External costs of risky health behaviors associated with leading actual causes of death in the U.S.: a review of the evidence and implications for future research.

PubMed

Zohrabian, Armineh; Philipson, Tomas J

2010-06-01

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.

External tissue expansion for difficult wounds using a simple cost effective technique.

PubMed

Nandhagopal, Vijayaraghavan; Chittoria, Ravi Kumar; Mohapatra, Devi Prasad; Thiruvoth, Friji Meethale; Sivakumar, Dinesh Kumar; Ashokan, Arjun

2015-01-01

To study and discuss role of external tissue expansion and wound closure (ETEWC) technique using hooks and rubber bands. The present study is a retrospective analysis of nine cases of wounds of different aetiology where ETEWC technique was applied using hooks and rubber bands. All the wounds in the study healed completely without split thickness skin graft (SSG) or flap. ETEWC technique using hooks and rubber bands is a cost-effective technique which can be used for wound closure without SSG or flap.

Lifetime costing of the body-in-white: Steel vs. aluminum

NASA Astrophysics Data System (ADS)

Han, Helen N.; Clark, Joel P.

1995-05-01

In order to make informed material choice decisions and to derive the maximum benefit from the use of alternative materials, the automobile producer must understand the full range of costs and benefits for each material. It is becoming clear that the conventional cost-benefit analysis structure currently used by the automotive industry must be broadened to include nontraditional costs such as the environmental externalities associated with the use of existing and potential automotive technologies. This article develops a methodology for comparing the costs and benefits associated with the use of alternative materials in automotive applications by focusing on steel and aluminum in the unibody body-in-white. Authors' Note: This is the first of two articles documenting a methodology for evaluating the lifetime monetary and environmental costs of alternative materials in automotive applications. This article addresses the traditional money costs while a subsequent paper, which is planned for the August issue, will address the environmental externalities.

The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities.

PubMed

Rajan, Prashant V; Qudsi, Rameez A; Dyer, George S M; Losina, Elena

2018-02-07

There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation. We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty. From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning. When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Economics of internal and external energy storage in solar power plant operation

NASA Technical Reports Server (NTRS)

Manvi, R.; Fujita, T.

1977-01-01

A simple approach is formulated to investigate the effect of energy storage on the bus-bar electrical energy cost of solar thermal power plants. Economic analysis based on this approach does not require detailed definition of a specific storage system. A wide spectrum of storage system candidates ranging from hot water to superconducting magnets can be studied based on total investment and a rough knowledge of energy in and out efficiencies. Preliminary analysis indicates that internal energy storage (thermal) schemes offer better opportunities for energy cost reduction than external energy storage (nonthermal) schemes for solar applications. Based on data and assumptions used in JPL evaluation studies, differential energy costs due to storage are presented for a 100 MWe solar power plant by varying the energy capacity. The simple approach presented in this paper provides useful insight regarding the operation of energy storage in solar power plant applications, while also indicating a range of design parameters where storage can be cost effective.

Is ambulatory monitoring for "community-acquired" syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring.

PubMed

Rockx, Marie Antoinette; Hoch, Jeffrey S; Klein, George J; Yee, Raymond; Skanes, Allan C; Gula, Lorne J; Krahn, Andrew D

2005-11-01

Out patient ambulatory monitoring is often performed in patients with syncope that present in the primary care setting to include or exclude an arrhythmia. The cost-effectiveness of 2 monitoring strategies was assessed in a prospective randomized trial. One hundred patients referred for ambulatory monitoring with syncope or presyncope were randomized to a 1-month external loop recorder (n = 49) or 48-hour Holter monitor (n = 51). Patients were offered crossover if there was failed activation or no symptom recurrence. The primary end point was symptom-rhythm correlation during monitoring. Direct costs were calculated based on the 2003 Ontario Health Insurance Plan fee schedule, combined with calculation of labor, materials, service, and overhead for diagnostic testing and related equipment. Before enrollment, the cost of all previous health care resource use was USD 472 +/- USD 397 (range USD 21-USD 1965). In the loop recorder group, 63% of patients had symptom recurrence and successful activation, compared with 24% in the Holter group (P < .0001). The cost per Holter was USD 177.64, and per loop recorder, USD 533.56, with a similar cost per diagnosis with the 2 techniques. The incremental cost-effectiveness ratio of the loop recorder was USD 901.74 per extra successful diagnosis. A strategy of Holter followed by offered loop recorder trended toward lower cost than initial loop recorder followed by Holter (USD 481 +/- USD 267 vs USD 551 +/- USD 83, P = .08), but was associated with a lower overall diagnostic yield (49% vs 63%) and a resultant higher cost per diagnosis (USD 982 vs USD 871, P = .08). Bootstrapping suggested that 90% of incremental cost-effectiveness ratios were less than USD 1250. Despite the increased upfront cost of external loop recorders, the marked improvement in diagnostic yield offsets the cost. External loop recorders are an economically attractive alternative. First-line use of external loop recorders in patients with "community-acquired" syncope and presyncope should be considered to optimize diagnostic yield given its value.

Job Analysis: A Local Government's Experience.

ERIC Educational Resources Information Center

Urbanek, Steve J.

1997-01-01

A county personnel department undertook reclassification of all positions by collecting and using job analysis data to rewrite job descriptions. External pay equity and validated selection procedures resulted with only a modest increase in payroll costs. (SK)

Costing nursing education programs. It's as easy as 1-2-3.

PubMed

Fisher, M L; Hume, R; Emerick, R

1998-01-01

Staff development departments are pressured to reveal the costs of their educational programs and to compete with outside vendors for programming. The process of implementing a spreadsheet template for costing out staff development programs is described. The template is easy to use and supports "what if" analysis. This model allows educators to evaluate cost implications of curricular decisions and to better negotiate with internal and external customers.

DIDEM - An integrated model for comparative health damage costs calculation of air pollution

NASA Astrophysics Data System (ADS)

Ravina, Marco; Panepinto, Deborah; Zanetti, Maria Chiara

2018-01-01

Air pollution represents a continuous hazard to human health. Administration, companies and population need efficient indicators of the possible effects given by a change in decision, strategy or habit. The monetary quantification of health effects of air pollution through the definition of external costs is increasingly recognized as a useful indicator to support decision and information at all levels. The development of modelling tools for the calculation of external costs can provide support to analysts in the development of consistent and comparable assessments. In this paper, the DIATI Dispersion and Externalities Model (DIDEM) is presented. The DIDEM model calculates the delta-external costs of air pollution comparing two alternative emission scenarios. This tool integrates CALPUFF's advanced dispersion modelling with the latest WHO recommendations on concentration-response functions. The model is based on the impact pathway method. It was designed to work with a fine spatial resolution and a local or national geographic scope. The modular structure allows users to input their own data sets. The DIDEM model was tested on a real case study, represented by a comparative analysis of the district heating system in Turin, Italy. Additional advantages and drawbacks of the tool are discussed in the paper. A comparison with other existing models worldwide is reported.

Economic valuation of a mangrove ecosystem threatened by shrimp aquaculture in Sri Lanka.

PubMed

Gunawardena, M; Rowan, J S

2005-10-01

Mangrove ecosystems in Sri Lanka are increasingly under threat from development projects, especially aquaculture. An economic assessment is presented for a relatively large (42 ha) shrimp culture development proposed for the Rekawa Lagoon system in the south of Sri Lanka, which involved an extended cost-benefit analysis of the proposal and an estimate of the "total economic value" (TEV) of a mangrove ecosystem. The analysis revealed that the internal benefits of developing the shrimp farm are higher than the internal costs in the ratio of 1.5:1. However, when the wider environmental impacts are more comprehensively evaluated, the external benefits are much lower than the external costs in a ratio that ranges between 1:6 and 1:11. In areas like Rekawa, where agriculture and fisheries are widely practiced at subsistence levels, shrimp aquaculture developments have disproportionately large impacts on traditional livelihoods and social welfare. Thus, although the analysis retains considerable uncertainties, more explicit costing of the environmental services provided by mangrove ecosystems demonstrates that low intensity, but sustainable, harvesting has far greater long-term value to local stakeholders and the wider community than large shrimp aquaculture developments.

Externalities and the Coase Theorem: A Diagrammatic Presentation

ERIC Educational Resources Information Center

Halteman, James

2005-01-01

In intermediate microeconomic textbooks the reciprocal nature of externalities is presented using numerical examples of costs and benefits. This treatment of the Coase theorem obscures the fact that externality costs and benefits are best understood as being on a continuum where costs vary with the degree of intensity of the externality. When…

Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment

PubMed Central

Kabali, Conrad; Xie, Xuanqian; Higgins, Caroline

2017-01-01

Background Ambulatory electrocardiography (ECG) monitors are often used to detect cardiac arrhythmia. For patients with symptoms, an external cardiac loop recorder will often be recommended. The improved recording capacity of newer Holter monitors and similar devices, collectively known as longterm continuous ambulatory ECG monitors, suggests that they will perform just as well as, or better than, external loop recorders. This health technology assessment aimed to evaluate the effectiveness, cost-effectiveness, and budget impact of longterm continuous ECG monitors compared with external loop recorders in detecting symptoms of cardiac arrhythmia. Methods Based on our systematic search for studies published up to January 15, 2016, we did not identify any studies directly comparing the clinical effectiveness of longterm continuous ECG monitors and external loop recorders. Therefore, we conducted an indirect comparison, using a 24-hour Holter monitor as a common comparator. We used a meta-regression model to control for bias due to variation in device-wearing time and baseline syncope rate across studies. We conducted a similar systematic search for cost-utility and cost-effectiveness studies comparing the two types of devices; none were found. Finally, we used historical claims data (2006–2014) to estimate the future 5-year budget impact in Ontario, Canada, of continued public funding for both types of longterm ambulatory ECG monitors. Results Our clinical literature search yielded 7,815 non-duplicate citations, of which 12 cohort studies were eligible for indirect comparison. Seven studies assessed the effectiveness of longterm continuous monitors and five assessed external loop recorders. Both types of devices were more effective than a 24-hour Holter monitor, and we found no substantial difference between them in their ability to detect symptoms (risk difference 0.01; 95% confidence interval −0.18, 0.20). Using GRADE for network meta-analysis, we evaluated the quality of the evidence as low. Our budget impact analysis showed that use of the longterm continuous monitors has grown steadily in Ontario since they became publicly funded in 2006, particularly since 2011 when monitors that can record for 14 days or longer became funded, and the use of external cardiac loop recorders has correspondingly declined. The analysis suggests that, with these trends, continued public funding of both types of longterm ambulatory ECG testing will result in additional costs ranging from $130,000 to $370,000 per year over the next 5 years. Conclusions Although both longterm continuous ambulatory ECG monitors and external cardiac loop recorders were more effective than a 24-hour Holter monitor in detecting symptoms of cardiac arrhythmia, we found no evidence to suggest that these two devices differ in effectiveness. Assuming that the use of longterm continuous monitors will continue to increase in the next 5 years, the public health care system in Ontario can expect to see added costs of $130,000 to $370,000 per year. PMID:28194254

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova.

PubMed

Kempers, Jari; Ketting, Evert; Lesco, Galina

2014-07-21

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies.

Prescription, Dispensation, and Generic Medicine Replacement Ratios: Influence on Japanese Medicine Costs

PubMed Central

Yokoi, Masayuki; Tashiro, Takao

2016-01-01

This study used publicly available data to examine the effect of the separation of dispensing and prescribing medicines between pharmacists in pharmacies and doctors in medical institutions (the separation system) and the generic medicine replacement ratio on the cost of various medicines in Japanese prefectures. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each administrative district is highly variable. In our multiple regression analysis, the dependent variables were the costs of daily medicines, specifically, total, internal, external, and injection medicines, as well as medical devices, and the independent variables were the expansion rate of the separation system and generic medicine replacement ratio. The expansion rate of the separation system showed a significant negative partial correlation with the daily costs of total, internal, and injection medicines as well as medical devices. Moreover, the rate of replacing brand name medicines with generic medicines showed a significant negative partial correlation with the daily costs of total and internal medicines. However, external and injection medicines and medical devices did not because only a few or no generic products of these types were sold in the Japanese market. Otherwise, expansion of the separation system was effective in reducing medicine costs, except in the case of external medicines. This suggests that the cost efficiency effect of the separation system does not function all the time. PMID:26234979

Emissions and Cost Implications of Controlled Electric Vehicle Charging in the U.S. PJM Interconnection.

PubMed

Weis, Allison; Michalek, Jeremy J; Jaramillo, Paulina; Lueken, Roger

2015-05-05

We develop a unit commitment and economic dispatch model to estimate the operation costs and the air emissions externality costs attributable to new electric vehicle electricity demand under controlled vs uncontrolled charging schemes. We focus our analysis on the PJM Interconnection and use scenarios that characterize (1) the most recent power plant fleet for which sufficient data are available, (2) a hypothetical 2018 power plant fleet that reflects upcoming plant retirements, and (3) the 2018 fleet with increased wind capacity. We find that controlled electric vehicle charging can reduce associated generation costs by 23%-34% in part by shifting loads to lower-cost, higher-emitting coal plants. This shift results in increased externality costs of health and environmental damages from increased air pollution. On balance, we find that controlled charging of electric vehicles produces negative net social benefits in the recent PJM grid but could have positive net social benefits in a future grid with sufficient coal retirements and wind penetration.

[Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy].

PubMed

Becerra Bachino, Virginia; Cots, Francesc; Guedea, Ferran; Pera, Joan; Boladeras, Ana; Aguiló, Ferran; Suárez, José Francisco; Gallo, Pedro; Murgui, Lluis; Pont, Angels; Cunillera, Oriol; Pardo, Yolanda; Ferrer, Montserrat

2011-01-01

To compare the initial costs of the three most established treatments for clinically localized prostate cancer according to risk, age and comorbidity groups, from the healthcare provider's perspective. We carried out a cost comparison study in a sample of patients consecutively recruited between 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain). The use of services up to 6 months after the treatment start date was obtained from hospital databases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristics of patients and treatments was collected prospectively. Costs were compared by using nonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regression model. Among the 398 patients included, the cost difference among treatments was statistically significant: medians were € 3,229.10, € 5,369.00 and € 6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001). In the multivariate analysis (adjusted R(2)=0.8), the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively). Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

The impact of external donor support through the U.S. President’s Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004–2011

PubMed Central

Pitman, John P.; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J.; Basavaraju, Sridhar V.; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A.; Lowrance, David W.; Sibinga, Cees Th. Smit

2015-01-01

Background External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004–2011, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. Material and methods A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004–2009) and the 2 years in which PEPFAR support began to decline (2010–2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Results Between 2004–2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. Discussion PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn. PMID:25369616

The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011.

PubMed

Pitman, John P; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J; Basavaraju, Sridhar V; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A; Lowrance, David W; Sibinga, Cees Th Smit

2015-04-01

External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.

Analysis of strategies to increase external fixator stiffness: is double stacking worth the cost?

PubMed

Strebe, Sara; Kim, Hyunchul; Russell, Joseph P; Hsieh, Adam H; Nascone, Jason; O'Toole, Robert V

2014-07-01

We compared the mechanical benefits and costs of 3 strategies that are commonly used to increase knee-spanning external fixator stiffness (resistance to deformation): double stacking, cross-linking, and use of an oblique pin. At our academic trauma centre and biomechanical testing laboratory, we used ultra-high-molecular-weight polyethylene bone models and commercially available external fixator components to simulate knee-spanning external fixation. The models were tested in anterior-posterior bending, medial-lateral bending, axial compression, and torsion. We recorded the construct stiffness for each strategy in all loading modes and assessed a secondary outcome of cost per 10% increase in stiffness. Double stacking significantly increased construct stiffness under anterior-posterior bending (109%), medial-lateral bending (22%), axial compression (150%), and torsion (41%) (p<0.05). Use of an oblique pin significantly increased stiffness under torsion (25%) (p<0.006). Cross-linking significantly increased stiffness only under torsion (29%) (p<0.002). Double stacking increased costs by 84%, cross-linking by 28%, and use of an oblique pin by 15% relative to a standard fixator. All 3 strategies increased stiffness under torsion to varying degrees, but only double stacking increased stiffness in all 4 testing modalities (p<0.05). Double stacking is most effective in increasing resistance to bending, particularly under anterior-posterior bending and axial compression, but requires a relatively high cost increase. Clinicians can use these data to help guide the most cost-effective strategy to increase construct stiffness based on the plane in which stiffness is needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison of external costs between dry tomb and bioreactor landfills: taking intergenerational effects seriously.

PubMed

Méry, Jacques; Bayer, Stefan

2005-12-01

Dry tomb and bioreactor landfills were analyzed with respect to their external costs in an intergenerational cost-benefit analysis in a partial framework which enabled a sounder comparison to be carried out between these two technologies from a socio-economic viewpoint. Obviously, this approach was only a first step for building a comprehensive basis of any environmental as well as fiscal policy in the field of waste management. All external costs are identified and evaluated in three different scenarios, corresponding to a worst case, a best guess and a best case. Obviously, discounting is crucial with respect to an intergenerational perspective. Generation-adjusted discounting (GAD) was applied to take into account equity as well as efficiency criteria, in order to deal with three different types of uncertainties that are decisive in waste policy decisions: a physical uncertainty is captured by introducing our three different scenarios; a macroeconomic uncertainty is taken into consideration by calculating present values using different real growth rates; and a microeconomic uncertainty is taken into account by considering individual peculiarities reflected in their subjective time preference rate. The findings show, that whenever there is a low real GDP growth of less than 1%, the bioreactor is generally superior to the dry tomb (lower present values of external costs). This statement becomes more valid as the growth rate decreases. However, whenever there are high positive growth rates, it is the dry tomb technology which is superior to the bioreactor system.

DORCA computer program. Volume 1: User's guide

NASA Technical Reports Server (NTRS)

Wray, S. T., Jr.

1971-01-01

The Dynamic Operational Requirements and Cost Analysis Program (DORCA) was written to provide a top level analysis tool for NASA. DORCA relies on a man-machine interaction to optimize results based on external criteria. DORCA relies heavily on outside sources to provide cost information and vehicle performance parameters as the program does not determine these quantities but rather uses them. Given data describing missions, vehicles, payloads, containers, space facilities, schedules, cost values and costing procedures, the program computes flight schedules, cargo manifests, vehicle fleet requirements, acquisition schedules and cost summaries. The program is designed to consider the Earth Orbit, Lunar, Interplanetary and Automated Satellite Programs. A general outline of the capabilities of the program are provided.

A cost-benefit analysis of a deposit-refund program for beverage containers in Israel.

PubMed

Lavee, Doron

2010-02-01

The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program--storage, collection, and treatment costs of empty containers, and all potential benefits--savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearly economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.

Green Net Value Added as a Sustainability Metric Based on ...

EPA Pesticide Factsheets

Sustainability measurement in economics involves evaluation of environmental and economic impact in an integrated manner. In this study, system level economic data are combined with environmental impact from a life cycle assessment (LCA) of a common product. We are exploring a costing approach that captures traditional costs but also incorporates externality costs to provide a convenient, easily interpretable metric. Green Net Value Added (GNVA) is a type of full cost accounting that incorporates total revenue, the cost of materials and services, depreciation, and environmental externalities. Two, but not all, of the potential environmental impacts calculated by the standard LCIA method (TRACI) could be converted to externality cost values. We compute externality costs disaggregated by upstream sectors, full cost, and GNVA to evaluate the relative sustainability of Bounty® paper towels manufactured at two production facilities. We found that the longer running, more established line had a higher GNVA than the newer line. The dominant factors contributing to externality costs are calculated to come from the stationary sources in the supply chain: electricity generation (27-35%), refineries (20-21%), pulp and paper making (15-23%). Health related externalities from Particulate Matter (PM2.5) and Carbon Dioxide equivalent (CO2e) emissions appear largely driven by electricity usage and emissions by the facilities, followed by pulp processing and transport. Supply

Advanced Fuel Cycle Cost Basis – 2017 Edition

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

Dixon, B. W.; Ganda, F.; Williams, K. A.

This report, commissioned by the U.S. Department of Energy (DOE) Office of Nuclear Energy (NE), provides a comprehensive set of cost data supporting a cost analysis for the relative economic comparison of options for use in the DOE Nuclear Technology Research and Development (NTRD) Program (previously the Fuel Cycle Research and Development (FCRD) and the Advanced Fuel Cycle Initiative (AFCI)). The report describes the NTRD cost basis development process, reference information on NTRD cost modules, a procedure for estimating fuel cycle costs, economic evaluation guidelines, and a discussion on the integration of cost data into economic computer models. This reportmore » contains reference cost data for numerous fuel cycle cost modules (modules A-O) as well as cost modules for a number of reactor types (R modules). The fuel cycle cost modules were developed in the areas of natural uranium mining and milling, thorium mining and milling, conversion, enrichment, depleted uranium disposition, fuel fabrication, interim spent fuel storage, reprocessing, waste conditioning, spent nuclear fuel (SNF) packaging, long-term monitored retrievable storage, managed decay storage, recycled product storage, near surface disposal of low-level waste (LLW), geologic repository and other disposal concepts, and transportation processes for nuclear fuel, LLW, SNF, transuranic, and high-level waste. Since its inception, this report has been periodically updated. The last such internal document was published in August 2015 while the last external edition was published in December of 2009 as INL/EXT-07-12107 and is available on the Web at URL: www.inl.gov/technicalpublications/Documents/4536700.pdf. This current report (Sept 2017) is planned to be reviewed for external release, at which time it will replace the 2009 report as an external publication. This information is used in the ongoing evaluation of nuclear fuel cycles by the NE NTRD program.« less

Nurse manager succession planning: A cost-benefit analysis.

PubMed

Phillips, Tracy; Evans, Jennifer L; Tooley, Stephanie; Shirey, Maria R

2018-03-01

This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover. An estimated 75% of nurse managers will leave the workforce by 2020. Many benefits are associated with proactively identifying and developing internal candidates. Fewer than 7% of health care organisations have implemented formal leadership succession planning programmes. A cost-benefit analysis of a formal succession-planning programme from one hospital illustrates the benefits of the programme in their organisation and can be replicated easily. Assumptions of nursing manager succession planning cost-benefit analysis are identified and discussed. The succession planning exemplar demonstrates the integration of cost-benefit analysis principles. Comparing the costs of a formal nurse manager succession planning strategy with the status quo results in a positive cost-benefit ratio. The implementation of a formal nurse manager succession planning programme effectively reduces replacement costs and time to transition into the new role. This programme provides an internal pipeline of future leaders who will be more successful than external candidates. Using an actual cost-benefit analysis equips nurse managers with valuable evidence depicting succession planning as a viable business strategy. © 2017 John Wiley & Sons Ltd.

Implications of environmental externalities assessments for solar thermal powerplants

NASA Astrophysics Data System (ADS)

Lee, A. D.; Baechler, M. C.

1991-03-01

Externalities are those impacts of one activity on other activities that are not priced in the marketplace. An externality is said to exist when two conditions hold: (1) the utility or operations of one economic agent, A, include nonmonetary variables whose values are chosen by another economic agent, B, without regard to the effects on A, and (2) B does not pay A compensation equal to the incremental costs inflicted on A. Electricity generation involves a wide range of potential and actual environmental impacts. Legislative, permitting, and regulatory requirements directly or indirectly control certain environmental impacts, implicitly causing them to become internalized in the cost of electricity generation. Electricity generation, however, often produces residual environmental impacts that meet the definition of an externality. Mechanisms have been developed by several states to include the costs associated with externalities in the cost-effectiveness analyses of new powerplants. This paper examines these costs for solar thermal plants and applies two states' scoring methodologies to estimate how including externalities would affect the levelized costs of power from a solar plant in the Pacific Northwest. It concludes that including externalities in the economics can reduce the difference between the levelized cost of a coal and solar plant by between 0.74 and 2.42 cents/kWh.

Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

PubMed

van der Kamp, Jonathan; Bachmann, Till M

2015-03-03

"Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

Filter replacement lifetime prediction

DOEpatents

Hamann, Hendrik F.; Klein, Levente I.; Manzer, Dennis G.; Marianno, Fernando J.

2017-10-25

Methods and systems for predicting a filter lifetime include building a filter effectiveness history based on contaminant sensor information associated with a filter; determining a rate of filter consumption with a processor based on the filter effectiveness history; and determining a remaining filter lifetime based on the determined rate of filter consumption. Methods and systems for increasing filter economy include measuring contaminants in an internal and an external environment; determining a cost of a corrosion rate increase if unfiltered external air intake is increased for cooling; determining a cost of increased air pressure to filter external air; and if the cost of filtering external air exceeds the cost of the corrosion rate increase, increasing an intake of unfiltered external air.

Solar thermal electricity generation

NASA Astrophysics Data System (ADS)

Gasemagha, Khairy Ramadan

1993-01-01

This report presents the results of modeling the thermal performance and economic feasibility of large (utility scale) and small solar thermal power plants for electricity generation. A number of solar concepts for power systems applications have been investigated. Each concept has been analyzed over a range of plant power ratings from 1 MW(sub e) to 300 MW(sub e) and over a range of capacity factors from a no-storage case (capacity factor of about 0.25 to 0.30) up to intermediate load capacity factors in the range of 0.46 to 0.60. The solar plant's economic viability is investigated by examining the effect of various parameters on the plant costs (both capital and O & M) and the levelized energy costs (LEC). The cost components are reported in six categories: collectors, energy transport, energy storage, energy conversion, balance of plant, and indirect/contingency costs. Concentrator and receiver costs are included in the collector category. Thermal and electric energy transport costs are included in the energy transport category. Costs for the thermal or electric storage are included in the energy storage category; energy conversion costs are included in the energy conversion category. The balance of plant cost category comprises the structures, land, service facilities, power conditioning, instrumentation and controls, and spare part costs. The indirect/contingency category consists of the indirect construction and the contingency costs. The concepts included in the study are (1) molten salt cavity central receiver with salt storage (PFCR/R-C-Salt); (2) molten salt external central receiver with salt storage (PFCR/R-E-Salt); (3) sodium external central receiver with sodium storage (PFCR/RE-Na); (4) sodium external central receiver with salt storage (PFCR/R-E-Na/Salt); (5) water/steam external central receiver with oil/rock storage (PFCR/R-E-W/S); (6) parabolic dish with stirling engine conversion and lead acid battery storage (PFDR/SLAB); (7) parabolic dish with stirling engine conversion and redox advanced battery storage (PFDR/S-RAB); and (8) parabolic trough with oil/rock storage (LFDR/R-HT-45). Key annual efficiency and economic results of the study are highlighted in tabular format for plant sizes and capacity factor that resulted in the lowest LEC over the analysis range.

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

PubMed Central

2014-01-01

Background Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH components (STI, early pregnancy and contraception, and HIV) are potentially cost saving. High cost savings resulting from averted lifetime treatment cost of HIV infected persons are likely to off-set the costs of STIs and unwanted pregnancies. PMID:25047074

Causes analysis on the serious defect of enterprise environmental responsibility—Based on the perspective of law and economics

NASA Astrophysics Data System (ADS)

Fa, L. N.

2017-11-01

As the important Environmental Interests of Subjects, enterprises behoove to undertake the corresponding responsibility of Pollution Control and Environmental Protection. The current situations in our country, however, appear as the serious lack of enterprise environmental responsibility. Based on the analysis of law and economics, this article reaches the conclusion through game analysis and cost-benefit analysis that the prisoners dilemma of environmental interest game between enterprises is the inherent causes for the serious defect of enterprise environmental responsibility. Meanwhile, at the point of cost-benefit, the externality of environment illegal act results in the imbalanced cost-benefit, lacking of the motivation to control pollution and protect environment in an active way.

Economics and Environmental Compatibility of Fusion Reactors —Its Analysis and Coming Issues— 4.Economic Effect of Fusion in Energy Market 4.2Various Externalities of Energy Systems and the Integrated Evaluation

NASA Astrophysics Data System (ADS)

Ito, Keishiro

The primacy of a nuclear fusion reactor in a competitive energy market remarkably depends on to what extent the reactor contributes to reduce the externalities of energy. The reduction effects are classified into two effects, which have quite dissimilar characteristics. One is an effect of environmental dimensions. The other is related to energy security. In this study I took up the results of EC's Extern Eproject studies as are presentative example of the former effect. Concerning the latter effect, I clarified the fundamental characteristics of externalities related to energy security and the conceptual framework for the purpose of evaluation. In the socio-economical evaluation of research into and development investments in nuclear fusions reactors, the public will require the development of integrated evaluation systems to support the cost-effect analysis of how well the reduction effects of externalities have been integrated with the effects of technological innovation, learning, spillover, etc.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Technical Reports Server (NTRS)

Brown, K. W.

1992-01-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Structural Tailoring of Advanced Turboprops (STAT). Theoretical manual

NASA Astrophysics Data System (ADS)

Brown, K. W.

1992-10-01

This manual describes the theories in the Structural Tailoring of Advanced Turboprops (STAT) computer program, which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analyses include an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution (1-p) forced response life prediction capability. The STAT constraints include blade stresses, blade resonances, flutter, tip displacements, and a 1-P forced response life fraction. The STAT variables include all blade internal and external geometry parameters needed to define a composite material blade. The STAT objective function is dependent upon a blade baseline definition which the user supplies to describe a current blade design for cost optimization or for the tailoring of an aeroelastic scale model.

Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis.

PubMed

Root, Brandon K; Barrena, Benjamin G; Mackenzie, Todd A; Bauer, David F

2016-02-01

To determine whether antibiotic impregnated external ventricular drains (AI-EVDs) are effective in preventing ventriculostomy associated infection (VAI), and to examine their cost effectiveness. A comprehensive literature search was performed for published data through May 2014, including randomized controlled trials and observational cohort studies comparing AI-EVDs with nonimpregnated controls. A meta-analysis of included studies was performed using a random effects model. Historical data at the authors' institution were used to estimate both the incremental price of AI-EVDs and the hospital expenses associated with VAI. Three randomized controlled trials and 5 observational studies met inclusion criteria. The analysis demonstrated a statistically significant protective effect of AI-EVDs against VAI (risk ratio = 0.31 [0.15-0.64]; P = 0.002), although there was significant heterogeneity (χ(2) = 18.08; P = 0.01; I(2) = 61%). The number of AI-EVDs needed to prevent one infection (Number needed to treat [NNT]) was 19. Based on $100 as the incremental price, and $30,000 as the estimated expense of one episode of VAI, AI-EVDs would result in an overall savings estimate of $28,100 (range, $26,400-$28,500) per NNT. If a hospital places 150 AI-EVDs annually, savings could range from $109,292 to $278,577 per year. Meta-analysis demonstrated a significant protective benefit of AI-EVDs against VAI, and this benefit is likely associated with cost savings. However, current data on AI-EVDs are limited, and overall hospital costs will vary among institutions. Although both the efficacy and cost effectiveness of AI-EVDs are supported by this analysis, further study of AI-EVDs is clearly warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Improved Nitrogen Removal Effect In Continuous Flow A2/O Process Using Typical Extra Carbon Source

NASA Astrophysics Data System (ADS)

Wu, Haiyan; Gao, Junyan; Yang, Dianhai; Zhou, Qi; Cai, Bijing

2010-11-01

In order to provide a basis for optimal selection of carbon source, three typical external carbon sources (i.e. methanol, sodium acetate and leachate) were applied to examine nitrogen removal efficiency of continuous flow A2/O system with the influent from the effluent of grit chamber in the second Kunming wastewater treatment plant. The best dosage was determined, and the specific nitrogen removal rate and carbon consumption rate were calculated with regard to individual external carbon source in A2/O system. Economy and technology analysis was also conducted to select the suitable carbon source with a low operation cost. Experimental results showed that the external typical carbon source caused a remarkable enhancement of system nitrate degradation ability. In comparison with the blank test, the average TN and NH3-N removal efficiency of system with different dosing quantities of external carbon source was improved by 15.2% and 34.2%, respectively. The optimal dosage of methanol, sodium acetate and leachate was respectively up to 30 mg/L, 40 mg/L and 100 mg COD/L in terms of a high nitrogen degradation effect. The highest removal efficiency of COD, TN and NH3-N reached respectively 92.3%, 73.9% and 100% with methanol with a dosage of 30 mg/L. The kinetic analysis and calculation revealed that the greatest denitrification rate was 0.0107 mg TN/mg MLVSSṡd with sodium acetate of 60 mg/L. As to carbon consumption rate, however, the highest value occurred in the blank test with a rate of 0.1955 mg COD/mg MLVSSṡd. Also, further economic analysis proved leachate to be pragmatic external carbon source whose cost was far cheaper than methanol.

