financial difficulties (+$2082, P = .05), those experiencing low satisfaction with care coordination (+$1714, P = .01), and those reporting low satisfaction with access to care (+$1237, P = .02) also incurred significant excess ACS hospitalization costs relative to persons reporting no such barriers. This pattern held true for those with and without a disability, but were especially marked among persons with no functional limitations. These findings suggest that a better understanding of how public policy might effectively improve care coordination and reduce financial barriers to care is essential to formulating programs that reduce excess hospitalizations among the large and growing number of elderly Medicare beneficiaries.

Costs of adverse drug events in German hospitals--a microcosting study.

PubMed

Rottenkolber, Dominik; Hasford, Joerg; Stausberg, Jürgen

2012-01-01

In Germany, only limited data are available to quantify the attributable resource utilization associated with adverse drug events (ADEs). The aim of this study was twofold: first, to calculate the direct treatment costs associated with ADEs leading to hospitalization and, second, to derive the excess costs and extra hospital days attributable to ADEs of inpatient treatments in selected German hospitals. This was a retrospective and medical record-based study performed from the hospitals' perspective based on administrative accounting data from three hospitals (49,462 patients) in Germany. Total treatment costs ("analysis 1") and excess costs (i.e., incremental resource utilization) between patients suffering from an ADE and those without ADEs were calculated by means of a propensity score-based matching algorithm ("analysis 2"). Mean treatment costs ("analysis 1") of ADEs leading to hospitalization (n = 564) were €1,978 ± 2,036 (range €191-18,147; median €1,446; €843-2,480 [Q1-Q3]). In analysis 2, the mean costs of inpatients suffering from an ADE (n = 1,891) as a concomitant disease or complication (€5,113 ± 10,059; range €179-246,288; median €2,701; €1,636-5,111 [Q1-Q3]) were significantly higher (€970; P < 0.0001) than those of non-ADE inpatients (€4,143 ± 6,968; range €154-148,479; median €2,387; €1,432-4,701 [Q1-Q3]). Mean inpatient length of stay of ADE patients (12.7 ± 17.2 days) and non-ADE patients (9.8 ± 11.6 days) differed by 2.9 days (P < 0.0001). A nationwide extrapolation resulted in annual total treatment costs of €1.058 billion. This is one of the first administrative data-based analyses calculating the economic consequences of ADEs in Germany. Further efforts are necessary to improve pharmacotherapy and relieve health care payers of preventable treatment costs. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

PubMed

Meier, Toni; Senftleben, Karolin; Deumelandt, Peter; Christen, Olaf; Riedel, Katja; Langer, Martin

2015-01-01

Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

The Cost of Agree-Disagree: Satisficing and Sacrificing Reliability

ERIC Educational Resources Information Center

McIntyre, Joe; Gehlbach, Hunter

2014-01-01

Of all the approaches to collecting data in the social sciences, the administration of questionnaires to respondents is among the most prevalent. Despite their popularity, there is broad consensus among survey design experts that using these items introduces excessive error into respondents' ratings. The authors attempt to answer the following…

48 CFR 1852.231-71 - Determination of compensation reasonableness.

Code of Federal Regulations, 2014 CFR

2014-10-01

... consistency of the plan among the categories of labor being proposed. Differences between benefits offered... cost reimbursement or non-competitive fixed-price type subcontracts having a total potential value in... prime contract in excess of 10 percent of the prime contract's total potential value, provide as part of...

48 CFR 1852.231-71 - Determination of compensation reasonableness.

Code of Federal Regulations, 2010 CFR

2010-10-01

... consistency of the plan among the categories of labor being proposed. Differences between benefits offered... cost reimbursement or non-competitive fixed-price type subcontracts having a total potential value in... prime contract in excess of 10 percent of the prime contract's total potential value, provide as part of...

48 CFR 1852.231-71 - Determination of compensation reasonableness.

Code of Federal Regulations, 2012 CFR

2012-10-01

... consistency of the plan among the categories of labor being proposed. Differences between benefits offered... cost reimbursement or non-competitive fixed-price type subcontracts having a total potential value in... prime contract in excess of 10 percent of the prime contract's total potential value, provide as part of...

48 CFR 1852.231-71 - Determination of compensation reasonableness.

Code of Federal Regulations, 2013 CFR

2013-10-01

... consistency of the plan among the categories of labor being proposed. Differences between benefits offered... cost reimbursement or non-competitive fixed-price type subcontracts having a total potential value in... prime contract in excess of 10 percent of the prime contract's total potential value, provide as part of...

48 CFR 1852.231-71 - Determination of compensation reasonableness.

Code of Federal Regulations, 2011 CFR

2011-10-01

... consistency of the plan among the categories of labor being proposed. Differences between benefits offered... cost reimbursement or non-competitive fixed-price type subcontracts having a total potential value in... prime contract in excess of 10 percent of the prime contract's total potential value, provide as part of...

41 CFR 109-43.304-1.50 - DOE reutilization screening.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Management Regulations System (Continued) DEPARTMENT OF ENERGY PROPERTY MANAGEMENT REGULATIONS UTILIZATION AND DISPOSAL 43-UTILIZATION OF PERSONAL PROPERTY 43.3-Utilization of Excess § 109-43.304-1.50 DOE... acquisition cost is $1,000 or more. (d) In exceptional or unusual cases when time is critical, screening of...

41 CFR 109-43.304-1.50 - DOE reutilization screening.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Regulations System (Continued) DEPARTMENT OF ENERGY PROPERTY MANAGEMENT REGULATIONS UTILIZATION AND DISPOSAL 43-UTILIZATION OF PERSONAL PROPERTY 43.3-Utilization of Excess § 109-43.304-1.50 DOE... acquisition cost is $1,000 or more. (d) In exceptional or unusual cases when time is critical, screening of...

45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

Code of Federal Regulations, 2014 CFR

2014-10-01

...: (1) Accident insurance. Accident insurance covers RSVP volunteers for personal injury during travel...) Excess automobile liability insurance. (i) For RSVP volunteers who drive in connection with their service... volunteers carry on their own automobiles; or (B) The limits of applicable state financial responsibility law...

45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

Code of Federal Regulations, 2010 CFR

2010-10-01

...: (1) Accident insurance. Accident insurance covers RSVP volunteers for personal injury during travel...) Excess automobile liability insurance. (i) For RSVP volunteers who drive in connection with their service... volunteers carry on their own automobiles; or (B) The limits of applicable state financial responsibility law...

45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

Code of Federal Regulations, 2013 CFR

2013-10-01

...: (1) Accident insurance. Accident insurance covers RSVP volunteers for personal injury during travel...) Excess automobile liability insurance. (i) For RSVP volunteers who drive in connection with their service... volunteers carry on their own automobiles; or (B) The limits of applicable state financial responsibility law...

45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

Code of Federal Regulations, 2011 CFR

2011-10-01

...: (1) Accident insurance. Accident insurance covers RSVP volunteers for personal injury during travel...) Excess automobile liability insurance. (i) For RSVP volunteers who drive in connection with their service... volunteers carry on their own automobiles; or (B) The limits of applicable state financial responsibility law...

45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

Code of Federal Regulations, 2012 CFR

2012-10-01

...: (1) Accident insurance. Accident insurance covers RSVP volunteers for personal injury during travel...) Excess automobile liability insurance. (i) For RSVP volunteers who drive in connection with their service... volunteers carry on their own automobiles; or (B) The limits of applicable state financial responsibility law...

Economic Impact of Childhood and Adult Attention-Deficit/Hyperactivity Disorder in the United States

ERIC Educational Resources Information Center

Doshi, Jalpa A.; Hodgkins, Paul; Kahle, Jennifer; Sikirica, Vanja; Cangelosi, Michael J.; Setyawan, Juliana; Erder, M. Haim; Neumann, Peter J.

2012-01-01

Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children in the United States and often persists into adulthood with associated symptomatology and impairments. This article comprehensively reviews studies reporting ADHD-related incremental (excess) costs for children/adolescents and…

48 CFR 552.270-18 - Default in Delivery-Time Extensions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Default in Delivery-Time Extensions. 552.270-18 Section 552.270-18 Federal Acquisition Regulations System GENERAL SERVICES... leases, in excess of the aggregate rent and estimated real estate tax and operating cost adjustments for...

48 CFR 552.270-18 - Default in Delivery-Time Extensions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Default in Delivery-Time Extensions. 552.270-18 Section 552.270-18 Federal Acquisition Regulations System GENERAL SERVICES... leases, in excess of the aggregate rent and estimated real estate tax and operating cost adjustments for...

48 CFR 552.270-18 - Default in Delivery-Time Extensions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Default in Delivery-Time Extensions. 552.270-18 Section 552.270-18 Federal Acquisition Regulations System GENERAL SERVICES... leases, in excess of the aggregate rent and estimated real estate tax and operating cost adjustments for...

48 CFR 552.270-18 - Default in Delivery-Time Extensions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Default in Delivery-Time Extensions. 552.270-18 Section 552.270-18 Federal Acquisition Regulations System GENERAL SERVICES... leases, in excess of the aggregate rent and estimated real estate tax and operating cost adjustments for...

Evaluating the effects of heavy sugar cane truck operations on repair cost of low volume highways : technical summary report.

DOT National Transportation Integrated Search

2008-10-01

Current Louisiana state laws allow truck operators hauling certain agricultural commodities to purchase : overweight permits and haul at gross vehicle weights (GVW) in excess of the legislated GVW limit of : 80,000 lb. For instance, sugar cane trucke...

Evaluating the Effects of Heavy Sugar Cane Truck Operations on Repair Cost of Low Volume Highways : Technical Summary Report

DOT National Transportation Integrated Search

2008-10-01

Current Louisiana state laws allow truck operators hauling certain agricultural commodities to purchase overweight permits and haul at gross vehicle weights (GVW) in excess of the legislated GVW limit of 80,000 lb. For instance, sugar cane truckers m...

Structural performance analysis and redesign

NASA Technical Reports Server (NTRS)

Whetstone, W. D.

1978-01-01

Program performs stress buckling and vibrational analysis of large, linear, finite-element systems in excess of 50,000 degrees of freedom. Cost, execution time, and storage requirements are kept reasonable through use of sparse matrix solution techniques, and other computational and data management procedures designed for problems of very large size.

Method for extraction of proteins and phosphate minerals from swine manure

USDA-ARS?s Scientific Manuscript database

The recovery of phosphorus and proteins from manure could be advantageous to both offset costs and to improve and lessen the environmental impacts of manure storage and treatment. Phosphorous in manure can contaminate rivers, lakes, and bays through runoff, if applied onto a cropland excessively. Th...

46 CFR 252.33 - Hull and machinery insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Hull and machinery insurance. 252.33 Section 252.33... Subsidy Rates § 252.33 Hull and machinery insurance. (a) Subsidy items. The fair and reasonable net premium costs (including stamp taxes) of hull and machinery, increased value, excess general average...

Conventional Arms Transfers to Developing Nations, 1999-2006

DTIC Science & Technology

2007-09-26

rifles and the production of 7.62mm ammunition at a cost in excess of $500 million. Venezuela’s populist President, Hugo Chavez, has taken a hostile...Martinique Mexico Montserrat Netherlands Antilles Nicaragua Panama Paraguay Peru St. Kitts & Nevis St. Lucia St. Pierre & Miquelon St. Vincent Suriname Trinidad Turks & Caicos Venezuela

Mounting Debt

ERIC Educational Resources Information Center

Fullerton, Jon

2004-01-01

The long economic boom enabled school districts nationwide to fund expensive reforms and hefty pay raises. Now, however, they are finding it nearly impossible to cut costs and balance their budgets. The specific path to financial distress is unique in each case. Any number of factors, from excessively generous concessions at the bargaining table…

Acoustical Environments. Educational Facilities Review Series Number 16.

ERIC Educational Resources Information Center

Baas, Alan M.

This review surveys documents and journal articles previously announced in RIE and CIJE that deal with the principles and techniques of sound transmission and control, particularly as they relate to school environments. School planners and administrators are advised that excessive acoustical insulation costs may be avoided by early decisions…

Fiscal Impacts of Charter Schools: Lessons from New York

ERIC Educational Resources Information Center

Bifulco, Robert; Reback, Randall

2014-01-01

This brief argues that charter school programs can have direct fiscal impacts on school districts for two reasons. First, operating two systems of public schools under separate governance arrangements can create excess costs. Second, charter school financing policies can distribute resources to or away from districts. Using the city school…

48 CFR 31.205-23 - Losses on other contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Losses on other contracts. 31.205-23 Section 31.205-23 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... Organizations 31.205-23 Losses on other contracts. An excess of costs over income under any other contract...

A soil survey and hydrologic assessment involving Cleveland vacant lots - implications for stormwater management

EPA Science Inventory

Our work centered on the possibility of using vacant land mass to infiltrate and otherwise absorb excess stormwater runoff quantity as a sustainable and putatively cost-effective way of managing combined sewer overflows (CSO). County-level, Order 2 soil surveys have been used for...

7 CFR 3550.52 - Loan purposes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... added to the loan amount in excess of the area loan limit and appraised value of the house. (e) Loan..., insurance premiums, real estate tax advances, or preliminary foreclosure costs; or (ii) If a loan of $5,000..., and loan closing fees; and appraisal, surveying, environmental, tax monitoring, and other technical...

DESIGN MANUAL - REMOVAL OF ARSENIC FROM DRINKING WATER SUPPLIES BY ION EXCHANGE

EPA Science Inventory

This design manual is an in-depth presentation of the steps required to design and operate a water treatment plant for removal of excess arsenic from drinking water using the anion exchange process. The treatment process is very reliable, simple and cost-effective. This design ...

36 CFR 327.30 - Shoreline Management on Civil Works Projects.

Code of Federal Regulations, 2011 CFR

2011-07-01

... excessive siltation, erosion, rapid dewatering, or exposure to high wind, wave, or current action and/or in..., hydro-electric power stations, work areas, water intake structures, etc. No shoreline use permits will... costs, one year permits should be issued only when the location or nature of the activity requires...

DESIGN MANUAL - REMOVAL OF ARSENIC FROM DRINKING WATER SUPPLIES BY ADSORPTIVE MEDIA

EPA Science Inventory

This design manual is an in-depth presentation of the steps required to design and operate a water treatment plant for removal of excess arsenic from drinking water using the adsorptive media process. The treatment process is very reliable, simple and cost-effective. The adsorpt...

48 CFR 552.270-18 - Default in Delivery-Time Extensions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Default in Delivery-Time Extensions. 552.270-18 Section 552.270-18 Federal Acquisition Regulations System GENERAL SERVICES... leases, in excess of the aggregate rent and estimated real estate tax and operating cost adjustments for...

48 CFR 331.101-70 - Salary rate limitation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Salary rate limitation... CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Applicability 331.101-70 Salary rate... used to pay the direct salary of an individual at a rate in excess of the Federal Executive Schedule...

A Loblolly Pine Management Guide: Natural Regeneration of Loblolly Pine

Treesearch

M. Boyd Edwards

1987-01-01

For many landowners, low cost makes natural regeneration an attractive alternative to planting when loblolly pine stands are harvested. Clearcutting, seed-tree, shelterwood, and selection methods can be used. Keys to success are a suitable seedbed.an adequate seed supply, sufficient moisture. and freedom from excessive competition.

Designing PURPA (Public Utilities Regulatory Act) power purchase auctions: Theory and practice. [Cogenerated electricity purchasing model

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

Rothkopf, M.H.; Kahn, E.P.; Teisberg, T.J.

The Public Utilities Regulatory Act (PURPA) requires there to be procedures for electric utilities to buy electric power from qualifying cogenerators and small power producers (QFs) at rates up to ''avoided cost.'' This has led to price-posting procedures at prices calculated as the utility's marginal cost. Unexpectedly large sales at these prices and slow adjustment to falling energy cost are partially responsible for payments to QFs in excess of the utility's true avoided cost. Using competitive bidding instead of posted prices has been proposed as a way to avoid this outcome. This report reviews bidding theory and explores four issuesmore » that arise in deisigning auction systems for the purchase of power from QFs under PURPA. 77 refs., 6 figs., 15 tabs.« less

Designing PURPA (Public Utilities Regulatory Policies Act) power purchase auctions: Theory and practice. [Buys from cogenerators and small power generators

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

Not Available

The Public Utilities Regulatory Act (PURPA) requires there to be procedures for electric utilities to buy electric power from qualifying cogenerators and small power producers (QFs) at rates up to ''avoided cost''. This has led to price-posting procedures at prices calculated as the utility's marginal cost. Unexpectedly large sales at these prices and slow adjustment to falling energy cost are partially responsible for payments to QFs in excess of the utility's true avoided cost. Using competitive bidding instead of posted prices has been proposed as a way to avoid this outcome. This report reviews bidding theory and explores four issuesmore » that arise in designing auction systems for the purchase of power from QFs under PURPA.« less

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion

PubMed Central

Kerkum, Yvette L.; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Harlaar, Jaap; Brehm, Merel-Anne

2015-01-01

Introduction Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05) was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Trial Registration Dutch Trial Register NTR3418 PMID:26600039

The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

PubMed

Kerkum, Yvette L; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap; Brehm, Merel-Anne

2015-01-01

Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05) was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Dutch Trial Register NTR3418.

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

The cost-effectiveness of weight management programmes in a postnatal population.

PubMed

Rawdin, A C; Duenas, A; Chilcott, J B

2014-09-01

The aim of the study was to estimate the cost-effectiveness of a weight management programme including elements of physical exercise and dietary restriction which are designed to help women lose excess weight gained during pregnancy in the vulnerable postnatal period and inhibit the development of behaviours which could lead to future excess weight gain and obesity. A mathematical model based on a regression equation predicting change in weight over a fifteen year postnatal period was developed. The model included programme effectiveness and resource data based on a randomized controlled trial of a weight management programme implemented in a postnatal population in the United States. Utility and mortality data based on body mass index categories were also included. The model adopted a National Health Service (NHS) and personal social services (PSS) perspective, a lifetime time horizon and estimated the cost effectiveness of a weight management programme against a no change comparator in terms of an incremental cost-effectiveness ratio (ICER). The baseline results show that the difference in weight between women who received the weight management programme and women who received the control intervention was 3.02 kg at six months and 3.53 kg at fifteen years following childbirth. This results in an ICER of £7355 per quality adjusted life year (QALY) for women who were married at childbirth. The estimated ICER would suggest that such a weight management programme is cost-effective at a NICE threshold of £20,000 per QALY. However significant structural and evidence based uncertainty is present in the analysis. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

PubMed

Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten; Hastrup, Lene H; Eliasen, Marie; Dantoft, Thomas M; Schröder, Andreas; Jørgensen, Torben

2018-05-01

Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population ( n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

Bayesian models for cost-effectiveness analysis in the presence of structural zero costs

PubMed Central

Baio, Gianluca

2014-01-01

Bayesian modelling for cost-effectiveness data has received much attention in both the health economics and the statistical literature, in recent years. Cost-effectiveness data are characterised by a relatively complex structure of relationships linking a suitable measure of clinical benefit (e.g. quality-adjusted life years) and the associated costs. Simplifying assumptions, such as (bivariate) normality of the underlying distributions, are usually not granted, particularly for the cost variable, which is characterised by markedly skewed distributions. In addition, individual-level data sets are often characterised by the presence of structural zeros in the cost variable. Hurdle models can be used to account for the presence of excess zeros in a distribution and have been applied in the context of cost data. We extend their application to cost-effectiveness data, defining a full Bayesian specification, which consists of a model for the individual probability of null costs, a marginal model for the costs and a conditional model for the measure of effectiveness (given the observed costs). We presented the model using a working example to describe its main features. © 2013 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd. PMID:24343868

Bayesian models for cost-effectiveness analysis in the presence of structural zero costs.

PubMed

Baio, Gianluca

2014-05-20

Bayesian modelling for cost-effectiveness data has received much attention in both the health economics and the statistical literature, in recent years. Cost-effectiveness data are characterised by a relatively complex structure of relationships linking a suitable measure of clinical benefit (e.g. quality-adjusted life years) and the associated costs. Simplifying assumptions, such as (bivariate) normality of the underlying distributions, are usually not granted, particularly for the cost variable, which is characterised by markedly skewed distributions. In addition, individual-level data sets are often characterised by the presence of structural zeros in the cost variable. Hurdle models can be used to account for the presence of excess zeros in a distribution and have been applied in the context of cost data. We extend their application to cost-effectiveness data, defining a full Bayesian specification, which consists of a model for the individual probability of null costs, a marginal model for the costs and a conditional model for the measure of effectiveness (given the observed costs). We presented the model using a working example to describe its main features. © 2013 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd.

Platform options for the Space Station program

NASA Technical Reports Server (NTRS)

Mangano, M. J.; Rowley, R. W.

1986-01-01

Platforms for polar and 28.5 deg orbits were studied to determine the platform requirements and characteristics necessary to support the science objectives. Large platforms supporting the Earth-Observing System (EOS) were initially studied. Co-orbiting platforms were derived from these designs. Because cost estimates indicated that the large platform approach was likely to be too expensive, require several launches, and generally be excessively complex, studies of small platforms were undertaken. Results of these studies show the small platform approach to be technically feasible at lower overall cost. All designs maximized hardware inheritance from the Space Station program to reduce costs. Science objectives as defined at the time of these studies are largely achievable.

The threat of human influenza: the viruses, disease impacts, and vaccine solutions.

PubMed

Yin, Jiehui Kevin; Salkeld, Glenn; Heron, Leon; Khandaker, Gulam; Rashid, Harunor; Booy, Robert

2014-01-01

Influenza is an acute respiratory illness that remains an important cause of excessive morbidity and mortality with substantial economic cost to the population. Influenza, being a virus that frequently mutates, is not amenable to elimination. Vaccination remains the most effective preventive measure. This review summarises the latest developments in the fields of biology and epidemiology relating to clinical and economic impacts of influenza disease, and vaccination. We suggest that future efforts should focus on developing safer, more effective, and cost-effective prophylactic vaccines for influenza.

Frequency stabilization for mobile satellite terminals via LORAN

NASA Technical Reports Server (NTRS)

Ernst, Gregory J.; Kee, Steven M.; Marquart, Robert C.

1990-01-01

Digital satellite communication systems require careful management of frequency stability. Historically, frequency stability has been accomplished by continuously powered, high cost, high performance reference oscillators. Today's low cost mobile satellite communication equipment must operate under wide ranging environmental conditions, stabilize quickly after application of power, and provide adequate performance margin to overcome RF link impairments unique to the land mobile environment. Methods for frequency stabilization in land mobile applications must meet these objectives without incurring excessive performance degradation. A frequency stabilization scheme utilizing the LORAN (Long Range Navigation) system is presented.

Economical and technical efficiencies evaluation of full scale piggery wastewater treatment BNR plants.

PubMed

Oa, S W; Choi, E; Kim, S W; Kwon, K H; Min, K S

2009-01-01

A method evaluating the economic efficiency of piggery waste treatment plant based on kinetics for nitrogen removal performances is executed in this study and five full scale plants were evaluated, monitored intensively during one year under steady-state conditions. The performance data from those surveyed plants were recalculated by first-order kinetic equation instead of the Monod's equation, and the nitrogen removal kinetics related with COD/TKN ratios. Two plants adapting two extreme strategies for pre treatment, 'excess phase separation', and 'minimum phase separation', were evaluated by the assessment of life cycle cost (LCC). Although the compared two plants use an opposite strategy to each other, similar evaluation results are deduced by nitrogen removal efficiencies and operational and construction costs. But the proportions of constituent elements are as different as two opposite strategies, so electrical and construction costs are inversely proportional to chemical costs and operational costs respectively.

Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort.

PubMed

Zhu, Carolyn W; Cosentino, Stephanie; Ornstein, Katherine; Gu, Yian; Scarmeas, Nikolaos; Andrews, Howard; Stern, Yaakov

2015-11-01

Few studies have examined patterns of health care utilization and costs during the period around incident dementia. Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan. Medicare utilization and expenditure were examined in individuals with clinically diagnosed dementia from 2 years before until 2 years after the initial diagnosis. A sample of non-demented individuals who were matched on socio-demographic and clinical characteristics at study enrollment was used as controls. Multivariable regression analysis estimated effects on Medicare utilization and expenditures associated with incident dementia. During the 2 years before incident dementia, rates of inpatient admissions and outpatient visits were similar between dementia patients and non-demented controls, but use of home health and skilled nursing care and durable medical equipment were already higher in dementia patients. Results showed a small but significant excess increase associated with incident dementia in inpatient admissions but not in other areas of care. In the 2 years before incident dementia, total Medicare expenditures were already higher in dementia patients than in non-demented controls. But we found no excess increases in Medicare expenditures associated with incident dementia. Demand for medical care already is increasing and costs are higher at the time of incident dementia. There was a small but significant excess risk of inpatient admission associated with incident dementia. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review.

PubMed

Daryabor, Alieh; Arazpour, Mokhtar; Samadian, Mohammad; Veiskarami, Masoumeh; Ahmadi Bani, Monireh

2017-05-01

Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS. This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations. Literature review. According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria. People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis. Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention. Implications for Rehabilitations Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications. Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition. Spinal orthoses do not decline excessive energy expenditure to walk versus without it.

The Salience of Alcohol-Related Issues across the Adult Lifespan

ERIC Educational Resources Information Center

Pettigrew, Simone; Pescud, Melanie

2016-01-01

Objective: The growing costs to the community of excessive alcohol consumption have resulted in pressure for governments and non-governmental organisations (NGOs) to develop strategies to address this problem, but they do so in a highly constrained resource environment. To provide evidence of health education approaches that may be effective…

Complementing the Numbers: A Text Mining Analysis of College Course Withdrawals

ERIC Educational Resources Information Center

Michalski, Greg V.

2011-01-01

Excessive college course withdrawals are costly to the student and the institution in terms of time to degree completion, available classroom space, and other resources. Although generally well quantified, detailed analysis of the reasons given by students for course withdrawal is less common. To address this, a text mining analysis was performed…

Water management in container nurseries to minimize pests

Treesearch

R. Kasten Dumroese; Diane L. Haase

2018-01-01

Water is the most important and most common chemical used in plant nurseries. It is also the most dangerous chemical used. Insufficient water, excessive water, and poorly timed irrigation can all lead to poor-quality crops and unacceptable mortality. Anticipated future declines of water availability, higher costs to use it, and continuing concerns about irrigation...

Missouri | Solar Research | NREL

Science.gov Websites

previous calendar year, 1% of utility's single-hour peak load (annually) and 5% of utility's single-hour peak load Credit: Net excess generation is credited at avoided-cost rate RECs: Renewable energy size limit: 100 kW Liability insurance: There are no requirements for systems <10 kW; systems >10

The Implications of Healthcare Utilization of Diabetes Disease Management

DTIC Science & Technology

2008-06-24

and $31 billion in excess general medical costs. The purpose of this study is to determine whether sustained hemoglobin HbA1c testing among patients is...of the independent ( HbA1c Testing 2005, 2006 and 2007), predicting outpatient utilization of patients at Fort Knox MEDDAC that were diagnosed with

34 CFR 386.33 - What are the requirements for grantees in disbursing scholarships?

Code of Federal Regulations, 2014 CFR

2014-07-01

... scholarships? 386.33 Section 386.33 Education Regulations of the Offices of the Department of Education... the requirements for grantees in disbursing scholarships? (a) Before disbursement of scholarship... scholarship by the amount in which the combined awards would be in excess of the cost of attendance, if a...

34 CFR 386.33 - What are the requirements for grantees in disbursing scholarships?

Code of Federal Regulations, 2011 CFR

2011-07-01

... scholarships? 386.33 Section 386.33 Education Regulations of the Offices of the Department of Education... the requirements for grantees in disbursing scholarships? (a) Before disbursement of scholarship... scholarship by the amount in which the combined awards would be in excess of the cost of attendance, if a...

34 CFR 386.33 - What are the requirements for grantees in disbursing scholarships?

Code of Federal Regulations, 2012 CFR

2012-07-01

... scholarships? 386.33 Section 386.33 Education Regulations of the Offices of the Department of Education... the requirements for grantees in disbursing scholarships? (a) Before disbursement of scholarship... scholarship by the amount in which the combined awards would be in excess of the cost of attendance, if a...

34 CFR 386.33 - What are the requirements for grantees in disbursing scholarships?

Code of Federal Regulations, 2013 CFR

2013-07-01

... scholarships? 386.33 Section 386.33 Education Regulations of the Offices of the Department of Education... the requirements for grantees in disbursing scholarships? (a) Before disbursement of scholarship... scholarship by the amount in which the combined awards would be in excess of the cost of attendance, if a...

45 CFR 162.925 - Additional requirements for health plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... clearinghouse to receive, process, or transmit a standard transaction may not charge fees or costs in excess of... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS General Provisions for Transactions § 162.925 Additional... transaction as a standard transaction, the health plan must do so. (2) A health plan may not delay or reject a...

18 CFR 2.20 - Good faith requests for transmission services and good faith responses by transmitting utilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... “rates, terms and conditions” element of the request. (12) Any other information to facilitate the expeditious processing of its request. Such information will improve the negotiation process, reduce costs... transmitting utility is attempting to frustrate the process by making excessive requests for clarification, it...

24 CFR 968.225 - Budget revisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form prescribed...

18 CFR 367.23 - Transactions with non-associate companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... excess or deficiency of the cost on servicing the non-associate companies must be charged to account 458... charged to account 458.4 (§ 367.4584). In computing charges to associate companies for any calendar year, any net credit in this account must be deducted from amounts reimbursable by associate companies as...

Young People and Alcohol--Where's the Risk? Changing the Focus of School-Based Prevention Initiatives

ERIC Educational Resources Information Center

Petrie, Margaret

2017-01-01

Research statistics highlighting the social costs of widespread excessive alcohol consumption have led to a proliferation of school-based prevention programmes that aim to give young people the skills and knowledge necessary to resist social pressure to drink alcohol and avoid potentially "risky" consumption. Such interventions offer,…

Factors influencing large wildland fire suppression expenditures

Treesearch

Jingjing Liang; Dave E. Calkin; Krista M. Gebert; Tyron J. Venn; Robin P. Silverstein

2008-01-01

There is an urgent and immediate need to address the excessive cost of large fires. Here, we studied large wildland fire suppression expenditures by the US Department of Agriculture Forest Service. Among 16 potential nonmanagerial factors, which represented fire size and shape, private properties, public land attributes, forest and fuel conditions, and geographic...

Evaluation of the Buckeye Crossbuck at public, passive railroad/highway grade crossings in Ohio : research implementation plan.

DOT National Transportation Integrated Search

2000-12-01

STATEMENT OF NEED: The state has been able to close more than 150 public grade crossings to motor vehicles since 1990 until 2000. : During that 10-year period, Ohio has completed in excess of 1400 light and gate projects at a cost exceeding $140 : mi...

Green tea: molecular targets in glucose uptake, inflammation, and insulin signaling pathways

USDA-ARS?s Scientific Manuscript database

Obesity is a major public health problem that leads to increased risk of developing diabetes, cardiovascular, and related diseases. The number of overweight and obese Americans has increased since the 1960s, and obesity may be responsible for as many as 300,000 deaths and medical costs in excess of...

Retrieving residue after overstory removal in true fir, northeastern California

Treesearch

Gary O. Fiddler; C. Phillip Weatherspoon

1986-01-01

Overstory removal cutting, the most common means of converting old-growth stands to young growth stands in California, can produce excessive residues that pose management problems. Utilization is an attractive option for managing residues. However, the cost of residue retrieval and utilization is often prohibitive. Residue retrieval by a private contractor was studied...

Report: Administrative Leave Decisions for EPA Employee Disciplinary Actions Should Be Better Documented, and Parameters on Use of Such Leave Should Be Established

EPA Pesticide Factsheets

Report #16-P-0036, November 9, 2015. EPA’s use of extended administrative leave can result in unnecessary and excessive payroll costs, and lack of documentation and justification can lead others to second guess the agency’s decisions.

20 CFR 641.430 - What are the responsibility conditions that an applicant must meet?

Code of Federal Regulations, 2011 CFR

2011-04-01

... Government property as instructed by the Department. (j) Failure to have maintained effective cash management or cost controls resulting in excess cash on hand. (k) Failure to ensure that a sub-recipient... failure to maintain a financial management system as required by Federal regulations. (d) Willful...

Attainable high capacity in Li-excess Li-Ni-Ru-O rock-salt cathode for lithium ion battery

NASA Astrophysics Data System (ADS)

Wang, Xingbo; Huang, Weifeng; Tao, Shi; Xie, Hui; Wu, Chuanqiang; Yu, Zhen; Su, Xiaozhi; Qi, Jiaxin; Rehman, Zia ur; Song, Li; Zhang, Guobin; Chu, Wangsheng; Wei, Shiqiang

2017-08-01

Peroxide structure O2n- has proven to appear after electrochemical process in many lithium-excess precious metal oxides, representing extra reversible capacity. We hereby report construction of a Li-excess rock-salt oxide Li1+xNi1/2-3x/2Ru1/2+x/2O2 electrode, with cost effective and eco-friendly 3d transition metal Ni partially substituting precious 4d transition metal Ru. It can be seen that O2n- is formed in pristine Li1.23Ni0.155Ru0.615O2, and stably exists in subsequent cycles, enabling discharge capacities to 295.3 and 198 mAh g-1 at the 1st/50th cycle, respectively. Combing ex-situ X-ray absorption near edge spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, high resolution transmission electron microscopy and electrochemical characterization, we demonstrate that the excellent electrochemical performance comes from both percolation network with disordered structure and cation/anion redox couples occurring in charge-discharge process. Li-excess and substitution of common element have been demonstrated to be a breakthrough for designing novel high performance commercial cathodes in rechargeable lithium ion battery field.

Pediatric Trauma Transfer Imaging Inefficiencies-Opportunities for Improvement with Cloud Technology.