A cost-benefit analysis of a deposit-refund program for beverage containers in Israel

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

Lavee, Doron, E-mail: doron@pareto.co.i

2010-02-15

The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program - storage, collection, and treatment costs of empty containers, and all potential benefits - savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearlymore » economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.« less

The Role of Advocacy Organizations in Reducing Negative Externalities

PubMed Central

Biglan, Anthony

2009-01-01

An externality is a cost that a corporation’s actions impose on society. For example, a power plant may emit mercury, but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the unsustainability of manufacturing processes, and marketing of products contributing to environmental damage, and economic policies that maintain high levels of poverty due to effective lobbying by the business community. This paper examines the problem of externalities in terms of metacontingencies. Externalities continue precisely because there is no cost to the organizations for practices that impose these costs on third parties. The paper describes the cultural practices needed to influence governments are motivated to make corporations bear the true costs of their practices—costs that are currently imposed on others. PMID:20011073

Pricing landfill externalities: emissions and disamenity costs in Cape Town, South Africa.

PubMed

Nahman, Anton

2011-01-01

The external (environmental and social) costs of landfilling (e.g. emissions to air, soil and water; and 'disamenities' such as odours and pests) are difficult to quantify in monetary terms, and are therefore not generally reflected in waste disposal charges or taken into account in decision making regarding waste management options. This results in a bias against alternatives such as recycling, which may be more expensive than landfilling from a purely financial perspective, but preferable from an environmental and social perspective. There is therefore a need to quantify external costs in monetary terms, so that different disposal options can be compared on the basis of their overall costs to society (financial plus external costs). This study attempts to estimate the external costs of landfilling in the City of Cape Town for different scenarios, using the benefits transfer method (for emissions) and the hedonic pricing method (for disamenities). Both methods (in particular the process of transferring and adjusting estimates from one study site to another) are described in detail, allowing the procedures to be replicated elsewhere. The results show that external costs are currently R111 (in South African Rands, or approximately US$16) per tonne of waste, although these could decline under a scenario in which energy is recovered, or in which the existing urban landfills are replaced with a new regional landfill. Copyright © 2011 Elsevier Ltd. All rights reserved.

Study on highway transportation greenhouse effect external cost estimation in China

NASA Astrophysics Data System (ADS)

Chu, Chunchao; Pan, Fengming

2017-03-01

This paper focuses on estimating highway transportation greenhouse gas emission volume and greenhouse gas external cost in China. At first, composition and characteristics of greenhouse gases were analysed about highway transportation emissions. Secondly, an improved model of emission volume was presented on basis of highway transportation energy consumption, which may be calculated by virtue of main affecting factors such as the annual average operation miles of each type of the motor vehicles and the unit consumption level. the model of emission volume was constructed which considered not only the availability of energy consumption statistics of highway transportation but also the greenhouse gas emission factors of various fuel types issued by IPCC. Finally, the external cost estimation model was established about highway transportation greenhouse gas emission which combined emission volume with the unit external cost of CO2 emissions. An example was executed to confirm presented model which ranged from 2011 to 2015 Year in China. The calculated result shows that the highway transportation total emission volume and greenhouse gas external cost are growing up, but the unit turnover external cost is steadily declining. On the whole overall, the situation is still grim about highway transportation greenhouse gas emission, and the green transportation strategy should be put into effect as soon as possible.

Environmental externalities: Thinking globally, taxing locally

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

Trisko, E.M.

1993-03-01

Assigning monetary externality values to the airborne emissions of electric power plants is gaining the attention of state utility commissions as a means to measure the social costs of alternative energy investments. Some commissions are using environmental externalities to encourage utility investments in energy conservation and renewable energy technologies such as solar, wind, and biomass. However, the monetization of externalities through so-called adders to direct generation costs can lead to inefficient resource allocation and expose consumers to electric rate increases without corresponding environmental benefits. The addition of externality values to direct electric generation costs distorts the economics of power supplymore » planning by creating artificial subsidies for generation sources that are not currently competitive in the market. Businesses and consumers will be forced to support higher-cost sources of electric generation as a consequence. Because pollutant emissions of all new sources of electric generation are stringently regulated, and generally are well below those of existing fossil-fired sources, little demonstrable environmental benefit would result from the expanded use of externality valuation.« less

Part Count: Monolithic Part Effects On Manufacturing Labor Cost, An Aircraft Applied Model

DTIC Science & Technology

2010-03-01

Fulfillment of the Requirements for the Degree of Master of Science in Financial Analysis Aaron M. Lemke, BS Captain, USAF March 2010... ACCA ), provides substantial support for the impact of part size on life cycle cost for payload aircraft. This research evaluates select methods used...1: Boeing 787 External Skin Materials (Boeing, 2010) ..........................................9 Figure 2: ACCA Task Sequence (Neumeier et al, 2009

Cost benefits of advanced software: A review of methodology used at Kennedy Space Center

NASA Technical Reports Server (NTRS)

Joglekar, Prafulla N.

1993-01-01

To assist rational investments in advanced software, a formal, explicit, and multi-perspective cost-benefit analysis methodology is proposed. The methodology can be implemented through a six-stage process which is described and explained. The current practice of cost-benefit analysis at KSC is reviewed in the light of this methodology. The review finds that there is a vicious circle operating. Unsound methods lead to unreliable cost-benefit estimates. Unreliable estimates convince management that cost-benefit studies should not be taken seriously. Then, given external demands for cost-benefit estimates, management encourages software enginees to somehow come up with the numbers for their projects. Lacking the expertise needed to do a proper study, courageous software engineers with vested interests use ad hoc and unsound methods to generate some estimates. In turn, these estimates are unreliable, and the cycle continues. The proposed methodology should help KSC to break out of this cycle.

Siting a municipal solid waste disposal facility, part II: the effects of external criteria on the final decision.

PubMed

Korucu, M Kemal; Karademir, Aykan

2014-02-01

The procedure of a multi-criteria decision analysis supported by the geographic information systems was applied to the site selection process of a planning municipal solid waste management practice based on twelve different scenarios. The scenarios included two different decision tree modes and two different weighting models for three different area requirements. The suitability rankings of the suitable sites obtained from the application of the decision procedure for the scenarios were assessed by a factorial experimental design concerning the effect of some external criteria on the final decision of the site selection process. The external criteria used in the factorial experimental design were defined as "Risk perception and approval of stakeholders" and "Visibility". The effects of the presence of these criteria in the decision trees were evaluated in detail. For a quantitative expression of the differentiations observed in the suitability rankings, the ranking data were subjected to ANOVA test after a normalization process. Then the results of these tests were evaluated by Tukey test to measure the effects of external criteria on the final decision. The results of Tukey tests indicated that the involvement of the external criteria into the decision trees produced statistically meaningful differentiations in the suitability rankings. Since the external criteria could cause considerable external costs during the operation of the disposal facilities, the presence of these criteria in the decision tree in addition to the other criteria related to environmental and legislative requisites could prevent subsequent external costs in the first place.

Frontier battery development for hybrid vehicles

PubMed Central

2012-01-01

Background Interest in hybrid-electric vehicles (HEVs) has recently spiked, partly due to an increasingly negative view toward the U.S. foreign oil dependency and environmental concerns. Though HEVs are becoming more common, they have a significant price premium over gasoline-powered vehicles. One of the primary drivers of this “hybrid premium” is the cost of the vehicles’ batteries. This paper focuses on these batteries used in hybrid vehicles, examines the types of batteries used for transportation applications and addresses some of the technological, environmental and political drivers in battery development and the deployment of HEVs. Methods This paper examines the claim, often voiced by HEV proponents, that by taking into account savings on gasoline and vehicle maintenance, hybrid cars are cheaper than traditional gasoline cars. This is done by a quantitative benefit-cost analysis, in addition to qualitative benefit-cost analysis from political, technological and environmental perspectives. Results The quantitative benefit-cost analysis shows that, taking account of all costs for the life of the vehicle, hybrid cars are in fact more expensive than gasoline-powered vehicles; however, after five years, HEVs will break even with gasoline cars. Conclusions Our results show that it is likely that after 5 years, using hybrid vehicles should be cheaper in effect and yield a positive net benefit to society. There are a number of externalities that could significantly impact the total social cost of the car. These externalities can be divided into four categories: environmental, industrial, R&D and political. Despite short-term implications and hurdles, increased HEV usage forecasts a generally favorable long-term net benefit to society. Most notably, increasing HEV usage could decrease greenhouse gas emissions, while also decreasing U.S. dependence on foreign oil. PMID:22540987

Frontier battery development for hybrid vehicles.

PubMed

Lewis, Heather; Park, Haram; Paolini, Maion

2012-04-23

Interest in hybrid-electric vehicles (HEVs) has recently spiked, partly due to an increasingly negative view toward the U.S. foreign oil dependency and environmental concerns. Though HEVs are becoming more common, they have a significant price premium over gasoline-powered vehicles. One of the primary drivers of this "hybrid premium" is the cost of the vehicles' batteries. This paper focuses on these batteries used in hybrid vehicles, examines the types of batteries used for transportation applications and addresses some of the technological, environmental and political drivers in battery development and the deployment of HEVs. This paper examines the claim, often voiced by HEV proponents, that by taking into account savings on gasoline and vehicle maintenance, hybrid cars are cheaper than traditional gasoline cars. This is done by a quantitative benefit-cost analysis, in addition to qualitative benefit-cost analysis from political, technological and environmental perspectives. The quantitative benefit-cost analysis shows that, taking account of all costs for the life of the vehicle, hybrid cars are in fact more expensive than gasoline-powered vehicles; however, after five years, HEVs will break even with gasoline cars. Our results show that it is likely that after 5 years, using hybrid vehicles should be cheaper in effect and yield a positive net benefit to society. There are a number of externalities that could significantly impact the total social cost of the car. These externalities can be divided into four categories: environmental, industrial, R&D and political. Despite short-term implications and hurdles, increased HEV usage forecasts a generally favorable long-term net benefit to society. Most notably, increasing HEV usage could decrease greenhouse gas emissions, while also decreasing U.S. dependence on foreign oil.

The external costs of a sedentary life-style.

PubMed Central

Keeler, E B; Manning, W G; Newhouse, J P; Sloss, E M; Wasserman, J

1989-01-01

Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise. PMID:2502036

A novel 3D imaging system for strawberry phenotyping.

PubMed

He, Joe Q; Harrison, Richard J; Li, Bo

2017-01-01

Accurate and quantitative phenotypic data in plant breeding programmes is vital in breeding to assess the performance of genotypes and to make selections. Traditional strawberry phenotyping relies on the human eye to assess most external fruit quality attributes, which is time-consuming and subjective. 3D imaging is a promising high-throughput technique that allows multiple external fruit quality attributes to be measured simultaneously. A low cost multi-view stereo (MVS) imaging system was developed, which captured data from 360° around a target strawberry fruit. A 3D point cloud of the sample was derived and analysed with custom-developed software to estimate berry height, length, width, volume, calyx size, colour and achene number. Analysis of these traits in 100 fruits showed good concordance with manual assessment methods. This study demonstrates the feasibility of an MVS based 3D imaging system for the rapid and quantitative phenotyping of seven agronomically important external strawberry traits. With further improvement, this method could be applied in strawberry breeding programmes as a cost effective phenotyping technique.

Cost-benefit analysis of water-reuse projects for environmental purposes: a case study for Spanish wastewater treatment plants.

PubMed

Molinos-Senante, M; Hernández-Sancho, F; Sala-Garrido, R

2011-12-01

Water reuse is an emerging and promising non-conventional water resource. Feasibility studies are essential tools in the decision making process for the implementation of water-reuse projects. However, the methods used to assess economic feasibility tend to focus on internal costs, while external impacts are relegated to unsubstantiated statements about the advantages of water reuse. Using the concept of shadow prices for undesirable outputs of water reclamation, the current study developed a theoretical methodology to assess internal and external economic impacts. The proposed methodological approach is applied to 13 wastewater treatment plants in the Valencia region of Spain that reuse effluent for environmental purposes. Internal benefit analyses indicated that only a proportion of projects were economically viable, while when external benefits are incorporated all projects were economically viable. In conclusion, the economic feasibility assessments of water-reuse projects should quantitatively evaluate economic, environmental and resource availability. Copyright © 2011 Elsevier Ltd. All rights reserved.

New reflective symmetry design capability in the JPL-IDEAS Structure Optimization Program

NASA Technical Reports Server (NTRS)

Strain, D.; Levy, R.

1986-01-01

The JPL-IDEAS antenna structure analysis and design optimization computer program was modified to process half structure models of symmetric structures subjected to arbitrary external static loads, synthesize the performance, and optimize the design of the full structure. Significant savings in computation time and cost (more than 50%) were achieved compared to the cost of full model computer runs. The addition of the new reflective symmetry analysis design capabilities to the IDEAS program allows processing of structure models whose size would otherwise prevent automated design optimization. The new program produced synthesized full model iterative design results identical to those of actual full model program executions at substantially reduced cost, time, and computer storage.

Closing the gap between socioeconomic and financial implications of residential and community level hydrogen-based energy systems: Incentives needed for a bridge to the future

NASA Astrophysics Data System (ADS)

Verduzco, Laura E.

The use of hydrogen as an energy carrier has the potential to decrease the amount of pollutants emitted to the atmosphere, significantly reduce our dependence on imported oil and resolve geopolitical issues related to energy consumption. The current status of hydrogen technology makes it prohibitive and financially risky for most investors to commit the money required for large-scale hydrogen production. Therefore, alternative strategies such as small and medium-scale hydrogen applications should be implemented during the early stages of the transition to the hydrogen economy in order to test potential markets and technology readiness. While many analysis tools have been built to estimate the requirements of the transition to a hydrogen economy, few have focused on small and medium-scale hydrogen production and none has paired financial with socioeconomic costs at the residential level. The computer-based tool (H2POWER) presented in this study calculates the capacity, cost and socioeconomic impact of the systems needed to meet the energy demands of a home or a community using home and neighborhood refueling units, which are systems that can provide electricity and heat to meet the energy demands of either (1) a home and automobile or (2) a cluster of homes and a number of automobiles. The financial costs of the production, processing and delivery sub-systems that conform the refueling units are calculated using cost data of existing technology and normalizing them to calculate capital and net present cost. The monetary value of the externalities (socioeconomic analysis) caused by each system is calculated by H2POWER through a statistical analysis of the cost associated to various externalities. Additionally, H2POWER calculates the financial impact of different penalties and incentives (such as net metering, low interest loans, fuel taxes, and emission penalties) on the cost of the system from the point of view of a developer and a homeowner. In order to assess the benefits and costs of hydrogen-based alternatives, H2POWER compares the financial and socioeconomic costs of home and neighborhood refueling units to a baseline of "conventional" sources of residential electricity, space heat, water heat, and vehicle fuel. The model can also calculate the "gap" between the financial cost of the technology and the environmental cost of the externalities that are generated using conventional energy sources. H2POWER is a flexible, user-friendly tool that allows the user to specify different production pathways, supplemental power sources (renewable and non-renewable), component characteristics, electricity mixes, and other analysis parameters in order to customize the results to specific projects. The model has also built-in default values for each of the input fields based on national averages, standard technology specifications and input from experts.

The vehicle design evaluation program - A computer-aided design procedure for transport aircraft

NASA Technical Reports Server (NTRS)

Oman, B. H.; Kruse, G. S.; Schrader, O. E.

1977-01-01

The vehicle design evaluation program is described. This program is a computer-aided design procedure that provides a vehicle synthesis capability for vehicle sizing, external load analysis, structural analysis, and cost evaluation. The vehicle sizing subprogram provides geometry, weight, and balance data for aircraft using JP, hydrogen, or methane fuels. The structural synthesis subprogram uses a multistation analysis for aerodynamic surfaces and fuselages to develop theoretical weights and geometric dimensions. The parts definition subprogram uses the geometric data from the structural analysis and develops the predicted fabrication dimensions, parts material raw stock buy requirements, and predicted actual weights. The cost analysis subprogram uses detail part data in conjunction with standard hours, realization factors, labor rates, and material data to develop the manufacturing costs. The program is used to evaluate overall design effects on subsonic commercial type aircraft due to parameter variations.

Synfuel program analysis. Volume 2: VENVAL users manual

NASA Astrophysics Data System (ADS)

Muddiman, J. B.; Whelan, J. W.

1980-07-01

This volume is intended for program analysts and is a users manual for the VENVAL model. It contains specific explanations as to input data requirements and programming procedures for the use of this model. VENVAL is a generalized computer program to aid in evaluation of prospective private sector production ventures. The program can project interrelated values of installed capacity, production, sales revenue, operating costs, depreciation, investment, dent, earnings, taxes, return on investment, depletion, and cash flow measures. It can also compute related public sector and other external costs and revenues if unit costs are furnished.

Theory for the evolution of diffusible external goods.

PubMed

Driscoll, William W; Pepper, John W

2010-09-01

Organisms from prokaryotes to plants and animals make costly investments in diffusible beneficial external products. While the costs of producing such products are born only by the producer, the benefits may be distributed more widely. How are external goods-producing populations stabilized against invasion by nonproducing variants that receive the benefits without paying the cost? This question parallels the classic question of altruism, but because external goods production need not be altruistic per se, a broader range of conditions may lead to the maintenance of these traits. We start from the physics of diffusion to develop an expression for the conditions that favor the production of diffusible external goods. Important variables in determining the evolutionary outcome include the diffusion coefficient of the good, the distance between individuals, and the uptake rate of the external good. These variables join the coefficient of relatedness and the cost/benefit ratio in an expanded form of Hamilton's rule that includes both selfish and altruistic paths to the evolution of external goods strategies. This expanded framework can be applied to any external goods trait, and is a useful heuristic even when it is difficult to quantify the fitness consequences of producing the good. © 2010 The Author(s). Journal compilation © 2010 The Society for the Study of Evolution.

Pesticide Environmental Accounting: a method for assessing the external costs of individual pesticide applications.

PubMed

Leach, A W; Mumford, J D

2008-01-01

The Pesticide Environmental Accounting (PEA) tool provides a monetary estimate of environmental and health impacts per hectare-application for any pesticide. The model combines the Environmental Impact Quotient method and a methodology for absolute estimates of external pesticide costs in UK, USA and Germany. For many countries resources are not available for intensive assessments of external pesticide costs. The model converts external costs of a pesticide in the UK, USA and Germany to Mediterranean countries. Economic and policy applications include estimating impacts of pesticide reduction policies or benefits from technologies replacing pesticides, such as sterile insect technique. The system integrates disparate data and approaches into a single logical method. The assumptions in the system provide transparency and consistency but at the cost of some specificity and precision, a reasonable trade-off for a method that provides both comparative estimates of pesticide impacts and area-based assessments of absolute impacts.

Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research.

PubMed

Handley, Margaret A; Lyles, Courtney R; McCulloch, Charles; Cattamanchi, Adithya

2018-04-01

Interventional researchers face many design challenges when assessing intervention implementation in real-world settings. Intervention implementation requires holding fast on internal validity needs while incorporating external validity considerations (such as uptake by diverse subpopulations, acceptability, cost, and sustainability). Quasi-experimental designs (QEDs) are increasingly employed to achieve a balance between internal and external validity. Although these designs are often referred to and summarized in terms of logistical benefits, there is still uncertainty about (a) selecting from among various QEDs and (b) developing strategies to strengthen the internal and external validity of QEDs. We focus here on commonly used QEDs (prepost designs with nonequivalent control groups, interrupted time series, and stepped-wedge designs) and discuss several variants that maximize internal and external validity at the design, execution and implementation, and analysis stages.

Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach.

PubMed

van den Berg, Ineke; Kaandorp, Guido C; Bosch, Johanna L; Duvekot, Johannes J; Arends, Lidia R; Hunink, M G Myriam

2010-04-01

To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation. A decision tree was developed to predict the number of caesarean sections prevented by BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVA-T was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results. We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed. The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was euro 451 (95% CI euro 109, euro 775; p=0.005) using moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use BVA-T. The expected value of perfect information from further research was euro0.32 per woman. The results suggest that offering BVA-T to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections, and is cost-effective compared to expectant management, including external cephalic version. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Finding External Indicators of Load on a Web Server via Analysis of Black-Box Performance Measurements

ERIC Educational Resources Information Center

Chiarini, Marc A.

2010-01-01

Traditional methods for system performance analysis have long relied on a mix of queuing theory, detailed system knowledge, intuition, and trial-and-error. These approaches often require construction of incomplete gray-box models that can be costly to build and difficult to scale or generalize. In this thesis, we present a black-box analysis…

The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review.

PubMed

Goorden, Maartje; Schawo, Saskia J; Bouwmans-Frijters, Clazien A M; van der Schee, Evelien; Hendriks, Vincent M; Hakkaart-van Roijen, Leona

2016-07-13

Family therapy and family-based treatment has been commonly applied in children and adolescents in mental health care and has been proven to be effective. There is an increased interest in economic evaluations of these, often expensive, interventions. The aim of this systematic review is to summarize and evaluate the evidence on cost-effectiveness of family/family-based therapy for externalizing disorders, substance use disorders and delinquency. A systematic literature search was performed in PubMed, Education Resource information Centre (ERIC), Psycinfo and Cochrane reviews including studies conducted after 1990 and before the first of August of 2013. Full economic evaluations investigating family/family-based interventions for adolescents between 10 and 20 years treated for substance use disorders, delinquency or externalizing disorders were included. Seven hundred thirty-one articles met the search criteria and 51 studies were initially selected. The final selection resulted in the inclusion of 11 studies. The quality of these studies was assessed. Within the identified studies, there was great variation in the specific type of family/family-based interventions and disorders. According to the outcomes of the checklists, the overall quality of the economic evaluations was low. Results varied by study. Due to the variations in setting, design and outcome it was not feasible to pool results using a meta-analysis. The quality of the identified economic evaluations of family/family-based therapy for treatment of externalizing disorders, adolescent substance use disorders and delinquency was insufficient to determine the cost-effectiveness. Although commonly applied, family/family-based therapy is costly and more research of higher quality is needed.

External damage cost of noise emitted from motor vehicles

DOT National Transportation Integrated Search

1998-10-01

With a detailed model of the cost of motor vehicle noise in the United States in 1990, it is estimated that the external damage cost of this noise could range from as little as $100 million per year to as much as $40 billion per year, although it is ...

Brief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.

PubMed

Carvalho, Brendan; Tan, Jonathan M; Macario, Alex; El-Sayed, Yasser Y; Sultan, Pervez

2013-07-01

In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia. From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled $8931 (2.5th-97.5th percentile prediction interval $8541-$9252). The cost was $9207 (2.5th-97.5th percentile prediction interval $8896-$9419) if ECV was attempted/performed without anesthesia. The expected mean incremental difference between the total cost of delivery that includes ECV with anesthesia and ECV without anesthesia was $-276 (2.5th-97.5th percentile prediction interval $-720 to $112). The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.

Transaction costs, externalities and information technology in health care.

PubMed

Ferguson, B; Keen, J

1996-01-01

This paper discusses some of the economic issues which underpin the rationale for investment in information and communications technologies (ICTs). Information imperfections lead to significant transaction costs (search, negotiating and monitoring) which in turn confer a negative externality on parties involved in exchange. This divergence in private and social costs leads to a degree of resource misallocation (efficiency loss) which, uncorrected, results in a sub-optimal outcome. Traditional solutions to this problem are to rely upon direct government action to reduce the costs of transacting between market agents, or to employ tax/subsidy measures and other legislative action to achieve the desired market outcome. Three key policy questions are raised in the context of the NHS purchaser/provider relationship. Firstly, what is the optimum level of transaction costs; secondly, can ICTs assist in lowering the level of transaction costs to the optimum level; thirdly, who should bear the investment cost in reducing the level of transaction costs? The issue of property rights in different information systems is discussed and raises interesting policy questions about how much investment should be undertaken centrally rather than devolved to a more local level. In some ways this economic framework offers a post hoc justification of why different ICT systems have been introduced at various levels of the NHS. Essentially this reduces to the problem of externalities: providing good information confers a positive externality: not providing relevant, timely and accurate information confers a negative externality, by increasing further the level of transaction costs. The crucial role which ICT systems can play lies in attempting to reduce the level of transaction costs and driving the market towards what Dahlman has described as the transaction-cost-constrained equilibrium.

Flight Testing and Real-Time System Identification Analysis of a UH-60A Black Hawk Helicopter with an Instrumented External Sling Load

NASA Technical Reports Server (NTRS)

McCoy, Allen H.

1998-01-01

Helicopter external air transportation plays an important role in today's world. For both military and civilian helicopters, external sling load operations offer an efficient and expedient method of handling heavy, oversized cargo. With the ability to reach areas otherwise inaccessible by ground transportation, helicopter external load operations are conducted in industries such as logging, construction, and fire fighting, as well as in support of military tactical transport missions. Historically, helicopter and load combinations have been qualified through flight testing, requiring considerable time and cost. With advancements in simulation and flight test techniques there is potential to substantially reduce costs and increase the safety of helicopter sling load certification. Validated simulation tools make possible accurate prediction of operational flight characteristics before initial flight tests. Real time analysis of test data improves the safety and efficiency of the testing programs. To advance these concepts, the U.S. Army and NASA, in cooperation with the Israeli Air Force and Technion, under a Memorandum of Agreement, seek to develop and validate a numerical model of the UH-60 with sling load and demonstrate a method of near real time flight test analysis. This thesis presents results from flight tests of a U.S. Army Black Hawk helicopter with various external loads. Tests were conducted as the U.S. first phase of this MOA task. The primary load was a container express box (CONEX) which contained a compact instrumentation package. The flights covered the airspeed range from hover to 70 knots. Primary maneuvers were pitch and roll frequency sweeps, steps, and doublets. Results of the test determined the effect of the suspended load on both the aircraft's handling qualities and its control system's stability margins. Included were calculations of the stability characteristics of the load's pendular motion. Utilizing CIFER(R) software, a method for near-real time system identification was also demonstrated during the flight test program.

Environmental trade-offs of tunnels vs cut-and-cover subways

USGS Publications Warehouse

Walton, M.

1978-01-01

Heavy construction projects in cities entail two kinds of cost - internal cost, which can be defined in terms of payments from one set of parties to another, and external cost, which is the cost borne by the community at large as the result of disutilities entailed in construction and operation. Environmental trade-offs involve external costs, which are commonly difficult to measure. Cut-and-cover subway construction probably entails higher external and internal cost than deep tunnel construction in many urban geological environments, but uncertainty concerning the costs and environmental trade-offs of tunneling leads to limited and timid use of tunneling by American designers. Thus uncertainty becomes a major trade-off which works against tunneling. The reverse is true in Sweden after nearly 30 years of subway construction. Econometric methods for measuring external costs exist in principle, but are limited in application. Economic theory based on market pressure does not address the real problem of urban environmental trade-offs. Nevertheless, the problem of uncertainty can be addressed by comparative studies of estimated and as-built costs of cut-and-cover vs tunnel projects and a review of environmental issues associated with such construction. Such a study would benefit the underground construction industry and the design of transportation systems. It would also help solve an aspect of the urban problem. ?? 1978.

An Approach for Economic Analysis of Intermodal Transportation

PubMed Central

Sahin, Bahri; Ust, Yasin; Guneri, Ali Fuat; Gulsun, Bahadir; Turan, Eda

2014-01-01

A different intermodal transportation model based on cost analysis considering technical, economical, and operational parameters is presented. The model consists of such intermodal modes as sea-road, sea-railway, road-railway, and multimode of sea-road-railway. A case study of cargo transportation has been carried out by using the suggested model. Then, the single road transportation mode has been compared to intermodal modes in terms of transportation costs. This comparison takes into account the external costs of intermodal transportation. The research reveals that, in the short distance transportation, single transportation modes always tend to be advantageous. As the transportation distance gets longer, intermodal transportation advantages begin to be effective on the costs. In addition, the proposed method in this study leads to determining the fleet size and capacity for transportation and the appropriate transportation mode. PMID:25152919

An approach for economic analysis of intermodal transportation.

PubMed

Sahin, Bahri; Yilmaz, Huseyin; Ust, Yasin; Guneri, Ali Fuat; Gulsun, Bahadir; Turan, Eda

2014-01-01

A different intermodal transportation model based on cost analysis considering technical, economical, and operational parameters is presented. The model consists of such intermodal modes as sea-road, sea-railway, road-railway, and multimode of sea-road-railway. A case study of cargo transportation has been carried out by using the suggested model. Then, the single road transportation mode has been compared to intermodal modes in terms of transportation costs. This comparison takes into account the external costs of intermodal transportation. The research reveals that, in the short distance transportation, single transportation modes always tend to be advantageous. As the transportation distance gets longer, intermodal transportation advantages begin to be effective on the costs. In addition, the proposed method in this study leads to determining the fleet size and capacity for transportation and the appropriate transportation mode.

Land use changes: economic, social, and environmental impacts

Treesearch

JunJie Wu

2008-01-01

Land use provides many economic and social benefits but often comes at a substantial cost to the environment. Although most economic costs are figured into land use decisions, most environmental externalities are not. These environmental externalities cause a divergence between private and social costs for some land uses, leading to an inefficient land allocation. For...

48 CFR 231.205-70 - External restructuring costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... sale/purchase of assets. (2) External restructuring activities means restructuring activities occurring... a factor of at least two to one; or (B) The costs allowed, and the business combination will result... will exceed the costs allowed by a factor of at least two to one on a present value basis. (ii) The...

Engineering Strategies and Methods for Avoiding Air-Quality Externalities: Dispersion Modeling, Home Energy Conservation, and Scenario Planning

NASA Astrophysics Data System (ADS)

Knox, Andrew James

Energy conservation can improve air quality by reducing emissions from fuel combustion. The human health value retained through better air quality can then offset the cost of energy conservation. Through this thesis' innovative yet widely-accessible combination of air pollution dispersion modeling and atmospheric chemistry, it is estimated that the health value retained by avoiding emissions from Ontario's former coal-fired generating stations is 5.74/MWh (using an upper-bound value of 265,000 per year of life lost). This value is combined with energy modeling of homes in the first-ever assessment of the air-quality health benefits of low-energy buildings. It is shown that avoided health damages can equal 7% of additional construction costs of energy efficient buildings in Ontario. At 7%, health savings are a significant item in the cost analysis of efficient buildings. Looking to energy efficiency in the context of likely future low-resource natural gas scenarios, building efficient buildings today is shown to be more economically efficient than any building retrofit option. Considering future natural gas scarcity in the context of Ontario's Long-Term Energy Plan reveals that Ontario may be forced to return to coal-fired electricity. Projected coal use would result in externalities greater than $600 million/year; 80% more than air-quality externalities from Ontario's electricity in 1985. Radically aggressive investment in electricity conservation (75% reduction per capita by 2075) is one promising path forward that keeps air-quality externalities below 1985 levels. Non-health externalities are an additional concern, the quantification, and ultimately monetization, of which could be practical using emerging air pollution monitoring technologies. Energy, conservation, energy planning, and energy's externalities form a complex situation in which today's decisions are critical to a successful future. It is clear that reducing the demand for energy is essential and that there are economically efficient conservation opportunities, particularly in the building sector, being missed.

High-Speed Machining (HSM) of Space Shuttle External Tank (ET) panels

NASA Astrophysics Data System (ADS)

Miller, J. A.

1983-02-01

The External Fuel Tank (ET) of the Space Shuttle is not recovered after launch and a new one must be provided for each launch. Currently, the external ""skin'' panels of the tank are produced by machining from solid wrought 2219-T87 aluminum plate stock approximately 1-3/4 inch thick. The reduction of costs in producing External Fuel Tank panels is obviously of increasing production rates and decreasing costs of the panels through the application of high-speed machining (HSM) techniques was conducted.

High-Speed Machining (HSM) of Space Shuttle External Tank (ET) panels

NASA Technical Reports Server (NTRS)

Miller, J. A.

1983-01-01

The External Fuel Tank (ET) of the Space Shuttle is not recovered after launch and a new one must be provided for each launch. Currently, the external ""skin'' panels of the tank are produced by machining from solid wrought 2219-T87 aluminum plate stock approximately 1-3/4 inch thick. The reduction of costs in producing External Fuel Tank panels is obviously of increasing production rates and decreasing costs of the panels through the application of high-speed machining (HSM) techniques was conducted.

The R&D Boundaries of the Firm: An Empirical Analysis.

ERIC Educational Resources Information Center

Pisano, Gary P.

1990-01-01

Examines how two sources of transaction costs, small-numbers bargaining hazards and appropriability concerns, may affect established firms' choices between inhouse and external sources of research and development when technological change shifts the locus of R & D expertise from established enterprises to new entrants, and established…

Spreadsheet Analysis of Harvesting Systems

Treesearch

R.B. Rummer; B.L. Lanford

1987-01-01

Harvesting systems can be modeled and analyzed on microcomputers using commercially available "spreadsheet" software. The effect of system or external variables on the production rate or system cost can be evaluated and alternative systems can be easily examined. The tedious calculations associated with such analyses are performed by the computer. For users...