PubMed

Puckett, Yana; To, Alvin

2016-01-01

This study examines the inefficiencies of radiologic imaging transfers from one hospital to the other during pediatric trauma transfers in an era of cloud based information sharing. Retrospective review of all patients transferred to a pediatric trauma center from 2008-2014 was performed. Imaging was reviewed for whether imaging accompanied the patient, whether imaging was able to be uploaded onto computer for records, whether imaging had to be repeated, and whether imaging obtained at outside hospitals (OSH) was done per universal pediatric trauma guidelines. Of the 1761 patients retrospectively reviewed, 559 met our inclusion criteria. Imaging was sent with the patient 87.7% of the time. Imaging was unable to be uploaded 31.9% of the time. CT imaging had to be repeated 1.8% of the time. CT scan was not done per universal pediatric trauma guidelines 1.2% of the time. Our study demonstrated that current imaging transfer is inefficient, leads to excess ionizing radiation, and increased healthcare costs. Universal implementation of cloud based radiology has the potential to eliminate excess ionizing radiation to children, improve patient care, and save cost to healthcare system.

Weight gain and nutritional efficacy in anorexia nervosa.

PubMed

Dempsey, D T; Crosby, L O; Pertschuk, M J; Feurer, I D; Buzby, G P; Mullen, J L

1984-02-01

To evaluate the usefulness of interval weight change in assessing nutritional support efficacy, we studied four anorexia nervosa patients (52% ideal body weight) requiring long-term total parenteral nutrition (TPN) for 63 +/- 18 days. Fluid and electrolyte deficits were corrected before the initiation of nutritional support. Resting energy expenditure was measured before the initiation of TPN and weekly thereafter, using indirect calorimetry. Daily caloric expenditure was estimated at 1.1 X resting energy expenditure, based on previous studies of continuous heart rate monitoring in this patient population. Daily excess calories were calculated as caloric intake minus caloric expenditure. Each patient was weighed daily and linear regression analysis (excess calories versus weight change) was performed for individual patients and the group over intervals of varying length. There was no individual or group correlation between excess calories and weight gain on a daily or weekly interval basis. Cumulative weight changes over the long-term course of TPN correlated significantly with cumulative excess calories for each patient and the whole group (r = +0.82, p less than 0.01). The excess calories required to gain a kilogram body weight ranged from 5569 to 15619 kcal/kg with a mean of 9768. Cumulative long-term weight changes during nutritional repletion in anorexia nervosa are meaningful indicators of caloric balance, but short interval weight changes (daily, weekly) are not. The caloric cost of weight gain is variable in this population.

Cost and performance of thermal storage concepts in solar thermal systems, Phase 2-liquid metal receivers

NASA Astrophysics Data System (ADS)

McKenzie, A. W.

Cost and performance of various thermal storage concepts in a liquid metal receiver solar thermal power system application have been evaluated. The objectives of this study are to provide consistently calculated cost and performance data for thermal storage concepts integrated into solar thermal systems. Five alternative storage concepts are evaluated for a 100-MW(e) liquid metal-cooled receiver solar thermal power system for 1, 6, and 15 hours of storage: sodium 2-tank (reference system), molten draw salt 2-tank, sand moving bed, air/rock, and latent heat (phase change) with tube-intensive heat exchange (HX). The results indicate that the all sodium 2-tank thermal storage concept is not cost-effective for storage in excess of 3 or 4 hours; the molten draw salt 2-tank storage concept provides significant cost savings over the reference sodium 2-tank concept; and the air/rock storage concept with pressurized sodium buffer tanks provides the lowest evaluated cost of all storage concepts considered above 6 hours of storage.

Time to revisit arsenic regulations: comparing drinking water and rice.

PubMed

Sauvé, Sébastien

2014-05-17

Current arsenic regulations focus on drinking water without due consideration for dietary uptake and thus seem incoherent with respect to the risks arising from rice consumption. Existing arsenic guidelines are a cost-benefit compromise and, as such, they should be periodically re-evaluated. Literature data was used to compare arsenic exposure from rice consumption relative to exposure arising from drinking water. Standard risk assessment paradigms show that arsenic regulations for drinking water should target a maximum concentration of nearly zero to prevent excessive lung and bladder cancer risks (among others). A feasibility threshold of 3 μg As l(-1) was determined, but a cost-benefit analysis concluded that it would be too expensive to target a threshold below 10 μg As l(-1). Data from the literature was used to compare exposure to arsenic from rice and rice product consumption relative to drinking water consumption. The exposure to arsenic from rice consumption can easily be equivalent to or greater than drinking water exposure that already exceeds standard risks and is based on feasibility and cost-benefit compromises. It must also be emphasized that many may disagree with the implications for their own health given the abnormally high cancer odds expected at the cost-benefit arsenic threshold. Tighter drinking water quality criteria should be implemented to properly protect people from excessive cancer risks. Food safety regulations must be put in place to prevent higher concentrations of arsenic in various drinks than those allowed in drinking water. Arsenic concentrations in rice should be regulated so as to roughly equate the risks and exposure levels observed from drinking water.

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

Neal, J.W.

The nation`s rural electric cooperatives own a high proportion of coal-fired generation, in excess of 80 percent of their generating capacity. As the electric utility industry moves toward a competitive electricity market, the generation mix for electric cooperatives is expected to change. Distributed generation will likely serve more customer loads than is now the case, and that will lead to an increase in gas-fired generation capacity. But, clean low-cost central station coal-fired capacity is expected to continue to be the primary source of power for growing rural electric cooperatives. Gasification combined cycle could be the lowest cost coal based generationmore » option in this new competitive market if both capital cost and electricity production costs can be further reduced. This paper presents anticipated utility business scenarios for the deregulated future and identifies combined cycle power plant configurations that might prove most competitive.« less

A survey of reimbursement practices of private health insurance companies for pharmaceuticals not covered under the Pharmaceutical Benefits Scheme 2008.

PubMed

Lingaratnam, Senthil M; Kirsa, Sue W; Mellor, James D; Jackson, John; Crellin, Wallace; Fitzsimons, Michael; Zalcberg, John R

2011-05-01

To describe the current practices and policy of Australian private health insurance (PHI) companies with respect to cover for pharmaceuticals not subsidised under the Pharmaceutical Benefits Scheme (PBS). A 2008 review of web-published policy statements for top-level hospital and comprehensive general treatment insurance, and survey of reimbursement practices by way of questionnaire, of 31 Australian-registered, open-membership PHI companies. Description of the level of pharmaceutical cover and important considerations identified by PHI companies for funding non-PBS pharmaceuticals through benefit entitlements or ex-gratia payments. Nine of thirty-one PHI companies (29%) provided responses accounting for ~60% market share of PHI. The majority of smaller PHI firms either declined participation or did not respond. The maximum limits offered for non-PBS pharmaceuticals, under comprehensive general treatment insurance, varied significantly and typically did not adequately cover high-cost pharmaceuticals. Some companies occasionally offered ex-gratia payments (or discretionary payments in excess of the policyholder's entitlement benefits) for high cost-pharmaceuticals. Factors considered important in their decision to approve or reject ex-gratia requests were provided. All results were de-identified. There is little consistency across PHI companies in the manner in which they handle requests for high-cost pharmaceuticals in excess of the defined benefit limits. Such information and processes are not transparent to consumers.

Transesterification of Waste Activated Sludge for Biosolids Reduction and Biodiesel Production.

PubMed

Maeng, Min Ho; Cha, Daniel K

2018-02-01

  Transesterification of waste activated sludge (WAS) was evaluated as a cost-effective technique to reduce excess biosolids and recover biodiesel feedstock from activated sludge treatment processes. A laboratory-scale sequencing batch reactor (SBR) was operated with recycling transesterification-treated WAS back to the aeration basin. Seventy percent recycling of WAS resulted in a 48% reduction of excess biosolids in comparison with a conventional SBR, which was operated in parallel as the control SBR. Biodiesel recovery of 8.0% (dried weight basis) was achieved at an optimum transesterification condition using acidic methanol and xylene as cosolvent. Average effluent soluble chemical oxygen demand (COD) and total suspended solids (TSS) concentrations from the test SBR and control SBR were comparable, indicating that the recycling of transesterification-treated WAS did not have detrimental effect on the effluent quality. This study demonstrated that transesterification and recycling of WAS may be a feasible technique for reducing excess biosolids, while producing valuable biodiesel feedstock from the activated sludge process.

Decomposition pathways of polytetrafluoroethylene by co-grinding with strontium/calcium oxides.

PubMed

Qu, Jun; He, Xiaoman; Zhang, Qiwu; Liu, Xinzhong; Saito, Fumio

2017-06-01

Waste polytetrafluoroethylene (PTFE) could be easily decomposed by co-grinding with inorganic additive such as strontium oxide (SrO), strontium peroxide (SrO 2 ) and calcium oxide (CaO) by using a planetary ball mill, in which the fluorine was transformed into nontoxic inorganic fluoride salts such as strontium fluoride (SrF 2 ) or calcium fluoride (CaF 2 ). Depending on the kind of additive as well as the added molar ratio, however, the reaction mechanism of the decomposition was found to change, with different compositions of carbon compounds formed. CO gas, the mixture of strontium carbonate (SrCO 3 ) and carbon, only SrCO 3 were obtained as reaction products respectively with equimolar SrO, excess SrO and excess SrO 2 to the monomer unit CF 2 of PTFE were used. Excess amount of CaO was needed to effectively decompose PTFE because of its lower reactivity compared with strontium oxide, but it promised practical applications due to its low cost.

A method for measuring sulfide toxicity in the nematode Caenorhabditis elegans.

PubMed

Livshits, Leonid; Gross, Einav

2017-01-01

Cysteine catabolism by gut microbiota produces high levels of sulfide. Excessive sulfide can interfere with colon function, and therefore may be involved in the etiology and risk of relapse of ulcerative colitis, an inflammatory bowel disease affecting millions of people worldwide. Therefore, it is crucial to understand how cells/animals regulate the detoxification of sulfide generated by bacterial cysteine catabolism in the gut. Here we describe a simple and cost-effective way to explore the mechanism of sulfide toxicity in the nematode Caenorhabditis elegans ( C. elegans ). •A rapid cost-effective method to quantify and study sulfide tolerance in C. elegans and other free-living nematodes.•A cost effective method to measure the concentration of sulfide in the inverted plate assay.

Cost containment and diffusion of MRI: oil and water?. Japanese experience.

PubMed

Korogi, Y; Takahashi, M

1997-01-01

The total number of MR units available in Japan relative to the population is the highest in the world. The total number of MR units installed in 1996 was 2,663, equivalent to 24 per million population. The average charge per procedure in Japan is only one fifth of that in the United States (USA), approximately US$200 and US$950, respectively, suggesting that economic considerations in Japan may not take the highest priority. Despite the low costs, the utilisation (the number of patients examined each year or per week) of MR units in Japan is only about half that in the USA. As such, an increase in the number of MR units per se does not result in excessive health care costs.

Benchmark calculations of excess electrons in water cluster cavities: balancing the addition of atom-centered diffuse functions versus floating diffuse functions.

PubMed

Zhang, Changzhe; Bu, Yuxiang

2016-09-14

Diffuse functions have been proved to be especially crucial for the accurate characterization of excess electrons which are usually bound weakly in intermolecular zones far away from the nuclei. To examine the effects of diffuse functions on the nature of the cavity-shaped excess electrons in water cluster surroundings, both the HOMO and LUMO distributions, vertical detachment energies (VDEs) and visible absorption spectra of two selected (H2O)24(-) isomers are investigated in the present work. Two main types of diffuse functions are considered in calculations including the Pople-style atom-centered diffuse functions and the ghost-atom-based floating diffuse functions. It is found that augmentation of atom-centered diffuse functions contributes to a better description of the HOMO (corresponding to the VDE convergence), in agreement with previous studies, but also leads to unreasonable diffuse characters of the LUMO with significant red-shifts in the visible spectra, which is against the conventional point of view that the more the diffuse functions, the better the results. The issue of designing extra floating functions for excess electrons has also been systematically discussed, which indicates that the floating diffuse functions are necessary not only for reducing the computational cost but also for improving both the HOMO and LUMO accuracy. Thus, the basis sets with a combination of partial atom-centered diffuse functions and floating diffuse functions are recommended for a reliable description of the weakly bound electrons. This work presents an efficient way for characterizing the electronic properties of weakly bound electrons accurately by balancing the addition of atom-centered diffuse functions and floating diffuse functions and also by balancing the computational cost and accuracy of the calculated results, and thus is very useful in the relevant calculations of various solvated electron systems and weakly bound anionic systems.

Funding innovation for treatment for rare diseases: adopting a cost-based yardstick approach

PubMed Central

2013-01-01

Background Manufacturers justify the high prices for orphan drugs on the basis that the associated R&D costs must be spread over few patients. The proliferation of these drugs in the last three decades, combined with high prices commonly in excess of $100,000 per patient per year are placing a substantial strain on the budgets of drug plans in many countries. Do insurers spend a growing portion of their budgets on small patient populations, or leave vulnerable patients without coverage for valuable treatments? We suggest that a third option is present in the form of a cost-based regulatory mechanism. Methods This article explores the use of a cost-based price control mechanism for orphan drugs, adapted from the standard models applied in utilities regulation. Results and conclusions A rate-of-return style model, employing yardsticked cost allocations and a modified two-stage rate of return calculation could be effective in setting a new standard for orphan drugs pricing. This type of cost-based pricing would limit the costs faced by insurers while continuing to provide an efficient incentive for new drug development. PMID:24237605

Low-Cost Composite Materials and Structures for Aircraft Applications

NASA Technical Reports Server (NTRS)

Deo, Ravi B.; Starnes, James H., Jr.; Holzwarth, Richard C.

2003-01-01

A survey of current applications of composite materials and structures in military, transport and General Aviation aircraft is presented to assess the maturity of composites technology, and the payoffs realized. The results of the survey show that performance requirements and the potential to reduce life cycle costs for military aircraft and direct operating costs for transport aircraft are the main reasons for the selection of composite materials for current aircraft applications. Initial acquisition costs of composite airframe components are affected by high material costs and complex certification tests which appear to discourage the widespread use of composite materials for aircraft applications. Material suppliers have performed very well to date in developing resin matrix and fiber systems for improved mechanical, durability and damage tolerance performance. The next challenge for material suppliers is to reduce material costs and to develop materials that are suitable for simplified and inexpensive manufacturing processes. The focus of airframe manufacturers should be on the development of structural designs that reduce assembly costs by the use of large-scale integration of airframe components with unitized structures and manufacturing processes that minimize excessive manual labor.

The social costs of uranium mining in the US Colorado Plateau cohort, 1960-2005.

PubMed

Jones, Benjamin A

2017-05-01

Long-term social costs associated with underground uranium mining are largely unknown. This study estimated health costs of Native American and white (Hispanic and non-Hispanic origin) uranium miners in the US Public Health Service Colorado Plateau cohort study. Elevated uranium miner person-years of life lost (PYLL) were calculated from the most recent study of the Colorado Plateau cohort over 1960-2005. Nine causes of death categories were included. Costs to society of miner PYLL were monetized using the value of a statistical life-year approach. Costs over 1960-2005 totaled $2 billion USD [95% CI: $1.8, $2.2], or $2.9 million per elevated miner death. This corresponds to $43.1 million [95%: $38.7, $48.7] in annual costs. Lung cancer was the most costly cause of death at $1.4 billion [95%: $1.3, $1.5]. Absolute health costs were largest for white miners, but Native Americans had larger costs per elevated death. Annual excess mortality over 1960-2005 averaged 366.4 per 100,000 miners; 404.6 (white) and 201.5 per 100,000 (Native American). This research advances our understanding of uranium extraction legacy impacts, particularly among indigenous populations.

24 CFR 248.161 - Mandatory sale of housing in excess of the Federal cost limit.

Code of Federal Regulations, 2010 CFR

2010-04-01

... value. At the time of submission of the offer, the potential purchaser must also submit the... potential income equal to the amount determined by multiplying 120 percent of the prevailing rents in the... amount not exceeding the difference between the amount of assistance provided under paragraph (c) of this...

24 CFR 248.161 - Mandatory sale of housing in excess of the Federal cost limit.

Code of Federal Regulations, 2012 CFR

2012-04-01

... value. At the time of submission of the offer, the potential purchaser must also submit the... potential income equal to the amount determined by multiplying 120 percent of the prevailing rents in the... amount not exceeding the difference between the amount of assistance provided under paragraph (c) of this...

24 CFR 248.161 - Mandatory sale of housing in excess of the Federal cost limit.

Code of Federal Regulations, 2014 CFR

2014-04-01

... value. At the time of submission of the offer, the potential purchaser must also submit the... potential income equal to the amount determined by multiplying 120 percent of the prevailing rents in the... amount not exceeding the difference between the amount of assistance provided under paragraph (c) of this...

24 CFR 248.161 - Mandatory sale of housing in excess of the Federal cost limit.

Code of Federal Regulations, 2011 CFR

2011-04-01

... value. At the time of submission of the offer, the potential purchaser must also submit the... potential income equal to the amount determined by multiplying 120 percent of the prevailing rents in the... amount not exceeding the difference between the amount of assistance provided under paragraph (c) of this...