Economic evaluation of interventions for problem drinking and alcohol dependence: do within-family external effects make a difference?

PubMed

Mortimer, Duncan; Segal, Leonie

2006-01-01

To propose methods for the inclusion of within-family external effects in clinical and economic evaluations. To demonstrate the extent of bias due to the exclusion of within-family external effects when measuring the relative performance of interventions for problem drinking and alcohol dependence. The timing and magnitude of treatment effects are modified to accommodate the external health-related quality of life impact of having a problem or dependent drinker in the family home. The inclusion of within-family external effects reduces cost per QALY estimates of interventions for problem drinking and alcohol dependence thereby improving the performance of all evaluated interventions. In addition, the inclusion of within-family external effects improves the relative performance of interventions targeted at those with moderate-to-severe alcohol dependence as compared to interventions targeted at less severe alcohol problems. Failure to take account of external effects in clinical and economic evaluations results in an uneven playing field. Interventions with readily quantifiable health benefits (where social costs and benefits are predominantly comprised of private costs and benefits) are at a distinct advantage when competing for public funding against interventions with quantitatively important external effects.

The Impact of Information Technology on Organizations: Implications for Organizational Integration and the Management of Information Technology.

DTIC Science & Technology

1998-03-01

and role model for its mission: "To be a great company by the year 2000 - to be to the cycling industry what Nike is to athletic shoes and Apple is to...position in industry by using three analytical techniques: strength, weaknesses, opportunities, and threats ( SWOT ) analysis; strategic cost...analysis; and competitive strength assessment. SWOT analysis shows a company’s internal and external factors. SWOT analysis provides a quick way for an

Suture Button Fixation Versus Syndesmotic Screws in Supination-External Rotation Type 4 Injuries: A Cost-Effectiveness Analysis.

PubMed

Neary, Kaitlin C; Mormino, Matthew A; Wang, Hongmei

2017-01-01

In stress-positive, unstable supination-external rotation type 4 (SER IV) ankle fractures, implant selection for syndesmotic fixation is a debated topic. Among the available syndesmotic fixation methods, the metallic screw and the suture button have been routinely compared in the literature. In addition to strength of fixation and ability to anatomically restore the syndesmosis, costs associated with implant use have recently been called into question. This study aimed to examine the cost-effectiveness of the suture button and determine whether suture button fixation is more cost-effective than two 3.5-mm syndesmotic screws not removed on a routine postoperative basis. Economic and decision analysis; Level of evidence, 2. Studies with the highest evidence levels in the available literature were used to estimate the hardware removal and failure rates for syndesmotic screws and suture button fixation. Costs were determined by examining the average costs for patients who underwent surgery for unstable SER IV ankle fractures at a single level-1 trauma institution. A decision analysis model that allowed comparison of the 2 fixation methods was developed. Using a 20% screw hardware removal rate and a 4% suture button hardware removal rate, the total cost for 2 syndesmotic screws was US$20,836 and the total effectiveness was 5.846. This yielded a total cost of $3564 per quality-adjusted life-year (QALY) over an 8-year time period. The total cost for suture button fixation was $19,354 and the total effectiveness was 5.904, resulting in a total cost of $3294 per QALY over the same time period. A sensitivity analysis was then conducted to assess suture button fixation costs as well as screw and suture button hardware removal rates. Other possible treatment scenarios were also examined, including 1 screw and 2 suture buttons for operative fixation of the syndesmosis. To become more cost-effective, the screw hardware removal rate would have to be reduced to less than 10%. Furthermore, fixation with a single suture button continued to be the dominant treatment strategy compared with 2 suture buttons, 1 screw, and 2 screws for syndesmotic fixation. This cost-effectiveness analysis suggests that for unstable SER IV ankle fractures, suture button fixation is more cost-effective than syndesmotic screws not removed on a routine basis. Suture button fixation was a dominant treatment strategy, because patients spent on average $1482 less and had a higher quality of life by 0.058 QALYs compared with patients who received fixation with 2 syndesmotic screws. Assuming that functional outcomes and failure rates were equivalent, screw fixation only became more cost-effective when the screw hardware removal rate was reduced to less than 10% or when the suture button cost exceeded $2000. In addition, fixation with a single suture button device proved more cost-effective than fixation with either 1 or 2 syndesmotic screws.

Sizing a rainwater harvesting cistern by minimizing costs

NASA Astrophysics Data System (ADS)

Pelak, Norman; Porporato, Amilcare

2016-10-01

Rainwater harvesting (RWH) has the potential to reduce water-related costs by providing an alternate source of water, in addition to relieving pressure on public water sources and reducing stormwater runoff. Existing methods for determining the optimal size of the cistern component of a RWH system have various drawbacks, such as specificity to a particular region, dependence on numerical optimization, and/or failure to consider the costs of the system. In this paper a formulation is developed for the optimal cistern volume which incorporates the fixed and distributed costs of a RWH system while also taking into account the random nature of the depth and timing of rainfall, with a focus on RWH to supply domestic, nonpotable uses. With rainfall inputs modeled as a marked Poisson process, and by comparing the costs associated with building a cistern with the costs of externally supplied water, an expression for the optimal cistern volume is found which minimizes the water-related costs. The volume is a function of the roof area, water use rate, climate parameters, and costs of the cistern and of the external water source. This analytically tractable expression makes clear the dependence of the optimal volume on the input parameters. An analysis of the rainfall partitioning also characterizes the efficiency of a particular RWH system configuration and its potential for runoff reduction. The results are compared to the RWH system at the Duke Smart Home in Durham, NC, USA to show how the method could be used in practice.

Incorporating external evidence in trial-based cost-effectiveness analyses: the use of resampling methods

PubMed Central

2014-01-01

Background Cost-effectiveness analyses (CEAs) that use patient-specific data from a randomized controlled trial (RCT) are popular, yet such CEAs are criticized because they neglect to incorporate evidence external to the trial. A popular method for quantifying uncertainty in a RCT-based CEA is the bootstrap. The objective of the present study was to further expand the bootstrap method of RCT-based CEA for the incorporation of external evidence. Methods We utilize the Bayesian interpretation of the bootstrap and derive the distribution for the cost and effectiveness outcomes after observing the current RCT data and the external evidence. We propose simple modifications of the bootstrap for sampling from such posterior distributions. Results In a proof-of-concept case study, we use data from a clinical trial and incorporate external evidence on the effect size of treatments to illustrate the method in action. Compared to the parametric models of evidence synthesis, the proposed approach requires fewer distributional assumptions, does not require explicit modeling of the relation between external evidence and outcomes of interest, and is generally easier to implement. A drawback of this approach is potential computational inefficiency compared to the parametric Bayesian methods. Conclusions The bootstrap method of RCT-based CEA can be extended to incorporate external evidence, while preserving its appealing features such as no requirement for parametric modeling of cost and effectiveness outcomes. PMID:24888356

Incorporating external evidence in trial-based cost-effectiveness analyses: the use of resampling methods.

PubMed

Sadatsafavi, Mohsen; Marra, Carlo; Aaron, Shawn; Bryan, Stirling

2014-06-03

Cost-effectiveness analyses (CEAs) that use patient-specific data from a randomized controlled trial (RCT) are popular, yet such CEAs are criticized because they neglect to incorporate evidence external to the trial. A popular method for quantifying uncertainty in a RCT-based CEA is the bootstrap. The objective of the present study was to further expand the bootstrap method of RCT-based CEA for the incorporation of external evidence. We utilize the Bayesian interpretation of the bootstrap and derive the distribution for the cost and effectiveness outcomes after observing the current RCT data and the external evidence. We propose simple modifications of the bootstrap for sampling from such posterior distributions. In a proof-of-concept case study, we use data from a clinical trial and incorporate external evidence on the effect size of treatments to illustrate the method in action. Compared to the parametric models of evidence synthesis, the proposed approach requires fewer distributional assumptions, does not require explicit modeling of the relation between external evidence and outcomes of interest, and is generally easier to implement. A drawback of this approach is potential computational inefficiency compared to the parametric Bayesian methods. The bootstrap method of RCT-based CEA can be extended to incorporate external evidence, while preserving its appealing features such as no requirement for parametric modeling of cost and effectiveness outcomes.

Satellite Power Systems (SPS) space transportation cost analysis and evaluation

NASA Technical Reports Server (NTRS)

1980-01-01

A picture of Space Power Systems space transportation costs at the present time is given with respect to accuracy as stated, reasonableness of the methods used, assumptions made, and uncertainty associated with the estimates. The approach used consists of examining space transportation costs from several perspectives to perform a variety of sensitivity analyses or reviews and examine the findings in terms of internal consistency and external comparison with analogous systems. These approaches are summarized as a theoretical and historical review including a review of stated and unstated assumptions used to derive the costs, and a performance or technical review. These reviews cover the overall transportation program as well as the individual vehicles proposed. The review of overall cost assumptions is the principal means used for estimating the cost uncertainty derived. The cost estimates used as the best current estimate are included.

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

Petruccelli, Umberto, E-mail: umberto.petruccelli@unibas.it

Many studies about the external costs generated by the transport system have been developed in the last twenty years. To standardize methodologies and assessment procedures to be used in the evaluation of the projects, some European countries recently have adopted specific guidelines that differ from each other in some aspects even sensibly. This paper presents a critical analysis of the British, Italian and German guidelines and is aimed at cataloguing the external cost types regarded and the assessment methods indicated as well as to highlight the differences of the results, in terms of applicability and reliability. The goal is tomore » contribute to a European standardization process that would lead to the drafting of guidelines suited for all EU countries. - Highlights: • The analyzed guidelines agree on the methods to evaluate costs from air pollution, greenhouse gases and accidents. • They recommend respectively: dose-resp. approach; costs to reduce/permit emissions; whole direct, indirect and social costs. • For noise, DE guide indicates defensive expenditure or SP methods; IT guide, SP method; UK guide, the hedonic prices one. • For on territory impact, DE guide regards only the barrier effect; the IT one, also the soil consumption and system effects. • British guide proposes a qualitative methodology to estimate the impact on various landscapes and environments.« less

Toward a Broader Concept of Value: Identifying and Defining Elements for an Expanded Cost-Effectiveness Analysis.

PubMed

Garrison, Louis P; Kamal-Bahl, Sachin; Towse, Adrian

2017-02-01

This commentary identifies and defines potentially useful expansions to traditional cost-effectiveness analysis as often used in health technology assessment. Since the seminal 1977 article by Weinstein and Stason, the recommended approach has been the use of the incremental cost-effectiveness ratio based on the metric of the cost per quality-adjusted life-year gained, allowing comparisons across different technologies. An expanded framework, incorporating a wider range of the elements of value, is proposed. In addition to the core value drivers of health gain and other health system cost savings (if any), we propose adding other less recognized elements related to the value of knowing and informational externalities. We describe each of five factors related to the value of knowing: 1) a reduction in uncertainty, reflecting the benefit of a companion diagnostic increasing the certainty of a patient׳s response to a medicine; 2) insurance value related to greater peace of mind due to protection against catastrophic health and financial loss; 3) the value of hope for a "cure," leading individuals to become risk seekers in some circumstances; 4) real option value due to life extension opening possibilities for individuals to benefit from future innovation; and 5) spillovers or externalities arising from benefits of scientific advances that cannot be entirely appropriated by those making the advances. Further thought and research are needed on how best to measure and integrate these elements into an incremental value framework and on coverage and pricing decisions. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

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

Kim, Hayeon, E-mail: kimh2@upmc.edu; Rajagopalan, Malolan S.; Beriwal, Sushil

Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction)more » with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100,000 per QALY gained, suggesting that selective SBRT use in patients with longer expected survival may be the most cost-effective approach.« less

737/CFM56-7 Aircraft Engine Systems

NASA Technical Reports Server (NTRS)

Wright, Steve; Shiosaki, Justin

2006-01-01

The configuration of the propulsion system engine externals must meet many airplane requirements such as cost, thrust, weight, range and systems power extraction. On the 737-700 several program requirements also played a major role in the development of the engine externals. These program goals were increased range, same cost as a 1994 737-300, 15% reduction in maintenance costs from the 737-300, and a propulsion package that appeared as if it was designed by one company. This presentation will show how these requirements shaped the design of the engine externals for the 737-700/CFM56-7B.

New Zealand Dairy Farming: Milking Our Environment for All Its Worth

NASA Astrophysics Data System (ADS)

Foote, Kyleisha J.; Joy, Michael K.; Death, Russell G.

2015-09-01

Over the past two decades there have been major increases in dairy production in New Zealand. This increase in intensity has required increased use of external inputs, in particular fertilizer, feed, and water. Intensified dairy farming thus incurs considerable environmental externalities: impacts that are not paid for directly by the dairy farmer. These externalities are left for the wider New Zealand populace to deal with, both economically and environmentally. This is counter-intuitive given the dairy industry itself relies on a `clean green' image to maximize returns. This is the first nationwide assessment of some of the environmental costs of the recent increase of dairy intensification in New Zealand. Significant costs arise from nitrate contamination of drinking water, nutrient pollution to lakes, soil compaction, and greenhouse gas emissions. At the higher end, the estimated cost of some environmental externalities surpasses the 2012 dairy export revenue of NZ11.6 billion and almost reaches the combined export revenue and dairy's contribution to Gross Domestic Product in 2010 of NZ5 billion. For the dairy industry to accurately report on its profitability and maintain its sustainable marketing label, these external costs should be reported. This assessment is in fact extremely conservative as many impacts have not been valued, thus, the total negative external impact of intensified dairying is probably grossly underestimated.

Increasing social welfare by taxing pesticide externalities in the Indian cotton sector.

PubMed

Rasche, Livia; Dietl, Alexander; Shakhramanyan, Nikolinka; Pandey, Divya; Schneider, Uwe A

2016-12-01

Pesticide use in the Indian cotton industry has decreased with the introduction of Bt cotton, but rates are still high in comparison with other countries. The adoption of alternative strategies, such as integrated pest management, has been slow, even though benefits are potentially high, more so if the full costs of the external effects of the technologies are taken into account. In order to estimate true societal benefits of different strategies, we compare their external costs and economic performance under external cost taxation, using a state-of-the-art partial equilibrium model of the Indian agricultural sector. Pesticide externalities lower social welfare in the Indian cotton sector by $US 400-2200 million, depending on the technologies employed. A full internalisation reduces producer revenues by $US 100 ha -1 if only Bt cotton is used, and by $US 30 ha -1 if IPM is another option. Consumers do not start to lose surplus until 20-70% are internalised, and losses are smaller if all technologies are available. External pesticide costs can be internalised partially without substantially affecting consumer surplus while still increasing social welfare, but producers need to have access to and the knowledge to employ all available cotton production technologies to minimise losses. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

New Zealand Dairy Farming: Milking Our Environment for All Its Worth.

PubMed

Foote, Kyleisha J; Joy, Michael K; Death, Russell G

2015-09-01

Over the past two decades there have been major increases in dairy production in New Zealand. This increase in intensity has required increased use of external inputs, in particular fertilizer, feed, and water. Intensified dairy farming thus incurs considerable environmental externalities: impacts that are not paid for directly by the dairy farmer. These externalities are left for the wider New Zealand populace to deal with, both economically and environmentally. This is counter-intuitive given the dairy industry itself relies on a 'clean green' image to maximize returns. This is the first nationwide assessment of some of the environmental costs of the recent increase of dairy intensification in New Zealand. Significant costs arise from nitrate contamination of drinking water, nutrient pollution to lakes, soil compaction, and greenhouse gas emissions. At the higher end, the estimated cost of some environmental externalities surpasses the 2012 dairy export revenue of NZ$11.6 billion and almost reaches the combined export revenue and dairy's contribution to Gross Domestic Product in 2010 of NZ$5 billion. For the dairy industry to accurately report on its profitability and maintain its sustainable marketing label, these external costs should be reported. This assessment is in fact extremely conservative as many impacts have not been valued, thus, the total negative external impact of intensified dairying is probably grossly underestimated.

Train integrity detection risk analysis based on PRISM

NASA Astrophysics Data System (ADS)

Wen, Yuan

2018-04-01

GNSS based Train Integrity Monitoring System (TIMS) is an effective and low-cost detection scheme for train integrity detection. However, as an external auxiliary system of CTCS, GNSS may be influenced by external environments, such as uncertainty of wireless communication channels, which may lead to the failure of communication and positioning. In order to guarantee the reliability and safety of train operation, a risk analysis method of train integrity detection based on PRISM is proposed in this article. First, we analyze the risk factors (in GNSS communication process and the on-board communication process) and model them. Then, we evaluate the performance of the model in PRISM based on the field data. Finally, we discuss how these risk factors influence the train integrity detection process.

Breath analysis using external cavity diode lasers: a review

NASA Astrophysics Data System (ADS)

Bayrakli, Ismail

2017-04-01

Most techniques that are used for diagnosis and therapy of diseases are invasive. Reliable noninvasive methods are always needed for the comfort of patients. Owing to its noninvasiveness, ease of use, and easy repeatability, exhaled breath analysis is a very good candidate for this purpose. Breath analysis can be performed using different techniques, such as gas chromatography mass spectrometry (MS), proton transfer reaction-MS, and selected ion flow tube-MS. However, these devices are bulky and require complicated procedures for sample collection and preconcentration. Therefore, these are not practical for routine applications in hospitals. Laser-based techniques with small size, robustness, low cost, low response time, accuracy, precision, high sensitivity, selectivity, low detection limit, real-time, and point-of-care detection have a great potential for routine use in hospitals. In this review paper, the recent advances in the fields of external cavity lasers and breath analysis for detection of diseases are presented.

Assessment of Health-Cost Externalities of Air Pollution at the National Level using the EVA Model System

NASA Astrophysics Data System (ADS)

Brandt, Jørgen; Silver, Jeremy David; Heile Christensen, Jesper; Skou Andersen, Mikael; Geels, Camilla; Gross, Allan; Buus Hansen, Ayoe; Mantzius Hansen, Kaj; Brandt Hedegaard, Gitte; Ambelas Skjøth, Carsten

2010-05-01

Air pollution has significant negative impacts on human health and well-being, which entail substantial economic consequences. We have developed an integrated model system, EVA (External Valuation of Air pollution), to assess health-related economic externalities of air pollution resulting from specific emission sources/sectors. The EVA system was initially developed to assess externalities from power production, but in this study it is extended to evaluate costs at the national level. The EVA system integrates a regional-scale atmospheric chemistry transport model (DEHM), address-level population data, exposure-response functions and monetary values applicable for Danish/European conditions. Traditionally, systems that assess economic costs of health impacts from air pollution assume linear approximations in the source-receptor relationships. However, atmospheric chemistry is non-linear and therefore the uncertainty involved in the linear assumption can be large. The EVA system has been developed to take into account the non-linear processes by using a comprehensive, state-of-the-art chemical transport model when calculating how specific changes to emissions affect air pollution levels and the subsequent impacts on human health and cost. Furthermore, we present a new "tagging" method, developed to examine how specific emission sources influence air pollution levels without assuming linearity of the non-linear behaviour of atmospheric chemistry. This method is more precise than the traditional approach based on taking the difference between two concentration fields. Using the EVA system, we have estimated the total external costs from the main emission sectors in Denmark, representing the ten major SNAP codes. Finally, we assess the impacts and external costs of emissions from international ship traffic around Denmark, since there is a high volume of ship traffic in the region.

Changes in Energy Cost and Total External Work of Muscles in Elite Race Walkers Walking at Different Speeds

PubMed Central

Chwała, Wiesław; Klimek, Andrzej; Mirek, Wacław

2014-01-01

The aim of the study was to assess energy cost and total external work (total energy) depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers. The study involved 12 competitive race walkers aged 24.9 4.10 years with 6 to 20 years of experience, who achieved a national or international sports level. Their aerobic endurance was determined by means of a direct method involving an incremental exercise test on the treadmill. The participants performed three tests walking each time with one of the three speeds according to the same protocol: an 8-minute walk with at steady speed was followed by a recovery phase until the oxygen debt was repaid. To measure exercise energy cost, an indirect method based on the volume of oxygen uptake was employed. The gait of the participants was recorded using the 3D Vicon opto-electronic motion capture system. Values of changes in potential energy and total kinetic energy in a gate cycle were determined based on vertical displacements of the centre of mass. Changes in mechanical energy amounted to the value of total external work of muscles needed to accelerate and lift the centre of mass during a normalised gait cycle. The values of average energy cost and of total external work standardised to body mass and distance covered calculated for technical speed, threshold and racing speeds turned out to be statistically significant (p 0.001). The total energy cost ranged from 51.2 kJ.m-1 during walking at technical speed to 78.3 kJ.m-1 during walking at a racing speed. Regardless of the type of speed, the total external work of muscles accounted for around 25% of total energy cost in race walking. Total external work mainly increased because of changes in the resultant kinetic energy of the centre of mass movement. PMID:25713673

Economic Analysis of Apixaban Therapy for Patients With Atrial Fibrillation From a US Perspective: Results From the ARISTOTLE Randomized Clinical Trial.

PubMed

Cowper, Patricia A; Sheng, Shubin; Lopes, Renato D; Anstrom, Kevin J; Stafford, Judith A; Davidson-Ray, Linda; Al-Khatib, Sana M; Ansell, Jack; Dorian, Paul; Husted, Steen; McMurray, John J V; Steg, P Gabriel; Alexander, John H; Wallentin, Lars; Granger, Christopher B; Mark, Daniel B

2017-05-01

The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban therapy was superior to warfarin therapy in preventing stroke and all-cause death while causing significantly fewer major bleeds. To establish the value proposition of substituting apixiban therapy for warfarin therapy in patients with atrial fibrillation, we performed a cost-effectiveness analysis using patient-level data from the ARISTOTLE trial. To assess the cost and cost-effectiveness of apixaban therapy compared with warfarin therapy in patients with atrial fibrillation from the perspective of the US health care system. This economic analysis uses patient-level resource use and clinical data collected in the ARISTOTLE trial, a multinational randomized clinical trial that observed 18 201 patients (3417 US patients) for a median of 1.8 years between 2006 and 2011. Apixaban therapy vs warfarin therapy. Within-trial resource use and cost were compared between treatments, using externally derived US cost weights. Life expectancies for US patients were estimated according to their baseline risk and treatment using time-based and age-based survival models developed using the overall ARISTOTLE population. Quality-of-life adjustment factors were obtained from external sources. Cost-effectiveness (incremental cost per quality-adjusted life-year gained) was evaluated from a US perspective, and extensive sensitivity analyses were performed. Of the 3417 US patients enrolled in ARISTOTLE, the mean (SD) age was 71 (10) years; 2329 (68.2%) were male and 3264 (95.5%) were white. After 2 years of anticoagulation therapy, health care costs (excluding the study drug) of patients treated with apixaban therapy and warfarin therapy were not statistically different (difference, -$60; 95% CI, -$2728 to $2608). Life expectancy, modeled from ARISTOTLE outcomes, was significantly longer with apixaban therapy vs warfarin therapy (7.94 vs 7.54 quality-adjusted life years). The incremental cost, including cost of anticoagulant and monitoring, of achieving these benefits was within accepted US norms ($53 925 per quality-adjusted life year, with 98% likelihood of meeting a $100 000 willingness-to-pay threshold). Results were generally consistent when model assumptions were varied, with lifetime cost-effectiveness most affected by the price of apixaban and the time horizon. Apixaban therapy for ARISTOTLE-eligible patients with atrial fibrillation provides clinical benefits at an incremental cost that represents reasonable value for money judged using US benchmarks for cost-effectiveness. clinicaltrials.gov Identifier: NCT00412984.

Economic Analysis of Apixaban Therapy for Patients With Atrial Fibrillation From a US Perspective

PubMed Central

Sheng, Shubin; Lopes, Renato D.; Anstrom, Kevin J.; Stafford, Judith A.; Davidson-Ray, Linda; Al-Khatib, Sana M.; Ansell, Jack; Dorian, Paul; Husted, Steen; McMurray, John J. V.; Steg, P. Gabriel; Alexander, John H.; Wallentin, Lars; Granger, Christopher B.; Mark, Daniel B.

2017-01-01

Importance The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban therapy was superior to warfarin therapy in preventing stroke and all-cause death while causing significantly fewer major bleeds. To establish the value proposition of substituting apixiban therapy for warfarin therapy in patients with atrial fibrillation, we performed a cost-effectiveness analysis using patient-level data from the ARISTOTLE trial. Objective To assess the cost and cost-effectiveness of apixaban therapy compared with warfarin therapy in patients with atrial fibrillation from the perspective of the US health care system. Design, Setting, and Participants This economic analysis uses patient-level resource use and clinical data collected in the ARISTOTLE trial, a multinational randomized clinical trial that observed 18 201 patients (3417 US patients) for a median of 1.8 years between 2006 and 2011. Interventions Apixaban therapy vs warfarin therapy. Main Outcomes and Measures Within-trial resource use and cost were compared between treatments, using externally derived US cost weights. Life expectancies for US patients were estimated according to their baseline risk and treatment using time-based and age-based survival models developed using the overall ARISTOTLE population. Quality-of-life adjustment factors were obtained from external sources. Cost-effectiveness (incremental cost per quality-adjusted life-year gained) was evaluated from a US perspective, and extensive sensitivity analyses were performed. Results Of the 3417 US patients enrolled in ARISTOTLE, the mean (SD) age was 71 (10) years; 2329 (68.2%) were male and 3264 (95.5%) were white. After 2 years of anticoagulation therapy, health care costs (excluding the study drug) of patients treated with apixaban therapy and warfarin therapy were not statistically different (difference, −$60; 95% CI, −$2728 to $2608). Life expectancy, modeled from ARISTOTLE outcomes, was significantly longer with apixaban therapy vs warfarin therapy (7.94 vs 7.54 quality-adjusted life years). The incremental cost, including cost of anticoagulant and monitoring, of achieving these benefits was within accepted US norms ($53 925 per quality-adjusted life year, with 98% likelihood of meeting a $100 000 willingness-to-pay threshold). Results were generally consistent when model assumptions were varied, with lifetime cost-effectiveness most affected by the price of apixaban and the time horizon. Conclusions and Relevance Apixaban therapy for ARISTOTLE-eligible patients with atrial fibrillation provides clinical benefits at an incremental cost that represents reasonable value for money judged using US benchmarks for cost-effectiveness. Trial Registration clinicaltrials.gov Identifier: NCT00412984 PMID:28355434

Assessing cost and effectiveness of radiation decontamination in Fukushima Prefecture, Japan.

PubMed

Yasutaka, Tetsuo; Naito, Wataru

2016-01-01

Despite the enormous cost of radiation decontamination in Fukushima Prefecture, it is not clear what levels of reduction in external radiation exposure are possible in the Special Decontamination Area, the Intensive Contamination Survey Areas and the whole of Fukushima. The objective of this study was to evaluate the cost and effectiveness of radiation decontamination in Fukushima Prefecture in its entirety. Using a geographic information system, we calculated the costs of removal, storage containers, transport, and temporary and interim storage facilities as well as the reduction in air dose rate for a cumulative external exposure for 9000 1 km × 1 km mesh units incorporating 51 municipalities. The decontamination cost for the basic scenario, for which forested areas within 20 m of habitation areas were decontaminated, was JPY2.53-5.12 trillion; the resulting reduction in annual external dose was about 2500 person-Sv. The transport, storage, and administrative costs of decontamination waste and removed soil reached JPY1.55-2.12 trillion under this scenario. Although implementing decontamination of all forested areas provides some major reductions in the external radiation dose for the average inhabitant, decontamination costs could potentially exceed JPY16 trillion. These results indicate that technologies for reducing the volume of decontamination waste and removed soil should be considered to reduce storage costs and that further discussions about forest decontamination policies are needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Faculty Productivity and Costs at the University of Texas at Austin: A Preliminary Analysis

ERIC Educational Resources Information Center

Vedder, Richard; Matgouranis, Christopher; Robe, Jonathan

2011-01-01

In this report, the authors examine recently released preliminary data concerning faculty compensation, teaching loads and external research grant awards at one of the nation's largest college campuses, The University of Texas at Austin. The authors use these data to assess faculty productivity (in terms of both teaching and research), and their…

Metabolic Cost of Lateral Stabilization during Walking in People with Incomplete Spinal Cord Injury

PubMed Central

Matsubara, J.H.; Wu, M.; Gordon, K.E.

2015-01-01

People with incomplete spinal cord injury (iSCI) expend considerable energy to walk, which can lead to rapid fatigue and limit community ambulation. Selecting locomotor patterns that enhance lateral stability may contribute to this population’s elevated cost of transport. The goal of the current study was to quantify the metabolic energy demands of maintaining lateral stability during gait in people with iSCI. To quantify this metabolic cost, we observed ten individuals with iSCI walking with and without external lateral stabilization. We hypothesized that with external lateral stabilization, people with iSCI would adapt their gait by decreasing step width, which would correspond with a substantial decrease in cost of transport. Our findings support this hypothesis. Subjects significantly (p < 0.05) decreased step width by 22%, step width variability by 18%, and minimum lateral margin of stability by 25% when they walked with external lateral stabilization compared to unassisted walking. Metabolic cost of transport also decreased significantly (p < 0.05) by 10% with external lateral stabilization. These findings suggest that this population is capable of adapting their gait to meet changing demands placed on balance. The percent reduction in cost of transport when walking with external lateral stabilization was strongly correlated with functional impairment level as assessed by subjects’ scores on the Berg Balance Scale (R = 0.778) and Lower Extremity Motor Score (R = 0.728). These relationships suggest that as functional balance and strength decrease, the amount of metabolic energy used to maintain lateral stability during gait will increase. PMID:25670651

A fully battery-powered inexpensive spectrophotometric system for high-sensitivity point-of-care analysis on a microfluidic chip

PubMed Central

Dou, Maowei; Lopez, Juan; Rios, Misael; Garcia, Oscar; Xiao, Chuan; Eastman, Michael

2016-01-01

A cost-effective battery-powered spectrophotometric system (BASS) was developed for quantitative point-of-care (POC) analysis on a microfluidic chip. By using methylene blue as a model analyte, we first compared the performance of the BASS with a commercial spectrophotometric system, and further applied the BASS for loop-mediated isothermal amplification (LAMP) detection and subsequent quantitative nucleic acid analysis which exhibited a comparable limit of detection to that of Nanodrop. Compared to the commercial spectrophotometric system, our spectrophotometric system is lower-cost, consumes less reagents, and has a higher detection sensitivity. Most importantly, it does not rely on external power supplies. All these features make our spectrophotometric system highly suitable for a variety of POC analyses, such as field detection. PMID:27143408

[Analysis of state costs of the social security benefits provided to the insured presenting with lung cancer and pulmonary diseases caused by external factors].

PubMed

Kuklińska-Janiak, Dorota

2013-12-01

Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the results of the performed analyses indicate that data on the social insurance money allow to comprehensively evaluate the health status of the insured men and women as well as their quality of life and therapeutical, rehabilitational and prophylactic needs. These data can and should, therefore, be utilized in both clinical practice and for accomplishment of the public health tasks.

A sustainability analysis of an incineration project in Serbia.

PubMed

Mikic, Miljan; Naunovic, Zorana

2013-11-01

The only option for municipal solid waste (MSW) treatment adopted so far in Serbia is landfilling. Similarly to other south-eastern European countries, Serbia is not recovering any energy from MSW. Fifty percent of electricity in Serbia is produced in coal-fired power plants with emission control systems dating from the 1980s. In this article, the option of MSW incineration with energy recovery is proposed and examined for the city of Novi Sad. A sustainability analysis consisting of financial, economic and sensitivity analyses was done in the form of a cost-benefit analysis following recommendations from the European Commission. Positive and negative social and environmental effects of electricity generation through incineration were valuated partly using conversion factors and shadow prices, and partly using the results of previous studies. Public aversion to MSW incineration was considered. The results showed that the incineration project would require external financial assistance, and that an increase of the electricity and/or a waste treatment fee is needed to make the project financially positive. It is also more expensive than the landfilling option. However, the economic analysis showed that society would have net benefits from an incineration project. The feed-in tariff addition of only €0.03 (KWh)(-1) to the existing electricity price, which would enable the project to make a positive contribution to economic welfare, is lower than the actual external costs of electricity generation from coal in Serbia.

Tunable External Cavity Quantum Cascade Lasers (EC-QCL): an application field for MOEMS based scanning gratings

NASA Astrophysics Data System (ADS)

Grahmann, Jan; Merten, André; Ostendorf, Ralf; Fontenot, Michael; Bleh, Daniela; Schenk, Harald; Wagner, Hans-Joachim

2014-03-01

In situ process information in the chemical, pharmaceutical or food industry as well as emission monitoring, sensitive trace detection and biological sensing applications would increasingly rely on MIR-spectroscopic anal­ysis in the 3 μm - 12 μm wavelength range. However, cost effective, portable, low power consuming and fast spectrometers with a wide tuning range are not available so far. To provide these MIR-spectrometer properties, the combination of quantum cascade lasers with a MOEMS scanning grating as wavelength selective element in the external cavity is addressed to provide a very compact and fast tunable laser source for spectroscopic analysis.

Optimal External Wrench Distribution During a Multi-Contact Sit-to-Stand Task.

PubMed

Bonnet, Vincent; Azevedo-Coste, Christine; Robert, Thomas; Fraisse, Philippe; Venture, Gentiane

2017-07-01

This paper aims at developing and evaluating a new practical method for the real-time estimate of joint torques and external wrenches during multi-contact sit-to-stand (STS) task using kinematics data only. The proposed method allows also identifying subject specific body inertial segment parameters that are required to perform inverse dynamics. The identification phase is performed using simple and repeatable motions. Thanks to an accurately identified model the estimate of the total external wrench can be used as an input to solve an under-determined multi-contact problem. It is solved using a constrained quadratic optimization process minimizing a hybrid human-like energetic criterion. The weights of this hybrid cost function are adjusted and a sensitivity analysis is performed in order to reproduce robustly human external wrench distribution. The results showed that the proposed method could successfully estimate the external wrenches under buttocks, feet, and hands during STS tasks (RMS error lower than 20 N and 6 N.m). The simplicity and generalization abilities of the proposed method allow paving the way of future diagnosis solutions and rehabilitation applications, including in-home use.

Who pays for obesity?

PubMed

Bhattacharya, Jay; Sood, Neeraj

2011-01-01

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

The Regulation of a Spatially Heterogeneous Externality: Tradable Groundwater Permits to Protect Streams

NASA Astrophysics Data System (ADS)

Kuwayama, Y.; Brozovic, N.

2012-12-01

Groundwater pumping from aquifers can reduce the flow of surface water in nearby streams through a process known as stream depletion. In the United States, recent awareness of this externality has led to intra- and inter-state conflict and rapidly-changing water management policies and institutions. A factor that complicates the design of groundwater management policies to protect streams is the spatial heterogeneity of the stream depletion externality; the marginal damage of groundwater use on stream flows depends crucially on the location of pumping relative to streams. Under these circumstances, economic theory predicts that spatially differentiated policies can achieve an aggregate reduction in stream depletion cost effectively. However, whether spatially differentiated policies offer significant abatement cost savings and environmental improvements over simpler, alternative policies is an empirical question. In this paper, we analyze whether adopting a spatially differentiated groundwater permit system can lead to significant savings in compliance costs while meeting targets on stream protection. Using a population data set of active groundwater wells in the Nebraska portion of the Republican River Basin, we implement an optimization model of each well owner's crop choice, land use, and irrigation decisions to determine the distribution of regulatory costs. We model the externality of pumping on streams by employing an analytical solution from the hydrology literature that determines reductions in stream flow caused by groundwater pumping over space and time. The economic and hydrologic model components are then combined into one optimization framework, which allows us to measure farmer abatement costs and stream flow benefits under a constrained optimal market that features spatially differentiated, tradable groundwater permits. We compare this outcome to the efficiency of alternative second-best policies, including spatially uniform permit markets and pumping restrictions based on geographic zones. Our analysis considers static policies for which abatement is fixed over time, as well as dynamic policies that allow abatement to vary over time and future compliance costs to be subject to a discount rate. We find that if current levels of stream flow in the Republican River Basin are held fixed, regulators can generate most of the potential abatement cost savings by establishing a one-to-one tradable permit system that does not account for spatial heterogeneity. We obtain this surprising result because the agronomic and climatic parameters in our data set that determine farmer abatement costs are spatially correlated with hydrologic parameters that determine the marginal damage of groundwater use on streams. However, we also find that if future legal or ecological circumstances require regulators to increase significantly the protection of streams from current levels, spatially differentiated policies will generate sizable cost savings compared to policies that ignore spatial heterogeneity.

Principles and methods of managerial cost-accounting systems.

PubMed

Suver, J D; Cooper, J C

1988-01-01

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

Assessment of past, present and future health-cost externalities of air pollution in Europe and the contribution from international ship traffic using the EVA model system

NASA Astrophysics Data System (ADS)

Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.

2013-03-01

An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been introduced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro yr-1 for the year 2000, decreasing to 537 bn Euro yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant positive impact on human health in Europe.

Assessment of past, present and future health-cost externalities of air pollution in Europe and the contribution from international ship traffic using the EVA model system

NASA Astrophysics Data System (ADS)

Brandt, J.; Silver, J. D.; Christensen, J. H.; Andersen, M. S.; Bønløkke, J. H.; Sigsgaard, T.; Geels, C.; Gross, A.; Hansen, A. B.; Hansen, K. M.; Hedegaard, G. B.; Kaas, E.; Frohn, L. M.

2013-08-01

An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North seas, since special regulatory actions on sulfur emissions, called SECA (sulfur emission control area), have been introduced in these areas. We conclude that, despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem for human health. Hence the related external costs are considerable. The total health-related external costs for the whole of Europe are estimated at 803 bn euros yr-1 for the year 2000, decreasing to 537 bn euros yr-1 in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680 000 yr-1, decreasing to approximately 450 000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulfur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant positive impact on human health in Europe.

Assessment of Past, Present and Future Health-Cost Ex-ternalities of Air Pollution in Europe and the contribution from International Ship Traffic using the EVA Model System

NASA Astrophysics Data System (ADS)

Brandt, Jørgen; Silver, Jeremy D.; Christensen, Jesper H.; Andersen, Mikael S.; Bønløkke, Jakob H.; Sigsgaard, Torben; Geels, Camilla; Gross, Allan; Hansen, Ayoe B.; Hansen, Kaj M.; Hedegaard, Gitte B.; Kaas, Eigil; Frohn, Lise M.

2013-04-01

An integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain has been developed, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The model system can be used to support policy-making with respect to emission control. In this study, we apply the EVA system to Europe, and perform a more detailed assessment of past, present, and future health-cost externalities of the total air pollution levels in Europe (including both natural and anthropogenic sources), represented by the years 2000, 2007, 2011, and 2020. We also assess the contribution to the health-related external costs from international ship traffic with special attention to the international ship traffic in the Baltic and North Seas, since special regulatory actions on sulphur emissions, called SECA (sulphur emission control area), have been intro-duced in these areas,. We conclude that despite efficient regulatory actions in Europe in recent decades, air pollution still constitutes a serious problem to human health, hence the related external costs are considerable. The total health-related external costs for the whole of Europe is estimated at 803 bn Euro/year for the year 2000, decreasing to 537 bn Euro/year in the year 2020. We estimate the total number of premature deaths in Europe in the year 2000 due to air pollution to be around 680,000/year, decreasing to approximately 450,000 in the year 2020. The contribution from international ship traffic in the Northern Hemisphere was estimated to 7% of the total health-related external costs in Europe in the year 2000, increasing to 12% in the year 2020. In contrast, the contribution from international ship traffic in the Baltic Sea and the North Sea decreases 36% due to the regulatory efforts of reducing sulphur emissions from ship traffic in SECA. Introducing this regulatory instrument for all international ship traffic in the Northern Hemisphere, or at least in areas close to Europe, would have a significant posi-tive impact on human health in Europe.

[Quality management in a public health agency].

PubMed

Villalbí, Joan R; Ballestín, Manuela; Casas, Conrad; Subirana, Teresa

2012-01-01

This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification. Copyright © 2011 SESPAS. Published by Elsevier España, S.L. All rights reserved.

A modified cost benefit analysis of coastal development (tourism) with special reference to Longbay Beach--Negril, Jamaica

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

Hinds, P.W.; Ngandu, M.

The purpose of this study is to estimate the cost and benefits of the Tourist Industry in Negril over the period 1970-93, including its impact on the environment. Traditional cost benefit analysis will be used with appropriate modifications. The Long Bay stretch has been an area of rapid expansion over the last ten to twenty years. This expansion has rapidly outgrown infrastructure development and this, the potential environmental problems are already showing up in marine pollution and other forms of environmental degradation. Although there is numerous evidence of environmental impacts on tourism, there has not been a lot of workmore » done on quantifying these impacts, and policy makers have not been ensuring that these externalities are internalized by these hotels, in an effort to make them better stewards of the environment. This study will not only look at the economic cost and benefit of the industry from the point of view of revenue and expenditure, but also the environment cost, benefit and policy recommendations necessary to accomplish this.« less

Multiyear Subcontractor Selection Criteria Analysis.

DTIC Science & Technology

1983-09-01

advancement are program instability, higher costs, and increased lead-times. Compounding the instability created by advancing technology are changes in...drive smaller firms out of business (17:46). Technology is advancing at an ever increasing pace, demanding higher performance and larger amounts of engi...Process Adding to the external factors mentioned above, the weapon systems acquisition process tends to retard pro- ductivity advancements by its very

Reliability-based management of buried pipelines considering external corrosion defects

NASA Astrophysics Data System (ADS)

Miran, Seyedeh Azadeh

Corrosion is one of the main deteriorating mechanisms that degrade the energy pipeline integrity, due to transferring corrosive fluid or gas and interacting with corrosive environment. Corrosion defects are usually detected by periodical inspections using in-line inspection (ILI) methods. In order to ensure pipeline safety, this study develops a cost-effective maintenance strategy that consists of three aspects: corrosion growth model development using ILI data, time-dependent performance evaluation, and optimal inspection interval determination. In particular, the proposed study is applied to a cathodic protected buried steel pipeline located in Mexico. First, time-dependent power-law formulation is adopted to probabilistically characterize growth of the maximum depth and length of the external corrosion defects. Dependency between defect depth and length are considered in the model development and generation of the corrosion defects over time is characterized by the homogenous Poisson process. The growth models unknown parameters are evaluated based on the ILI data through the Bayesian updating method with Markov Chain Monte Carlo (MCMC) simulation technique. The proposed corrosion growth models can be used when either matched or non-matched defects are available, and have ability to consider newly generated defects since last inspection. Results of this part of study show that both depth and length growth models can predict damage quantities reasonably well and a strong correlation between defect depth and length is found. Next, time-dependent system failure probabilities are evaluated using developed corrosion growth models considering prevailing uncertainties where three failure modes, namely small leak, large leak and rupture are considered. Performance of the pipeline is evaluated through failure probability per km (or called a sub-system) where each subsystem is considered as a series system of detected and newly generated defects within that sub-system. Sensitivity analysis is also performed to determine to which incorporated parameter(s) in the growth models reliability of the studied pipeline is most sensitive. The reliability analysis results suggest that newly generated defects should be considered in calculating failure probability, especially for prediction of long-term performance of the pipeline and also, impact of the statistical uncertainty in the model parameters is significant that should be considered in the reliability analysis. Finally, with the evaluated time-dependent failure probabilities, a life cycle-cost analysis is conducted to determine optimal inspection interval of studied pipeline. The expected total life-cycle costs consists construction cost and expected costs of inspections, repair, and failure. The repair is conducted when failure probability from any described failure mode exceeds pre-defined probability threshold after each inspection. Moreover, this study also investigates impact of repair threshold values and unit costs of inspection and failure on the expected total life-cycle cost and optimal inspection interval through a parametric study. The analysis suggests that a smaller inspection interval leads to higher inspection costs, but can lower failure cost and also repair cost is less significant compared to inspection and failure costs.

Economic evaluation of occupational safety preventive measures in a hospital.

PubMed

Ramos, Delfina G; Arezes, Pedro M; Afonso, Paulo

2015-01-01

When an organization performs an integrated analysis of risks through its Occupational Health and Safety Management System, several steps are suggested to address the implications of the identified risks. Namely, the organization should make a detailed analysis of the monetary impact for the organization of each of the preventive measures considered. However, it is also important to perform an analysis of the impact of each measure on society (externalities). The aim of this paper is to present a case study related to the application of the proposed economic evaluation methodology. An analysis of the work accidents in a hospital has been made. Three of the major types of accidents have been selected: needle stings, falls and excessive strain. Following the risk assessment, some preventive measures have been designed. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organization's perspective) and in economic terms (including the benefits for the worker and for the Society). While the financial ratio is only advantageous in some cases, when the externalities are taken into account, the B/C ratio increases significantly. It is important to consider external benefits to make decisions concerning the implementation of preventive measures in Occupational Health and Safety projects.

[Radiology in managed care environment: opportunities for cost savings in an HMO].

PubMed

Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M

2003-09-01

A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these initiatives are similar to the reforms to reduce cost and improve quality that are already implemented or proposed within the German healthcare system.

Space shuttle phase B extension, volume 1

NASA Technical Reports Server (NTRS)

1971-01-01

In order to define a system which would significantly reduce payload delivery costs, activities were extended to modifications of the reusable space shuttle design concept. Considered were systems using orbiters with external propellant tanks and an interim expendable booster which allowed phased development of the usable orbiter and booster. Analyzed were: Merits of internal and external propellant tanks and the impact of external LH2 compared to L02 and LH2; impact of cargo bay size; impact abort; merit of expendable booster options; and merit of a phased development program. Studies showed that external L02/LH2 and the continued use of the J-2S engine on the orbiter reduced program cost and risk.

Structural tailoring of advanced turboprops

NASA Technical Reports Server (NTRS)

Brown, K. W.; Hopkins, Dale A.

1988-01-01

The Structural Tailoring of Advanced Turboprops (STAT) computer program was developed to perform numerical optimization on highly swept propfan blades. The optimization procedure seeks to minimize an objective function defined as either: (1) direct operating cost of full scale blade or, (2) aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. The STAT analysis system includes an aerodynamic efficiency evaluation, a finite element stress and vibration analysis, an acoustic analysis, a flutter analysis, and a once-per-revolution forced response life prediction capability. STAT includes all relevant propfan design constraints.

Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

PubMed

McGuffin, M; Merino, T; Keller, B; Pignol, J-P

2017-03-01

Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

The role, costs and value for money of external consultancies in the health sector: A study of New Zealand's District Health Boards.

PubMed

Penno, Erin; Gauld, Robin

2017-04-01

Public spending on external consultancies, particularly within the health sector, is highly controversial in many countries. Yet, despite the apparently large sums of money involved, there is little international analysis surrounding the scope of activities of consultants, meaning there is little understanding of how much is spent, for what purpose and with what result. This paper examines spending on external consultancies in each of New Zealand's 20 District Health Boards (DHB). Using evidence obtained from DHBs, it provides an insight into the cost and activities of consultants within the New Zealand health sector, the policies behind their engagement and the processes in place to ensure value for money. It finds that DHB spending on external consultants is substantial, at $NZ10-60 million annually. However, few DHBs had policies governing when consultants should be engaged and many were unable to easily identify the extent or purpose of consultancies within their organisation, making it difficult to derive an accurate picture of consultant activity throughout the DHB sector. Policies surrounding value for money were uncommon and, where present, were rarely applied. Given the large sums being spent by New Zealand's DHBs, and assuming expenditure is similar in other health systems, our findings point to the need for greater accountability for expenditure and better evidence of value for money of consultancies within publicly funded health systems. Copyright © 2017 Elsevier B.V. All rights reserved.

Good research practices for measuring drug costs in cost-effectiveness analyses: an international perspective: the ISPOR Drug Cost Task Force report--Part VI.

PubMed

Shi, Lizheng; Hodges, Meredith; Drummond, Michael; Ahn, Jeonghoon; Li, Shu Chuen; Hu, Shanlian; Augustovski, Federico; Hay, Joel W; Smeeding, Jim

2010-01-01

The pharmacoeconomic guidelines available in the literature or promulgated in many countries are either vague or silent about how drug costs should be established or measured so an international comparison of cost-effectiveness analysis (CEA) results can be made. The objective of this report is to provide guidance and recommendations on how drug costs should be measured for CEAs done from an internationally comparative perspective. Members of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis (Drug Cost Task Force [DCTF]) subgroup from several countries were experienced developers or users of CEA models, and worked in academia, industry, and as advisors to governments. They solicited comments on drafts from a core group of 174 external reviewers and more broadly, from the members of the ISPOR at the ISPOR 12th Annual International meeting and via the ISPOR Web site. Drug units should be standardized in terms of volume of active ingredient, regardless of packaging and dosing strength variations across countries. Drug costs should be measured in local currency per unit of active ingredient and should be converted to other currencies using sensitivity analyses of purchasing power parities (PPP) and exchange rates, whichever is more appropriate. When using drug prices from different years, the consumer price index for the local currency should be applied before the PPP and/or exchange rate conversion. CEA researchers conducting international pharmacoeconomic analysis should tailor the appropriate measure of drug costs to the international perspective, to maintain clarity and transparency on drug cost measurement in the context of international drug comparison and report the sensitivity of CEA results to reasonable cost conversions.

The economic aspects of artificial snow production in the perspective of climate change

NASA Astrophysics Data System (ADS)

Gonseth, C.

2012-04-01

Snowmaking is now used by ski resorts worldwide as a measure to cope with both natural snow reduction and variability. This extensive recourse casts doubt on its sustainability mainly because of the large amount of natural resources being used (energy, water). In the middle to long run, this problem is expected to increase with future climate change triggering the production of more snow. The research field that focuses on the economic aspects of artificial snow production is still in its infancy but potentially covers a wide array of issues. Among these issues, benefits and costs of snowmaking are important ones. On the one hand, benefits arise as snowmaking extends or preserves the operating period of ski areas. Several empirical studies speculate or show that snowmaking considerably reduces the sensitivity of tourism consumption to variations in snow conditions. These benefits have long been neglected in studies analyzing the consequences of climate change for the winter tourism sector. While failing to introduce these benefits, many studies have generated overly high costs of climate change. On the other hand, investments and operating costs of artificial snow production depend upon several factors, such as technology and local conditions. Consequently, costs vary considerably from one location to another and over time, yet indicative values can be found in the literature. In addition, artificial snow production generates external costs, i.e. costs that are not born by those producing it. Typical of these external costs are environmental ones that are related to CO2 emissions or biodiversity losses. To our knowledge, very little has been done so far to integrate these costs in economic studies. To the extent that vertical integration is absent, it may happen as well that snow production generates important external benefits for different stakeholders at a given ski resort. From an economic point of view, both types of externalities could lead to investment levels that are not optimal in the sense that they do not maximize social welfare. More generally, economic analysis has the potential to explain current investment and snow production levels and to determine optimal ones. It can also predict the evolution of these levels under a warmer climate. For instance, such predictions were carried out for Switzerland as well as for other Alpine countries using a computable general equilibrium model of the world economy with a time horizon up to 2050, the GEMINI-E3 model. With all these points in mind, this presentation aims at reviewing what has been done so far on the economic aspects of artificial snow production and also at identifying avenues for future research.

Examining the impact of cell phone conversations on driving using meta-analytic techniques.

PubMed

Horrey, William J; Wickens, Christopher D

2006-01-01

The performance costs associated with cell phone use while driving were assessed meta-analytically using standardized measures of effect size along five dimensions. There have been many studies on the impact of cell phone use on driving, showing some mixed findings. Twenty-three studies (contributing 47 analysis entries) met the appropriate conditions for the meta-analysis. The statistical results from each of these studies were converted into effect sizes and combined in the meta-analysis. Overall, there were clear costs to driving performance when drivers were engaged in cell phone conversations. However, subsequent analyses indicated that these costs were borne primarily by reaction time tasks, with far smaller costs associated with tracking (lane-keeping) performance. Hands-free and handheld phones revealed similar patterns of results for both measures of performance. Conversation tasks tended to show greater costs than did information-processing tasks (e.g., word games). There was a similar pattern of results for passenger and remote (cell phone) conversations. Finally, there were some small differences between simulator and field studies, though both exhibited costs in performance for cell phone use. We suggest that (a) there are significant costs to driver reactions to external hazards or events associated with cell phone use, (b) hands-free cell phones do not eliminate or substantially reduce these costs, and (c) different research methodologies or performance measures may underestimate these costs. Potential applications of this research include the assessment of performance costs attributable to different types of cell phones, cell phone conversations, experimental measures, or methodologies.

The Role of Advocacy Organizations in Reducing Negative Externalities

ERIC Educational Resources Information Center

Biglan, Anthony

2009-01-01

An externality is a cost that a corporation's actions impose on society. For example, a power plant may emit mercury but might not pay for the cost of that pollution to the people living near the plant. It is possible to analyze a diverse range of problems of society in these terms, including the health effects of corporate practices, the…

Mental states inside out: switching costs for emotional and nonemotional sentences that differ in internal and external focus.

PubMed

Oosterwijk, Suzanne; Winkielman, Piotr; Pecher, Diane; Zeelenberg, René; Rotteveel, Mark; Fischer, Agneta H

2012-01-01

Mental states-such as thinking, remembering, or feeling angry, happy, or dizzy-have a clear internal component. We feel a certain way when we are in these states. These internal experiences may be simulated when people understand conceptual references to mental states. However, mental states can also be described from an "external" perspective, for example when referring to "smiling." In those cases, simulation of visible outside features may be more relevant for understanding. In a switching costs paradigm, we presented semantically unrelated sentences describing emotional and nonemotional mental states while manipulating their internal or external focus. The results show that switching costs occur when participants shift between sentences with an internal and an external focus. This suggests that different forms of simulation underlie understanding these sentences. In addition, these effects occurred for emotional and nonemotional mental states, suggesting that they are grounded in a similar way-through the process of simulation.

Access Based Cost Estimation for Beddown Analysis

DTIC Science & Technology

2006-03-23

logic. This research expands upon the existing research by using Visual Basic for Applications ( VBA ) to further customize and streamline the...methods with the use of VBA . Calculations are completed in either underlying Form VBA code or through global modules accessible throughout the...query and SQL referencing. Attempts were made where possible to align data structures with possible external sources to minimize import errors and

Innovative and Cost Effective Remediation of Orbital Debris

DTIC Science & Technology

2014-04-25

to face international opposition because it could be used offensively to disable spacecraft. 4 Technical Analysis Most of StreamSat’s... LDR ). 5 They demonstrated droplet dispersion of less than 1 micro radian for some generators and devised an instrument for measuring the...error can be limited to less than one micro radian using existing technology and techniques. During transit, external forces will alter the path of

Evaluation of cost-effectiveness from the funding body's point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique.

PubMed

Noritomi, Danilo Teixeira; Zigaib, Rogério; Ranzani, Otavio T; Teich, Vanessa

2016-01-01

To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this case was the SUS.

Implantable or external defibrillators for individuals at increased risk of cardiac arrest: where cost-effectiveness hits fiscal reality.

PubMed

Cram, Peter; Katz, David; Vijan, Sandeep; Kent, David M; Langa, Kenneth M; Fendrick, A Mark

2006-01-01

Implantable cardioverter defibrillators (ICDs) are highly effective at preventing cardiac arrest, but their availability is limited by high cost. Automated external defibrillators (AEDs) are likely to be less effective, but also less expensive. We used decision analysis to evaluate the clinical and economic trade-offs of AEDs, ICDs, and emergency medical services equipped with defibrillators (EMS-D) for reducing cardiac arrest mortality. A Markov model was developed to compare the cost-effectiveness of three strategies in adults meeting entry criteria for the MADIT II Trial: strategy 1, individuals experiencing cardiac arrest are treated by EMS-D; strategy 2, individuals experiencing cardiac arrest are treated with an in-home AED; and strategy 3, individuals receive a prophylactic ICD. The model was then used to quantify the aggregate societal benefit of these three strategies under the conditions of a constrained federal budget. Compared with EMS-D, in-home AEDs produced a gain of 0.05 quality-adjusted life-years (QALYs) at an incremental cost of $5225 ($104,500 per QALY), while ICDs produced a gain of 0.90 QALYs at a cost of $114,660 ($127,400 per QALY). For every $1 million spent on defibrillators, 1.7 additional QALYs are produced by purchasing AEDs (9.6 QALYs/$million) instead of ICDs (7.9 QALYs/$million). Results were most sensitive to defibrillator complication rates and effectiveness, defibrillator cost, and adults' risk of cardiac arrest. Both AEDs and ICDs reduce cardiac arrest mortality, but AEDs are significantly less expensive and less effective. If financial constraints were to lead to rationing of defibrillators, it might be preferable to provide more people with a less effective and less expensive intervention (in-home AEDs) instead of providing fewer people with a more effective and more costly intervention (ICDs).

Evolution of external female genital mutilation: why do males harm their mates?

PubMed

Mouginot, Pierick; Uhl, Gabriele; Fromhage, Lutz

2017-11-01

Sperm competition may select for male reproductive traits that influence female mating or oviposition rate. These traits may induce fitness costs to the female; however, they may be costly for the males as well as any decrease in female fitness also affects male fitness. Male adaptations to sperm competition manipulate females by altering not only female behaviour or physiology, but also female morphology. In orb-weaving spiders, mating may entail mutilation of external structures of the female genitalia, which prevents genital coupling with subsequent males. Here, we present a game theoretical model showing that external female genital mutilation is favoured even under relatively high costs of mutilation, and that it is favoured by a high number of mate encounters per female and last-male sperm precedence.

Evolution of external female genital mutilation: why do males harm their mates?

PubMed Central

Uhl, Gabriele

2017-01-01

Sperm competition may select for male reproductive traits that influence female mating or oviposition rate. These traits may induce fitness costs to the female; however, they may be costly for the males as well as any decrease in female fitness also affects male fitness. Male adaptations to sperm competition manipulate females by altering not only female behaviour or physiology, but also female morphology. In orb-weaving spiders, mating may entail mutilation of external structures of the female genitalia, which prevents genital coupling with subsequent males. Here, we present a game theoretical model showing that external female genital mutilation is favoured even under relatively high costs of mutilation, and that it is favoured by a high number of mate encounters per female and last-male sperm precedence. PMID:29291104

Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury.

PubMed

O'Grady, Kathleen M; Power, Hollie A; Olson, Jaret L; Morhart, Michael J; Harrop, A Robertson; Watt, M Joe; Chan, K Ming

2017-10-01

Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury. In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed. Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group. Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction. Therapeutic, II.

Global economic evaluations of rotavirus vaccines: A systematic review.

PubMed

Kotirum, Surachai; Vutipongsatorn, Naaon; Kongpakwattana, Khachen; Hutubessy, Raymond; Chaiyakunapruk, Nathorn

2017-06-08

World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted. We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs. 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings. Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

PubMed Central

Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2015-01-01

Objectives Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. PMID:26683885

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries.

PubMed

Burnett, Susan; Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2016-04-01

Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. © The Author(s) 2015.

TED-Time and life saving External Defibrillator for home-use.

PubMed

Weiss, Teddy A; Rosenheck, Shimon; Gorni, Shraga; Katz, Ioni; Mendelbaum, Mendel; Gilon, Dan

2014-06-01

Sudden Cardiac Death--SCD --is a major unmet health problem that needs urgent and prompt solution. AICDs are very expensive, risky and indicated for a small group of patients, at the highest risk. AEDs--Automatic External Defibrillators--are designed for public places and although safe, cannot enter the home-market due to their cost and need for constant, high-cost maintenance. We developed TED, a low-cost AED that derives its energy off the mains, designed for home-use, to save SCD victims' lives. Copyright © 2014 Elsevier Inc. All rights reserved.

Expanding Private Production of Defense Services,

DTIC Science & Technology

1996-01-01

the commercial firms that typi- cally come to mind as characteristic of entrepreneurial enterprise. Which bundle offers the most effective unity of... The second step toward expanded outsourcing is to identify the ac- tivities that are most cost- effective to outsource. A review of the empirical...workload between internal and external sources when the following circumstances apply: (1) an external source looks more cost- effective , but an

Expressing air pollution-induced health-related externalities in physical terms with the help of DALYs.

PubMed

Bachmann, Till M; van der Kamp, Jonathan

2017-06-01

The unintended impacts of industrial activity on human health and the environment have regularly been assessed and monetised (referred to as "external costs"). External costs are, however, a rather abstract aggregate so that decision makers cannot easily relate them to tangible impacts. At the same time, physical health impact indicators have different units that cannot readily be compared and communicated in a joint way. To support better informed decisions at policy or company level, we propose and demonstrate a way to facilitate communication on non-monetized, that is, physical health indicators quantified in studies. The concept Disability-Adjusted Life Year (DALY) is chosen as metric due to its widespread use. We establish a comprehensive and consistent set of six health endpoints caused by particles and ozone, and derive related up-to-date DALYs. Further we apply the DALY values to a French smart grid demonstration project. Owing to its size, the gains in terms of reduced DALYs are however small. In contrast to external cost assessments, in the frame of which morbidity endpoints usually contribute to around 10-15%, they are found to be insubstantial in the overall DALY score (i.e. below 1%). This is because DALYs only consider time losses weighted by severity while external costs also factor in further welfare effects, i.e. combining resource, disutility and opportunity costs of illness. As a result, methodological limitations, mainly existing for the morbidity-related DALY values, appear to be less of concern. Overall, using the DALYs with and without morbidity impacts is justifiable. Either choice in the communication of health-related physical externalities induces the need to explain the limitations in terms of the treatment of morbidity endpoints (notably their definition and the disability weights used) or their complete disregard. Copyright © 2017 Elsevier Ltd. All rights reserved.

Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?

PubMed

Petrovic, Milos; Deschamps, Kevin; Verschueren, Sabine M; Bowling, Frank L; Maganaris, Constantinos N; Boulton, Andrew J M; Reeves, Neil D

2017-09-01

Diabetes patients display gait alterations compared to controls including a higher metabolic cost of walking. This study aimed to investigate whether differences in external moment arm (ExtMA) and effective mechanical advantage (EMA) at the ankle in diabetes patients could partly explain the increased cost of walking compared to controls. Thirty one non-diabetic controls (Ctrl); 22 diabetes patients without peripheral neuropathy (DM) and 14 patients with moderate/severe diabetic peripheral neuropathy (DPN) underwent gait analysis using a motion analysis system and force plates. The internal Achilles tendon moment arm length was determined using magnetic resonance imaging during weight-bearing and ExtMA was calculated using gait analysis. A greater value (P<0.01) for the EMA at the ankle was found in the DPN (0.488) and DM (0.46) groups compared to Ctrl (0.448). The increased EMA was mainly caused by a smaller ExtMA in the DPN (9.63cm; P<0.01) and DM (10.31cm) groups compared to Ctrl (10.42cm) These findings indicate that the ankle plantarflexor muscles would need to generate lower forces to overcome the external resistance during walking compared to controls. Our findings do not explain the previously observedhigher metabolic cost of walking in the DM and DPN groups, but uncover a new mechanism through which patients with diabetes and particularly those with DPN reduce the joint moment at the ankle during walking: by applying the ground reaction force more proximally on the foot, or at an angle directed more towards the ankle, thereby increasing the EMA and reducing the ankle joint moment. Copyright © 2017. Published by Elsevier B.V.

A cost analysis of reusable and disposable flexible optical scopes for intubation.

PubMed

Tvede, M F; Kristensen, M S; Nyhus-Andreasen, M

2012-05-01

Intubation using a flexible optical scope (FOS) is a cornerstone technique for managing the predicted and unpredicted difficult airway. The term FOS covers both fibre-optic scopes and videoscopes. The total costs of using flexible scopes for intubation are unknown. The recent introduction of a disposable flexible scope for intubation merits closer scrutiny of the total costs associated with both modalities. The costs incurred during intubations using FOSs at a large anaesthesia department were identified, and a series of intubations using a disposable scope were analyzed for comparison. Recognized health-economic methodology was applied. During a 1-year period, 360 FOS intubations were performed. In this clinical setting, the average cost of an intubation using a reusable FOS was €177.7. When using the disposable Ambu(®) aScope (Ambu A/S, Ballerup, Denmark), the cost was €204.4. The break-even point, i.e. the number of intubations per month where the cost of using disposable and non-disposable equipment is identical, was 22.5/month. A subgroup analysis looking solely at intubations performed with flexible videoscopes revealed that the cost per intubation was equal for disposable and reusable videoscopes. At our institution, the total cost of an intubation is greater when using disposable compared with reusable equipment (€204.4 vs. €177.7). If video equipment with an external monitor is considered mandatory, the expenses are of equal magnitude. The cost analysis is particularly sensitive to the actual number of flexible optic intubations performed; with fewer intubations, the total cost will begin to favour disposable equipment. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure.