24 CFR 248.161 - Mandatory sale of housing in excess of the Federal cost limit.

Code of Federal Regulations, 2013 CFR

2013-04-01

... value. At the time of submission of the offer, the potential purchaser must also submit the... potential income equal to the amount determined by multiplying 120 percent of the prevailing rents in the... amount not exceeding the difference between the amount of assistance provided under paragraph (c) of this...

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs are...

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... property under their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs...

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... property under their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs...

25 CFR 170.618 - Can a tribe keep savings resulting from project administration?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can a tribe keep savings resulting from project... Agreements Under Isdeaa § 170.618 Can a tribe keep savings resulting from project administration? When actual... estimated costs, the Secretary will determine the use of the excess funds after consultation with the tribe...

25 CFR 170.618 - Can a tribe keep savings resulting from project administration?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Can a tribe keep savings resulting from project... Agreements Under Isdeaa § 170.618 Can a tribe keep savings resulting from project administration? When actual... estimated costs, the Secretary will determine the use of the excess funds after consultation with the tribe...

48 CFR 52.215-22 - Limitations on Pass-Through Charges-Identification of Subcontract Effort.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... The offeror's proposal shall exclude excessive pass-through charges. (c) Performance of work by the..., under the contract, task order, or delivery order. (2) If the offeror intends to subcontract more than 70 percent of the total cost of work to be performed under the contract, task order, or delivery...

Organisational Communication and Its Relationships with Occupational Stress of Primary School Staff in Western Australia

ERIC Educational Resources Information Center

De Nobile, John

2016-01-01

Occupational stress is an important issue for most occupations and often arises when the demands of the workplace become excessive or aspects of work are unpleasant. If left unmanaged occupational stress can lead to a range of outcomes that can cost organisations dearly, including burnout, physical sickness, absenteeism and turnover. Some aspects…

Forest road design to minimize erosion in the Southern Appalachians

Treesearch

L.W. Swift

1985-01-01

Excessive erosion and low serviceability of roads are continuing problems associated with forest management in the mountains of the southeastern United States. Road and erosion research.at Coweeta Hydrologic Laboratory in western North Carolina dates from roadbank stabilization work in the 1930's. Emphasis has been to develop and demonstrate a low-cost, low-...

Compensation Rules for Climate Policy in the Electricity Sector

ERIC Educational Resources Information Center

Burtraw, Dallas; Palmer, Karen

2008-01-01

Most previous cap and trade programs have distributed emission allowances for free to incumbent producers. However, in the electricity sector the value of CO[subscript 2] allowances may be far in excess of costs to industry and giving them away to firms diverts allowance value from other purposes. Using a detailed simulation model, this paper…

Hillslope erosion rates in the oak savannas of the southwestern borderlands region

Treesearch

Aaron T. Kauffman; Cody L. Stropki; Peter F. Ffolliott; Gerald J. Gottfried; Daniel G. Neary

2007-01-01

Hillslope soil erosion on watershed landscapes can lower the productivity of upland sites and adversely impact water quality and downstream (off-site) areas. It is not surprising, therefore, that excessive soil erosion and the consequent sedimentation can represent significant costs to the land and people that are affected. The first known estimates of hillslope soil...

49 CFR 26.55 - How is DBE participation counted toward goals?

Code of Federal Regulations, 2014 CFR

2014-10-01

... by paragraph (a)(2) of this section) that is performed by the DBE's own forces. Include the cost of...-assisted contract, toward DBE goals, provided you determine the fee to be reasonable and not excessive as... work of the contract that the DBE performs with its own forces toward DBE goals. (c) Count expenditures...

49 CFR 26.55 - How is DBE participation counted toward goals?

Code of Federal Regulations, 2013 CFR

2013-10-01

... by paragraph (a)(2) of this section) that is performed by the DBE's own forces. Include the cost of...-assisted contract, toward DBE goals, provided you determine the fee to be reasonable and not excessive as... work of the contract that the DBE performs with its own forces toward DBE goals. (c) Count expenditures...

49 CFR 26.55 - How is DBE participation counted toward goals?

Code of Federal Regulations, 2012 CFR

2012-10-01

... by paragraph (a)(2) of this section) that is performed by the DBE's own forces. Include the cost of...-assisted contract, toward DBE goals, provided you determine the fee to be reasonable and not excessive as... work of the contract that the DBE performs with its own forces toward DBE goals. (c) Count expenditures...

49 CFR 26.55 - How is DBE participation counted toward goals?

Code of Federal Regulations, 2011 CFR

2011-10-01

... by paragraph (a)(2) of this section) that is performed by the DBE's own forces. Include the cost of...-assisted contract, toward DBE goals, provided you determine the fee to be reasonable and not excessive as... work of the contract that the DBE performs with its own forces toward DBE goals. (c) Count expenditures...

Obesity Prevention in Young Schoolchildren: Results of a Pilot Study

ERIC Educational Resources Information Center

Manger, William M.; Manger, Lynn S.; Minno, Alexander M.; Killmeyer, Mike; Holzman, Robert S.; Schullinger, John N.; Roccella, Edward J.

2012-01-01

Background: Overweight and obesity occur in 17% of children in the United States. Complications of excess weight in Americans cause 216,000 to 300,000 deaths yearly and cost $147 billion. Methods: A convenience sample of 14 intervention and 15 control schools in the Catholic Diocese of Pittsburgh was used. A program to improve lifestyle (Values…

Stacked -gene hybrids were not found to be superior to glyphosate resistant or Non-GMO corn hybrids

USDA-ARS?s Scientific Manuscript database

Seed costs of modern corn hybrids genetically modified with multiple traits for insect and herbicide resistance “stacked-gene” are in excess of $100.00 US per acre. Yields and net returns per acre along with yield component data were determined for ten hybrids, four stacked-gene, four glyphosate re...

20 CFR 667.170 - What responsibility review does the Department conduct for awards made under WIA title I...

Code of Federal Regulations, 2011 CFR

2011-04-01

... effective cash management or cost controls resulting in excess cash on hand; (11) Failure to ensure that a... consider the organization's history with regard to the management of other grants, including DOL grants... management system as required by Federal regulations; (4) Willful obstruction of the audit process; (5...

Regulation and accreditation: the pros and cons for psychiatric facilities.

PubMed

Houck, J H

1984-12-01

Psychiatric hospitals must be regulated, and someone must write the rules, says the author. But the rules of such agencies as the Joint Commission on Accreditation of Hospitals and Medicare are rarely subjected to rigorous testing, either for efficacy or for cost-effectiveness. The author discusses the problems of expense, inconsistency, and excessive documentation created by the regulatory process, plus positive aspects such as the stimulus for improvement. One urgent need, he believes, is to reconcile more closely the views of the cost-cutters and the standard-setters before they inflict irreparable damage on some segments of the hospital system.

X-Ray astronomy the 1980's. [conferences

NASA Technical Reports Server (NTRS)

Holt, S. S. (Editor)

1981-01-01

The status of the current understanding of important problems to which X-ray astronomical techniques can be applied is summarized and the prospects for such research in the future is discussed. Relatively near-term X-ray astronomical research objectives are presented. The importance of a continuing program of balloon-borne research as a cost effective means by which studies at energies in excess of 20 keV may be performed is emphasized. The scientific opportunities presented by the Space Transpotation System to develop low cost experiments which are beyond the scope of balloon-borne capabilities are also highlighted.

Study on improvement of sludge dewaterability with H2O2 cell lysis

NASA Astrophysics Data System (ADS)

Zhuo, Qiongfang; Yi, Hao; Zhang, Zhengke; Wang, Ji; Feng, Lishi; Xu, Zhencheng; Guo, Qingwei; Jin, Zhong; Lan, Yongzhe

2017-12-01

Excess sludge is the product of sewage treatment plants. With continuous perfection of municipal sewage treatment facilities in China, sludge output increases as a result of the growth of sewage treatment plants. Excess sludge has complicated compositions, including heavy metals, PPCPs, persistent organic pollutants. It owns high contents of organic matters and water. High-efficiency and low-cost dehydration of sludge is the key of sludge disposal. How to improve sludge dehydration efficiency is the research hotspot in the world. In this study, effects of hydrogen peroxide content and pH on sludge dehydration were discussed by chemical disintegration technique. The optimal hydrogen peroxide content and pH were discussed, aiming to search a high-efficiency sludge conditioner.

Bedside determination of bicarbonate and base excess, blood oxygen saturation and content, VD/VT, and P50 using a programmable calculator.

PubMed

Wilkinson, P L

1979-06-01

Assessing and modifying oxygen transport are major parts of ICU patient management. Determination of base excess, blood oxygen saturation and content, dead space ventilation, and P50 helps in this management. A program is described for determining these variables using a T1 59 programmable calculator and PC 100A printer. Each variable can be independently calculated without running the whole program. The calculator-printer's small size, low cost, and hard copy printout make it a valuable and versatile tool for calculating physiological variables. The program is easily entered by an stored on magnetic card, and prompts the user to enter the appropriate variables, making is easy to run by untrained personnel.

Applicability of effective fragment potential version 2 - Molecular dynamics (EFP2-MD) simulations for predicting excess properties of mixed solvents

NASA Astrophysics Data System (ADS)

Kuroki, Nahoko; Mori, Hirotoshi

2018-02-01

Effective fragment potential version 2 - molecular dynamics (EFP2-MD) simulations, where the EFP2 is a polarizable force field based on ab initio electronic structure calculations were applied to water-methanol binary mixture. Comparing EFP2s defined with (aug-)cc-pVXZ (X = D,T) basis sets, it was found that large sets are necessary to generate sufficiently accurate EFP2 for predicting mixture properties. It was shown that EFP2-MD could predict the excess molar volume. Since the computational cost of EFP2-MD are far less than ab initio MD, the results presented herein demonstrate that EFP2-MD is promising for predicting physicochemical properties of novel mixed solvents.

Profitability analysis in the hospital industry.

PubMed Central

Cleverley, W O

1978-01-01

Measures of marginal profit are derived for the two payment classes--cost payers and charge payers--that the hospital industry must consider in profitability analysis, i.e., prediction of the excess of revenue over expenses. Two indexes of profitability, use when payment mix is constant and when it is nonconstant, respectively, are derived from the two marginal profit measures, and one of them is shown to be a modification of the contribution margin, the conventional measure of profitability used in general industry. All three measures--the contribution margin and the two new indexes of profitability--are used to estimate changes in net income resulting from changes in patient volume with and without accompanying changes in payment mix. The conventional measure yields large overestimates of expected excess revenue. PMID:632101

Modeling and Analysis of Wholesale Electricity Market Design. Understanding the Missing Money Problem. December 2013 - January 2015

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

Papalexopoulos, A.; Hansen, C.; Perrino, D.

This project examined the impact of renewable energy sources, which have zero incremental energy costs, on the sustainability of conventional generation. This “missing money” problem refers to market outcomes in which infra-marginal energy revenues in excess of operations and maintenance (O&M) costs are systematically lower than the amortized costs of new entry for a marginal generator. The problem is caused by two related factors: (1) conventional generation is dispatched less, and (2) the price that conventional generation receives for its energy is lower. This lower revenue stream may not be sufficient to cover both the variable and fixed costs ofmore » conventional generation. In fact, this study showed that higher wind penetrations in the Electric Reliability Council of Texas (ERCOT) system could cause many conventional generators to become uneconomic.« less

Plan selection in Medicare Part D: Evidence from administrative data

PubMed Central

Heiss, Florian; Leive, Adam; McFadden, Daniel; Winter, Joachim

2014-01-01

We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25 percent of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15 percent of expected total out-of-pocket cost for drugs and Part D insurance. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeable fraction of consumers place large values on plan features other than cost, they are not optimizing effectively. PMID:24308882

Balancing low cost with reliable operation in the rotordynamic design of the ALS Liquid Hydrogen Fuel Turbopump

NASA Technical Reports Server (NTRS)

Greenhill, L. M.

1990-01-01

The Air Force/NASA Advanced Launch System (ALS) Liquid Hydrogen Fuel Turbopump (FTP) has primary design goals of low cost and high reliability, with performance and weight having less importance. This approach is atypical compared with other rocket engine turbopump design efforts, such as on the Space Shuttle Main Engine (SSME), which emphasized high performance and low weight. Similar to the SSME turbopumps, the ALS FTP operates supercritically, which implies that stability and bearing loads strongly influence the design. In addition, the use of low cost/high reliability features in the ALS FTP such as hydrostatic bearings, relaxed seal clearances, and unshrouded turbine blades also have a negative influence on rotordynamics. This paper discusses the analysis conducted to achieve a balance between low cost and acceptable rotordynamic behavior, to ensure that the ALS FTP will operate reliably without subsynchronous instabilities or excessive bearing loads.

Demulsification key to production efficiency

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

Svetgoff, J.A.

1988-08-01

Concern over the declining profitability in the petroleum industry has generated renewed interest in reducing costs and enhancing profits. This article discusses one are often overlooked when trying to optimize profits, the process of demulsification. Resolving crude oil emulsions is a costly operational problem in most producing fields. Because it is one of the least understood facets of the petroleum industry, the costs associated with demulsification are often excessive. Although there are many similarities, desalting is a separate subject from demulsification. The removal of produced water from crude oil is the primary goal of demulsification, while minimizing the salt contentmore » in crude oil is the object of a desalting program. Understanding demulsification and desalting concepts is important to design engineers. The author discusses how this knowledge enables them to design systems that minimize operating costs while meeting present, as well as future, needs.« less

The cost of cancer care: Part II.

PubMed

Eagle, David

2012-11-01

The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancer care in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend.

The Color of Debt: Racial Disparities in Anticipated Medical Student Debt in the United States

PubMed Central

Dugger, Robert A.; El-Sayed, Abdulrahman M.; Dogra, Anjali; Messina, Catherine; Bronson, Richard; Galea, Sandro

2013-01-01

Context The cost of American medical education has increased substantially over the past decade. Given racial/ethnic inequalities in access to financial resources, it is plausible that increases in student debt burden resulting from these increases in cost may not be borne equally. Objective To evaluate racial/ethnic disparities in medical student debt. Design, Setting, and Participants Authors collected self-reported data from a non-representative sample of 2414 medical students enrolled at 111/159 accredited US medical schools between December 1st 2010 and March 27th 2011. After weighting for representativeness by race and class year and calculating crude anticipated debt by racial/ethnic category, authors fit multivariable regression models of debt by race/ethnicity adjusted for potential confounders. Main Outcome Measures Anticipated educational debt upon graduation greater than $150,000. Results 62.1% of medical students anticipated debt in excess of $150,000 upon graduation. The proportion of Blacks, Whites, Hispanics, and Asians reporting anticipated educational debt in excess of $150,000 was 77.3%, 65.1%, 57.2% and 50.2%, respectively. Both Black and White medical students demonstrated a significantly higher likelihood of anticipated debt in excess of $150,000 when compared to Asians [Blacks (OR = 2.7, 1.3–5.6), Whites (OR = 1.7, 1.3–2.2)] in adjusted models. Conclusion Black medical students had significantly higher anticipated debt than Asian students. This finding has implications for understanding differential enrollment among minority groups in US medical schools. PMID:24019975

Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency.

PubMed

Gilmer, Todd P; Ojeda, Victoria D; Barrio, Concepcion; Fuentes, Dahlia; Garcia, Piedad; Lanouette, Nicole M; Lee, Kelly C

2009-02-01

The authors examined data for 7,784 Latino, Asian, and non-Latino white Medi-Cal beneficiaries with schizophrenia to determine the relationship between patients' preferred language for mental health services--English, Spanish, or an Asian language--and their adherence to treatment with antipsychotic medications. Data reflected 31,560 person-years from 1999 to 2004. Pharmacy records were analyzed to assess medication adherence by use of the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<.5), partially adherent (MPR=.5-<.8), or adherent (MPR=.8-1.1) or as an excess filler of prescriptions (MPR<1.1). Regression models were used to examine adherence, hospitalization, and costs by race-ethnicity and language status. Latinos with limited English proficiency were more likely than English-proficient Latinos to be medication adherent (41% versus 36%; p<.001) and less likely to be excess fillers (15% versus 20%; p<.001). Asians with limited English proficiency were less likely than English-proficient Asians to be adherent (40% versus 45%; p=.034), more likely to be nonadherent (29% versus 22%; p<.001), and less likely to be excess fillers (13% versus 17%; p=.004). When analyses controlled for adherence and comorbidities, clients with limited English proficiency had lower rates of hospitalization and lower health care costs than English-proficient and white clients. Adherence to antipsychotic medications varied by English proficiency among and within ethnic groups. Policies supporting the training of bilingual and multicultural providers from ethnic minority groups and interventions that capitalize on patients' existing social support networks may improve adherence to treatment in linguistically diverse populations.

Prioritizing quality improvement in general surgery.

PubMed

Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for < 1% of excess hospital days. A relatively small number of procedures account for a disproportionate share of the morbidity, mortality, and excess hospital days in general surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

DRG migration: A novel measure of inefficient surgical care in a value-based world.

PubMed

Hughes, Byron D; Mehta, Hemalkumar B; Sieloff, Eric; Shan, Yong; Senagore, Anthony J

2018-03-01

Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). The incidence of DRG migration was 14.2%. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care. Copyright © 2017 Elsevier Inc. All rights reserved.

Economic costs of electrical system instability and power outages caused by snakes on the Island of Guam

USGS Publications Warehouse

Fritts, T.H.

2002-01-01

The Brown Tree Snake, Boiga irregularis, is an introduced species on Guam where it causes frequent electrical power outages. The snake's high abundance, its propensity for climbing, and use of disturbed habitats all contribute to interruption of Guam's electrical service and the activities that depend on electrical power. Snakes have caused more than 1600 power outages in the 20-yr period of 1978-1997 and most recently nearly 200 outages per year. Single outages spanning the entire island and lasting 8 or more hours are estimated to cost in excess of $3,000,000 in lost productivity, but the costs of outages that involve only parts of the island or those of shorter durations are more difficult to quantify. Costs to the island's economy have exceeded $4.5 M per year over a 7-yr period without considering repair costs, damage to electrical equipment, and lost revenues. Snakes pose the greatest problem on high voltage transmission lines, on transformers, and inside electrical substations.

Optimizing emissions targets for residential recycling programmes: Why 'more' is not necessarily better with respect to diversion.

PubMed

Lakhan, Calvin

2016-11-01

This study highlights the economic and environmental challenges of recycling in Ontario, specifically examining the effect of attempting to increase the emissions target for the province's household recycling programme. The findings from the cost model analysis found that Ontario's Blue Box programme reduces overall carbon emissions by approximately 1.8 million tonnes every year. This study also found that targeting specific materials for recovery could result in a scenario where the province could improve both overall diversion and emissions offsets while reducing material management costs. Under our modelled scenario, as the tonnes of greenhouse gases (GHGs) avoided increases, the system cost per tonne of GHG avoided initial declines. However, after avoiding 2.05 million tonnes of GHGs, the system cost/tonne GHG avoided increases. To achieve an emissions target in excess of 2.05 million tonnes, the province will have to start recycling higher cost non-core materials (composite materials, other plastics, etc.). © The Author(s) 2016.

Configuring Airspace Sectors with Approximate Dynamic Programming

NASA Technical Reports Server (NTRS)

Bloem, Michael; Gupta, Pramod

2010-01-01

In response to changing traffic and staffing conditions, supervisors dynamically configure airspace sectors by assigning them to control positions. A finite horizon airspace sector configuration problem models this supervisor decision. The problem is to select an airspace configuration at each time step while considering a workload cost, a reconfiguration cost, and a constraint on the number of control positions at each time step. Three algorithms for this problem are proposed and evaluated: a myopic heuristic, an exact dynamic programming algorithm, and a rollouts approximate dynamic programming algorithm. On problem instances from current operations with only dozens of possible configurations, an exact dynamic programming solution gives the optimal cost value. The rollouts algorithm achieves costs within 2% of optimal for these instances, on average. For larger problem instances that are representative of future operations and have thousands of possible configurations, excessive computation time prohibits the use of exact dynamic programming. On such problem instances, the rollouts algorithm reduces the cost achieved by the heuristic by more than 15% on average with an acceptable computation time.

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.

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

Kim, Woohyun; Katipamula, Srinivas; Lutes, Robert G.

Small- and medium-sized (<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 utilize 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 U.S. for many reasons, chief among them is to mitigate the climatemore » 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, where an RTU goes through ON and OFF cycles too frequently. Excessive cycling can lead to excessive wear and lead to premature failure of the compressor or its components. The short cycling can result in a significantly decreased average efficiency (up to 10%), even if there are no physical failures in the equipment. Also, SMBs use a time-of-day scheduling is to start the RTUs before the building will be occupied and shut it off when unoccupied. 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 report describes three algorithms for detecting the zone set point temperature, RTU cycling rate and occupancy schedule detection 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 and occupancy schedule using symbolic aggregate approximation technique. The report describes the three algorithms, results from testing the algorithms using field data, how the algorithms can be used to improve SMBs efficiency, and presents related conclusions.« less

[QUATERNARY PREVENTION: AN ATTEMPT TO AVOID THE EXCESSES OF MEDICINE].

PubMed

Noble, María

2015-01-01

Seduced by technology, biometrics, practical guidelines and the use of medication, medicine has been driven away from the subject of its care. Quaternary prevention is, among other voices around the world, trying to denounce the consequent excesses of medical practice given by this situation. There are visible excesses, such as the long list of studies being performed on patients without indication, and others, much more subtle, as excessive prevention and the continuous and progressive medicalization of life itself that are rooted in our culture and demanded by a society that requests certainty at almost any cost. Quaternary prevention proposes a series of actions leaning towards avoiding and diminishing the damage produced by health care activities, in order to protect the subject of overdiagnosis and overtreatment; offering also ethical and viable alternatives in which the balance of risks and benefits (based on the best evidences) respects the autonomy of the subject by properly informing and allowing him to decide among the best options he has; altogether in a process that contemplates a rational and equitable use of resources. In order to achieve this, reliable sources of information and a medical education not dependent on industries related to technology or pharmaceuticals, are vital; in conjuction with a medicine that restablishes the subject as its main and central interest.

[Quaternary prevention: An attempt to avoid the excesses of Medicine].

PubMed

Noble, María

2015-09-01

Seduced by technology, biometrics, practical guidelines and the use of medication, medicine has been driven away from the subject of its care. Quaternary prevention is, among other voices around the world, trying to denounce the consequent excesses of medical practice given by this situation. There are visible excesses, such as the long list of studies being performed on patients without indication, and others, much more subtle, as excessive prevention and the continuous and progressive medicalization of life itself that are rooted in our culture and demanded by a society that requests certainty at almost any cost. Quaternary prevention proposes a series of actions leaning towards avoiding and diminishing the damage produced by health care activities, in order to protect the subject of overdiagnosis and overtreatment; offering also ethical and viable alternatives in which the balance of risks and benefits (based on the best evidences) respects the autonomy of the subject by properly informing and allowing him to decide among the best options he has; altogether in a process that contemplates a rational and equitable use of resources. In order to achieve this, reliable sources of information and a medical education not dependent on industries related to technology or pharmaceuticals, are vital; in conjuction with a medicine that restablishes the subject as its main and central interest.

A Comparison of Ambulatory Surgery Center Production Costs and Medicare Payments: Evidence on Colonoscopy and Endoscopy.

PubMed

Mitchell, Jean M; Carey, Kathleen

2016-02-01

Ambulatory surgery centers (ASCs) are freestanding facilities that specialize in surgical and diagnostic procedures that do not require an overnight stay. While it is generally assumed that ASCs are less costly than hospital outpatient surgery departments, there is sparse empirical evidence regarding their relative production costs. To estimate ASC production costs using financial and claims records for procedures performed by surgery centers that specialize in gastroenterology procedures (colonoscopy and endoscopy). We estimate production costs in ASCs that specialize in gastroenterology procedures using financial cost and patient discharge data from Pennsylvania for the time period 2004-2013. We focus on the 2 primary procedures (colonoscopies and endoscopies) performed at each ASC. We use our estimates to predict average costs for each procedure and then compare predicted costs to Medicare ACS payments for these procedures. Comparisons of the costs of each procedure with 2013 national Medicare ASC payment rates suggest that Medicare payments exceed production costs for both colonoscopy and endoscopy. This study demonstrated that it is feasible to estimate production costs for procedures performed in freestanding surgery centers. The procedure-specific cost estimates can then be compared with ASC payment rates to ascertain if payments are aligned with costs. This approach can serve as an evaluation template for CMS and private insurers who are concerned that ASC facility payments for specific procedures may be excessive.

Excessive response-repetition costs under task switching: how response inhibition amplifies response conflict.

PubMed

Grzyb, Kai Robin; Hübner, Ronald

2013-01-01

The size of response-repetition (RR) costs, which are usually observed on task-switch trials, strongly varies between conditions with univalent and bivalent stimuli. To test whether top-down or bottom-up processes can account for this effect, we assessed in Experiment 1 baselines for univalent and bivalent stimulus conditions (i.e., for stimuli that are associated with either 1 or 2 tasks). Experiment 2 examined whether the proportion of these stimulus types affects RR costs. As the size of RR costs was independent of proportion, a top-down explanation could be excluded. However, there was an increase in RR costs if the current stimulus induced a response conflict. To account for this effect, we proposed an amplification of response conflict account. It assumes that the basic mechanism that leads to RR costs amplifies response conflict, which, in turn, increases RR costs. Experiment 3 confirmed this bottom-up explanation by showing that the increase in RR costs varies with previous-trial congruency, which is known to affect RR costs. Experiment 4 showed that the increase can also be found with univalent stimuli that induce response conflict. Altogether, the results are in line with a response inhibition account of RR costs. Implications for alternative accounts are also discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Modeling the clinical and economic implications of obesity using microsimulation.

PubMed

Su, W; Huang, J; Chen, F; Iacobucci, W; Mocarski, M; Dall, T M; Perreault, L

2015-01-01

The obesity epidemic has raised considerable public health concerns, but there are few validated longitudinal simulation models examining the human and economic cost of obesity. This paper describes a microsimulation model as a comprehensive tool to understand the relationship between body weight, health, and economic outcomes. Patient health and economic outcomes were simulated annually over 10 years using a Markov-based microsimulation model. The obese population examined is nationally representative of obese adults in the US from the 2005-2012 National Health and Nutrition Examination Surveys, while a matched normal weight population was constructed to have similar demographics as the obese population during the same period. Prediction equations for onset of obesity-related comorbidities, medical expenditures, economic outcomes, mortality, and quality-of-life came from published trials and studies supplemented with original research. Model validation followed International Society for Pharmacoeconomics and Outcomes Research practice guidelines. Among surviving adults, relative to a matched normal weight population, obese adults averaged $3900 higher medical expenditures in the initial year, growing to $4600 higher expenditures in year 10. Obese adults had higher initial prevalence and higher simulated onset of comorbidities as they aged. Over 10 years, excess medical expenditures attributed to obesity averaged $4280 annually-ranging from $2820 for obese category I to $5100 for obese category II, and $8710 for obese category III. Each excess kilogram of weight contributed to $140 higher annual costs, on average, ranging from $136 (obese I) to $152 (obese III). Poor health associated with obesity increased work absenteeism and mortality, and lowered employment probability, personal income, and quality-of-life. This validated model helps illustrate why obese adults have higher medical and indirect costs relative to normal weight adults, and shows that medical costs for obese adults rise more rapidly with aging relative to normal weight adults.

Time to revisit arsenic regulations: comparing drinking water and rice

PubMed Central

2014-01-01

Background Current arsenic regulations focus on drinking water without due consideration for dietary uptake and thus seem incoherent with respect to the risks arising from rice consumption. Existing arsenic guidelines are a cost-benefit compromise and, as such, they should be periodically re-evaluated. Discussion Literature data was used to compare arsenic exposure from rice consumption relative to exposure arising from drinking water. Standard risk assessment paradigms show that arsenic regulations for drinking water should target a maximum concentration of nearly zero to prevent excessive lung and bladder cancer risks (among others). A feasibility threshold of 3 μg As l-1 was determined, but a cost-benefit analysis concluded that it would be too expensive to target a threshold below 10 μg As l-1. Data from the literature was used to compare exposure to arsenic from rice and rice product consumption relative to drinking water consumption. The exposure to arsenic from rice consumption can easily be equivalent to or greater than drinking water exposure that already exceeds standard risks and is based on feasibility and cost-benefit compromises. It must also be emphasized that many may disagree with the implications for their own health given the abnormally high cancer odds expected at the cost-benefit arsenic threshold. Summary Tighter drinking water quality criteria should be implemented to properly protect people from excessive cancer risks. Food safety regulations must be put in place to prevent higher concentrations of arsenic in various drinks than those allowed in drinking water. Arsenic concentrations in rice should be regulated so as to roughly equate the risks and exposure levels observed from drinking water. PMID:24884827

Nursing home performance under case-mix reimbursement: responding to heavy-care incentives and market changes.

PubMed Central

Davis, M A; Freeman, J W; Kirby, E C

1998-01-01

OBJECTIVE: To examine the effect of case mix-adjusted reimbursement policy and market factors on nursing home performance. DATA SOURCES AND STUDY SETTING: Data from Medicaid certification inspection surveys, Medicaid cost reports, and the Kentucky State Center for Health Statistics for the years 1989 and 1991, to examine changes in nursing home performance stemming from the adoption of case mix-adjusted reimbursement in 1990. STUDY DESIGN: In addition to cross-sectional regressions, a first-difference approach to fixed-effects regression analyses was employed to control for facility differences that were essentially fixed during the survey years and to estimate the effects of time-varying predictors on changes in facility expenditures, efficiency, and profitability. PRINCIPAL FINDINGS: Facilities that increased the proportion of Medicaid residents and eliminated excess capacity experienced higher profitability gains during the beginning phase of case-mix reimbursement. Having a heavy-care resident population was positively related to expenditures prior to reimbursement reform, and it was negatively related to expenditures after the case-mix reimbursement policy was introduced. While facility-level changes in case mix had no reliable influence on costs or profits, nursing homes showing an increased prevalence of poor-quality nursing practices exhibited increases in efficiency and profitability. At the market level, reductions in excess or empty nursing home beds were accompanied by a significant growth in home health services. Moreover, nursing homes located in markets with expanding home health services exhibited higher increases in costs per case-mix unit. CONCLUSIONS: Characteristics of the reimbursement system appear to reward a cost minimization orientation with potentially detrimental effects on quality of care. These effects, exacerbated by a supply-constrained market, may be mitigated by policies that encourage the expansion of home health service availability. PMID:9776938

Nursing home performance under case-mix reimbursement: responding to heavy-care incentives and market changes.

PubMed

Davis, M A; Freeman, J W; Kirby, E C

1998-10-01

To examine the effect of case mix-adjusted reimbursement policy and market factors on nursing home performance. Data from Medicaid certification inspection surveys, Medicaid cost reports, and the Kentucky State Center for Health Statistics for the years 1989 and 1991, to examine changes in nursing home performance stemming from the adoption of case mix-adjusted reimbursement in 1990. In addition to cross-sectional regressions, a first-difference approach to fixed-effects regression analyses was employed to control for facility differences that were essentially fixed during the survey years and to estimate the effects of time-varying predictors on changes in facility expenditures, efficiency, and profitability. Facilities that increased the proportion of Medicaid residents and eliminated excess capacity experienced higher profitability gains during the beginning phase of case-mix reimbursement. Having a heavy-care resident population was positively related to expenditures prior to reimbursement reform, and it was negatively related to expenditures after the case-mix reimbursement policy was introduced. While facility-level changes in case mix had no reliable influence on costs or profits, nursing homes showing an increased prevalence of poor-quality nursing practices exhibited increases in efficiency and profitability. At the market level, reductions in excess or empty nursing home beds were accompanied by a significant growth in home health services. Moreover, nursing homes located in markets with expanding home health services exhibited higher increases in costs per case-mix unit. Characteristics of the reimbursement system appear to reward a cost minimization orientation with potentially detrimental effects on quality of care. These effects, exacerbated by a supply-constrained market, may be mitigated by policies that encourage the expansion of home health service availability.

Patient Characteristics and Costs in Recurrent or Refractory Head and Neck Cancer: Retrospective Analysis of a Community Oncology Database.

PubMed

Fisher, Maxine D; Fernandes, Ancilla W; Olufade, Temitope O; Miller, Paul J; Walker, Mark S; Fenton, Moon

2018-04-01

The goal of this study was to describe patient characteristics, health resource utilization (HRU), and costs associated with treating recurrent or refractory head and neck cancer (HNC) among patients with disease progression in the community oncology setting. This retrospective observational study was conducted by using data from the Vector Oncology Data Warehouse. Patients had been diagnosed with locally advanced or metastatic (stage III-IVc) HNC between January 1, 2007, and October 1, 2015. Patients also had evidence of at least 1 systemic anticancer therapy regimen following the diagnosis of advanced HNC, with at least 1 disease progression. Costs, treatment patterns, and HRU were evaluated beginning with diagnosis of advanced HNC through 3 lines of therapy. Costs of surgery or radiation were not available for inclusion in the analysis. Total cost for the study period and cost per month were analyzed by using a generalized linear regression model. The study included 462 patients (median age, 61 years; range, 26-99 years); of these, 81% were male, 77% were white, and 21% were black. At initial diagnosis, the most frequent tumor locations were the hypopharynx/larynx (31%) and the oropharynx (31%). Human papilloma virus testing was most frequent among the oropharynx group (22% tested, 52% positive). Overall, 42% were current tobacco users and 22% were current or past alcohol abusers/excessive users. Platinum-based combination therapies were the most frequently administered chemotherapy in both first (42%) and second (40%) lines of treatment. Through the overall study period (mean, 20.5 months), 74% of patients were hospitalized, 19% had an emergency department visit, and 100% had an office visit. The overall mean (SD) duration of hospital stay was 12.6 days, and the median number of office visits per patient was 35. The mean monthly health care cost for the overall study period was $14,391 (95% CI, 12,739-16,044). Hospitalization costs represented ~57% of the total expenditures. Statistically significant predictors of higher overall cost included primary tumor location in the oral cavity, history of alcohol abuse/excess use, use of cetuximab, and higher comorbidity index. Older age and being stage IV versus other stages of disease at diagnosis were associated with lower overall cost. These data suggest that costs of care in patients with recurrent or refractory HNC are related to patient characteristics and treatment patterns. Identification of factors contributing to the costs of care in HNC may provide a useful foundation for developing strategies to control rising costs. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Investigation of remote sensing techniques as inputs to operational resource management models. [South Dakota

NASA Technical Reports Server (NTRS)

Schmer, F. A. (Principal Investigator); Isakson, R. E.; Eidenshink, J. C.