PubMed

Reed, Shelby D; Neilson, Matthew P; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H; Polsky, Daniel E; Graham, Felicia L; Bowers, Margaret T; Paul, Sara C; Granger, Bradi B; Schulman, Kevin A; Whellan, David J; Riegel, Barbara; Levy, Wayne C

2015-11-01

Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying Seattle Heart Failure Model scores. The model can be used to evaluate parallel-group and single-cohort study designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. The Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

High-resolution modelling of health impacts and related external cost from air pollution over 36 years using the integrated model system EVA

NASA Astrophysics Data System (ADS)

Brandt, Jørgen; Andersen, Mikael S.; Bønløkke, Jakob; Christensen, Jesper H.; Geels, Camilla; Hansen, Kaj M.; Hertel, Ole; Im, Ulas; Jensen, Steen S.; Ketzel, Matthias; Nielsen, Ole-Kenneth; Plejdrup, Marlene S.; Sigsgaard, Torben

2016-04-01

A high-resolution assessment of health impacts from air pollution and related external cost has been conducted for Denmark using the integrated EVA model system. The EVA system is based on the impact-pathway methodology, where the site-specific emissions will result, via atmospheric transport and chemistry, in a concentration distribution, which together with detailed population data, is used to estimate the population-level exposure. Using exposure-response functions and economic valuations, the exposure is transformed into impacts on human health and related external costs. In this study we have used a coupling of two chemistry transport models to calculate the air pollution concentration at different domain and scales; the Danish Eulerian Hemispheric Model (DEHM) to calculate the air pollution levels in the Northern Hemisphere with a resolution down to 5.6 km x 5.6 km and the Urban Background Model (UBM) to further calculate the air pollution in Denmark at 1 km x 1 km resolution using results from DEHM as boundary conditions. Both the emission data as well as the population density has been represented in the model system with the same high resolution. Previous health impact assessments related to air pollution have been made on a lower resolution. In this study, the integrated model system, EVA, has been used to estimate the health impacts and related external cost for Denmark at a 1 km x 1 km resolution. New developments of the integrated model system will be presented as well as the development of health impacts and related external costs in Europe and Denmark over a period of 36 years (1979-2014). Acknowledgements This work was funded by: DCE - National Centre for Environment and Energy. Project: "Health impacts and external costs from air pollution in Denmark over 25 years" and NordForsk under the Nordic Programme on Health and Welfare. Project: "Understanding the link between air pollution and distribution of related health impacts and welfare in the Nordic countries (NordicWelfAir)".

Determination and Applications of Environmental Costs at Different Sized Airports: Aircraft Noise and Engine Emissions

NASA Technical Reports Server (NTRS)

Lu, Cherie; Lierens, Abigail

2003-01-01

With the increasing trend of charging for externalities and the aim of encouraging the sustainable development of the air transport industry, there is a need to evaluate the social costs of these undesirable side effects, mainly aircraft noise and engine emissions, for different airports. The aircraft noise and engine emissions social costs are calculated in monetary terms for five different airports, ranging from hub airports to small regional airports. The number of residences within different levels of airport noise contours and the aircraft noise classifications are the main determinants for accessing aircraft noise social costs. Whist, based on the damages of different engine pollutants on the human health, vegetation, materials, aquatic ecosystem and climate, the aircraft engine emissions social costs vary from engine types to aircraft categories. The results indicate that the relationship appears to be curvilinear between environmental costs and the traffic volume of an airport. The results and methodology of environmental cost calculation could input for to the proposed European wide harmonized noise charges as well as the social cost benefit analysis of airports.

Environmental damage costs from airborne pollution of industrial activities in the greater Athens, Greece area and the resulting benefits from the introduction of BAT

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

Mirasgedis, S.; Hontou, V.; Georgopoulou, E.

2008-01-15

Attributing costs to the environmental impacts associated with industrial activities can greatly assist in protecting human health and the natural environment as monetary values are capable of directly influencing technological and policy decisions without changing the rules of the market. This paper attempts to estimate the external cost attributable to the atmospheric pollution from 'medium and high environmental burden' industrial activities located in the greater Athens area and the benefits from Best Available Techniques (BAT) introduction. To this end a number of typical installations were defined to be used in conjunction with the Impact Pathway Approach developed in the contextmore » of the ExternE project to model all industrial sectors/sub-sectors located in the area of interest. Total environmental externalities due to air pollutants emitted by these industrial activities were found to reach 211 M Euro per year, associated mainly with human mortality and morbidity due to PM{sub 10} emissions, as well as with climate change impacts due to CO{sub 2} emissions for which non-metallic minerals and oil processing industries are the main sources. The results obtained can be used as the basis for an integrated evaluation of potential BAT, taking into account not only private costs and benefits but also the environmental externalities, thus leading to policy decisions that maximize social welfare in each industrial sector/sub-sector.« less

Cost Analysis of Roof-Only Air Sealing and Insulation Strategies on 1 1/2-Story Homes in Cold Climates

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

Ojczyk, C.

The External Thermal and Moisture Management System (ETMMS), typically seen in deep energy retrofits, is a valuable approach for the roof-only portions of existing homes, particularly the 1 ½-story home. It is effective in reducing energy loss through the building envelope, improving building durability, reducing ice dams, and providing opportunities to improve occupant comfort and health.

Cost Analysis of Roof-Only Air Sealing and Insulation Strategies on 1 1/2-Story Homes in Cold Climates

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

Ojczyk, C.

The External Thermal and Moisture Management System (ETMMS), typically seen in deep energy retrofits, is a valuable approach for the roof-only portions of existing homes, particularly the 1 1/2-story home. It is effective in reducing energy loss through the building envelope, improving building durability, reducing ice dams, and providing opportunities to improve occupant comfort and health.

A Cost Analysis Model for Army Sponsored Graduate Dental Education Programs.

DTIC Science & Technology

1997-04-01

characteristics of a good measurement tool ? Cooper and Emory in their textbook, Business Research Methods, state there are three major criteria for evaluating...a measurement tool : validity, reliability, and practicality (Cooper and Emory 1995). Validity can be compartmentalized into internal and external...tremendous expense? The AEGD-1 year program is used extensively as a recruiting tool to encourage senior dental students to join the Army Dental Corps. The

Automotive Stirling reference engine design report

NASA Technical Reports Server (NTRS)

1981-01-01

The reference Stirling engine system is described which provides the best possible fuel economy while meeting or exceeding all other program objectives. The system was designed to meet the requirements of a 1984 Pontiac Phoenix (X-body). This design utilizes all new technology that can reasonably be expected to be developed by 1984 and that is judged to provide significant improvement, relative to development risk and cost. Topics covered include: (1) external heat system; (2) hot engine system; (3) cold engine system; (4) engine drive system; (5) power control system and auxiliaries; (6) engine instalation; (7) optimization and vehicle simulation; (8) engine materials; and (9) production cost analysis.

Robust and efficient anomaly detection using heterogeneous representations

NASA Astrophysics Data System (ADS)

Hu, Xing; Hu, Shiqiang; Xie, Jinhua; Zheng, Shiyou

2015-05-01

Various approaches have been proposed for video anomaly detection. Yet these approaches typically suffer from one or more limitations: they often characterize the pattern using its internal information, but ignore its external relationship which is important for local anomaly detection. Moreover, the high-dimensionality and the lack of robustness of pattern representation may lead to problems, including overfitting, increased computational cost and memory requirements, and high false alarm rate. We propose a video anomaly detection framework which relies on a heterogeneous representation to account for both the pattern's internal information and external relationship. The internal information is characterized by slow features learned by slow feature analysis from low-level representations, and the external relationship is characterized by the spatial contextual distances. The heterogeneous representation is compact, robust, efficient, and discriminative for anomaly detection. Moreover, both the pattern's internal information and external relationship can be taken into account in the proposed framework. Extensive experiments demonstrate the robustness and efficiency of our approach by comparison with the state-of-the-art approaches on the widely used benchmark datasets.

Space Operations Center system analysis study extension. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1982-01-01

The analysis fo Space Operations Center (SOC) systems is summarized. Design considerations, configurations of the manned orbital space station, planned operational and research missions, and subsystem tradeoffs are considered. Integration into the space transportation system is discussed. A modular design concept permitting growth of the SOC as its functions are expanded is described. Additional considerations are special requirements for habitat modules, design modifications needed to operate in geosynchronous orbits, and use of the external tank for cryogenic propellant storage or as a pressurized hangar. A cost summary is presented.

Anesthetic management of external cephalic version.

PubMed

Chalifoux, Laurie A; Sullivan, John T

2013-09-01

Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery. Copyright © 2013 Elsevier Inc. All rights reserved.

Cost-effectiveness of supported employment adapted for people with affective disorders.

PubMed

Saha, Sanjib; Bejerholm, Ulrika; Gerdtham, Ulf-G; Jarl, Johan

2018-04-01

The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.

Nottingham Health Science Biobank: a sustainable bioresource.

PubMed

Matharoo-Ball, Balwir; Thomson, Brian J

2014-10-01

Nottingham Health Science Biobank (NHSB) was established in 2011 by a 3-year "pump priming" grant from the United Kingdom National Institute of Health Research. Before biobanking operations began, NHSB commissioned a financial report on the full costs of biobanking and worked with key stakeholders and external consultants to develop a business plan with the aim of achieving financial and operational sustainability. The plan included: scanning published information, telephone interviews with commercial companies, Freedom of Information Requests, dialogue with prospective customers, and a market analysis of global trends in the use of human tissue samples in research. Our financial report provided a comprehensive and structured costing template for biobanking and confirmed the absolute requirement to ensure cost-efficient processes, careful staff utilization, and maximization of sample turnover. Together with our external consultants, we developed a business model responsive to global interest in healthcare founded on i) identification of key therapeutic areas that mapped to the strengths of the NHSB; ii) a systematic approach to identifying companies operating in these therapy areas; iii) engagement with noncommercial stakeholders to agree strategically aligned sample collection with the aim of ensuring the value of our tissue resource. By adopting this systematic approach to business modelling, the NHSB has achieved sustainability after less than 3 years of operation.

Computational techniques for design optimization of thermal protection systems for the space shuttle vehicle. Volume 1: Final report

NASA Technical Reports Server (NTRS)

1971-01-01

Computational techniques were developed and assimilated for the design optimization. The resulting computer program was then used to perform initial optimization and sensitivity studies on a typical thermal protection system (TPS) to demonstrate its application to the space shuttle TPS design. The program was developed in Fortran IV for the CDC 6400 but was subsequently converted to the Fortran V language to be used on the Univac 1108. The program allows for improvement and update of the performance prediction techniques. The program logic involves subroutines which handle the following basic functions: (1) a driver which calls for input, output, and communication between program and user and between the subroutines themselves; (2) thermodynamic analysis; (3) thermal stress analysis; (4) acoustic fatigue analysis; and (5) weights/cost analysis. In addition, a system total cost is predicted based on system weight and historical cost data of similar systems. Two basic types of input are provided, both of which are based on trajectory data. These are vehicle attitude (altitude, velocity, and angles of attack and sideslip), for external heat and pressure loads calculation, and heating rates and pressure loads as a function of time.

The application of a low-cost 3D depth camera for patient set-up and respiratory motion management in radiotherapy

NASA Astrophysics Data System (ADS)

Tahavori, Fatemeh

Respiratory motion induces uncertainty in External Beam Radiotherapy (EBRT), which can result in sub-optimal dose delivery to the target tissue and unwanted dose to normal tissue. The conventional approach to managing patient respiratory motion for EBRT within the area of abdominal-thoracic cancer is through the use of internal radiological imaging methods (e.g. Megavoltage imaging or Cone-Beam Computed Tomography) or via surrogate estimates of tumour position using external markers placed on the patient chest. This latter method uses tracking with video-based techniques, and relies on an assumed correlation or mathematical model, between the external surrogate signal and the internal target position. The marker's trajectory can be used in both respiratory gating techniques and real-time tracking methods. Internal radiological imaging methods bring with them limited temporal resolution, and additional radiation burden, which can be addressed by external marker-based methods that carry no such issues. Moreover, by including multiple external markers and placing them closer to the internal target organs, the effciency of correlation algorithms can be increased. However, the quality of such external monitoring methods is underpinned by the performance of the associated correlation model. Therefore, several new approaches to correlation modelling have been developed as part of this thesis and compared using publicly-available datasets. Highly competitive results have been obtained when compared against state-of-the-art methods. Marker-based methods also have the disadvantages of requiring manual set-up time for marker placement and patient positioning and potential issues with reproducibility of marker placement. This motivates the investigation of non-contact marker-free methods for use in EBRT, which is the main topic of this thesis. The Microsoft Kinect is used as an example of a low-cost consumer grade 3D depth camera for capturing and analysing external respiratory motion. This thesis makes the first presentation of detailed studies of external respiratory motion captured using such low-cost technology and demonstrates its potential in a healthcare environment. Firstly, the fundamental performance of a range of Microsoft Kinect sensors is assessed for use in radiotherapy (and potentially other healthcare applications), in terms of static and dynamic performance using both phantoms and volunteers. Then external respiratory motion is captured using the above technology from a group of 32 healthy volunteers and Principal Component Analysis (PCA) is applied to a region of interest encompassing the complete anterior surface to demonstrate breathing style. This work demonstrates that this surface motion can be compactly described by the first two PCA eigenvectors. The reproducibility of subject-specific EBRT set-up using conventional laser-based alignment and marker-based Deep Inspiration Breath Hold (DIBH) methods are also studied using the Microsoft Kinect sensor. A cohort of five healthy female volunteers is repeatedly set-up for left-sided breast cancer EBRT and multiple DIBH episodes captured over five separate sessions representing multiple fractionated radiotherapy treatment sessions, but without dose delivery. This provided an independent assessment that subjects were set-up and generally achieved variations within currently accepted margins of clinical practice. Moreover, this work demonstrated the potential role of consumer-grade 3D depth camera technology as a possible replacement for marker based set-up and DIBH management procedures. This brings with it the additional benefits of low cost, and potential through-put benefits, as patient set-up could ultimately be fully automated with this technology, and DIBH could be independently monitored without requiring preparatory manual intervention.

Room temperature stretch forming of scale space shuttle external tank dome gores. Volume 1: Technical

NASA Technical Reports Server (NTRS)

Blunck, R. D.; Krantz, D. E.

1974-01-01

An account of activities and data gathered in the Room Temperature Stretch Forming of One-third Scale External Tank Bulkhead Gores for space shuttle study, and a tooling design and production cost study are reported. The following study phases are described: (1) the stretch forming of three approximately one-third scale external tank dome gores from single sheets of 2219-T37 aluminum alloy; (2) the designing of a full scale production die, including a determination of tooling requirements; and (3) the determination of cost per gore at the required production rates, including manufacturing, packaging, and shipping.

Commercial Aircraft Maintenance Experience Relating to Engine External Hardware

NASA Technical Reports Server (NTRS)

Soditus, Sharon M.

2006-01-01

Airlines are extremely sensitive to the amount of dollars spent on maintaining the external engine hardware in the field. Analysis reveals that many problems revolve around a central issue, reliability. Fuel and oil leakage due to seal failure and electrical fault messages due to wire harness failures play a major role in aircraft delays and cancellations (D&C's) and scheduled maintenance. Correcting these items on the line requires a large investment of engineering resources and manpower after the fact. The smartest and most cost effective philosophy is to build the best hardware the first time. The only way to do that is to completely understand and model the operating environment, study the field experience of similar designs and to perform extensive testing.

Cost-effectiveness of external cephalic version for term breech presentation.

PubMed

Tan, Jonathan M; Macario, Alex; Carvalho, Brendan; Druzin, Maurice L; El-Sayed, Yasser Y

2010-01-21

External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness. The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean. From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.

Trade-off between speed and cost in shortcuts to adiabaticity

NASA Astrophysics Data System (ADS)

Campbell, Steve

Recent years have witnessed a surge of interest in the study of thermal nano-machines that are capable of converting disordered forms of energy into useful work. It has been shown for both classical and quantum systems that external drivings can allow a system to evolve adiabatically even when driven in finite time, a technique commonly known as shortcuts to adiabaticity. It was suggested to use such external drivings to render the unitary processes of a thermodynamic cycle quantum adiabatic, while being performed in finite time. However, implementing an additional external driving requires resources that should be accounted for. Furthermore, and in line with natural intuition, these transformations should not be achievable in arbitrarily short times. First, we will present a computable measure of the cost of a shortcut to adiabaticity. Using this, we then examine the speed with which a quantum system can be driven. As a main result, we will establish a rigorous link between this speed, the quantum speed limit, and the (energetic) cost of implementing such a shortcut to adiabaticity. Interestingly, this link elucidates a trade-off between speed and cost, namely that instantaneous manipulation is impossible as it requires an infinite cost.

A beamline systems model for Accelerator-Driven Transmutation Technology (ADTT) facilities

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

Todd, A.M.M.; Paulson, C.C.; Peacock, M.A.

1995-10-01

A beamline systems code, that is being developed for Accelerator-Driven Transmutation Technology (ADTT) facility trade studies, is described. The overall program is a joint Grumman, G.H. Gillespie Associates (GHGA) and Los Alamos National Laboratory effort. The GHGA Accelerator Systems Model (ASM) has been adopted as the framework on which this effort is based. Relevant accelerator and beam transport models from earlier Grumman systems codes are being adapted to this framework. Preliminary physics and engineering models for each ADTT beamline component have been constructed. Examples noted include a Bridge Coupled Drift Tube Linac (BCDTL) and the accelerator thermal system. A decisionmore » has been made to confine the ASM framework principally to beamline modeling, while detailed target/blanket, balance-of-plant and facility costing analysis will be performed externally. An interfacing external balance-of-plant and facility costing model, which will permit the performance of iterative facility trade studies, is under separate development. An ABC (Accelerator Based Conversion) example is used to highlight the present models and capabilities.« less

A beamline systems model for Accelerator-Driven Transmutation Technology (ADTT) facilities

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

Todd, Alan M. M.; Paulson, C. C.; Peacock, M. A.

1995-09-15

A beamline systems code, that is being developed for Accelerator-Driven Transmutation Technology (ADTT) facility trade studies, is described. The overall program is a joint Grumman, G. H. Gillespie Associates (GHGA) and Los Alamos National Laboratory effort. The GHGA Accelerator Systems Model (ASM) has been adopted as the framework on which this effort is based. Relevant accelerator and beam transport models from earlier Grumman systems codes are being adapted to this framework. Preliminary physics and engineering models for each ADTT beamline component have been constructed. Examples noted include a Bridge Coupled Drift Tube Linac (BCDTL) and the accelerator thermal system. Amore » decision has been made to confine the ASM framework principally to beamline modeling, while detailed target/blanket, balance-of-plant and facility costing analysis will be performed externally. An interfacing external balance-of-plant and facility costing model, which will permit the performance of iterative facility trade studies, is under separate development. An ABC (Accelerator Based Conversion) example is used to highlight the present models and capabilities.« less

Full cost accounting for the life cycle of coal.

PubMed

Epstein, Paul R; Buonocore, Jonathan J; Eckerle, Kevin; Hendryx, Michael; Stout Iii, Benjamin M; Heinberg, Richard; Clapp, Richard W; May, Beverly; Reinhart, Nancy L; Ahern, Melissa M; Doshi, Samir K; Glustrom, Leslie

2011-02-01

Each stage in the life cycle of coal-extraction, transport, processing, and combustion-generates a waste stream and carries multiple hazards for health and the environment. These costs are external to the coal industry and are thus often considered "externalities." We estimate that the life cycle effects of coal and the waste stream generated are costing the U.S. public a third to over one-half of a trillion dollars annually. Many of these so-called externalities are, moreover, cumulative. Accounting for the damages conservatively doubles to triples the price of electricity from coal per kWh generated, making wind, solar, and other forms of nonfossil fuel power generation, along with investments in efficiency and electricity conservation methods, economically competitive. We focus on Appalachia, though coal is mined in other regions of the United States and is burned throughout the world. © 2011 New York Academy of Sciences.

Capital Costs: A Conceptual Framework for Colleges and Universities

ERIC Educational Resources Information Center

Cash, Samuel G.

2004-01-01

The increased attention to costs in recent years at colleges and universities draws attention to the matter of whether all costs are reflected and accounted for in the institution's internal and external financial reports. One category--capital costs--is thought by some to be overlooked at times. The possible neglect of capital costs in…

Selling In-House Training Outside.

ERIC Educational Resources Information Center

Hequet, Marc

1991-01-01

Questions to consider before marketing in-house training externally include (1) balancing internal and external clients, accounting for costs, being concerned about proprietary information, finding the right niche, and determining whether profitability is a goal. (SK)

The Application of Cost/Benefit Analysis in the Development of Voluntary Standards

DTIC Science & Technology

1986-07-01

to which it is accepted and used without external pressures . 0. RECENT EFFORTS A significant modification to the voluntary standards mechanism...voluntary system. The organizations chosen for study are SAE, ASTM, and ANSI. Although they represent three of the largest and most influencial groups ... group technically competent to deal with problems covered and do not represent an industry trade position. . . . Over the years, the extensive use of SAE

Low-Cost Bio-Based Phase Change Materials as an Energy Storage Medium in Building Envelopes

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

Biswas, Kaushik; Abhari, Mr. Ramin; Shukla, Dr. Nitin

2015-01-01

A promising approach to increasing the energy efficiency of buildings is the implementation of phase change material (PCM) in building envelope systems. Several studies have reported the energy saving potential of PCM in building envelopes. However, wide application of PCMs in building applications has been inhibited, in part, by their high cost. This article describes a novel paraffin product made of naturally occurring fatty acids/glycerides trapped into high density polyethylene (HDPE) pellets and its performance in a building envelope application, with the ultimate goal of commercializing a low-cost PCM platform. The low-cost PCM pellets were mixed with cellulose insulation, installedmore » in external walls and field-tested under natural weatherization conditions for a period of several months. In addition, several PCM samples and PCM-cellulose samples were prepared under controlled conditions for laboratory-scale testing. The laboratory tests were performed to determine the phase change properties of PCM-enhanced cellulose insulation both at microscopic and macroscopic levels. This article presents the data and analysis from the exterior test wall and the laboratory-scale test data. PCM behavior is influenced by the weather and interior conditions, PCM phase change temperature and PCM distribution within the wall cavity, among other factors. Under optimal conditions, the field data showed up to 20% reduction in weekly heat transfer through an external wall due to the PCM compared to cellulose-only insulation.« less

Research and Development Strategies in the Semiconductor Industry

NASA Astrophysics Data System (ADS)

Bowling, Allen

2003-03-01

In the 21st Century semiconductor industry, there is a critical balance between internally funded semiconductor research and development (R) and externally funded R. External R may include jointly-funded research collaborations/partnerships with other device manufacturers, jointly-funded consortia-based R, and individually-funded research programs at universities and other contract research locations. Each of these approaches has merits and each has costs. There is a critical balance between keeping the internal research and development pipeline filled and keeping it from being overspent. To meet both competitive schedule and cost goals, a semiconductor device manufacturer must decide on a model for selection of internal versus external R. Today, one of the most critical decisions is whether or not to do semiconductor research and development on 300 mm silicon wafers. Equipment suppliers are doing first development on 300 mm equipment. So, for the device manufacturer, there is a balance between the cost of doing development on 300 mm wafers and the development time schedule driven by equipment availability. In the face of these cost and schedule elements, device manufacturers are looking to consortia such as SEMATECH, SRC, and SRC MARCO for early development and screening of new materials and device structure approaches. This also causes much more close development collaboration between device manufacturer and equipment supplier. Many device manufacturers are also making use of direct contract research with universities and other contract-research organizations, such as IMEC, LETI, and other government-funded research organizations around the world. To get the most out of these external research interactions, the company must develop a strategy for management and technology integration of external R.

Uncertainty and sensitivity analysis of control strategies using the benchmark simulation model No1 (BSM1).

PubMed

Flores-Alsina, Xavier; Rodriguez-Roda, Ignasi; Sin, Gürkan; Gernaey, Krist V

2009-01-01

The objective of this paper is to perform an uncertainty and sensitivity analysis of the predictions of the Benchmark Simulation Model (BSM) No. 1, when comparing four activated sludge control strategies. The Monte Carlo simulation technique is used to evaluate the uncertainty in the BSM1 predictions, considering the ASM1 bio-kinetic parameters and influent fractions as input uncertainties while the Effluent Quality Index (EQI) and the Operating Cost Index (OCI) are focused on as model outputs. The resulting Monte Carlo simulations are presented using descriptive statistics indicating the degree of uncertainty in the predicted EQI and OCI. Next, the Standard Regression Coefficients (SRC) method is used for sensitivity analysis to identify which input parameters influence the uncertainty in the EQI predictions the most. The results show that control strategies including an ammonium (S(NH)) controller reduce uncertainty in both overall pollution removal and effluent total Kjeldahl nitrogen. Also, control strategies with an external carbon source reduce the effluent nitrate (S(NO)) uncertainty increasing both their economical cost and variability as a trade-off. Finally, the maximum specific autotrophic growth rate (micro(A)) causes most of the variance in the effluent for all the evaluated control strategies. The influence of denitrification related parameters, e.g. eta(g) (anoxic growth rate correction factor) and eta(h) (anoxic hydrolysis rate correction factor), becomes less important when a S(NO) controller manipulating an external carbon source addition is implemented.

Cost analysis of one of the first outpatient wound clinics in the Netherlands.

PubMed

Rondas, A A L M; Schols, J M G; Halfens, R J G; Hull, H R; Stobberingh, E E; Evers, S M A A

2015-09-01

To perform, from an insurance perspective, a cost analysis of one of the outpatient community wound care clinics in the Netherlands, the Knowledge Centre in Wound Care (KCWC) at Venray. This study involved a cost analysis based on an observational cohort study with a one-year pre-admission and a one-year post-admission comparison of costs. Patients were included when they first consulted the outpatient wound care clinic. Participants were all insured by the same health insurance company, Coöperatie Volksgezondheidszorg (VGZ). A standard six-step procedure for performing cost studies was used to calculate the costs. Given the skewed cost data, non-parametric bootstrapping was used to test for statistical differences. There were 172 patients included in this study. The difference in costs related to wound care between the year before and the year after initial admission to the wound clinic amounted to an average reduction of €2621 (£1873) per patient in the base case analysis. The categories 'general practitioner', 'hospital care', 'mental health care' and 'transport' scored lower, indicating lower costs, in the year after admission to the wound clinic. In this study, only the reimbursement data of patients of one health insurance company, and specifically only those made under the 2006 Dutch Health Insurance Act, were available. Because of the observational design, definitive conclusions cannot be made regarding a demonstrated reduction of costs in the year post admission. Nevertheless, this study is a first attempt of a cost analysis of an equipped outpatient wound clinic as an innovative way of responding to the increasing number of chronic wounds in the Netherlands. The calculations show that savings in wound care are possible. A possible conflict of interest should be mentioned. First author AALM Rondas, PhD student at Maastricht University, is working at the KCWC wound clinic at Venray in the Netherlands as a physician. However, the research data were provided externally by Coöperatie Volksgezondheidszorg (VGZ) and checked by the academic co-authors, none of whom have a conflict of interest. The authors have no financial or commercial interest to declare.

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

NASA Technical Reports Server (NTRS)

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

2013-01-01

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

Mission analysis of photovoltaic solar energy systems. Quarterly progress report, 1 March 1976-31 May 1976

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

Leonard, S.L.; Munjal, P.K.; Rattin, E.J.

1976-06-01

The main emphasis of the activity during the second quarter of this project continued to be on Task 1, Analysis of Near-Term Missions, and on Task 2, Analysis of Major Mid-Term Missions. In addition, considerable progress was also made on Task 6, Comparison of the True Societal Costs of Conventional and Photovoltaic Power Production, and starts were made on Task 3, Review and Updating of the ERDA Technology Implementation Plan, and Task 4, Critical External Issues. As was planned, work on Task 5, Impact of Incentives, was deferred to the second half of the program. Progress is reported. (WHK)

The strategic significance of negative externalities.

DOT National Transportation Integrated Search

2012-12-01

Negative externalities have competitive relevance in a market when they have selective impacts as, for : example, when a product in use imposes greater costs on consumers of rival products than on other people. : Because managers have discretion ...

Architectural Considerations of Fiber-Radio Millimeter-Wave Wireless Access Systems

NASA Astrophysics Data System (ADS)

Kitayama, Ken-Ichi

The architecture of fiber-radio mm-wave wireless access systems critically depends upon the optical mm-wave generation and transport techniques. Four optical mm-wave generation and transport techniques: 1) optical self-heterodyning, 2) external modulation, 3) up- and downconversion, and 4) optical transceiver, will be assessed. From the technical viewpoints, their advantages and disadvantages are discussed. The economical assessment, focusing on the cost of a base station BS ( ), will suggest that the optical transceiver looks the most promising in the long run, but in the near future, however, the external modulation will be cost-effective. The experimental results of 60 GHz testbeds using the external modulation will support the conclusion.

Satellite Power System (SPS): an Overview of Prospective Organizational Structures in the Solar Satellite Field

NASA Technical Reports Server (NTRS)

Edler, H. G.

1978-01-01

A literature survey, interviews with acknowledged experts in the fields of organizational entities, space, solar energy, and the SPS concept, and an analysis of these inputs to identify the organizational alternatives and make judgments as to their feasibility to serve as patterns for a future SPS entity are presented. Selection and evaluation criteria were determined to include timeliness, reliability, and adequacy to contribute meaningfully to the U.S. supply; political feasibility (both national and international) and cost-effectiveness (including environmental and other external costs). Based on these criteria, four organizational alternatives are discussed which offer reasonable promise as potential options for SPS. These included three domestic alternatives and one international alternative.

The economics of alcohol abuse and alcohol-control policies.

PubMed

Cook, Philip J; Moore, Michael J

2002-01-01

Economic research has contributed to the evaluation of alcohol policy through empirical analysis of the effects of alcohol-control measures on alcohol consumption and its consequences. It has also provided an accounting framework for defining and comparing costs and benefits of alcohol consumption and related policy interventions, including excise taxes. The most important finding from the economics literature is that consumers tend to drink less ethanol, and have fewer alcohol-related problems, when alcoholic beverage prices are increased or alcohol availability is restricted. That set of findings is relevant for policy purposes because alcohol abuse imposes large "external" costs on others. Important challenges remain, including developing a better understanding of the effects of drinking on labor-market productivity.

Regression analysis on the variation in efficiency frontiers for prevention stage of HIV/AIDS.

PubMed

Kamae, Maki S; Kamae, Isao; Cohen, Joshua T; Neumann, Peter J

2011-01-01

To investigate how the cost effectiveness of preventing HIV/AIDS varies across possible efficiency frontiers (EFs) by taking into account potentially relevant external factors, such as prevention stage, and how the EFs can be characterized using regression analysis given uncertainty of the QALY-cost estimates. We reviewed cost-effectiveness estimates for the prevention and treatment of HIV/AIDS published from 2002-2007 and catalogued in the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry. We constructed efficiency frontier (EF) curves by plotting QALYs against costs, using methods used by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany. We stratified the QALY-cost ratios by prevention stage, country of study, and payer perspective, and estimated EF equations using log and square-root models. A total of 53 QALY-cost ratios were identified for HIV/AIDS in the Tufts CEA Registry. Plotted ratios stratified by prevention stage were visually grouped into a cluster consisting of primary/secondary prevention measures and a cluster consisting of tertiary measures. Correlation coefficients for each cluster were statistically significant. For each cluster, we derived two EF equations - one based on the log model, and one based on the square-root model. Our findings indicate that stratification of HIV/AIDS interventions by prevention stage can yield distinct EFs, and that the correlation and regression analyses are useful for parametrically characterizing EF equations. Our study has certain limitations, such as the small number of included articles and the potential for study populations to be non-representative of countries of interest. Nonetheless, our approach could help develop a deeper appreciation of cost effectiveness beyond the deterministic approach developed by IQWiG.

Valuation of plug-in vehicle life-cycle air emissions and oil displacement benefits

PubMed Central

Michalek, Jeremy J.; Chester, Mikhail; Jaramillo, Paulina; Samaras, Constantine; Shiau, Ching-Shin Norman; Lave, Lester B.

2011-01-01

We assess the economic value of life-cycle air emissions and oil consumption from conventional vehicles, hybrid-electric vehicles (HEVs), plug-in hybrid-electric vehicles (PHEVs), and battery electric vehicles in the US. We find that plug-in vehicles may reduce or increase externality costs relative to grid-independent HEVs, depending largely on greenhouse gas and SO2 emissions produced during vehicle charging and battery manufacturing. However, even if future marginal damages from emissions of battery and electricity production drop dramatically, the damage reduction potential of plug-in vehicles remains small compared to ownership cost. As such, to offer a socially efficient approach to emissions and oil consumption reduction, lifetime cost of plug-in vehicles must be competitive with HEVs. Current subsidies intended to encourage sales of plug-in vehicles with large capacity battery packs exceed our externality estimates considerably, and taxes that optimally correct for externality damages would not close the gap in ownership cost. In contrast, HEVs and PHEVs with small battery packs reduce externality damages at low (or no) additional cost over their lifetime. Although large battery packs allow vehicles to travel longer distances using electricity instead of gasoline, large packs are more expensive, heavier, and more emissions intensive to produce, with lower utilization factors, greater charging infrastructure requirements, and life-cycle implications that are more sensitive to uncertain, time-sensitive, and location-specific factors. To reduce air emission and oil dependency impacts from passenger vehicles, strategies to promote adoption of HEVs and PHEVs with small battery packs offer more social benefits per dollar spent. PMID:21949359

Valuation of plug-in vehicle life-cycle air emissions and oil displacement benefits.