1977-01-01

The author has identified the following significant results. Successful operational applications of LANDSAT data were found for level 1 land use mapping, drainage network delineation, and aspen mapping. Visual LANDSAT interpretation using 1:125,000 color composite imagery was the least expensive method of obtaining timely level 1 land use data. With an average agricultural/rangeland interpretation accuracy in excess of 80%, such a data source was considered the most cost effective of those sources available to state agencies. Costs do not compare favorably with those incurred using the present method of extracting land use data from historical tabular summaries. The cost increase in advancing from the present procedure to a satellite-based data source was justified in terms of expanded data content.

Minimisation of costs by using disintegration at a full-scale anaerobic digestion plant.

PubMed

Winter, A

2002-01-01

Various half-scale and lab-scale investigations have already shown that the disintegration of excess sludge is a possible pre-treatment to optimise anaerobic digestion. To control these results different methods of disintegration were investigated at a full-scale plant. Two stirred ball mills and a plant for oxidation with ozone were applied. A positive influence of disintegration on the anaerobic biodegradability can be established with application of a stirred ball mill. Biogas production as well as the degree of degradation were increased by about 20%. Laboratory investigations also validate that disintegration increases the polymer demand and leads to a lower solid content after dewatering. A higher pollution level of process water after dewatering even with ammonia and COD corroborates the results of the anaerobic degradation. Capital costs for the stirred ball mill, costs for energy, manpower and maintenance can be covered if the specific costs for disposal are high. If the development of costs in future and the current discussion about sludge disposal are taken into account sewage sludge disintegration can be a suitable technique to minimise costs at waste water treatment plants.

Ethical implications of excessive cluster sizes in cluster randomised trials.

PubMed

Hemming, Karla; Taljaard, Monica; Forbes, Gordon; Eldridge, Sandra M; Weijer, Charles

2018-02-20

The cluster randomised trial (CRT) is commonly used in healthcare research. It is the gold-standard study design for evaluating healthcare policy interventions. A key characteristic of this design is that as more participants are included, in a fixed number of clusters, the increase in achievable power will level off. CRTs with cluster sizes that exceed the point of levelling-off will have excessive numbers of participants, even if they do not achieve nominal levels of power. Excessively large cluster sizes may have ethical implications due to exposing trial participants unnecessarily to the burdens of both participating in the trial and the potential risks of harm associated with the intervention. We explore these issues through the use of two case studies. Where data are routinely collected, available at minimum cost and the intervention poses low risk, the ethical implications of excessively large cluster sizes are likely to be low (case study 1). However, to maximise the social benefit of the study, identification of excessive cluster sizes can allow for prespecified and fully powered secondary analyses. In the second case study, while there is no burden through trial participation (because the outcome data are routinely collected and non-identifiable), the intervention might be considered to pose some indirect risk to patients and risks to the healthcare workers. In this case study it is therefore important that the inclusion of excessively large cluster sizes is justifiable on other grounds (perhaps to show sustainability). In any randomised controlled trial, including evaluations of health policy interventions, it is important to minimise the burdens and risks to participants. Funders, researchers and research ethics committees should be aware of the ethical issues of excessively large cluster sizes in cluster trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Passive PE Sampling in Support of In Situ Remediation of Contaminated Sediments

DTIC Science & Technology

2015-08-01

elements: • Expendable items: including materials such as stainless steel mixing bowls/spoons, decontamination supplies (buckets, brushes, distilled...PE samplers. Traditional sediment sampling equipment would include items such as decontamination fluids, stainless steel mixing bowls and spoons...hazardous/hazardous wastes (excess sediment, decontamination fluids). There is not expected to be a big difference in solid waste disposal costs

A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

Treesearch

Daniel Boyd Kramer; Stephen Polasky; Anthony Starfield; Brian Palik; Lynn Westphal; Stephanie Snyder; Pamela Jakes; Rachel Hudson; Eric Gustafson

2006-01-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to...

In Their Own Words: A Text Analytics Investigation of College Course Attrition

ERIC Educational Resources Information Center

Michalski, Greg V.

2014-01-01

Excessive course attrition is costly to both the student and the institution. While most institutions have systems to quantify and report the numbers, far less attention is typically paid to each student's reason(s) for withdrawal. In this case study, text analytics was used to analyze a large set of open-ended written comments in which students…

48 CFR 1652.249-72 - FEHBP termination for default-negotiated benefits contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... negligence of the Carrier. Examples of such causes include (1) acts of God or of the public enemy, (2) acts... negligence of the Carrier. (d) If the failure to perform is caused by the default of a subcontractor at any... without the fault or negligence of either, the Carrier shall not be liable for any excess costs for...

Risk Leading Indicators for DOD Acquisition Programs

DTIC Science & Technology

2014-08-12

Adverse consequences include development time and cost overrun, technical performance and reliability shortfall, and excessive production , operation...prior to contract award, but is outside the scope of this paper. Risk exposure early warning complements the risk identification practices and...likelihood and magnitude are priorities for tracking and mitigation. The practices and procedures in the guide start with identifying risk events. Risk

Energy efficient engine component development and integration program

NASA Technical Reports Server (NTRS)

1981-01-01

The technology that will improve the energy efficiency of propulsion systems for subsonic commercial aircraft is investigated. A reduction of 14.4% in cruise installed sfc (0.572 versus 0.668 for the CF6-50C) and a direct operation cost reduction in excess of the 5% goal is projected. Noise and emissions projections are consistent with the established goals.

Mitigation of non-point source of fluoride on groundwater by dug well recharge

NASA Astrophysics Data System (ADS)

Ganesan, G.; Lakshmanan, E.

2017-12-01

Groundwater used for drinking purpose is affected in many regions due to the presence of excess fluoride. The excess intake of fluoride through drinking water causes fluorosis to human in many states of India, including Tamil Nadu. The present study was carried out with the objective of assessing hydrogeochemistry of groundwater and the feasibility of dug well recharge to reduce the fluoride concentration in Vaniyar river basin, Tamil Nadu, India. The major source for fluoride in groundwater of this area is the epidote hornblende gneissic and charnockite which are the major rocks occurring in this region. As a pilot study a cost effective induced recharge structure was constructed at Papichettipatty village in the study region. The study shows that the groundwater level around the recharge site raised up to 2 m from 14.5 m (bgl) and fluoride concentration has decreased from 3.8 mg/l to 0.9 mg/l due to dilution. The advantage of this induced recharge structure is of its low cost, the ease of implementation, improved groundwater recharge and dilution of fluoride in groundwater. An area of about 1.5 km2 has benefited due to this dug well recharge system.

The Economic Impact of Adult Hearing Loss: A Systematic Review.

PubMed

Huddle, Matthew G; Goman, Adele M; Kernizan, Faradia C; Foley, Danielle M; Price, Carrie; Frick, Kevin D; Lin, Frank R

2017-10-01

Hearing impairment (HI) is highly prevalent in older adults and has been associated with adverse health outcomes. However, the overall economic impact of HI is not well described. The goal of this review was to summarize available data on all relevant costs associated with HI among adults. A literature search of PubMed, Embase, the Cochrane Library, CINAHL, and Scopus was conducted in August 2015. For this systematic review, data extraction and quality assessment were performed by 2 independent reviewers. Eligibility criteria for included studies were presence of quantitative estimation of economic impact or loss of productivity of patients with HI, full-text English-language access, and publication in an academic, peer-reviewed journal or government report prior to August 2015. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A meta-analysis was not performed owing to the studies' heterogeneity in outcomes measures, methodology, and study country. The initial literature search yielded 4595 total references. After 2043 duplicates were removed, 2552 publications underwent title and abstract review, yielding 59 articles for full-text review. After full-text review, 25 articles were included. Of the included articles, 8 incorporated measures of disability; 5 included direct estimates of medical expenditures; 8 included other cost estimates; and 7 were related to noise-induced or work-related HI. Estimates of the economic cost of lost productivity varied widely, from $1.8 to $194 billion in the United States. Excess medical costs resulting from HI ranged from $3.3 to $12.8 billion in the United States. Hearing loss is associated with billions of dollars of excess costs in the United States, but significant variance is seen between studies. A rigorous, comprehensive estimate of the economic impact of hearing loss is needed to help guide policy decisions around the management of hearing loss in adults.

Economic impact of clinical variability in preoperative testing for major outpatient surgery.

PubMed

Gil-Borrelli, Christian Carlo; Agustí, Salomé; Pla, Rosa; Díaz-Redondo, Alicia; Zaballos, Matilde

2016-05-01

With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated. Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

The total lifetime costs of smoking.

PubMed

Rasmussen, Susanne R; Prescott, Eva; Sørensen, Thorkild I A; Søgaard, Jes

2004-03-01

Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy. A dynamic (life cycle) method taking differences in life expectancy into account. Main outcome measures were direct and indirect lifetime health costs for ever-smokers and never-smokers, and cost ratios (ever-smokers to never-smokers). The estimations were based on annual disease rates of use of the healthcare services, smoking relative risks, smoking prevalences, and costs. Annual direct and indirect costs of ever-smokers were higher than for never-smokers in all age groups of both genders. The direct and indirect cost ratios were highest at age 45 for women, and at age 35 and 40 for men, respectively. Taking life expectancy differences into account, direct and indirect lifetime health costs for men aged 35, discounted by 5% per year were 66% and 83% higher in ever-smokers than in never-smokers. Corresponding results for women were 74% and 79%, respectively. The results are insensitive to a broad range of relative risk-estimates and discount rates including no discounting. Excess costs of ever-smokers disappear if the inclusion of smoking-related diseases is narrowed to that of previous studies. Smoking imposes costs to society even when taking life expectancy into consideration--both in direct and indirect costs.

Activity-Based Costing in the After Press Services Industry

NASA Astrophysics Data System (ADS)

Shevasuthisilp, Suntichai; Punsathitwong, Kosum

2009-10-01

This research was conducted to apply activity-based costing (ABC) in an after press service company in Chiang Mai province, Thailand. The company produces all of its products by one-stop service (such as coating, stitching, binding, die cutting, and gluing). All products are made to order, and have different sizes and patterns. A strategy of low price is used to compete in the marketplace. After cost analysis, the study found that the company has high overhead (36.5% of total cost). The company's problem is its use of traditional cost accounting, which has low accuracy in assigning overhead costs. If management uses this information when pricing customer orders, losses may occur because real production costs may be higher than the selling price. Therefore, the application of ABC in cost analysis can help executives receive accurate cost information; establish a sound pricing strategy; and improve the manufacturing process by determining work activities which have excessively high production costs. According to this research, 6 out of 56 items had a production cost higher than the selling price, leading to losses of 123,923 baht per year. Methods used to solve this problem were: reducing production costs; establishing suitable prices; and creating a sales promotion with lower prices for customers whose orders include processes involving unused capacity. These actions will increase overall sales of the company, and allow more efficient use of its machinery.

Study on environmental cost accounting under low-carbon economy

NASA Astrophysics Data System (ADS)

Pei, Zhoukun

2017-03-01

With the strengthen of people's ability to use and transform nature, on the one hand, people acquire more resources from nature and make life more comfortable, on the other hand, the amount of waste that people emit has also increased rapidly. Excessive excavation of resources and disposal of waste emissions led to the deterioration of the environment, affecting the country's sustainable development and the Earth's ecological balance. In this paper, from the perspective of low-carbon economy, to explore corporate environmental cost recognition, measurement, collection, distribution methods, expectations for the relevant enterprises, especially high-polluting, high-emission energy-based enterprises to learn from.

Seasonal thermal storage: Swedish practice, developments and cost projections

NASA Astrophysics Data System (ADS)

Margen, P.

1981-06-01

The types of heat store being developed in Sweden for seasonal storage of heat are discussed. This type of storage allows summer excess heat from industrial waste heat plants, garbage burning plants and future central solar heat stations to be stored for winter use on district heating networks. Whereas above ground steel or concrete tanks are usually too expensive insulated earth pits, uninsulated rock caverns and deep ground schemes using rock or clay promise to achieve sufficiently low costs to justify storage when supplied with free or cheap summer treat. For all these concepts demonstration plants were or are being built in Sweden.

Rationale for cost-effective laboratory medicine.

PubMed Central

Robinson, A

1994-01-01

There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States. PMID:8055467

Cost effectiveness of brief interventions for reducing alcohol consumption.

PubMed

Wutzke, S E; Shiell, A; Gomel, M K; Conigrave, K M

2001-03-01

The direct costs and health effects of a primary-care-based brief intervention for hazardous alcohol consumption were examined. The total cost of the intervention was calculated from costs associated with: marketing the intervention programme; providing training and support in the use of the intervention materials; physician time required for providing brief advice for 'at-risk' drinkers. The effect of the intervention on health outcomes was expressed in terms of number of life years saved by preventing alcohol-related deaths. This was derived by combining estimates of the impact of the programme if it were implemented nationally with available evidence on the health effects of excess alcohol consumption. Results are based on international trial evidence showing the physical resources required by the intervention and its effectiveness combined with Australian price data. The costs associated with screening and brief advice using the current intervention programme range from Aus$19.14 to Aus$21.50. The marginal costs per additional life year saved were below Aus$1873. The robustness of the model used is supported by an extensive sensitivity analysis. In comparison with existing health promotion strategies the costs and effects of the current intervention are highly encouraging.

Improving quality of life in multiple sclerosis: an unmet need.

PubMed

Zwibel, Howard L; Smrtka, Jennifer

2011-05-01

Multiple sclerosis (MS) affects approximately 400,000 people in the United States and 2.1 million people worldwide. It is the most common chronic, non-traumatic neurological disorder afflicting young people during their peak productive ages. MS can diminish quality of life (QOL) by interfering with the ability to work, pursue leisure activities, and carry on usual life roles. Symptoms that affect QOL may include impaired mobility, fatigue, depression, pain, spasticity, cognitive impairment, sexual dysfunction, bowel and bladder dysfunction, vision and hearing problems, seizures, and sDwallowing and breathing difficulties. Direct medical costs of MS in the United States are estimated in excess of $10 billion per year. Indirect costs of MS include costs of reduced employment or unemployment, assistive equipment, disability related home modifications, and paid and unpaid personal care. Although direct medical costs predominate in the earlier stages of MS, indirect costs of productivity loss are responsible for higher costs later. Disease-modifying therapies (DMTs) lessen symptoms, reduce relapses, and delay disability progression. Unfortunately, many DMTs might produce only modest improvements in QOL. Although symptom-specific therapies do not delay disease progression, they may delay unemployment and dependency, thereby reducing indirect costs.

Excess sludge reduction using pilot-scale lysis-cryptic growth system integrated ultrasonic/alkaline disintegration and hydrolysis/acidogenesis pretreatment.

PubMed

Ma, Huaji; Zhang, Shuting; Lu, Xuebin; Xi, Bo; Guo, Xingli; Wang, Han; Duan, Jingxiao

2012-07-01

A pilot-scale lysis-cryptic growth system was built and operated continuously for excess sludge reduction. Combined ultrasonic/alkaline disintegration and hydrolysis/acidogenesis were integrated into its sludge pretreatment system. Continuous operation showed that the observed biomass yield and the sludge reduction efficiency of the lysis-cryptic growth system were 0.27 kg VSS/kg COD consumed and 56.5%, respectively. The water quality of its effluent was satisfactory. The sludge pretreatment system performed well and its TCOD removal efficiency was 7.9% which contributed a sludge reduction efficiency of 2.1%. The SCOD, VFA, TN, NH(4)(+)-N, TP and pH in the supernatant of pretreated sludge were 1790 mg/L, 1530 mg COD/L, 261.1mg/L, 114.0mg/L, 93.1mg/L and 8.69, respectively. The total operation cost of the lysis-cryptic growth system was $ 0.186/m(3) wastewater, which was 11.4% less than that of conventional activated sludge (CAS) system without excess sludge pretreatment. Copyright © 2012 Elsevier Ltd. All rights reserved.