PubMed

Michalek, Jeremy J; Chester, Mikhail; Jaramillo, Paulina; Samaras, Constantine; Shiau, Ching-Shin Norman; Lave, Lester B

2011-10-04

We assess the economic value of life-cycle air emissions and oil consumption from conventional vehicles, hybrid-electric vehicles (HEVs), plug-in hybrid-electric vehicles (PHEVs), and battery electric vehicles in the US. We find that plug-in vehicles may reduce or increase externality costs relative to grid-independent HEVs, depending largely on greenhouse gas and SO(2) emissions produced during vehicle charging and battery manufacturing. However, even if future marginal damages from emissions of battery and electricity production drop dramatically, the damage reduction potential of plug-in vehicles remains small compared to ownership cost. As such, to offer a socially efficient approach to emissions and oil consumption reduction, lifetime cost of plug-in vehicles must be competitive with HEVs. Current subsidies intended to encourage sales of plug-in vehicles with large capacity battery packs exceed our externality estimates considerably, and taxes that optimally correct for externality damages would not close the gap in ownership cost. In contrast, HEVs and PHEVs with small battery packs reduce externality damages at low (or no) additional cost over their lifetime. Although large battery packs allow vehicles to travel longer distances using electricity instead of gasoline, large packs are more expensive, heavier, and more emissions intensive to produce, with lower utilization factors, greater charging infrastructure requirements, and life-cycle implications that are more sensitive to uncertain, time-sensitive, and location-specific factors. To reduce air emission and oil dependency impacts from passenger vehicles, strategies to promote adoption of HEVs and PHEVs with small battery packs offer more social benefits per dollar spent.

Valuing environmental health for informed policy-making.

PubMed

Máca, Vojtěch; Melichar, Jan; Ščasný, Milan; Kohlová, Markéta Braun

2017-03-01

Monetized environmental health impact assessments help to better evaluate the environmental burden of a wide range of economic activities. Apart from the limitations and uncertainties in physical and biological science used in such assessments, assumptions taken from economic valuation may also substantially influence subsequent policy-making considerations. This study attempts to demonstrate the impact of normative policy assumptions on quantified external costs using a case study of recently discussed variants of future coal mining and use of extracted coal in electricity and heat generation in the Czech Republic. A bottom-up impact-pathway approach is used for quantification of external costs. Several policy perspectives are elaborated for aggregating impacts that differ in geographic coverage and in how valuation of quantified impacts is adjusted in a particular perspective. We find that the fraction of monetized external impacts taken into policy-making considerations may vary according to choice of decision perspective up to a factor of 10. At present there are virtually no hard rules for defining geographical boundaries or adjusting values for a summation of monetized environmental impacts. We, however, stress that any rigorous external cost assessment should, for instance in a separate calculation, take account of impacts occurring beyond country borders.

Evaluation of Delivery Costs for External Beam Radiation Therapy and Brachytherapy for Locally Advanced Cervical Cancer Using Time-Driven Activity-Based Costing.

PubMed

Bauer-Nilsen, Kristine; Hill, Colin; Trifiletti, Daniel M; Libby, Bruce; Lash, Donna H; Lain, Melody; Christodoulou, Deborah; Hodge, Constance; Showalter, Timothy N

2018-01-01

To evaluate the delivery costs, using time-driven activity-based costing, and reimbursement for definitive radiation therapy for locally advanced cervical cancer. Process maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information, and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource and then calculated the total cost of patient care according to CCR and time for each resource. Costs were compared with 2016 Medicare reimbursement and relative value units (RVUs). The total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs constituting 49.8%. Brachytherapy cost $8610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). External beam radiation therapy cost $4055.01 (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and external beam radiation therapy delivery ($4798.73 vs $1404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with intensity modulated radiation therapy or 135.90 RVUs with 3-dimensional conformal radiation therapy, with total reimbursement of $23,321.71 and $16,071.90, respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3-dimensional conformal radiation therapy (1.63 minutes) or intensity modulated radiation therapy (1.32 minutes). Time-driven activity-based costing was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources constituted the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We hypothesize that the significant discrepancy between treatment costs and physician effort versus reimbursement may be a potential driver of reported national trends toward poor compliance with brachytherapy, and we suggest re-evaluation of payment policies to incentivize quality care. Copyright © 2017 Elsevier Inc. All rights reserved.

Building America Case Study: Cost Analysis of Roof-Only Air Sealing and Insulation Strategies on 1-1/2 Story Homes in Cold Climates, Minneapolis, MN (Fact Sheet)

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

Not Available

The External Thermal and Moisture Management System (ETMMS), typically seen in deep energy retrofits, is a valuable approach for the roof-only portions of existing homes, particularly the 1 1/2-story home. It is effective in reducing energy loss through the building envelope, improving building durability, reducing ice dams, and providing opportunities to improve occupant comfort and health.

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

28 CFR 100.15 - Disallowed costs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... limited to: (1) Accounting and Finance, External Relations, Human Resources, Information Management, Legal...) costs are disallowed. G&A costs include, but are not limited to, any management, financial, and other... include, but are not limited to, any Marketing, Sales, Product Management, and Advertising expenses. (c...

Game Theory and Risk-Based Levee System Design

NASA Astrophysics Data System (ADS)

Hui, R.; Lund, J. R.; Madani, K.

2014-12-01

Risk-based analysis has been developed for optimal levee design for economic efficiency. Along many rivers, two levees on opposite riverbanks act as a simple levee system. Being rational and self-interested, land owners on each river bank would tend to independently optimize their levees with risk-based analysis, resulting in a Pareto-inefficient levee system design from the social planner's perspective. Game theory is applied in this study to analyze decision making process in a simple levee system in which the land owners on each river bank develop their design strategies using risk-based economic optimization. For each land owner, the annual expected total cost includes expected annual damage cost and annualized construction cost. The non-cooperative Nash equilibrium is identified and compared to the social planner's optimal distribution of flood risk and damage cost throughout the system which results in the minimum total flood cost for the system. The social planner's optimal solution is not feasible without appropriate level of compensation for the transferred flood risk to guarantee and improve conditions for all parties. Therefore, cooperative game theory is then employed to develop an economically optimal design that can be implemented in practice. By examining the game in the reversible and irreversible decision making modes, the cost of decision making myopia is calculated to underline the significance of considering the externalities and evolution path of dynamic water resource problems for optimal decision making.

Life support technology investment strategies for flight programs: An application of decision analysis

NASA Technical Reports Server (NTRS)

Schlater, Nelson J.; Simonds, Charles H.; Ballin, Mark G.

1993-01-01

Applied research and technology development (R&TD) is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Given the increased awareness of limitations in resources, effective R&TD today needs a method for up-front assessment of competing technologies to help guide technology investment decisions. Such an assessment approach must account for uncertainties in system performance parameters, mission requirements and architectures, and internal and external events influencing a development program. The methodology known as decision analysis has the potential to address these issues. It was evaluated by performing a case study assessment of alternative carbon dioxide removal technologies for NASA"s proposed First Lunar Outpost program. An approach was developed that accounts for the uncertainties in each technology's cost and performance parameters as well as programmatic uncertainties such as mission architecture. Life cycle cost savings relative to a baseline, adjusted for the cost of money, was used as a figure of merit to evaluate each of the alternative carbon dioxide removal technology candidates. The methodology was found to provide a consistent decision-making strategy for the develpoment of new life support technology. The case study results provided insight that was not possible from more traditional analysis approaches.

Life support technology investment strategies for flight programs: An application of decision analysis

NASA Technical Reports Server (NTRS)

Schlater, Nelson J.; Simonds, Charles H.; Ballin, Mark G.

1993-01-01

Applied research and technology development (R&TD) is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Given the increased awareness of limitations in resources, effective R&TD today needs a method for up-front assessment of competing technologies to help guide technology investment decisions. Such an assessment approach must account for uncertainties in system performance parameters, mission requirements and architectures, and internal and external events influencing a development program. The methodology known as decision analysis has the potential to address these issues. It was evaluated by performing a case study assessment of alternative carbon dioxide removal technologies for NASA's proposed First Lunar Outpost program. An approach was developed that accounts for the uncertainties in each technology's cost and performance parameters as well as programmatic uncertainties such as mission architecture. Life cycle cost savings relative to a baseline, adjusted for the cost of money, was used as a figure of merit to evaluate each of the alternative carbon dioxide removal technology candidates. The methodology was found to provide a consistent decision-making strategy for development of new life support technology. The case study results provided insight that was not possible from more traditional analysis approaches.

Conceptual design study of 1985 commercial VTOL transports that utilize rotors

NASA Technical Reports Server (NTRS)

Kefford, N. F. K.; Munch, C. L.

1975-01-01

Conceptual design studies of pure and compound helicopter commercial short-haul transport aircraft for initial fabrication in 1980 were performed to determine their technical and economic feasibility. One-hundred-passenger configurations were optimized for minimum direct operating cost consistent with producibility and marketability, with emphasis on proper account of mass properties, performance and handling qualities adequacy, and suppression of internal and external noise. The effect of external noise constraints was assessed, in terms of gross weight and direct operating cost, for each aircraft.

NASAwide electronic publishing system: Electronic printing and duplicating, stage-2 evaluation report (GSFC)

NASA Technical Reports Server (NTRS)

Tuey, Richard C.; Lane, Robert; Hart, Susan V.

1995-01-01

The NASA Scientific and Technical Information Office was assigned the responsibility to continue with the expansion of the NASAwide networked electronic duplicating effort by including the Goddard Space Flight Center (GSFC) as an additional node to the existing configuration of networked electronic duplicating systems within NASA. The subject of this report is the evaluation of a networked electronic duplicating system which meets the duplicating requirements and expands electronic publishing capabilities without increasing current operating costs. This report continues the evaluation reported in 'NASA Electronic Publishing System - Electronic Printing and Duplicating Evaluation Report' (NASA TM-106242) and 'NASA Electronic Publishing System - Stage 1 Evaluation Report' (NASA TM-106510). This report differs from the previous reports through the inclusion of an external networked desktop editing, archival, and publishing functionality which did not exist with the previous networked electronic duplicating system. Additionally, a two-phase approach to the evaluation was undertaken; the first was a paper study justifying a 90-day, on-site evaluation, and the second phase was to validate, during the 90-day evaluation, the cost benefits and productivity increases that could be achieved in an operational mode. A benchmark of the functionality of the networked electronic publishing system and external networked desktop editing, archival, and publishing system was performed under a simulated daily production environment. This report can be used to guide others in determining the most cost effective duplicating/publishing alternative through the use of cost/benefit analysis and return on investment techniques. A treatise on the use of these techniques can be found by referring to 'NASA Electronic Publishing System -Cost/Benefit Methodology' (NASA TM-106662).

Differences in the use of outsourcing in public and private institutions providing medical services.

PubMed

Czerw, Aleksandra I; Kowalska, Mariola; Religioni, Urszula

2014-06-29

The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing. The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser. Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed - Fisher's exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies. The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services.

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

PubMed

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

2008-10-01

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

Mechanical work and energy consumption in children with cerebral palsy after single-event multilevel surgery.

PubMed

Marconi, Valeria; Hachez, Hélèn; Renders, Anne; Docquier, Pierre-Louis; Detrembleur, Chrisitine

2014-09-01

Multilevel surgery is commonly performed to improve walking in children with cerebral palsy (CP). Classical gait analysis (kinetics, kinematics) demonstrated positive outcomes after this intervention, however it doesn't give global indication about gait's features. The assessment of energy cost and mechanical work of locomotion can provide an overall description of walking functionality. Therefore, we propose to describe the effects of multilevel surgery in children with CP, considering energetics, mechanical work, kinetic and kinematic of walking. We measured external, internal, total work, energy cost, recovery, efficiency, kinetic and kinematic of walking in 10 children with CP (4 girls, 6 boys; 13 years ± 2) before and 1 year after multilevel surgery. Kinetic and kinematic results are partially comparable to previous findings, energy cost of walking is significantly reduced (p < 0.05); external, internal, total work, recovery, efficiency are not significantly different (p = 0.129; p = 0.147; p = 0.795; p = 0.119; p = 0.21). The improvement of the walking's energy consumption is not accompanied by a corresponding improvement of mechanical work. Therefore it is conceivable that the improvement of walking economy depend on a reduced effort of the muscle to maintain the posture, rather then to an improvement of the mechanism of energy recovery typical of human locomotion. Copyright © 2014 Elsevier B.V. All rights reserved.

[Cost-benefit analysis to substituting natural gas for coal project in large Chinese cities].

PubMed

Mao, Xianqiang; Peng, Yingdeng; Guo, Xiurui

2002-09-01

Since China's large cities were faced with serious coal-smoke pollution with PM10 and SO2 as the main pollutants, natural gas is becoming one of the most attractive clean replacers of coal. To clarify the wide disputation and doubt on the rationality of burning natural gas instead of coal, cost-benefit analysis (CBA) of urban natural gas substitution projects in Beijing and Chongqing was done respectively, in which, the health benefit was carefully estimated with epidemical dose-response function as the main external benefit. The final result shows that in large cities with intensively concentrated population and economic activities, natural gas consumption as municipal civil energy has obvious priority in terms of large environmental benefit from reducing non-point and low-altitude air pollutant concentration. This paper finally recommends that market oriented system reform in natural gas production and retailing system should be considered.

What have we learned on costs and financing of routine immunization from the comprehensive multi-year plans in GAVI eligible countries?

PubMed

Brenzel, Logan

2015-05-07

Immunization is one of the most cost-effective health interventions, but as countries introduce new vaccines and scale-up immunization coverage, costs will likely increase. This paper updates estimates of immunization costs and financing based on information from comprehensive multi-year plans (cMYPs) from GAVI-eligible countries during a period when countries planned to introduce a range of new vaccines (2008-2016). The analysis database included information from baseline and 5-year projection years for each country cMYP, resulting in a total sample size of 243 observations. Two-thirds were from African countries. Cost data included personnel, vaccine, injection, transport, training, maintenance, cold chain and other capital investments. Financing from government and external sources was evaluated. All estimates were converted to 2010 US Dollars. Statistical analysis was performed using STATA, and results were population-weighted. Results pertain to country planning estimates. Average annual routine immunization cost was $62 million. Vaccines continued to be the major cost driver (51%) followed by immunization-specific personnel costs (22%). Non-vaccine delivery costs accounted for almost half of routine program costs (44%). Routine delivery cost per dose averaged $0.61 and the delivery cost per infant was $10. The cost per DTP3 vaccinated child was $27. Routine program costs increased with each new vaccine introduced. Costs accounted for 5% of government health expenditures. Governments accounted for 67% of financing. Total and average costs of routine immunization programs are rising as coverage rates increase and new vaccines are introduced. The cost of delivering vaccines is nearly equivalent to the cost of vaccines. Governments are financing greater proportions of the immunization program but there may be limits in resource scarce countries. Price reductions for new vaccines will help reduce costs and the burden of financing. Strategies to improve efficiency in service delivery should be pursued. Copyright © 2015 Elsevier Ltd. All rights reserved.

Use of Treated Municipal Wastewater as Power Plant Cooling System Makeup Water: Tertiary Treatment versus Expanded Chemical Regimen for Recirculating Water Quality Management

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

David Dzombak; Radisav Vidic; Amy Landis

Treated municipal wastewater is a common, widely available alternative source of cooling water for thermoelectric power plants across the U.S. However, the biodegradable organic matter, ammonia-nitrogen, carbonate and phosphates in the treated wastewater pose challenges with respect to enhanced biofouling, corrosion, and scaling, respectively. The overall objective of this study was to evaluate the benefits and life cycle costs of implementing tertiary treatment of secondary treated municipal wastewater prior to use in recirculating cooling systems. The study comprised bench- and pilot-scale experimental studies with three different tertiary treated municipal wastewaters, and life cycle costing and environmental analyses of various tertiarymore » treatment schemes. Sustainability factors and metrics for reuse of treated wastewater in power plant cooling systems were also evaluated. The three tertiary treated wastewaters studied were: secondary treated municipal wastewater subjected to acid addition for pH control (MWW_pH); secondary treated municipal wastewater subjected to nitrification and sand filtration (MWW_NF); and secondary treated municipal wastewater subjected nitrification, sand filtration, and GAC adsorption (MWW_NFG). Tertiary treatment was determined to be essential to achieve appropriate corrosion, scaling, and biofouling control for use of secondary treated municipal wastewater in power plant cooling systems. The ability to control scaling, in particular, was found to be significantly enhanced with tertiary treated wastewater compared to secondary treated wastewater. MWW_pH treated water (adjustment to pH 7.8) was effective in reducing scale formation, but increased corrosion and the amount of biocide required to achieve appropriate biofouling control. Corrosion could be adequately controlled with tolytriazole addition (4-5 ppm TTA), however, which was the case for all of the tertiary treated waters. For MWW_NF treated water, the removal of ammonia by nitrification helped to reduce the corrosivity and biocide demand. Also, the lower pH and alkalinity resulting from nitrification reduced the scaling to an acceptable level, without the addition of anti-scalant chemicals. Additional GAC adsorption treatment, MWW_NFG, yielded no net benefit. Removal of organic matter resulted in pitting corrosion in copper and cupronickel alloys. Negligible improvement was observed in scaling control and biofouling control. For all of the tertiary treatments, biofouling control was achievable, and most effectively with pre-formed monochloramine (2-3 ppm) in comparison with NaOCl and ClO2. Life cycle cost (LCC) analyses were performed for the tertiary treatment systems studied experimentally and for several other treatment options. A public domain conceptual costing tool (LC3 model) was developed for this purpose. MWW_SF (lime softening and sand filtration) and MWW_NF were the most cost-effective treatment options among the tertiary treatment alternatives considered because of the higher effluent quality with moderate infrastructure costs and the relatively low doses of conditioning chemicals required. Life cycle inventory (LCI) analysis along with integration of external costs of emissions with direct costs was performed to evaluate relative emissions to the environment and external costs associated with construction and operation of tertiary treatment alternatives. Integrated LCI and LCC analysis indicated that three-tiered treatment alternatives such as MWW_NSF and MWW_NFG, with regular chemical addition for treatment and conditioning and/or regeneration, tend to increase the impact costs and in turn the overall costs of tertiary treatment. River water supply and MWW_F alternatives with a single step of tertiary treatment were associated with lower impact costs, but the contribution of impact costs to overall annual costs was higher than all other treatment alternatives. MWW_NF and MWW_SF alternatives exhibited moderate external impact costs with moderate infrastructure and chemical conditioner dosing, which makes them (especially MWW_NF) better treatment alternatives from the environmental sustainability perspective since they exhibited minimal contribution to environmental damage from emissions.« less

Distributed Finite Element Analysis Using a Transputer Network

NASA Technical Reports Server (NTRS)

Watson, James; Favenesi, James; Danial, Albert; Tombrello, Joseph; Yang, Dabby; Reynolds, Brian; Turrentine, Ronald; Shephard, Mark; Baehmann, Peggy

1989-01-01

The principal objective of this research effort was to demonstrate the extraordinarily cost effective acceleration of finite element structural analysis problems using a transputer-based parallel processing network. This objective was accomplished in the form of a commercially viable parallel processing workstation. The workstation is a desktop size, low-maintenance computing unit capable of supercomputer performance yet costs two orders of magnitude less. To achieve the principal research objective, a transputer based structural analysis workstation termed XPFEM was implemented with linear static structural analysis capabilities resembling commercially available NASTRAN. Finite element model files, generated using the on-line preprocessing module or external preprocessing packages, are downloaded to a network of 32 transputers for accelerated solution. The system currently executes at about one third Cray X-MP24 speed but additional acceleration appears likely. For the NASA selected demonstration problem of a Space Shuttle main engine turbine blade model with about 1500 nodes and 4500 independent degrees of freedom, the Cray X-MP24 required 23.9 seconds to obtain a solution while the transputer network, operated from an IBM PC-AT compatible host computer, required 71.7 seconds. Consequently, the $80,000 transputer network demonstrated a cost-performance ratio about 60 times better than the $15,000,000 Cray X-MP24 system.

Three-year financial analysis of pharmacy services at an independent community pharmacy.

PubMed

Doucette, William R; McDonough, Randal P; Mormann, Megan M; Vaschevici, Renata; Urmie, Julie M; Patterson, Brandon J

2012-01-01

To assess the financial performance of pharmacy services including vaccinations, cholesterol screenings, medication therapy management (MTM), adherence management services, employee health fairs, and compounding services provided by an independent community pharmacy. Three years (2008-10) of pharmacy records were examined to determine the total revenue and costs of each service. Costs included products, materials, labor, marketing, overhead, equipment, reference materials, and fax/phone usage. Costs were allocated to each service using accepted principles (e.g., time for labor). Depending on the service, the total revenue was calculated by multiplying the frequency of the service by the revenue per patient or by adding the total revenue received. A sensitivity analysis was conducted for the adherence management services to account for average dispensing net profit. 7 of 11 pharmacy services showed a net profit each year. Those services include influenza and herpes zoster immunization services, MTM, two adherence management services, employee health fairs, and prescription compounding services. The services that realized a net loss included the pneumococcal immunization service, cholesterol screenings, and two adherence management services. The sensitivity analysis showed that all adherence services had a net gain when average dispensing net profit was included. Most of the pharmacist services had an annual positive net gain. It seems likely that these services can be sustained. Further cost management, such as reducing labor costs, could improve the viability of services with net losses. However, even with greater efficiency, external factors such as competition and reimbursement challenge the sustainability of these services.

In-Silico Screening of Ligand Based Pharmacophore, Database Mining and Molecular Docking on 2, 5-Diaminopyrimidines Azapurines as Potential Inhibitors of Glycogen Synthase Kinase-3β.

PubMed

Mishra, Pooja; Kesar, Seema; Paliwal, Sarvesh K; Chauhan, Monika; Madan, Kirtika

2018-05-29

Glycogen synthase kinase-3β plays a significant role in the regulation of various pathological pathways relating to central nervous system (CNS). Dysregulation of Glycogen synthase kinase 3 (GSK-3) activity gives a rise to numerous neuroinflammation and neurodegenerative related disorders that affect the whole central nervous system. By the sequential application of in-silico tools, efforts have been attempted to design the novel GSK-3β inhibitors. Owing to the potential role of GSK-3β in nervous disorders, we have attempted to develop the quantitative four featured pharmacophore model comprising two hydrogen bond acceptors (HBA), one ring aromatic (RA), and one hydrophobe (HY), which were further affirmed by cost-function analysis, rm2 matrices, internal and external test set validation and Güner-Henry (GH) scoring analysis. Validated pharmacophoric model was used for virtual screening and out of 345 compounds, two potential virtual hits were finalized that were on the basis of fit value, estimated activity and Lipinski's violation. The chosen compounds were subjected to dock within the active site of GSK-3β Result: Four essential features, i.e., two hydrogen bond acceptors(HBA), one ring aromatic(RA), and one hydrophobe(HY), were subjected to build the pharmacophoric model and showed good correlation coefficient, RMSD and cost difference values of 0.91, 0.94 and 42.9 respectively and further model was validated employing cost-function analysis, rm2-matrices, internal and external test set prediction with r2 value of 0.77 and 0.84. Docked conformations showed potential interactions in between the features of the identified hits (NCI 4296, NCI 3034) and the amino acids present in the active site. In line with the overhead discussion, and through our stepwise computational approaches, we have identified novel, structurally diverse glycogen synthase kinase inhibitors. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

14 CFR 1274.205 - Consortia as recipients.

Code of Federal Regulations, 2012 CFR

2012-01-01

... better share the projects financial costs (e.g., the 50 percent recipient's cost share or other costs of... issues; (8) Internal and external reporting requirements; (9) Management structure of the consortium; (10... the consortia members (12) Agreements, if any, to share existing technology and data; (13) The firm...

14 CFR 1274.205 - Consortia as recipients.

Code of Federal Regulations, 2013 CFR

2013-01-01

... better share the projects financial costs (e.g., the 50 percent recipient's cost share or other costs of... issues; (8) Internal and external reporting requirements; (9) Management structure of the consortium; (10... the consortia members (12) Agreements, if any, to share existing technology and data; (13) The firm...

Cost-effectiveness of external cephalic version for term breech presentation

PubMed Central

2010-01-01

Background External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. Methods A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness. Results The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean. Conclusions From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV. PMID:20092630

The ``battle of gold'' under the light of green economics: a case study from Greece

NASA Astrophysics Data System (ADS)

Damigos, D.; Kaliampakos, D.

2006-05-01

Mining firms stimulate local and national economies but this comes at a certain cost. In the light of increasing public concern, external costs of environmental degradation and social disruption are no longer of pure academic interest. The assessment of mining projects on the grounds of sustainable development is critical in order to decide whether the exploitation of mineral resources is socially desirable. In practice, few steps have been taken towards this end. In this paper, a case study is illustrated that provides the means for evaluating the social worthiness of mining projects. The analysis, which is the first of its kind in Greece, deals with a major problem of the mining industry: the gold debate on the grounds of green economics. The assessment is based on the social cost benefit approach. Well-established techniques (e.g. benefit transfer) and innovative approaches have been adopted to overcome various practical problems

Wireless Sensor Network-Based Service Provisioning by a Brokering Platform

PubMed Central

Guijarro, Luis; Pla, Vicent; Vidal, Jose R.; Naldi, Maurizio; Mahmoodi, Toktam

2017-01-01

This paper proposes a business model for providing services based on the Internet of Things through a platform that intermediates between human users and Wireless Sensor Networks (WSNs). The platform seeks to maximize its profit through posting both the price charged to each user and the price paid to each WSN. A complete analysis of the profit maximization problem is performed in this paper. We show that the service provider maximizes its profit by incentivizing all users and all Wireless Sensor Infrastructure Providers (WSIPs) to join the platform. This is true not only when the number of users is high, but also when it is moderate, provided that the costs that the users bear do not trespass a cost ceiling. This cost ceiling depends on the number of WSIPs, on the value of the intrinsic value of the service and on the externality that the WSIP has on the user utility. PMID:28498347

Wireless Sensor Network-Based Service Provisioning by a Brokering Platform.

PubMed

Guijarro, Luis; Pla, Vicent; Vidal, Jose R; Naldi, Maurizio; Mahmoodi, Toktam

2017-05-12

This paper proposes a business model for providing services based on the Internet of Things through a platform that intermediates between human users and Wireless Sensor Networks (WSNs). The platform seeks to maximize its profit through posting both the price charged to each user and the price paid to each WSN. A complete analysis of the profit maximization problem is performed in this paper. We show that the service provider maximizes its profit by incentivizing all users and all Wireless Sensor Infrastructure Providers (WSIPs) to join the platform. This is true not only when the number of users is high, but also when it is moderate, provided that the costs that the users bear do not trespass a cost ceiling. This cost ceiling depends on the number of WSIPs, on the value of the intrinsic value of the service and on the externality that the WSIP has on the user utility.

External impacts of an intraurban air transportation system in the San Francisco Bay area

NASA Technical Reports Server (NTRS)

Lu, J. Y.; Gebman, J. R.; Kirkwood, T. F.; Mcclure, P. T.; Stucker, J. P.

1972-01-01

The effects are studied of an intraurban V/STOL commuter system on the economic, social, and physical environment of the San Francisco Bay Area. The Bay Area was chosen mainly for a case study; the real intent of the analysis is to develop methods by which the effects of such a system could be evaluated for any community. Aspects of the community life affected include: income and employment, benefits and costs, noise, air pollution, and road congestion.

Space Station Systems Analysis Study. Volume 2: Program options, book 1, parts 1 and 2

NASA Technical Reports Server (NTRS)

1977-01-01

Program options are defined and requirements are determined for integrating crew, mass, volume, and electrical power for a space construction base which incorporates the space shuttle external tanks. Orbits, stabilization, flight control hardware, as well as modules and aids for orbital assembly and servicing are considered. The effectiveness of various program options for life science and radio astronomy missions, for the solar terrestrial observatory, and for public service platforms is assessed. Technology development items are identified and costs are estimated.

Business Models for Cost Sharing and Capability Sustainment

DTIC Science & Technology

2012-04-30

studies in the research include the following:  Programs o F-35 Lightning II (U.S./UK) o AV-8B/Harrier (U.S./UK) o Super Hornet (U.S.) o...made to learn internally how the Typhoon aircraft could benefit from an RTI approach. Externally, the use of a small group , such as the RTI team...long time frame. In order to identify the key factors in the Harrier RTI success, a SWOT analysis was carried out. The results are shown in Table 1

Heat storage capability of a rolling cylinder using Glauber's salt

NASA Technical Reports Server (NTRS)

Herrick, C. S.; Zarnoch, K. P.

1980-01-01

The rolling cylinder phase change heat storage concept was developed to the point where a prototype design is completed and a cost analysis is prepared. A series of experimental and analytical tasks are defined to establish the thermal, mechanical, and materials behavior of rolling cylinder devices. These tasks include: analyses of internal and external heat transfer; performance and lifetime testing of the phase change materials; corrosion evaluation; development of a mathematical model; and design of a prototype and associated test equipment.

C-130 Advanced Technology Center wing box conceptual design/cost study

NASA Technical Reports Server (NTRS)

Whitehead, R. S.; Foreman, C. R.; Silva, K.

1992-01-01

A conceptual design was developed by Northrop/LTV for an advanced C-130 Center Wing Box (CWB) which could meet the severe mission requirements of the SOF C-130 aircraft. The goals for the advanced technology CWB relative to the current C-130H CWB were: (1) the same acquisition cost; (2) lower operating support costs; (3) equal or lower weight; (4) a 30,000 hour service life for the SOF mission; and (5) minimum impact on the current maintenance concept. Initially, the structural arrangement, weight, external and internal loads, fatigue spectrum, flutter envelope and design criteria for the SOF C-130 aircraft CWB were developed. An advanced materials assessment was then conducted to determine the suitability of advanced materials for a 1994 production availability and detailed trade studies were performed on candidate CWB conceptual designs. Finally, a life-cycle cost analysis was performed on the advanced CWB. The study results showed that a hybrid composite/metallic CWB could meet the severe SOF design requirements, reduce the CWB weight by 14 pct., and was cost effective relative to an all metal beefed up C-130H CWB.

Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

PubMed

Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

2015-09-01

The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

Mask manufacturing improvement through capability definition and bottleneck line management

NASA Astrophysics Data System (ADS)

Strott, Al

1994-02-01

In 1989, Intel's internal mask operation limited itself to research and development activities and re-inspection and pellicle application of externally manufactured masks. Recognizing the rising capital cost of mask manufacturing at the leading edge, Intel's Mask Operation management decided to offset some of these costs by manufacturing more masks internally. This was the beginning of the challenge they set to manufacture at least 50% of Intel's mask volume internally, at world class performance levels. The first step in responding to this challenge was the completion of a comprehensive operation capability analysis. A series of bottleneck improvements by focus teams resulted in an average cycle time improvement to less than five days on all product and less than two days on critical products.

14 CFR § 1274.205 - Consortia as recipients.

Code of Federal Regulations, 2014 CFR

2014-01-01

... better share the projects financial costs (e.g., the 50 percent recipient's cost share or other costs of... issues; (8) Internal and external reporting requirements; (9) Management structure of the consortium; (10... the consortia members (12) Agreements, if any, to share existing technology and data; (13) The firm...

Audio Teleconferencing: Low Cost Technology for External Studies Networking.

ERIC Educational Resources Information Center

Robertson, Bill

1987-01-01

This discussion of the benefits of audio teleconferencing for distance education programs and for business and government applications focuses on the recent experience of Canadian educational users. Four successful operating models and their costs are reviewed, and it is concluded that audio teleconferencing is cost efficient and educationally…

Application of laser technology in treatment of diseases of the external genitals

NASA Astrophysics Data System (ADS)

Wilczak, Maciej; Wozniak, Jakub; Sajdak, Stefan; Opala, Tomasz; Rabiega, Dorota

2000-11-01

Lasersurgery is the very profitable method of treatment of diseases of external sexual organs, with regard to high efficiency and little relapses. Lasersurgery is recommended especially for pregnant women considering possibility of physiological childbirth. We prefer laser CO2 in connexion with colposcope in treatment of diseases of external sexual organs. The application of this method is limited by the high cost of equipment.

Cost Studies in Higher Education. The AIR Professional File, No. 7, Fall 1980.

ERIC Educational Resources Information Center

Hample, Stephen R.

A guide to cost studies in higher education is presented, with emphasis directed to the response of a four-year public institution to an externally mandated cost study. Cost studies are usually requested to guide budget allocations, either from an internal campus need or from outside pressures. Although much effort has been expended by various…

Accountable Care Organizations and Transaction Cost Economics.

PubMed

Mick, Stephen S Farnsworth; Shay, Patrick D

2016-12-01

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information "impactedness." Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development. © The Author(s) 2016.

Indirect cost of maternal deaths in the WHO African Region in 2010.

PubMed

Kirigia, Joses Muthuri; Mwabu, Germano Mwige; Orem, Juliet Nabyonga; Muthuri, Rosenabi Deborah Karimi

2014-08-31

An estimated 147,741 maternal deaths occurred in 2010 in 45 of the 47 countries in the African Region of the World Health Organization (WHO). The objective of this study was to estimate the indirect cost of maternal deaths in the Region to provide data for use in advocacy for increased domestic and external investment in multisectoral policy interventions to curb maternal mortality. This study used the cost-of-illness method to estimate the indirect cost of maternal mortality, i.e. the loss in non-health gross domestic product (GDP) attributable to maternal deaths. Estimates on maternal mortality for 2010 from Trends in maternal mortality: 1990 to 2010 published by WHO, UNICEF, UNFPA and the World Bank were used in these calculations. Values for future non-health GDP lost were converted into their present values by applying a 3% discount rate. One-way sensitivity analysis at 5% and 10% discount rates assessed the impact on non-health GDP loss. Indirect cost analysis was undertaken for the countries, categorized under three income groups. Group 1 consisted of nine high and upper middle income countries, Group 2 of 12 lower middle income countries, and Group 3 of 26 low income countries. Estimates for Seychelles in Group 1 and South Sudan in Group 3 were not provided in the source used. The 147,741 maternal deaths that occurred in 45 countries in the African Region in 2010 resulted in a total non-health GDP loss of Int$ 4.5 billion (PPP). About 24.5% of the loss was in Group 1 countries, 44.9% in Group 2 countries and 30.6% in Group 3 countries. This translated into losses in non-health GDP of Int$ 139,219, Int$ 35,440 and Int$ 16,397 per maternal death, respectively, for the three groups. Using discount rates of 5% and 10% reduced the total non-health GDP loss by 19.1% and 47.7%, respectively. Maternal mortality is responsible for a noteworthy level of non-health GDP loss among the countries in the African Region. There is urgent need, therefore, to increase domestic and external investment to scale up coverage of existing cost-effective, multisectoral women's health interventions to reduce maternal morbidity and mortality.

Variation in costs of cone beam CT examinations among healthcare systems.

PubMed

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-10-01

To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, "out of pocket" costs for examination fee and visits). The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000-227 000). Variation in indirect costs were mainly owing to examination fees (range €0-102.02). Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.

A Determination of Military and Civilian Personnel Costs as Related to a Member of Technical Staff

DTIC Science & Technology

1992-06-01

Costs, 1986 4 2. Direct Total Manpower Bidget Costs, 1992 5 3. Pay Raises 1985-1992 6 4. Support Costs 9 5. Internal Support Personnel 10 6. External...34 Incremental Costs of Military and Civilian Manpower in the Military Services." This docu- ment provides the basis for this section. The report assesses...6 Aug 91. MTS Workyear Cost Comparison. Internal AFSC paper, 20 November 1990. Palmer, Adele R., Osbaldeston, David J., Incremental Costs of Military

Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis.

PubMed

Boronat, F; Barrachina, I; Budia, A; Vivas Consuelo, D; Criado, M C

The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). A total of 32,510 outpatient consultations, 7,527 techniques, 2,860 interventions and 4,855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Optimal joint management of a coastal aquifer and a substitute resource

NASA Astrophysics Data System (ADS)

Moreaux, M.; Reynaud, A.

2004-06-01

This article characterizes the optimal joint management of a coastal aquifer and a costly water substitute. For this purpose we use a mathematical representation of the aquifer that incorporates the displacement of the interface between the seawater and the freshwater of the aquifer. We identify the spatial cost externalities created by users on each other and we show that the optimal water supply depends on the location of users. Users located in the coastal zone exclusively use the costly substitute. Those located in the more upstream area are supplied from the aquifer. At the optimum their withdrawal must take into account the cost externalities they generate on users located downstream. Last, users located in a median zone use the aquifer with a surface transportation cost. We show that the optimum can be implemented in a decentralized economy through a very simple Pigouvian tax. Finally, the optimal and decentralized extraction policies are simulated on a very simple example.

Potential of extensification of European agriculture for a more sustainable food system, focusing on nitrogen

NASA Astrophysics Data System (ADS)

van Grinsven, Hans J. M.; Willem Erisman, Jan; de Vries, Wim; Westhoek, Henk

2015-02-01

Most global strategies for future food security focus on sustainable intensification of production of food and involve increased use of nitrogen fertilizer and manure. The external costs of current high nitrogen (N) losses from agriculture in the European Union, are 0.3-1.9% of gross domestic product (GDP) in 2008. We explore the potential of sustainable extensification for agriculture in the EU and The Netherlands by analysing cases and scenario studies focusing on reducing N inputs and livestock densities. Benefits of extensification are higher local biodiversity and less environmental pollution and therefore less external costs for society. Extensification also has risks such as a reduction of yields and therewith a decrease of the GDP and farm income and a smaller contribution to the global food production, and potentially an i0ncrease of global demand for land. We demonstrate favourable examples of extensification. Reducing the N fertilization rate for winter wheat in Northwest Europe to 25-30% below current N recommendations accounts for the external N cost, but requires action to compensate for a reduction in crop yield by 10-20%. Dutch dairy and pig farmers changing to less intensive production maintain or even improve farm income by price premiums on their products, and/or by savings on external inputs. A scenario reducing the Dutch pig and poultry sector by 50%, the dairy sector by 20% and synthetic N fertilizer use by 40% lowers annual N pollution costs by 0.2-2.2 billion euro (40%). This benefit compensates for the loss of GDP in the primary sector but not in the supply and processing chain. A 2030 scenario for the EU27 reducing consumption and production of animal products by 50% (demitarean diet) reduces N pollution by 10% and benefits human health. This diet allows the EU27 to become a food exporter, while reducing land demand outside Europe in 2030 by more than 100 million hectares (2%), which more than compensates increased land demand when changing to organic farming. We conclude that in Europe extensification of agriculture is sustainable when combined with adjusted diets and externalization of environmental costs to food prices.

Weighing the costs: Implementing the SLMTA programme in Zimbabwe using internal versus external facilitators.

PubMed

Shumba, Edwin; Nzombe, Phoebe; Mbinda, Absolom; Simbi, Raiva; Mangwanya, Douglas; Kilmarx, Peter H; Luman, Elizabeth T; Zimuto, Sibongile N

2014-01-01

In 2010, the Zimbabwe Ministry of Health and Child Welfare (MoHCW) adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a tool for laboratory quality systems strengthening. To evaluate the financial costs of SLMTA implementation using two models (external facilitators; and internal local or MoHCW facilitators) from the perspective of the implementing partner and to estimate resources needed to scale up the programme nationally in all 10 provinces. The average expenditure per laboratory was calculated based on accounting records; calculations included implementing partner expenses but excluded in-kind contributions and salaries of local facilitators and trainees. We also estimated theoretical financial costs, keeping all contextual variables constant across the two models. Resource needs for future national expansion were estimated based on a two-phase implementation plan, in which 12 laboratories in each of five provinces would implement SLMTA per phase; for the internal facilitator model, 20 facilitators would be trained at the beginning of each phase. The average expenditure to implement SLMTA in 11 laboratories using external facilitators was approximately US$5800 per laboratory; expenditure in 19 laboratories using internal facilitators was approximately $6000 per laboratory. The theoretical financial cost of implementing a 12-laboratory SLMTA cohort keeping all contextual variables constant would be approximately $58 000 using external facilitators; or $15 000 using internal facilitators, plus $86 000 to train 20 facilitators. The financial cost for subsequent SLMTA cohorts using the previously-trained internal facilitators would be approximately $15 000, yielding a break-even point of 2 cohorts, at $116 000 for either model. Estimated resources required for national implementation in 120 laboratories would therefore be $580 000 using external facilitators ($58 000 per province) and $322 000 using internal facilitators ($86 000 for facilitator training in each of two phases plus $15 000 for SLMTA implementation in each province). Investing in training of internal facilitators will result in substantial savings over the scale-up of the programme. Our study provides information to assist policy makers to develop strategic plans for investing in laboratory strengthening.

A novel method for automated tracking and quantification of adult zebrafish behaviour during anxiety.

PubMed

Nema, Shubham; Hasan, Whidul; Bhargava, Anamika; Bhargava, Yogesh

2016-09-15

Behavioural neuroscience relies on software driven methods for behavioural assessment, but the field lacks cost-effective, robust, open source software for behavioural analysis. Here we propose a novel method which we called as ZebraTrack. It includes cost-effective imaging setup for distraction-free behavioural acquisition, automated tracking using open-source ImageJ software and workflow for extraction of behavioural endpoints. Our ImageJ algorithm is capable of providing control to users at key steps while maintaining automation in tracking without the need for the installation of external plugins. We have validated this method by testing novelty induced anxiety behaviour in adult zebrafish. Our results, in agreement with established findings, showed that during state-anxiety, zebrafish showed reduced distance travelled, increased thigmotaxis and freezing events. Furthermore, we proposed a method to represent both spatial and temporal distribution of choice-based behaviour which is currently not possible to represent using simple videograms. ZebraTrack method is simple and economical, yet robust enough to give results comparable with those obtained from costly proprietary software like Ethovision XT. We have developed and validated a novel cost-effective method for behavioural analysis of adult zebrafish using open-source ImageJ software. Copyright © 2016 Elsevier B.V. All rights reserved.

Quantifying the Sensitivity of the Production of Environmental Externalities to Market-Based Interventions in the Power Sector

NASA Astrophysics Data System (ADS)

Peer, R.; Sanders, K.

2017-12-01

The optimization function that governs the dispatching of power generators to meet electricity demand minimizes the marginal cost of electricity generation without regard to the environmental or public health damages caused by power production. Although technologies exist for reducing the externalities resulting from electricity generation at power plants, current solutions typically raise the cost of power production or introduce operational challenges for the grid. This research quantifies the trade-offs and couplings between the cooling water, greenhouse gas emissions, and air quality impacts of different power generating technologies under business as usual market conditions, as well as a series of market-based interventions aimed to reduce the production of those externalities. Using publicly available data from the US Environmental Protection Agency (EPA) and the US Energy Information Administration (EIA) for power plant water use and emissions, a unit commitment and dispatch power market simulation model is modified to evaluate the production of environmental externalities from power production. Scenarios are developed to apply a set of fees for cooling water, carbon dioxide, nitrous oxide and sulfur oxide emissions, respectively. Trade-offs between environmental performance, overall generation costs, and shifts in the power plants dispatched to meet demand are quantified for each power market simulation. The results from this study will provide insight into the development of a novel market-based framework that modifies the optimization algorithms governing the dispatching of electricity onto the grid in efforts to achieve cost-effective improvements in its environmental performance without the need for new infrastructure investments.

Social dilemma in the external immune system of the red flour beetle? It is a matter of time.

PubMed

Gokhale, Chaitanya S; Traulsen, Arne; Joop, Gerrit

2017-09-01

Sociobiology has revolutionized our understanding of interactions between organisms. Interactions may present a social dilemma where the interests of individual actors do not align with those of the group as a whole. Viewed through a sociobiological lens, nearly all interactions can be described regarding their costs and benefits, and a number of them then resemble a social dilemma. Numerous experimental systems, from bacteria to mammals, have been proposed as models for studying such dilemmas. Here, we make use of the external immune system of the red flour beetle, Tribolium castaneum , to investigate how the experimental duration can affect whether the external secretion comprises a social dilemma or not. Some beetles (secretors) produce a costly quinone-rich external secretion that inhibits microbial growth in the surrounding environment, providing the secretors with direct personal benefits. However, as the antimicrobial secretion acts in the environment of the beetle, it is potentially also advantageous to other beetles (nonsecretors), who avoid the cost of producing the secretion. We test experimentally if the secretion qualifies as a public good. We find that in the short term, costly quinone secretion can be interpreted as a public good presenting a social dilemma where the presence of secretors increases the fitness of the group. In the long run, the benefit to the group of having more secretors vanishes and becomes detrimental to the group. Therefore, in such seminatural environmental conditions, it turns out that qualifying a trait as social can be a matter of timing.

Walking- and cycling track networks in Norwegian cities : cost-benefit analyses including health effects and external costs of road traffic : summary

DOT National Transportation Integrated Search

2002-04-01

Cost- benefit analyses of walking- and cycling track net-works in three Norwegian cities are presented in this study. A project group working with a National Cycling Strategy in Norway initialised the study. Motivation for starting the study is the P...

Primary treatments for clinically localized prostate cancer: a comprehensive lifetime cost-utility analysis

PubMed Central

Cooperberg, Matthew R.; Ramakrishna, Naren R.; Duff, Steven B.; Hughes, Kathleen E.; Sadownik, Sara; Smith, Joseph A.; Tewari, Ashutosh K.

2012-01-01

Objectives To characterize the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (dose-escalated 3-dimensional conformal radiation, intensity-modulated radiation, brachytherapy, or combination), using a comprehensive, lifetime decision analytic model. Patients and Methods A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes following primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. Patients could experience remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the U.S. payer perspective, with incorporation of patient costs in a sensitivity analysis. Results Differences in quality-adjusted life years across modalities were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6 to 10.5 for intermediate-risk patients, and 7.8 to 9.3 for high-risk patients. There were no statistically significant differences among surgical modalities, which tended to be more effective than radiation modalities, with the exception of combination external beam + brachytherapy for high-risk disease. Radiation modalities were consistently more expensive than surgical modalities; costs ranged from $19,901 (robot-assisted prostatectomy for low-risk disease) to $50,276 (combination radiation for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Conclusions Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions regarding strategies to improve efficiency of treatment selection for localized prostate cancer. PMID:23279038

Can market-based policies accomplish the optimal floodplain management? A gap between static and dynamic models.

PubMed

Mori, Koichiro

2009-02-01

The purpose of this short article is to set static and dynamic models for optimal floodplain management and to compare policy implications from the models. River floodplains are important multiple resources in that they provide various ecosystem services. It is fundamentally significant to consider environmental externalities that accrue from ecosystem services of natural floodplains. There is an interesting gap between static and dynamic models about policy implications for floodplain management, although they are based on the same assumptions. Essentially, we can derive the same optimal conditions, which imply that the marginal benefits must equal the sum of the marginal costs and the social external costs related to ecosystem services. Thus, we have to internalise the external costs by market-based policies. In this respect, market-based policies seem to be effective in a static model. However, they are not sufficient in the context of a dynamic model because the optimal steady state turns out to be unstable. Based on a dynamic model, we need more coercive regulation policies.

An Engineering Perspective of External Cardiac Loop Recorder: A Systematic Review

PubMed Central

2016-01-01

External cardiac loop recorder (ELR) is a kind of ECG monitoring system that records cardiac activities of a subject continuously for a long time. When the heart palpitations are not the frequent and nonspecific character, it is difficult to diagnose the disease. In such a case, ELR is used for long-term monitoring of heart signal of the patient. But the cost of ELR is very high. Therefore, it is not prominently available in developing countries like India. Since the design of ELR includes the ECG electrodes, instrumentation amplifier, analog to digital converter, and signal processing unit, a comparative review of each part of the ELR is presented in this paper in order to design a cost effective, low power, and compact kind of ELR. This review will also give different choices available for selecting and designing each part of the ELR system. Finally, the review will suggest the better choice for designing a cost effective external cardiac loop recorder that helps to make it available even for rural people in India. PMID:27872843

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

PubMed

Hoyme, Derek B; Atkins, Dianne L

2017-02-01

To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience

PubMed Central

Hoyme, Derek B.; Atkins, Dianne L.

2017-01-01

Objective To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Study design Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Results Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Conclusions Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. PMID:27852456

An Analytic Model for DoD Investment & Divestment Decisions (Briefing Charts)

DTIC Science & Technology

2015-05-01

cost drives Strategic; Performance mixed; cost drives Invest Insurance Risk Mitigation √ “Making Trade-Offs in Corporate Portfolio Decisions...Effects (SE) + Insurance Intended externalities, unintended consequences Are SE measureable? Do they add/subtract so NPV is worthwhile? Deadweight...Sustainable Cost Effective Cost is supportable, LPO outsourced, or is income Advantageous NPV? Y Y Y Y either N N N N Secondary Effects+ Insurance

Identifying external nutrient reduction requirements and potential in the hypereutrophic Lake Taihu Basin, China.

PubMed

Peng, Jiao-Ting; Zhu, Xiao-Dong; Sun, Xiang; Song, Xiao-Wei

2018-04-01

Reducing external nutrient loads is the first step for controlling eutrophication. Here, we identified external nutrient reduction requirements and potential of strategies for achieving reductions to remediate a eutrophic water body, Lake Taihu, China. A mass balance approach based on the entire lake was used to identify nutrient reduction requirements; an empirical export coefficient approach was introduced to estimate the nutrient reduction potential of the overall program on integrated regulation of Taihu Lake Basin (hereafter referred to as the "Guideline"). Reduction requirements included external total nitrogen (TN) and total phosphorus (TP) loads, which should be reduced by 41-55 and 25-50%, respectively, to prevent nutrient accumulation in Lake Taihu and to meet the planned water quality targets. In 2010, which is the most seriously polluted calendar year during the 2008-2014 period, the nutrient reduction requirements were estimated to be 36,819 tons of N and 2442 tons of P, and the potential nutrient reduction strategies would reduce approximately 25,821 tons of N and 3024 tons of P. Since there is a net N remaining in the reduction requirements, it should be the focus and deserves more attention in identifying external nutrient reduction strategies. Moreover, abatement measures outlined in the Guideline with high P reduction potential required large monetary investments. Achieving TP reduction requirement using the cost-effective strategy costs about 80.24 million USD. The design of nutrient reduction strategies should be enacted according to regional and sectoral differences and the cost-effectiveness of abatement measures.

Differences in the use of outsourcing in public and private institutions providing medical services

PubMed Central

Kowalska, Mariola; Religioni, Urszula

2014-01-01

Introduction The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing. Material and methods The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser. Results Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed – Fisher's exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies. Conclusions The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services. PMID:25097595

Vehicle Design Evaluation Program (VDEP). A computer program for weight sizing, economic, performance and mission analysis of fuel-conservative aircraft, multibodied aircraft and large cargo aircraft using both JP and alternative fuels

NASA Technical Reports Server (NTRS)

Oman, B. H.

1977-01-01

The NASA Langley Research Center vehicle design evaluation program (VDEP-2) was expanded by (1) incorporating into the program a capability to conduct preliminary design studies on subsonic commercial transport type aircraft using both JP and such alternate fuels as hydrogen and methane;(2) incorporating an aircraft detailed mission and performance analysis capability; and (3) developing and incorporating an external loads analysis capability. The resulting computer program (VDEP-3) provides a preliminary design tool that enables the user to perform integrated sizing, structural analysis, and cost studies on subsonic commercial transport aircraft. Both versions of the VDEP-3 Program which are designated preliminary Analysis VDEP-3 and detailed Analysis VDEP utilize the same vehicle sizing subprogram which includes a detailed mission analysis capability, as well as a geometry and weight analysis for multibodied configurations.

Cost optimization for buildings with hybrid ventilation systems

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

Ji, Kun; Lu, Yan

A method including: computing a total cost for a first zone in a building, wherein the total cost is equal to an actual energy cost of the first zone plus a thermal discomfort cost of the first zone; and heuristically optimizing the total cost to identify temperature setpoints for a mechanical heating/cooling system and a start time and an end time of the mechanical heating/cooling system, based on external weather data and occupancy data of the first zone.

Student Residence.

ERIC Educational Resources Information Center

Department of Education and Science, London (England).

Principal facility requirements and costs of residential accommodations for students are discussed. After specifying the various space and facility requirements and providing cost information for the various classes of facilities, the report details requirements pertaining to external works (road access; car parking; grassing, planting, and…

Tuning in to the Voices: A Multisite fMRI Study of Auditory Hallucinations

PubMed Central

Ford, Judith M.; Roach, Brian J.; Jorgensen, Kasper W.; Turner, Jessica A.; Brown, Gregory G.; Notestine, Randy; Bischoff-Grethe, Amanda; Greve, Douglas; Wible, Cynthia; Lauriello, John; Belger, Aysenil; Mueller, Bryon A.; Calhoun, Vincent; Preda, Adrian; Keator, David; O'Leary, Daniel S.; Lim, Kelvin O.; Glover, Gary; Potkin, Steven G.; Mathalon, Daniel H.

2009-01-01

Introduction: Auditory hallucinations or voices are experienced by 75% of people diagnosed with schizophrenia. We presumed that auditory cortex of schizophrenia patients who experience hallucinations is tonically “tuned” to internal auditory channels, at the cost of processing external sounds, both speech and nonspeech. Accordingly, we predicted that patients who hallucinate would show less auditory cortical activation to external acoustic stimuli than patients who did not. Methods: At 9 Functional Imaging Biomedical Informatics Research Network (FBIRN) sites, whole-brain images from 106 patients and 111 healthy comparison subjects were collected while subjects performed an auditory target detection task. Data were processed with the FBIRN processing stream. A region of interest analysis extracted activation values from primary (BA41) and secondary auditory cortex (BA42), auditory association cortex (BA22), and middle temporal gyrus (BA21). Patients were sorted into hallucinators (n = 66) and nonhallucinators (n = 40) based on symptom ratings done during the previous week. Results: Hallucinators had less activation to probe tones in left primary auditory cortex (BA41) than nonhallucinators. This effect was not seen on the right. Discussion: Although “voices” are the anticipated sensory experience, it appears that even primary auditory cortex is “turned on” and “tuned in” to process internal acoustic information at the cost of processing external sounds. Although this study was not designed to probe cortical competition for auditory resources, we were able to take advantage of the data and find significant effects, perhaps because of the power afforded by such a large sample. PMID:18987102

Automatic system for 3D reconstruction of the chick eye based on digital photographs.

PubMed

Wong, Alexander; Genest, Reno; Chandrashekar, Naveen; Choh, Vivian; Irving, Elizabeth L

2012-01-01

The geometry of anatomical specimens is very complex and accurate 3D reconstruction is important for morphological studies, finite element analysis (FEA) and rapid prototyping. Although magnetic resonance imaging, computed tomography and laser scanners can be used for reconstructing biological structures, the cost of the equipment is fairly high and specialised technicians are required to operate the equipment, making such approaches limiting in terms of accessibility. In this paper, a novel automatic system for 3D surface reconstruction of the chick eye from digital photographs of a serially sectioned specimen is presented as a potential cost-effective and practical alternative. The system is designed to allow for automatic detection of the external surface of the chick eye. Automatic alignment of the photographs is performed using a combination of coloured markers and an algorithm based on complex phase order likelihood that is robust to noise and illumination variations. Automatic segmentation of the external boundaries of the eye from the aligned photographs is performed using a novel level-set segmentation approach based on a complex phase order energy functional. The extracted boundaries are sampled to construct a 3D point cloud, and a combination of Delaunay triangulation and subdivision surfaces is employed to construct the final triangular mesh. Experimental results using digital photographs of the chick eye show that the proposed system is capable of producing accurate 3D reconstructions of the external surface of the eye. The 3D model geometry is similar to a real chick eye and could be used for morphological studies and FEA.

Authentication of organic feed by near-infrared spectroscopy combined with chemometrics: a feasibility study.

PubMed

Tres, A; van der Veer, G; Perez-Marin, M D; van Ruth, S M; Garrido-Varo, A

2012-08-22

Organic products tend to retail at a higher price than their conventional counterparts, which makes them susceptible to fraud. In this study we evaluate the application of near-infrared spectroscopy (NIRS) as a rapid, cost-effective method to verify the organic identity of feed for laying hens. For this purpose a total of 36 organic and 60 conventional feed samples from The Netherlands were measured by NIRS. A binary classification model (organic vs conventional feed) was developed using partial least squares discriminant analysis. Models were developed using five different data preprocessing techniques, which were externally validated by a stratified random resampling strategy using 1000 realizations. Spectral regions related to the protein and fat content were among the most important ones for the classification model. The models based on data preprocessed using direct orthogonal signal correction (DOSC), standard normal variate (SNV), and first and second derivatives provided the most successful results in terms of median sensitivity (0.91 in external validation) and median specificity (1.00 for external validation of SNV models and 0.94 for DOSC and first and second derivative models). A previously developed model, which was based on fatty acid fingerprinting of the same set of feed samples, provided a higher sensitivity (1.00). This shows that the NIRS-based approach provides a rapid and low-cost screening tool, whereas the fatty acid fingerprinting model can be used for further confirmation of the organic identity of feed samples for laying hens. These methods provide additional assurance to the administrative controls currently conducted in the organic feed sector.

IUS/TUG orbital operations and mission support study. Volume 3: Space tug operations

NASA Technical Reports Server (NTRS)

1975-01-01

A study was conducted to develop space tug operational concepts and baseline operations plan, and to provide cost estimates for space tug operations. Background data and study results are presented along with a transition phase analysis (the transition from interim upper state to tug operations). A summary is given of the tug operational and interface requirements with emphasis on the on-orbit checkout requirements, external interface operational requirements, safety requirements, and system operational interface requirements. Other topics discussed include reference missions baselined for the tug and details for the mission functional flows and timelines derived for the tug mission, tug subsystems, tug on-orbit operations prior to the tug first burn, spacecraft deployment and retrieval by the tug, operations centers, mission planning, potential problem areas, and cost data.

Influence of Building Material Solution of Structures to Effectiveness of Real Estate Development

NASA Astrophysics Data System (ADS)

Somorová, Viera

2015-11-01

Real estate development is in its essence the development process characterized by a considerable dynamics. The purpose of the development process is the creation of buildings which can be either rented by future unknown users or sold in the real estate market. A first part of the paper is dedicated to the analysis of the parameters of buildings solutions considering the future operating costs in a phase of designing. Material solution of external structures is a main factor not only in determining the future operating costs but also in achieving the subsequent economic effectiveness of the real estate development. To determine the relationship between economic efficiency criteria and determine the optimal material variant of building constructions for the specific example is the aim of the second part of paper.

Comparative analysis of dose rates in bricks determined by neutron activation analysis, alpha counting and X-ray fluorescence analysis for the thermoluminescence fine grain dating method

NASA Astrophysics Data System (ADS)

Bártová, H.; Kučera, J.; Musílek, L.; Trojek, T.

2014-11-01

In order to evaluate the age from the equivalent dose and to obtain an optimized and efficient procedure for thermoluminescence (TL) dating, it is necessary to obtain the values of both the internal and the external dose rates from dated samples and from their environment. The measurements described and compared in this paper refer to bricks from historic buildings and a fine-grain dating method. The external doses are therefore negligible, if the samples are taken from a sufficient depth in the wall. However, both the alpha dose rate and the beta and gamma dose rates must be taken into account in the internal dose. The internal dose rate to fine-grain samples is caused by the concentrations of natural radionuclides 238U, 235U, 232Th and members of their decay chains, and by 40K concentrations. Various methods can be used for determining trace concentrations of these natural radionuclides and their contributions to the dose rate. The dose rate fraction from 238U and 232Th can be calculated, e.g., from the alpha count rate, or from the concentrations of 238U and 232Th, measured by neutron activation analysis (NAA). The dose rate fraction from 40K can be calculated from the concentration of potassium measured, e.g., by X-ray fluorescence analysis (XRF) or by NAA. Alpha counting and XRF are relatively simple and are accessible for an ordinary laboratory. NAA can be considered as a more accurate method, but it is more demanding regarding time and costs, since it needs a nuclear reactor as a neutron source. A comparison of these methods allows us to decide whether the time- and cost-saving simpler techniques introduce uncertainty that is still acceptable.

Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care.

PubMed

Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina

2012-02-01

The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

Reflections on Costing, Pricing and Income Measurement at UK Higher Education Institutions

ERIC Educational Resources Information Center

Oduoza, Chike F.

2009-01-01

In these days of radical contraction of funding and expansion in student numbers, universities are under pressure to prioritise their resources, as well as to achieve effective costing and pricing to support judgement and decision making for funding and any external work undertaken. This study reviews costing, pricing and income measurement in…

Costs, needs must be balanced when buying computer systems.

PubMed

Krantz, G M; Doyle, J J; Stone, S G

1989-06-01

A healthcare institution must carefully examine its internal needs and external requirements before selecting an information system. The system's costs must be carefully weighed because significant computer cost overruns can cripple overall hospital finances. A New Jersey hospital carefully studied these issues and determined that a contract with a regional data center was its best option.

A comparison of cost effectiveness using data from randomized trials or actual clinical practice: selective cox-2 inhibitors as an example.

PubMed

van Staa, Tjeerd-Pieter; Leufkens, Hubert G; Zhang, Bill; Smeeth, Liam

2009-12-01

Data on absolute risks of outcomes and patterns of drug use in cost-effectiveness analyses are often based on randomised clinical trials (RCTs). The objective of this study was to evaluate the external validity of published cost-effectiveness studies by comparing the data used in these studies (typically based on RCTs) to observational data from actual clinical practice. Selective Cox-2 inhibitors (coxibs) were used as an example. The UK General Practice Research Database (GPRD) was used to estimate the exposure characteristics and individual probabilities of upper gastrointestinal (GI) events during current exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) or coxibs. A basic cost-effectiveness model was developed evaluating two alternative strategies: prescription of a conventional NSAID or coxib. Outcomes included upper GI events as recorded in GPRD and hospitalisation for upper GI events recorded in the national registry of hospitalisations (Hospital Episode Statistics) linked to GPRD. Prescription costs were based on the prescribed number of tables as recorded in GPRD and the 2006 cost data from the British National Formulary. The study population included over 1 million patients prescribed conventional NSAIDs or coxibs. Only a minority of patients used the drugs long-term and daily (34.5% of conventional NSAIDs and 44.2% of coxibs), whereas coxib RCTs required daily use for at least 6-9 months. The mean cost of preventing one upper GI event as recorded in GPRD was US$104k (ranging from US$64k with long-term daily use to US$182k with intermittent use) and US$298k for hospitalizations. The mean costs (for GPRD events) over calendar time were US$58k during 1990-1993 and US$174k during 2002-2005. Using RCT data rather than GPRD data for event probabilities, the mean cost was US$16k with the VIGOR RCT and US$20k with the CLASS RCT. The published cost-effectiveness analyses of coxibs lacked external validity, did not represent patients in actual clinical practice, and should not have been used to inform prescribing policies. External validity should be an explicit requirement for cost-effectiveness analyses.

Proceedings: National conference on environmental externalities

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

Not Available

1990-12-31

This report is the proceedings of the National Conference on Environmental Externalities. A environmental externality is the environmental impact of a process or a plant that society must endure. It is a social cost and is paid, but not by the company who produced it or the company`s customers who endure it. The main purpose of this report is to gather the many designs and ideas of how and why to internalize the externalities into the pricing systems of the public utility commissions, especially that of the electric utilities. Economic and sociological aspects of the internalization of these externalities aremore » given in these proceedings. Individual papers are processed separately for databases. (MB)« less

Externalities from Alcohol Consumption in the 2005 US National Alcohol Survey: Implications for Policy

PubMed Central

Greenfield, Thomas K.; Ye, Yu; Kerr, William; Bond, Jason; Rehm, Jürgen; Giesbrecht, Norman

2009-01-01

A subsample (n = 2,550) of the 2005 US National Alcohol Survey of adults was used to estimate prevalence and correlates of six externalities from alcohol abuse––family problems, assaults, accompanying intoxicated driver, vehicular accident, financial problems and vandalized property––all from another’s drinking. On a lifetime basis, 60% reported externalities, with a lower 12-month rate (9%). Women reported more family/marital and financial impacts and men more assaults, accompanying drunk drivers, and accidents. Being unmarried, older, white and ever having monthly heavy drinking or alcohol problems was associated with more alcohol externalities. Publicizing external costs of drinking could elevate political will for effective alcohol controls. PMID:20049257

[Trends in hospital care].

PubMed

Vecina Neto, Gonzalo; Malik, Ana Maria

2007-01-01

This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.