Together Achieving More: Primary Care Team Communication and Alcohol-Related Health Care Utilization and Costs

PubMed Central

Mundt, Marlon P.; Zakletskaia, Larissa I.; Shoham, David A.; Tuan, Wen-Jan; Carayon, Pascale

2015-01-01

Background Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Methods Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team’s primary care patient panel. Results Teams (n=31) whose RNs displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (RR=0.90; 95% CI: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1030 (95% CI: −$1819, −$241) lower alcohol-related patient health care costs per 1000 team patients in the past 12 months. Conversely, teams whose primary care practitioner had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR=1.12; 95: CI: 1.03, 1.23) and $1428 (95% CI: $378, $2478) higher alcohol-related healthcare costs per 1000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and co-morbidity diagnoses. Conclusions Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members. PMID:26350957

Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

PubMed

Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

2015-10-01

Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose face-to-face and electronic communication networks include more team members and whose communication to the PCP has been streamlined to fewer team members. Copyright © 2015 by the Research Society on Alcoholism.

Overlay removable denture for treatment of worn teeth.

PubMed

Beyth, Nurit; Tamari, Israel; Buller Sharon, Anat

2014-01-01

Rehabilitation of partially edentulous patients with excessively worn dentitions can be challenging. Factors including medical history as well as the cost of the treatment and patient wishes for simpler approaches must be considered. This manuscript describes the use of an overlay partial denture to treat patients with excessive wear of the maxillary teeth. We describe a technique to restore severely worn teeth using heat-cured acrylic as part of a partial or full denture. Minimal preparations of the teeth are required, and the restoration provides protection from further wear, and stabilizes the occlusion. This solution was functionally and esthetically suitable to the patients. The technique can be used in medically complex patients where extractions are contraindicated, such as post radiation therapy or bisphosphonate treatment. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

Using Data Mining to Explore Why Community College Transfer Students Earn Bachelor's Degrees with Excess Credits. CCRC Working Paper No. 100

ERIC Educational Resources Information Center

Fink, John; Jenkins, Davis; Kopko, Elizabeth; Ran, Florence Xiaotao

2018-01-01

Community college transfer students encounter challenges progressing toward a bachelor's degree, leading to widespread transfer credit loss. This in turn may lower students' chances of credential completion and increase the time and costs for students, their families, and taxpayers. In this study we review three definitions of credit transfer…

Asset Allocation and Optimal Contract for Delegated Portfolio Management

NASA Astrophysics Data System (ADS)

Liu, Jingjun; Liang, Jianfeng

This article studies the portfolio selection and the contracting problems between an individual investor and a professional portfolio manager in a discrete-time principal-agent framework. Portfolio selection and optimal contracts are obtained in closed form. The optimal contract was composed with the fixed fee, the cost, and the fraction of excess expected return. The optimal portfolio is similar to the classical two-fund separation theorem.

The Retrograde of Shipping Containers from Afghanistan

DTIC Science & Technology

2013-04-01

detention costs; however, many are still marked with carrier identification markings. To mitigate the problem, Mobile Container Assistance Teams ( MCATs ...comply with the USCENTCOM letter of instruction, the MCATs inventoried containers and locations in theater, with the intent to return carrier...Expeditionary Disposal Remediation Team (EDRT) out to the COPs and FOBs to linkup with MCATs , and the unit CCO to assess all excess containers.96

ASSESSING THE TRAINING NEEDS WITHIN A FIRM (IN INDUSTRIAL TRAINING INTERNATIONAL, 2(9)/346-353, SEP 1967).

ERIC Educational Resources Information Center

1967

A CASE STUDY BY A SENIOR TRAINING OFFICER OF THE BRITISH ENGINEERING INDUSTRIAL TRAINING BOARD SHOWS WHY A FIRM MUST EXAMINE IN DETAIL A NUMBER OF FACTORS TO DETERMINE WHERE TO APPLY ITS TRAINING EFFORT. EXCESSIVE LABOR COSTS MAY BE ATTRIBUTED TO INADEQUATE OR INAPPROPRIATE INITIAL TRAINING, HIGH LABOR TURNOVER DUE TO LOW WAGES, ESTABLISHMENT OF…

Effect of Hardwood Sawmill Edging and Trimming Practices on Furniture Part Production

Treesearch

D. Earl Kline; Carmen Regalado; Eugene M. Wengert; Fred M. Lamb; Philip A. Araman

1993-01-01

In a recent edging and trimming study at three hardwood sawmills, it was observed that the lumber volume produced was approximately 10 percent less than would be necessary to make the most valuable lumber. Furthermore, the excess portion of wood that was removed from the edging and trimming process contained a large percentage of clear wood. In light of rising costs...

Hurricane risk assessment: Rollback or ride out

NASA Technical Reports Server (NTRS)

Wohlman, Richard A.

1993-01-01

Winds in excess of 74.5 knots could cause severe damage to a space shuttle on the launch pad. Current plans exist for rollback to the Vehicle Assembly Building, but require 48 hour leadtime to implement. Decisions based upon cost/loss are evaluated to ascertain whether predetermined forecast probabilities for rollback/rideout decisions can be made far in advance of hurricane seasons for use in decision making.

Response to Intervention (RTI): A Mixed Methods Study Evaluating the Effects of Behavior Training Software on Behavior of In-School Suspension Students

ERIC Educational Resources Information Center

Cooper, Rosie Nicole

2014-01-01

Excessive classroom disruption is prevalent among today's public high schools and is a deterrent to the academic and social achievements of students. Using Response to Intervention (RtI) to equip in-school suspension (ISS) programs with a research-based behavioral curriculum is one possible solution to efficiently and cost-effectively remediating…

Regulations of the Commission of Education Subchapter P. Pursuant to Sections 207 and 4403 of the Education Law. Part 200--Handicapped Children. Revised.

ERIC Educational Resources Information Center

New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

The 1980 New York State regulations for Sections 207 and 4403 of the Education Law are concerned with the education of handicapped children. Individual sections focus on the following aspects: definitions, excess cost aid to school districts for the education of pupils with handicapping conditions, the local committee on the handicapped,…

Recurrent Clostridium difficile infection among Medicare patients in nursing homes: A population-based cohort study.

PubMed

Zilberberg, Marya D; Shorr, Andrew F; Jesdale, William M; Tjia, Jennifer; Lapane, Kate

2017-03-01

We explored the epidemiology and outcomes of Clostridium difficile infection (CDI) recurrence among Medicare patients in a nursing home (NH) whose CDI originated in acute care hospitals.We conducted a retrospective, population-based matched cohort combining Medicare claims with Minimum Data Set 3.0, including all hospitalized patients age ≥65 years transferred to an NH after hospitalization with CDI 1/2011-11/2012. Incident CDI was defined as ICD-9-CM code 008.45 with no others in prior 60 days. CDI recurrence was defined as (within 60 days of last day of CDI treatment): oral metronidazole, oral vancomycin, or fidaxomicin for ≥3 days in part D file; or an ICD-9-CM code for CDI (008.45) during a rehospitalization. Cox proportional hazards and linear models, adjusted for age, gender, race, and comorbidities, examined mortality within 60 days and excess hospital days and costs, in patients with recurrent CDI compared to those without.Among 14,472 survivors of index CDI hospitalization discharged to an NH, 4775 suffered a recurrence. Demographics and clinical characteristics at baseline were similar, as was the risk of death (24.2% with vs 24.4% without). Median number of hospitalizations was 2 (IQR 1-3) among those with and 0 (IQR 0-1) among those without recurrence. Adjusted excess hospital days per patient were 20.3 (95% CI 19.1-21.4) and Medicare reimbursements $12,043 (95% CI $11,469-$12,617) in the group with a recurrence.Although recurrent CDI did not increase the risk of death, it was associated with a far higher risk of rehospitalization, excess hospital days, and costs to Medicare.

Influence of mechanical disintegration on the microbial growth of aerobic sludge biomass: A comparative study of ultrasonic and shear gap homogenizers by oxygen uptake measurements.

PubMed

Divyalakshmi, P; Murugan, D; Sivarajan, M; Saravanan, P; Lajapathi Rai, C

2015-11-01

Wastewater treatment plant incorporates physical, chemical and biological processes to treat and remove the contaminants. The main drawback of conventional activated sludge process is the huge production of excess sludge, which is an unavoidable byproduct. The treatment and disposal of excess sludge costs about 60% of the total operating cost. The ideal way to reduce excess sludge production during wastewater treatment is by preventing biomass formation within the aerobic treatment train rather than post treatment of the generated sludge. In the present investigation two different mechanical devices namely, Ultrasonic and Shear Gap homogenizers have been employed to disintegrate the aerobic biomass. This study is intended to restrict the multiplication of microbial biomass and at the same time degrade the organics present in wastewater by increasing the oxidative capacity of microorganisms. The disintegrability on biomass was determined by biochemical methods. Degree of inactivation provides the information on inability of microorganisms to consume oxygen upon disruption. The soluble COD quantifies the extent of release of intra cellular compounds. The participation of disintegrated microorganism in wastewater treatment process was carried out in two identical respirometeric reactors. The results show that Ultrasonic homogenizer is very effective in the disruption of microorganisms leading to a maximum microbial growth reduction of 27%. On the other hand, Shear gap homogenizer does not favor the sludge growth reduction rather it facilitates the growth. This study also shows that for better microbial growth reduction, floc size reduction alone is not sufficient but also microbial disruption is essential. Copyright © 2015 Elsevier Inc. All rights reserved.

Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency

PubMed Central

Gilmer, Todd P.; Ojeda, Victoria D.; Barrio, Concepcion; Fuentes, Dahlia; Garcia, Piedad; Lanouette, Nicole M.; Lee, Kelly C.

2011-01-01

OBJECTIVES We examined the relationship between preferred English, Spanish, or an Asian language for mental health services and adherence to treatment with antipsychotic medication and Medi-Cal beneficiaries with schizophrenia in San Diego, California. METHODS Data included 31,560 person-years from 1999–2004. Pharmacy records were analyzed to assess adherence to antipsychotic medication, based on the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<0.5), partially adherent (0.5<=MPR<0.8), adherent (0.8<=MPR<=1.1), or as an excess filler (MPR>1.1). Regression models were used to examine adherence, hospitalization, and costs by race/ethnicity and language status. RESULTS Limited English proficient Latinos were more likely to be adherent to antipsychotic medications than English proficient Latinos (40.8% vs. 35.9%, P<0.001). Limited English proficient Latinos were less likely to be excess fillers than English proficient Latinos (15.1% vs. 20.4%, P<0.001). Limited English proficient Asians were less likely to be adherent than English proficient Asians (40.1% vs. 45.1%, P=0.034). Compared to English proficient Asians, limited English proficient Asians were more likely to be nonadherent (28.7% vs. 22.0%, P<0.001) and less likely to be excess fillers (12.5% vs. 17.4%, P=0.004). Controlling for adherence and comorbidities, limited English proficient clients had lower rates of hospitalization and health care costs than English proficient and white clients. CONCLUSIONS Adherence to antipsychotic medications varies among and within ethnic groups by English proficiency. Policies supporting the training of bilingual and multicultural ethnic minority providers, and interventions that capitalize on existing social support networks, may improve adherence to treatment among linguistically diverse populations. PMID:19176410

The costs of obesity in the workplace.

PubMed

Finkelstein, Eric A; DiBonaventura, Marco daCosta; Burgess, Somali M; Hale, Brent C

2010-10-01

To quantify per capita and aggregate medical expenditures and the value of lost productivity, including absenteeism and presenteeism, because of overweight, and grade I, II, and III obesity among U.S. employees. Cross-sectional analysis of the 2006 Medical Expenditure Panel Survey and the 2008 National Health and Wellness Survey. Among men, estimates range from -$322 for overweight to $6087 for grade III obese men. For women, estimates range from $797 for overweight to $6694 for grade III. In aggregate, the annual cost attributable to obesity among full-time employees is $73.1 billion. Individuals with a body mass index >35 represent 37% of the obese population but are responsible for 61% of excess costs. Successful efforts to reduce the prevalence of obesity, especially among those with a body mass index >35, could result in significant savings to employers.

Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

PubMed

Hung, Jung-Hua; Chang, Li

2008-03-01

Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey

PubMed Central

Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

2016-01-01

Objective In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. Methods A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Results Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Conclusions Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective. PMID:27322384

Economic costs of electrical system instability and power outages caused by snakes on the Island of Guam

USGS Publications Warehouse

Fritts, T.H.

2002-01-01

The Brown Tree Snake, Boiga irregularis, is an introduced species on Guam where it causes frequent electrical power outages. The snake's high abundance, its propensity for climbing, and use of disturbed habitats all contribute to interruption of Guam's electrical service and the activities that depend on electrical power. Snakes have caused more than 1600 power outages in the 20-yr period of 1978–1997 and most recently nearly 200 outages per year. Single outages spanning the entire island and lasting 8 or more hours are estimated to cost in excess of $3,000,000 in lost productivity, but the costs of outages that involve only parts of the island or those of shorter durations are more difficult to quantify. Costs to the island's economy have exceeded $4.5 M $4.5M"> per year over a 7-yr period without considering repair costs, damage to electrical equipment, and lost revenues. Snakes pose the greatest problem on high voltage transmission lines, on transformers, and inside electrical substations.

What could family income be if health insurance were more affordable?

PubMed

Young, Richard A; Devoe, Jennifer E

2012-10-01

Adjusted for inflation, household income has been relatively flat since the mid-1990s, but the inflation rate of employer-sponsored health insurance has been greater than both household income growth and general inflation for 50 years. We estimated the effect on average family income if health insurance inflation matched the general inflation rate since 1996, and those savings were given to employees as income. We used data from the Medical Expenditure Panel Survey, the Milliman Medical Index, and other federal sources to model the relationship between private health insurance costs and household income over the last 15 years. If the cost of family health care costs had kept pace with the Consumer Price Index (CPI) rate since 1996, the average family income could have been $8,410 higher in 2010 ($68,805 versus $60,395), 13.9% more than actual earnings. If health care costs had not exceeded the CPI rate since 1996 and if all the excess costs were converted into employee wages, median family income could be substantially higher today.

Comparison of sampling methodologies for nutrient monitoring in streams: uncertainties, costs and implications for mitigation

NASA Astrophysics Data System (ADS)

Audet, J.; Martinsen, L.; Hasler, B.; de Jonge, H.; Karydi, E.; Ovesen, N. B.; Kronvang, B.

2014-07-01

Eutrophication of aquatic ecosystems caused by excess concentrations of nitrogen and phosphorus may have harmful consequences for biodiversity and poses a health risk to humans via the water supplies. Reduction of nitrogen and phosphorus losses to aquatic ecosystems involves implementation of costly measures, and reliable monitoring methods are therefore essential to select appropriate mitigation strategies and to evaluate their effects. Here, we compare the performances and costs of three methodologies for the monitoring of nutrients in rivers: grab sampling, time-proportional sampling and passive sampling using flow proportional samplers. Assuming time-proportional sampling to be the best estimate of the "true" nutrient load, our results showed that the risk of obtaining wrong total nutrient load estimates by passive samplers is high despite similar costs as the time-proportional sampling. Our conclusion is that for passive samplers to provide a reliable monitoring alternative, further development is needed. Grab sampling was the cheapest of the three methods and was more precise and accurate than passive sampling. We conclude that although monitoring employing time-proportional sampling is costly, its reliability precludes unnecessarily high implementation expenses.

Comparison of sampling methodologies for nutrient monitoring in streams: uncertainties, costs and implications for mitigation

NASA Astrophysics Data System (ADS)

Audet, J.; Martinsen, L.; Hasler, B.; de Jonge, H.; Karydi, E.; Ovesen, N. B.; Kronvang, B.

2014-11-01

Eutrophication of aquatic ecosystems caused by excess concentrations of nitrogen and phosphorus may have harmful consequences for biodiversity and poses a health risk to humans via water supplies. Reduction of nitrogen and phosphorus losses to aquatic ecosystems involves implementation of costly measures, and reliable monitoring methods are therefore essential to select appropriate mitigation strategies and to evaluate their effects. Here, we compare the performances and costs of three methodologies for the monitoring of nutrients in rivers: grab sampling; time-proportional sampling; and passive sampling using flow-proportional samplers. Assuming hourly time-proportional sampling to be the best estimate of the "true" nutrient load, our results showed that the risk of obtaining wrong total nutrient load estimates by passive samplers is high despite similar costs as the time-proportional sampling. Our conclusion is that for passive samplers to provide a reliable monitoring alternative, further development is needed. Grab sampling was the cheapest of the three methods and was more precise and accurate than passive sampling. We conclude that although monitoring employing time-proportional sampling is costly, its reliability precludes unnecessarily high implementation expenses.

Reimagining cost recovery in Pakistan's irrigation system through willingness-to-pay estimates for irrigation water from a discrete choice experiment

NASA Astrophysics Data System (ADS)

Bell, Andrew Reid; Shah, M. Azeem Ali; Ward, Patrick S.

2014-08-01

It is widely argued that farmers are unwilling to pay adequate fees for surface water irrigation to recover the costs associated with maintenance and improvement of delivery systems. In this paper, we use a discrete choice experiment to study farmer preferences for irrigation characteristics along two branch canals in Punjab Province in eastern Pakistan. We find that farmers are generally willing to pay well in excess of current surface water irrigation costs for increased surface water reliability and that the amount that farmers are willing to pay is an increasing function of their existing surface water supply as well as location along the main canal branch. This explicit translation of implicit willingness-to-pay (WTP) for water (via expenditure on groundwater pumping) to WTP for reliable surface water demonstrates the potential for greatly enhanced cost recovery in the Indus Basin Irrigation System via appropriate setting of water user fees, driven by the higher WTP of those currently receiving reliable supplies.

Low-Cost Innovation in Spaceflight: The Near Earth Asteroid Rendezvous (NEAR) Shoemaker Mission

NASA Technical Reports Server (NTRS)

McCurdy, Howard E.

2005-01-01

On a spring day in 1996, at their research center in the Maryland countryside, representatives from the Johns Hopkins University Applied Physics Laboratory (APL) presented Administrator Daniel S. Goldin of the National Aeronautics and Space Administration (NASA) with a check for $3.6 million. 1 Two and a half years earlier, APL officials had agreed to develop a spacecraft capable of conducting an asteroid rendezvous and to do so for slightly more than $122 million. This was a remarkably low sum for a spacecraft due to conduct a planetaryclass mission. By contrast, the Mars Observer spacecraft launched in 1992 for an orbital rendezvous with the red planet had cost $479 million to develop, while the upcoming Cassini mission to Saturn required a spacecraft whose total cost was approaching $1.4 billion. In an Agency accustomed to cost overruns on major missions, the promise to build a planetary-class spacecraft for about $100 million seemed excessively optimistic.

Reimagining cost recovery in Pakistan's irrigation system through willingness-to-pay estimates for irrigation water from a discrete choice experiment

PubMed Central

Bell, Andrew Reid; Shah, M Azeem Ali; Ward, Patrick S

2014-01-01

It is widely argued that farmers are unwilling to pay adequate fees for surface water irrigation to recover the costs associated with maintenance and improvement of delivery systems. In this paper, we use a discrete choice experiment to study farmer preferences for irrigation characteristics along two branch canals in Punjab Province in eastern Pakistan. We find that farmers are generally willing to pay well in excess of current surface water irrigation costs for increased surface water reliability and that the amount that farmers are willing to pay is an increasing function of their existing surface water supply as well as location along the main canal branch. This explicit translation of implicit willingness-to-pay (WTP) for water (via expenditure on groundwater pumping) to WTP for reliable surface water demonstrates the potential for greatly enhanced cost recovery in the Indus Basin Irrigation System via appropriate setting of water user fees, driven by the higher WTP of those currently receiving reliable supplies. PMID:25552779

Prehospital traumatic cardiac arrest: the cost of futility.

PubMed

Rosemurgy, A S; Norris, P A; Olson, S M; Hurst, J M; Albrink, M H

1993-09-01

Of 12,462 trauma patients cared for by prehospital services from October 1, 1989 to March 31, 1991, 138 patients underwent CPR at the scene or during transport because of the absence of blood pressure, pulse, and respiration. Ninety-six (70%) suffered blunt trauma, 42 (30%) suffered penetrating trauma. Sixty (43%) were transported by air utilizing county-wide transport protocols. None of the patients survived. Aggregate care cost $871,186.00. In 11 cases (8%), tissue for transplantation was procured (only corneas). Trauma patients who require CPR at the scene or in transport die. Infrequent organ procurement does not seem to justify the cost (primarily borne by hospitals), consumption of resources, and exposure of health care providers to occupational health hazards. The wisdom of transporting trauma victims suffering cardiopulmonary arrest at the scene or during transport must be questioned. Allocation of resources to these patients is not an insular medical issue, but a broad concern for our society, and society should decide if the "cost of futility" is excessive.

Meeting the challenge of the 80's cost reduction measures at the Iron Ore Company of Canada's Carol Project 1980-85

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

Tinto, I.A.

1985-01-01

The mining facilities, crushing plant, and concentrator of the Iron Ore Company of Canada were in operation by 1962. Today, the Carol Project has the capacity to produce 20 million tonnes of concentrate from which 10.5 million tonnes of pellets can be produced. The period 1980-85 spans a period of energy crisis, world-wide recession, and a consequent re-structuring of the North American steel industry as it struggles to survive in an arena of excess world stell making capacity, government subsidized industries, and the increasing competition from overseas and from developing countries. This paper reviews cost reduction programs implemented by themore » Iron Ore Company of Canada at its 'Carol Project' and emphasizes improvements made in labour productivity, energy conservation, mining strategy, quality control, and reduced cost through technical innovations over this difficult period. The cost reduction program is reviewed under the headings of labor productivity, energy conservation, mining strategy, technical innovations and quality control.« less

Decentralized method for utility regulation: a comment

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

Sharkey, W.W.

The author comments on the article by Loeb and Magat in this journal issue (P 399); he feels their idea is worthy of more-detailed examination on an industry-specific level. He confines his comments, however, to a more-general comparison of the Loeb-Magat (L-M) scheme, traditional rate-of-return regulation, and pure franchise bidding. The basic L-M proposal consists of two parts. First it is shown that if a utility is subsidized by an amount corresponding to total consumer surplus, then it will have the incentive to pursue cost-minimizing behavior and to set its price equal to the marginal cost of production. Mr. Sharkeymore » believes that this pure subsidy scheme would be wholly unworkable in practice. The second part of the L-M proposal consists of the subsidy scheme combined with either franchise bidding or a lump-sum tax. Mr. Sharkey feels that this proposal has considerable merit if conditions exist such that the net subsidy paid to the utility is sufficiently small; net subsidy is defined as the excess of the actual subsidy plus revenues of the firm over the total cost of production. Thus, the net subsidy is the excess profit the utility receives compared to a utility perfectly regulated by traditional means. Mr. Sharkey elaborates on some of his objections to the L-M proposal for cases in which the net subsidy is large. Then, he briefly considers the characteristics of a natural monopoly market which could potentially be regulated by a combined subsidy-franchise-tax scheme.« less

Mental retardation and prenatal methylmercury toxicity

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

Trasande, L.; Schechter, C.B.; Haynes, K.A.

2006-03-15

Methylmercury (MeHg) is a developmental neurotoxicant; exposure results principally from consumption of seafood contaminated by mercury (Hg). In this analysis, the burden of mental retardation (MR) associated with methylmercury exposure in the 2000 U.S. birth cohort is estimated, and the portion of this burden attributable to mercury (Hg) emissions from coal-fired power plants is identified. The aggregate loss in cognition associated with MeHg exposure in the 2000 U.S. birth cohort was estimated using two previously published dose-response models that relate increases in cord blood Hg concentrations with decrements in IQ. MeHg exposure was assumed not to be correlated with nativemore » cognitive ability. Previously published estimates were used to estimate economic costs of MR caused by MeHg. Downward shifts in IQ resulting from prenatal exposure to MeHg of anthropogenic origin are associated with 1,566 excess cases of MR annually (range: 376-14,293). This represents 3.2% of MR cases in the US (range: 0.8%-29.2%). The MR costs associated with decreases in IQ in these children amount to $2.0 billion/year (range: $0.5-17.9 billion). Hg from American power plants accounts for 231 of the excess MR cases year (range: 28-2,109), or 0.5% (range: 0.06%-4.3%) of all MR. These cases cost $289 million (range: $35 million-2.6 billion). Toxic injury to the fetal brain caused by Hg emitted from coal-fired power plants exacts a significant human and economic toll on American children.« less

Alternatives to Crop Insurance for Mitigating Hydrologic Risk in the Upper Mississippi River Basin

NASA Astrophysics Data System (ADS)

Baker, J. M.; Griffis, T. J.; Gorski, G.; Wood, J. D.

2015-12-01

Corn and soybean production in the Upper Mississippi River Basin can be limited by either excess or shortage of water, often in the same year within the same watershed. Most producers indemnify themselves against these hazards through the Federal crop insurance program, which is heavily subsidized, thus discouraging expenditures on other forms of risk mitigation. The cost is not trivial, amounting to more than 60 billion USD over the past 15 years. Examination of long-term precipitation and streamflow records at the 8-digit scale suggests that inter-annual hydrologic variability in the region is increasing, particularly in an area stretching from NW IL through much of IA and southern MN. Analysis of crop insurance statistics shows that these same watersheds exhibit the highest frequency of coincident claims for yield losses to both excess water and drought within the same year. An emphasis on development of water management strategies to increase landscape storage and subsequent reuse through supplemental irrigation in this region could reduce the cost of the crop insurance program and stabilize yield. However, we also note that analysis of yield data from USDA-NASS shows that interannual yield variability at the watershed scale is much more muted than the indemnity data suggest, indicating that adverse selection is probably a factor in the crop insurance marketplace. Consequently, we propose that hydrologic mitigation practices may be most cost-effective if they are carefully targeted, using topographic, soil, and meteorological data, in combination with more site-specificity in crop insurance data.

The Large Benefits of Small-Satellite Missions

NASA Astrophysics Data System (ADS)

Baker, Daniel N.; Worden, S. Pete

2008-08-01

Small-spacecraft missions play a key and compelling role in space-based scientific and engineering programs [Moretto and Robinson, 2008]. Compared with larger satellites, which can be in excess of 2000 kilograms, small satellites range from 750 kilograms-roughly the size of a golf cart-to less than 1 kilogram, about the size of a softball. They have been responsible for greatly reducing the time needed to obtain science and technology results. The shorter development times for smaller missions can reduce overall costs and can thus provide welcome budgetary options for highly constrained space programs. In many cases, we contend that 80% (or more) of program goals can be achieved for 20% of the cost by using small-spacecraft solutions.

The Economic Effect of Competition in the Air Transportation Industry

NASA Technical Reports Server (NTRS)

Hubbard, H. B.

1972-01-01

The air transportation industry has been described as a highly-competitive, regulated oligopoly or as a price-regulated cartel with blocked entry, resulting in excessive service and low load factors. The current structure of the industry has been strongly influenced by the hypotheses that increased levels of competition are desirable per se, and that more competing carriers can be economically supported in larger markets, in longer haul markets, with lower unit costs, and with higher fare levels. An elementary application of competition/game theory casts doubt on the validity of these hypotheses, but rather emphasizes the critical importance of the short-term non-variable costs in determining economic levels of competition.

41 CFR 102-75.895 - What wording must generally be in the excess profits clause that is required in the offer to...

Code of Federal Regulations, 2011 CFR

2011-01-01

... date of conveyance. With respect to the property described in this deed, if at any time within a 3-year..., shall sell or enter into agreements to sell the property, either in a single transaction or in a series..., and other site or public improvements. (3) The direct costs actually incurred and paid for design and...

41 CFR 102-75.895 - What wording must generally be in the excess profits clause that is required in the offer to...

Code of Federal Regulations, 2013 CFR

2013-07-01

... date of conveyance. With respect to the property described in this deed, if at any time within a 3-year..., shall sell or enter into agreements to sell the property, either in a single transaction or in a series..., and other site or public improvements. (3) The direct costs actually incurred and paid for design and...

41 CFR 102-75.895 - What wording must generally be in the excess profits clause that is required in the offer to...

Code of Federal Regulations, 2014 CFR

2014-01-01

... date of conveyance. With respect to the property described in this deed, if at any time within a 3-year..., shall sell or enter into agreements to sell the property, either in a single transaction or in a series..., and other site or public improvements. (3) The direct costs actually incurred and paid for design and...

41 CFR 102-75.895 - What wording must generally be in the excess profits clause that is required in the offer to...

Code of Federal Regulations, 2012 CFR

2012-01-01

... date of conveyance. With respect to the property described in this deed, if at any time within a 3-year..., shall sell or enter into agreements to sell the property, either in a single transaction or in a series..., and other site or public improvements. (3) The direct costs actually incurred and paid for design and...

Crafting the Department of Defense Energy Strategy

DTIC Science & Technology

2010-03-01

various biomasses – corn, cellulose, and algae for example – with varying costs and with varying degrees of net greenhouse gas emission. 54 These same...have varying degrees of net emissions. Because corn ethanol production uses a tremendous amount of petroleum to fertilize, cultivate , transport and...lengthy periods of time. Other techniques involve using excess carbon dioxide to feed biofuel feedstocks such as algae at a co- located energy

State of South Carolina Cooperative Aquatic Plant Control Program.

DTIC Science & Technology

1980-11-01

Carolina Water Resources Commission. Abstract: The proposed program provides for a comprehensive plan to control noxious aquatic plants within the state...public water bodies in South Carolina to a more natural condition by controlling the excessive growth of aquatic vegetation in the interest of...Herbicides Proposed for Use in the Aquatic Plant Management Program D Cost Estimate E EPA Established Tolerances for Selected Herbicides in Potable Water F

Prosthesis Material

NASA Technical Reports Server (NTRS)

1995-01-01

In this photograph, Sandra Rossi user her NASA-developed prosthesis for the first time. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

VEBAs--ordinary and necessary expenses--deductions and constructive dividends. Neonatology Associates, P.A. v. Commissioner of Internal Revenue.

PubMed

2004-01-01

Contributions made by professional medical corporations into voluntary employee benefit program plans (VEBAs), which were well in excess of the cost of the term life insurance provided to the participants, were not ordinary and necessary business expenses, and the distributions of surplus cash to owner physicians upon conversion to individual policies constituted constructive dividends taxable to the individual taxpayers.

A Classification and Analysis of National Contract Management Journal Articles from 1990 to 1999 and Journal of Supply Chain Management Articles from 1987 to 2000

DTIC Science & Technology

2001-12-01

defense profits become excessive. Sorenson uses the Capital Asset Pricing Model ( CAPM ) to compare the risk-reward relationship for defense...firms. THEORETICAL, NORMATIVE, EMPIRICAL, INDUCTIVE [58] “A Comment on Using the Capital Asset Pricing ...combination asset revaluation, pensions, post-retirement health benefits, software capitalization , Material Management and Accounting System (MMAS), cost

Developing a Universal Navy Uniform Adoption Model for Use in Forecasting

DTIC Science & Technology

2015-12-01

manpower , and allowance data in order to build the model. Once chosen, the best candidate model will be validated against alternate sales data from a...inventory shortage or excess inventory holding costs caused by overestimation. 14. SUBJECT TERMS demand management, demand forecasting, Defense...software will be used to identify relationships between uniform sales, time, manpower , and allowance data in order to build the model. Once chosen, the

Compliance with the CURB-65 score and the consequences of non-implementation.

PubMed

Guo, Q; Li, H-Y; Zhou, Y-P; Li, M; Chen, X-K; Liu, H; Peng, H-L; Yu, H-Q; Chen, X; Liu, N; Liang, L-H; Zhao, Q-Z; Jiang, M

2011-12-01

The CURB-65 (confusion, urea >7 mmol/l, respiratory rate ≥ 30 breaths/min, low blood pressure and age ≥ 65 years) score is a simple, well-validated tool for the assessment of severity in community-acquired pneumonia (CAP). It is unknown whether it is used routinely in China. To determine the frequency of use of the CURB-65 score in routine hospital practice and the consequences of non-implementation. A retrospective analysis of medical records from 1230 in-patients with CAP in a Chinese medical college-affiliated hospital. No CAP patient underwent the CURB-65 test at admission. Based on the British Thoracic Society guidelines, the 716 (58.2%) in-patients with a CURB65 score of 0 and the 402 (32.7%) in-patients with CURB-65 score of 1 should have received ambulatory treatment, whereas the 14 (1.2%) patients with CURB65 scores of ≥ 3 should have been admitted to the critical care unit. The maximum excess total annual costs for managing CAP patients with CURB-65 scores of 0 and 1 were estimated at respectively US$94 383.12 and US$66 313.92 in the hospital. The CURB-65 scoring tool in patients with CAP was not applied in routine hospital practice, resulting in inappropriate hospitalisation and excess costs.

Evaluation of Spacecraft Shielding Effectiveness for Radiation Protection

NASA Technical Reports Server (NTRS)

Cucinotta, Francis A.; Wilson, John W.

1999-01-01

The potential for serious health risks from solar particle events (SPE) and galactic cosmic rays (GCR) is a critical issue in the NASA strategic plan for the Human Exploration and Development of Space (HEDS). The excess cost to protect against the GCR and SPE due to current uncertainties in radiation transmission properties and cancer biology could be exceedingly large based on the excess launch costs to shield against uncertainties. The development of advanced shielding concepts is an important risk mitigation area with the potential to significantly reduce risk below conventional mission designs. A key issue in spacecraft material selection is the understanding of nuclear reactions on the transmission properties of materials. High-energy nuclear particles undergo nuclear reactions in passing through materials and tissue altering their composition and producing new radiation types. Spacecraft and planetary habitat designers can utilize radiation transport codes to identify optimal materials for lowering exposures and to optimize spacecraft design to reduce astronaut exposures. To reach these objectives will require providing design engineers with accurate data bases and computationally efficient software for describing the transmission properties of space radiation in materials. Our program will reduce the uncertainty in the transmission properties of space radiation by improving the theoretical description of nuclear reactions and radiation transport, and provide accurate physical descriptions of the track structure of microscopic energy deposition.