Global alliances effect in coalition forming

NASA Astrophysics Data System (ADS)

Vinogradova, Galina; Galam, Serge

2014-11-01

Coalition forming is investigated among countries, which are coupled with short range interactions, under the influence of externally-set opposing global alliances. The model extends a recent Natural Model of coalition forming inspired from Statistical Physics, where instabilities are a consequence of decentralized maximization of the individual benefits of actors. In contrast to physics where spins can only evaluate the immediate cost/benefit of a flip of orientation, countries have a long horizon of rationality, which associates with the ability to envision a way up to a better configuration even at the cost of passing through intermediate loosing states. The stabilizing effect is produced through polarization by the global alliances of either a particular unique global interest factor or multiple simultaneous ones. This model provides a versatile theoretical tool for the analysis of real cases and design of novel strategies. Such analysis is provided for several real cases including the Eurozone. The results shed a new light on the understanding of the complex phenomena of planned stabilization in the coalition forming.

Technology Solutions Case Study: Cost Analysis of Roof-Only Air Sealing and Insulation Strategies on 1-1/2 Story Homes in Cold Climates, Minneapolis, MN

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

None

This case study describes the External Thermal and Moisture Management System developed by the NorthernSTAR Building America Partnership. This system is typically used in deep energy retrofits and is a valuable approach for the roof-only portions of existing homes, particularly the 1 1/2-story home. It is effective in reducing energy loss through the building envelope, improving building durability, reducing ice dams, and providing opportunities to improve occupant comfort and health.

Information systems analysis approach in hospitals: a national survey.

PubMed

Wong, B K; Sellaro, C L; Monaco, J A

1995-03-01

A survey of 216 hospitals reveals that some hospitals do not conduct cost-benefit analyses or analyze possible adverse effects in feasibility studies. In determining and analyzing system requirements, external factors that initiate the transaction are not examined, and computer-aided software engineering (CASE) tools are seldom used. Some hospitals do not investigate the advantages and disadvantages of using in-house-developed software versus purchased software packages in the evaluation of alternatives. The survey finds that, overall, most hospitals follow the traditional systems development life cycle (SDLC) approach in analyzing information systems.

AIRSAR Automated Web-based Data Processing and Distribution System

NASA Technical Reports Server (NTRS)

Chu, Anhua; vanZyl, Jakob; Kim, Yunjin; Lou, Yunling; Imel, David; Tung, Wayne; Chapman, Bruce; Durden, Stephen

2005-01-01

In this paper, we present an integrated, end-to-end synthetic aperture radar (SAR) processing system that accepts data processing requests, submits processing jobs, performs quality analysis, delivers and archives processed data. This fully automated SAR processing system utilizes database and internet/intranet web technologies to allow external users to browse and submit data processing requests and receive processed data. It is a cost-effective way to manage a robust SAR processing and archival system. The integration of these functions has reduced operator errors and increased processor throughput dramatically.

The Energy Future.

PubMed

Newman, John; Bonino, Christopher A; Trainham, James A

2018-06-07

The foreseeable energy future will be driven by economics of known technologies and the desire to reduce CO 2 emissions to the atmosphere. Renewable energy options are compared with each other and with the use of fossil fuels with carbon capture and sequestration (CCS). Economic analysis is used to determine the best of several alternatives. One can disagree on the detailed costs, including externalities such as climate change and air and water pollution. But the differences in capital and operating costs between known technologies are so significant that one can draw clear conclusions. Results show that renewable energy cannot compete with fossil fuels on a cost basis alone because energy is intrinsic to the molecule, except for hydroelectricity. However, fossil fuels are implicated in climate change. Using renewable energy exclusively, including transportation and electricity needs, could reduce the standard of living in the United States by 43% to 62%, which would correspond to the level in about 1970. If capture and sequester of CO 2 are implemented, the cost of using fossil fuels will increase, but they beat renewable energy handily as an economic way to produce clean energy.

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

NASA Astrophysics Data System (ADS)

Morrow, William Russell, III

Reduction of the negative environmental and human health externalities resulting from both the electricity and transportation sectors can be achieved through technologies such as clean coal, natural gas, nuclear, hydro, wind, and solar photovoltaic technologies for electricity; reformulated gasoline and other fossil fuels, hydrogen, and electrical options for transportation. Negative externalities can also be reduced through demand reductions and efficiency improvements in both sectors. However, most of these options come with cost increases for two primary reasons: (1) most environmental and human health consequences have historically been excluded from energy prices; (2) fossil energy markets have been optimizing costs for over 100 years and thus have achieved dramatic cost savings over time. Comparing the benefits and costs of alternatives requires understanding of the tradeoffs associated with competing technology and lifestyle choices. As bioenergy is proposed as a large-scale feedstock within the United States, a question of "best use" of bioenergy becomes important. Bioenergy advocates propose its use as an alternative energy resource for electricity generation and transportation fuel production, primarily focusing on ethanol. These advocates argue that bioenergy offers environmental and economic benefits over current fossil energy use in each of these two sectors as well as in the U.S. agriculture sector. Unfortunately, bioenergy research has offered very few comparisons of these two alternative uses. This thesis helps fill this gap. This thesis compares the economics of bioenergy utilization by a method for estimating total financial costs for each proposed bioenergy use. Locations for potential feedstocks and bio-processing facilities (co-firing switchgrass and coal in existing coal fired power plants and new ethanol refineries) are estimated and linear programs are developed to estimate large-scale transportation infrastructure costs for each sector. Each linear program minimizes required bioenergy distribution and infrastructure costs. Truck and rail are the only two transportation modes allowed as they are the most likely bioenergy transportation modes. Switchgrass is chosen as a single bioenergy feedstock. All resulting costs are presented in units which reflect current energy markets price norms (¢/kWh, $/gal). The use of a common metric, carbon-dioxide emissions, allows a comparison of the two proposed uses. Additional analysis is provided to address aspects of each proposed use which are not reflected by a carbon-dioxide reduction metric. (Abstract shortened by UMI.)

Variation in costs of cone beam CT examinations among healthcare systems

PubMed Central

Christell, H; Birch, S; Hedesiu, M; Horner, K; Ivanauskaité, D; Nackaerts, O; Rohlin, M; Lindh, C

2012-01-01

Objectives To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients' and accompanying persons' time, “out of pocket” costs for examination fee and visits). Results The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range €148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range €0–102.02). Conclusions Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances. PMID:22499131

Systemic Obstacles to Lifelong Learning: The Influence of the Educational System Design on Learning Attitudes

ERIC Educational Resources Information Center

Lavrijsen, Jeroen; Nicaise, Ides

2017-01-01

Comparative research has often emphasized the importance of external barriers (e.g. enrolment costs) to explain inequalities in lifelong learning participation. However, individuals, in particular the low educated, are often not only prevented from participation by external barriers, but also by negative psychological dispositions about learning.…

75 FR 64773 - Study Required by Section 989G(b) of the Dodd-Frank Act Regarding Compliance With Section 404(b...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

..., which addresses management's responsibility for reporting on the effectiveness of internal control over...) Quantitative and qualitative information about the trends of internal and external costs of having an external... over time; (3) Characteristics of internal controls, management's evaluation process and corporate...

Current external beam radiation therapy quality assurance guidance: does it meet the challenges of emerging image-guided technologies?

PubMed

Palta, Jatinder R; Liu, Chihray; Li, Jonathan G

2008-01-01

The traditional prescriptive quality assurance (QA) programs that attempt to ensure the safety and reliability of traditional external beam radiation therapy are limited in their applicability to such advanced radiation therapy techniques as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, inverse treatment planning, stereotactic radiosurgery/radiotherapy, and image-guided radiation therapy. The conventional QA paradigm, illustrated by the American Association of Physicists in Medicine Radiation Therapy Committee Task Group 40 (TG-40) report, consists of developing a consensus menu of tests and device performance specifications from a generic process model that is assumed to apply to all clinical applications of the device. The complexity, variation in practice patterns, and level of automation of high-technology radiotherapy renders this "one-size-fits-all" prescriptive QA paradigm ineffective or cost prohibitive if the high-probability error pathways of all possible clinical applications of the device are to be covered. The current approaches to developing comprehensive prescriptive QA protocols can be prohibitively time consuming and cost ineffective and may sometimes fail to adequately safeguard patients. It therefore is important to evaluate more formal error mitigation and process analysis methods of industrial engineering to more optimally focus available QA resources on process components that have a significant likelihood of compromising patient safety or treatment outcomes.

Approximate simulation model for analysis and optimization in engineering system design

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw

1989-01-01

Computational support of the engineering design process routinely requires mathematical models of behavior to inform designers of the system response to external stimuli. However, designers also need to know the effect of the changes in design variable values on the system behavior. For large engineering systems, the conventional way of evaluating these effects by repetitive simulation of behavior for perturbed variables is impractical because of excessive cost and inadequate accuracy. An alternative is described based on recently developed system sensitivity analysis that is combined with extrapolation to form a model of design. This design model is complementary to the model of behavior and capable of direct simulation of the effects of design variable changes.

[Development of a secure and cost-effective infrastructure for the access of arbitrary web-based image distribution systems].

PubMed

Hackländer, T; Kleber, K; Schneider, H; Demabre, N; Cramer, B M

2004-08-01

To build an infrastructure that enables radiologists on-call and external users a teleradiological access to the HTML-based image distribution system inside the hospital via internet. In addition, no investment costs should arise on the user side and the image data should be sent renamed using cryptographic techniques. A pure HTML-based system manages the image distribution inside the hospital, with an open source project extending this system through a secure gateway outside the firewall of the hospital. The gateway handles the communication between the external users and the HTML server within the network of the hospital. A second firewall is installed between the gateway and the external users and builds up a virtual private network (VPN). A connection between the gateway and the external user is only acknowledged if the computers involved authenticate each other via certificates and the external users authenticate via a multi-stage password system. All data are transferred encrypted. External users get only access to images that have been renamed to a pseudonym by means of automated processing before. With an ADSL internet access, external users achieve an image load frequency of 0.4 CT images per second. More than 90 % of the delay during image transfer results from security checks within the firewalls. Data passing the gateway induce no measurable delay. Project goals were realized by means of an infrastructure that works vendor independently with any HTML-based image distribution systems. The requirements of data security were realized using state-of-the-art web techniques. Adequate access and transfer speed lead to a widespread acceptance of the system on the part of external users.

Financial competitiveness of organic agriculture on a global scale.

PubMed

Crowder, David W; Reganold, John P

2015-06-16

To promote global food and ecosystem security, several innovative farming systems have been identified that better balance multiple sustainability goals. The most rapidly growing and contentious of these systems is organic agriculture. Whether organic agriculture can continue to expand will likely be determined by whether it is economically competitive with conventional agriculture. Here, we examined the financial performance of organic and conventional agriculture by conducting a meta-analysis of a global dataset spanning 55 crops grown on five continents. When organic premiums were not applied, benefit/cost ratios (-8 to -7%) and net present values (-27 to -23%) of organic agriculture were significantly lower than conventional agriculture. However, when actual premiums were applied, organic agriculture was significantly more profitable (22-35%) and had higher benefit/cost ratios (20-24%) than conventional agriculture. Although premiums were 29-32%, breakeven premiums necessary for organic profits to match conventional profits were only 5-7%, even with organic yields being 10-18% lower. Total costs were not significantly different, but labor costs were significantly higher (7-13%) with organic farming practices. Studies in our meta-analysis accounted for neither environmental costs (negative externalities) nor ecosystem services from good farming practices, which likely favor organic agriculture. With only 1% of the global agricultural land in organic production, our findings suggest that organic agriculture can continue to expand even if premiums decline. Furthermore, with their multiple sustainability benefits, organic farming systems can contribute a larger share in feeding the world.

School food, politics and child health.

PubMed

Bundy, Donald A P; Drake, Lesley J; Burbano, Carmen

2013-06-01

An analysis undertaken jointly in 2009 by the UN World Food Programme, The Partnership for Child Development and the World Bank was published as Rethinking School Feeding to provide guidance on how to develop and implement effective school feeding programmes as a productive safety net and as part of the efforts to achieve Education for All. The present paper reflects on how understanding of school feeding has changed since that analysis. Data on school feeding programme outcomes were collected through a literature review. Regression models were used to analyse relationships between school feeding costs (from data that were collected), the per capita costs of primary education and Gross Domestic Product per capita. Data on the transition to national ownership, supply chains and country examples were collected through country case studies. School feeding programmes increase school attendance, cognition and educational achievement, as well as provide a transfer of resources to households with possible benefits to local agricultural production and local market development. Low-income countries exhibit large variations in school feeding costs, with concomitant opportunities for cost containment. Countries are increasingly looking to transition from externally supported projects to national programmes. School feeding is now clearly evident as a major social programme in most countries with a global turnover in excess of $US 100 billion. This argues for a continuing focus on the evidence base with a view to helping countries ensure that their programmes are as cost-effective as possible. Clear policy advice has never been more important.

Is Municipal Solid Waste Recycling Economically Efficient?

NASA Astrophysics Data System (ADS)

Lavee, Doron

2007-12-01

It has traditionally been argued that recycling municipal solid waste (MSW) is usually not economically viable and that only when externalities, long-term dynamic considerations, and/or the entire product life cycle are taken into account, recycling becomes worthwhile from a social point of view. This article explores the results of a wide study conducted in Israel in the years 2000 2004. Our results reveal that recycling is optimal more often than usually claimed, even when externality considerations are ignored. The study is unique in the tools it uses to explore the efficiency of recycling: a computer-based simulation applied to an extensive database. We developed a simulation for assessing the costs of handling and treating MSW under different waste-management systems and used this simulation to explore possible cost reductions obtained by designating some of the waste (otherwise sent to landfill) to recycling. We ran the simulation on data from 79 municipalities in Israel that produce over 60% of MSW in Israel. For each municipality, we were able to arrive at an optimal method of waste management and compare the costs associated with 100% landfilling to the costs born by the municipality when some of the waste is recycled. Our results indicate that for 51% of the municipalities, it would be efficient to adopt recycling, even without accounting for externality costs. We found that by adopting recycling, municipalities would be able to reduce direct costs by an average of 11%. Through interviews conducted with representatives of municipalities, we were also able to identify obstacles to the utilization of recycling, answering in part the question of why actual recycling levels in Israel are lower than our model predicts they should be.

Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom.

PubMed

Vaidya, Anil; Vaidya, Param; Both, Brigitte; Brew-Graves, Chris; Bulsara, Max; Vaidya, Jayant S

2017-08-17

The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks' course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost-effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer's perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs). In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGIT-IORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses. TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain. ISRCTN34086741; post results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementation of Haccp in the Mexican Poultry Processing Industry

NASA Astrophysics Data System (ADS)

Maldonado-Siman, Ema; Martínez-Hernández, Pedro Arturo; Ruíz-Flores, Agustín; García-Muñiz, José G.; Cadena-Meneses, José A.

Hazard Analysis and Critical Control Point (HACCP) is a safety and quality management tool used as major issue in international and domestic trade in food industry. However, detailed information on costs and benefits of HACCP implementation is needed to provide appropriate advice to food processing plants. This paper reports on the perceptions of costs and benefits by the Mexican poultry processing plants and sale destinations. The results suggest that the major costs of implementing and operating HACCP within poultry processing plants are record keeping and external technical advice. The main benefit indicated by the majority of processing plants is a reduction in microbial counts. Over 39% of poultry production is sent to nation-wide chains of supermarkets, and less than 13% is sent to international markets. It was concluded that the adoption of HACCP by the Mexican poultry processing sector is based on the concern to increase and keep the domestic market, rather than to compete in the international market.

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

PubMed

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

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios

PubMed Central

Semple, John L; Coyte, Peter C

2014-01-01

Background Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications. Objective The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients. Methods This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks. Results This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up. Conclusions Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective. PMID:25245774

Externalities of energy use, analyzed for shipping and electricity generation

NASA Astrophysics Data System (ADS)

Thomson, Heather

Energy use is central to the modern lifestyle, but producing this energy often comes at an environmental cost. The three studies in this paper look at the tradeoffs involved in energy production. The first looks at transitioning marine vessels to natural gas from current distillate fuels. While natural gas will reduce local air pollutants, such as sulfur oxides and particulate matter, the implications for greenhouse gases depend on how the natural gas is extracted, processed, distributed, and used. Applying a "technology warming potential" (TWP) approach, natural gas as a marine fuel achieves climate parity within 30 years for diesel ignited engines, though it could take up to 190 years to reach climate parity with conventional fuels in a spark ignited engine. Movement towards natural gas as a marine fuel continues to progress, and conditions exist in some regions to make a near-term transition to natural gas feasible. The second study looks at externalities associated with electricity generation. The impact on the surrounding community is one concern when siting new electricity generating facilities. A survey was conducted of residents living near an industrial scale wind turbine and a coal-fired power plant to determine their visual and auditory effects on the residents. Results concluded that respondents living near the wind turbine were in favor of the facility. They were willing to pay an average of 2.56 a month to keep the turbine in its current location. Respondents living near the coal plant were opposed to the facility. They were willing to spend 1.82 a month to have the facility removed. The third study presents a cost effectiveness analysis of three of the main fuels used for electricity generation, namely coal, natural gas, and wind. This analysis adds social costs to the private costs traditionally utilized by investors making decisions. It utilizes previous research on visual and auditory amenity and disamenity values as well as recent published studies on the impacts of electricity generation on water use, wildlife, and property values, among others, as well as other impacts well documented in the literature. When literature values were not identical, low, medium, and high values were considered in order to look at the full range of values. On average, the cost of wind power is 0.0332/kWh, natural gas power is 0.1071/kWh, and coal $0.1314/kWh.

Strategic Planning for Health Care Cost Controls in a Constantly Changing Environment.

PubMed

Hembree, William E

2015-01-01

Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges.

Congestion Pricing for Aircraft Pushback Slot Allocation.

PubMed

Liu, Lihua; Zhang, Yaping; Liu, Lan; Xing, Zhiwei

2017-01-01

In order to optimize aircraft pushback management during rush hour, aircraft pushback slot allocation based on congestion pricing is explored while considering monetary compensation based on the quality of the surface operations. First, the concept of the "external cost of surface congestion" is proposed, and a quantitative study on the external cost is performed. Then, an aircraft pushback slot allocation model for minimizing the total surface cost is established. An improved discrete differential evolution algorithm is also designed. Finally, a simulation is performed on Xinzheng International Airport using the proposed model. By comparing the pushback slot control strategy based on congestion pricing with other strategies, the advantages of the proposed model and algorithm are highlighted. In addition to reducing delays and optimizing the delay distribution, the model and algorithm are better suited for use for actual aircraft pushback management during rush hour. Further, it is also observed they do not result in significant increases in the surface cost. These results confirm the effectiveness and suitability of the proposed model and algorithm.

Rapid prototyping prosthetic hand acting by a low-cost shape-memory-alloy actuator.

PubMed

Soriano-Heras, Enrique; Blaya-Haro, Fernando; Molino, Carlos; de Agustín Del Burgo, José María

2018-06-01

The purpose of this article is to develop a new concept of modular and operative prosthetic hand based on rapid prototyping and a novel shape-memory-alloy (SMA) actuator, thus minimizing the manufacturing costs. An underactuated mechanism was needed for the design of the prosthesis to use only one input source. Taking into account the state of the art, an underactuated mechanism prosthetic hand was chosen so as to implement the modifications required for including the external SMA actuator. A modular design of a new prosthesis was developed which incorporated a novel SMA actuator for the index finger movement. The primary objective of the prosthesis is achieved, obtaining a modular and functional low-cost prosthesis based on additive manufacturing executed by a novel SMA actuator. The external SMA actuator provides a modular system which allows implementing it in different systems. This paper combines rapid prototyping and a novel SMA actuator to develop a new concept of modular and operative low-cost prosthetic hand.

Congestion Pricing for Aircraft Pushback Slot Allocation

PubMed Central

Zhang, Yaping

2017-01-01

In order to optimize aircraft pushback management during rush hour, aircraft pushback slot allocation based on congestion pricing is explored while considering monetary compensation based on the quality of the surface operations. First, the concept of the “external cost of surface congestion” is proposed, and a quantitative study on the external cost is performed. Then, an aircraft pushback slot allocation model for minimizing the total surface cost is established. An improved discrete differential evolution algorithm is also designed. Finally, a simulation is performed on Xinzheng International Airport using the proposed model. By comparing the pushback slot control strategy based on congestion pricing with other strategies, the advantages of the proposed model and algorithm are highlighted. In addition to reducing delays and optimizing the delay distribution, the model and algorithm are better suited for use for actual aircraft pushback management during rush hour. Further, it is also observed they do not result in significant increases in the surface cost. These results confirm the effectiveness and suitability of the proposed model and algorithm. PMID:28114429

Freedom Star tows a barge with an SLWT into Port Canaveral for the first time

NASA Technical Reports Server (NTRS)

1998-01-01

Freedom Star, one of NASA's two solid rocket booster recovery ships, tows a barge containing the third Space Shuttle super lightweight external tank (SLWT) into Port Canaveral. This SLWT will be used to launch the orbiter Discovery on mission STS-95 in October. This first-time towing arrangement, part of a cost savings plan by NASA to prudently manage existing resources, began June 12 from the Michoud Assembly Facility in New Orleans where the Shuttle's external tanks are manufactured. The barge will now be transported up the Banana River to the LC-39 turn basin using a conventional tugboat. Previously, NASA relied on an outside contractor to provide external tank towing services at a cost of about $120,000 per trip. The new plan allows NASA's Space Flight Operations contractor, United Space Alliance (USA), to provide the same service directly to NASA using the recovery ships during their downtime between Shuttle launches. Studies show a potential savings of about $50,000 per trip. The cost of the necessary ship modifications should be paid back by the fourteenth tank delivery. The other recovery ship, Liberty Star, has also undergone deck strengthening enhancements and will soon have the necessary towing winch installed.

Recovery Ship Freedom Star

NASA Technical Reports Server (NTRS)

1998-01-01

Freedom Star, one of NASA's two solid rocket booster recovery ships, is towing a barge containing the third Space Shuttle Super Lightweight External Tank (SLWT) into Port Canaveral. This SLWT was slated for use to launch the orbiter Discovery on mission STS-95 in October 1998. This first time towing arrangement, part of a cost saving plan by NASA to prudently manage existing resources, began June 12 from the Michoud Assembly Facility in New Orleans where the Shuttle's external tanks were manufactured. The barge was transported up Banana River to the LC-39 turn basin using a conventional tug boat. Previously, NASA relied on an outside contractor to provide external tank towing services at a cost of about $120,000 per trip. The new plan allowed NASA's Space Flight Operations contractor, United Space Alliance (USA), to provide the same service to NASA using the recovery ships during their downtime between Shuttle launches. Studies showed a potential savings of about $50,000 per trip. The cost of the necessary ship modifications would be paid back by the fourteenth tank delivery. The other recovery ship, Liberty Star, also underwent deck strengthening enhancements and had the necessary towing wench installed.

Economics of regulation: externalities and institutional issues

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

Kahn, A.E.

In two previous articles, ''Can An Economist Find Happiness Setting Public Utility Rates'' and ''Applications of Economics to Public Utility Rate Structures'', appearing in Public Utilities Fortnightly January 5 and January 19, 1978, respectively, the author summarized his experiences in applying elementary economic principles to the regulation of public utilities in New York state, specifically to setting utility rates. In this article, Mr. Kahn discusses second-best considerations and externalities. He points out that opponents of marginal-cost pricing--particularly of electricity--have in recent years become enthusiastic exponents of the theory of second best. What is required, he feels, is an examination ofmore » how other, most directly pertinent prices in the economy do actually stand relative to their marginal costs. These would be the prices of goods and services for which electricity is a substitute; with which electricity is used as a complement; in whose supply electricity is an input; and which themselves constitute inputs in the production and delivery of electricity. Oil and gas are more complicated cases. External costs, such as abatement requirements, are considered when setting rates. The author points out other regulatory issues to be considered in decision making to conclude this series of articles. (MCW)« less

A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process.

PubMed

Schommer, Jon C; Worley, Marcia M; Kjos, Andrea L; Pakhomov, Serguei V S; Schondelmeyer, Stephen W

2009-06-01

Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.

The assessment of health impacts and external costs of natural gas-fired power plant of Qom.

PubMed

Fouladi Fard, Reza; Naddafi, Kazem; Yunesian, Masud; Nabizadeh Nodehi, Ramin; Dehghani, Mohammad Hadi; Hassanvand, Mohammad Sadegh

2016-10-01

The external health damage costs of the combined cycle natural gas-fired power plant of Qom were investigated via the simplified impact pathway approach. Emitted particulate matter (PM 10 ) and gaseous pollutants (NO x , CO, and SO 2 ) from the power plant stack were measured The health effects and related costs were estimated by QUERI model from AirPacts according to the emissions, source and stack parameters, pollutant depletion velocities, exposure-response functions, local and regional population density, and detailed meteorological data. The results showed that the main health effect was assigned to the nitrate as restricted activity days (RAD) with 25,240 days/year. For all pollutants, the maximum health damage costs were related to the long-term mortality (49 %), restricted activity days (27 %), and chronic bronchitis (21 %). The annual health damage costs were approximately 4.76 million US$, with the cost being 0.096 US per kWh of generating electricity. Although the health damage costs of gas-fired power plant were lower than those of other heavy fuels, it seems essential to consider the health and environmental damages and focus on the emission control strategies, particularly in site selection for the new power plants and expanding the current ones.

Cost analysis of magnetically controlled growing rods compared with traditional growing rods for early-onset scoliosis in the US: an integrated health care delivery system perspective

PubMed Central

Polly, David W; Ackerman, Stacey J; Schneider, Karen; Pawelek, Jeff B; Akbarnia, Behrooz A

2016-01-01

Purpose Traditional growing rod (TGR) for early-onset scoliosis (EOS) is effective but requires repeated invasive surgical lengthenings under general anesthesia. Magnetically controlled growing rod (MCGR) is lengthened noninvasively using a hand-held magnetic external remote controller in a physician office; however, the MCGR implant is expensive, and the cumulative cost savings have not been well studied. We compared direct medical costs of MCGR and TGR for EOS from the US integrated health care delivery system perspective. We hypothesized that over time, the MCGR implant cost will be offset by eliminating repeated TGR surgical lengthenings. Methods For both TGR and MCGR, the economic model estimated the cumulative costs for initial implantation, lengthenings, revisions due to device failure, surgical-site infections, device exchanges (at 3.8 years), and final fusion, over a 6-year episode of care. Model parameters were estimated from published literature, a multicenter EOS database of US institutions, and interviews. Costs were discounted at 3.0% annually and represent 2015 US dollars. Results Of 1,000 simulated patients over 6 years, MCGR was associated with an estimated 270 fewer deep surgical-site infections and 197 fewer revisions due to device failure compared with TGR. MCGR was projected to cost an additional $61 per patient over the 6-year episode of care compared with TGR. Sensitivity analyses indicated that the results were sensitive to changes in the percentage of MCGR dual rod use, months between TGR lengthenings, percentage of hospital inpatient (vs outpatient) TGR lengthenings, and MCGR implant cost. Conclusion Cost neutrality of MCGR to TGR was achieved over the 6-year episode of care by eliminating repeated TGR surgical lengthenings. To our knowledge, this is the first cost analysis comparing MCGR to TGR – from the US provider perspective – which demonstrates the efficient provision of care with MCGR. PMID:27695352

Treatments for Metastatic Prostate Cancer (mPC): A Review of Costing Evidence.

PubMed

Norum, Jan; Nieder, Carsten

2017-12-01

Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC). We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers. A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed ® search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument. A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In most studies, cabazitaxel was not recommended, because of high cost. Looking at bone-targeting drugs, generic zoledronic acid (ZA) was recommended. External beam radiotherapy (EBRT) was analysed in three studies, and single fraction radiotherapy was concluded to be cost saving. Radium-223 was documented as beneficial, but costly. The quality of the studies was generally good, but sensitivity analyses, discounting and the measurement of health outcomes were present in less than two thirds of the selected studies. The treatment of mCRPC was associated with significant cost. In the post-docetaxel setting, single fraction radiotherapy and enzalutamide were considered cost-effective in most studies. Generic ZA was the recommended bone-targeting therapy.

Determining a sustainable and economically optimal wastewater treatment and discharge strategy.

PubMed

Hardisty, Paul E; Sivapalan, Mayuran; Humphries, Robert

2013-01-15

Options for treatment and discharge of wastewater in regional Western Australia (WA) are examined from the perspective of overall sustainability and social net benefit. Current practice in the state has typically involved a basic standard of treatment deemed to be protective of human health, followed by discharge to surface water bodies. Community and regulatory pressure to move to higher standards of treatment is based on the presumption that a higher standard of treatment is more protective of the environment and society, and thus is more sustainable. This analysis tests that hypothesis for Western Australian conditions. The merits of various wastewater treatment and discharge strategies are examined by quantifying financial costs (capital and operations), and by monetising the wider environmental and social costs and benefits of each option over an expanded planning horizon (30 years). Six technical treatment-disposal options were assessed at a test site, all of which met the fundamental criterion of protecting human health. From a financial perspective, the current business-as-usual option is preferred - it is the least cost solution. However, valuing externalities such as water, greenhouse gases, ecological impacts and community amenity, the status quo is revealed as sub-optimal. Advanced secondary treatment with stream disposal improves water quality and provides overall net benefit to society. All of the other options were net present value (NPV) negative. Sensitivity analysis shows that the favoured option outperforms all of the others under a wide range of financial and externality values and assumptions. Expanding the findings across the state reveals that moving from the identified socially optimal level of treatment to higher (tertiary) levels of treatment would result in a net loss to society equivalent to several hundred million dollars. In other words, everyone benefits from improving treatment to the optimum point. But society, the environment, and the Corporation are all worse off when treatment levels are pushed beyond what is economic and sustainable. Copyright © 2012 Elsevier Ltd. All rights reserved.

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed

Wonderling, D; McDermott, C; Buxton, M; Kinmonth, A L; Pyke, S; Thompson, S; Wood, D

1996-05-18

To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. 13 general practices across Britain. 4185 men aged 40-59 and their 2827 partners. Nurse led programme using a family centered approach, with follow up according to degree of risk. Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed Central

Wonderling, D.; McDermott, C.; Buxton, M.; Kinmonth, A. L.; Pyke, S.; Thompson, S.; Wood, D.

1996-01-01

OBJECTIVE--To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. DESIGN--Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. SETTING--13 general practices across Britain. SUBJECTS--4185 men aged 40-59 and their 2827 partners. INTERVENTION--Nurse led programme using a family centered approach, with follow up according to degree of risk. MAIN OUTCOME MEASURES--Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. RESULTS--Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). CONCLUSIONS--The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women. PMID:8634617

Application of Energy Integration Techniques to the Design of Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Levri, Julie; Finn, Cory

2000-01-01

Exchanging heat between hot and cold streams within an advanced life support system can save energy. This savings will reduce the equivalent system mass (ESM) of the system. Different system configurations are examined under steady-state conditions for various percentages of food growth and waste treatment. The scenarios investigated represent possible design options for a Mars reference mission. Reference mission definitions are drawn from the ALSS Modeling and Analysis Reference Missions Document, which includes definitions for space station evolution, Mars landers, and a Mars base. For each scenario, streams requiring heating or cooling are identified and characterized by mass flow, supply and target temperatures and heat capacities. The Pinch Technique is applied to identify good matches for energy exchange between the hot and cold streams and to calculate the minimum external heating and cooling requirements for the system. For each pair of hot and cold streams that are matched, there will be a reduction in the amount of external heating and cooling required, and the original heating and cooling equipment will be replaced with a heat exchanger. The net cost savings can be either positive or negative for each stream pairing, and the priority for implementing each pairing can be ranked according to its potential cost savings. Using the Pinch technique, a complete system heat exchange network is developed and heat exchangers are sized to allow for calculation of ESM. The energy-integrated design typically has a lower total ESM than the original design with no energy integration. A comparison of ESM savings in each of the scenarios is made to direct future Pinch Analysis efforts.

The social costs of homeowner decisions in fire-prone communities: information, insurance, and amenities

Treesearch

Gwenlyn Busby; Gregory S. Amacher; Robert G. Haight

2013-01-01

In this article, we consider wildfire risk management decisions using a dynamic stochastic model of homeowner interaction in a setting where spatial externalities arise. Our central objective is to apply observations from the social science literature about homeowner preferences to this economic externality problem and determine how assumptions about insurance,...

Federally sponsored multidisciplinary research centers: Learning, evaluation, and vicious circles.

PubMed

Youtie, Jan; Corley, Elizabeth A

2011-02-01

Despite the increasing investment in multi-year federally funded science and technology centers in universities, there are few studies of how these centers engage in learning and change based on information submitted from various agents in the oversight and evaluation process. One challenge is how to manage and respond to this evaluative information, especially when it is conflicting. Although the center can learn and adapt in response to this information, it can also become subject to a vicious circle of continuous restructuring and production of documentation to address various and potentially inconsistent recommendations. In this paper we illustrate the effects of such a dynamic based on our experiences as external evaluators of the $25 million NSF-funded Learning in Informal and Formal Environments (LIFE) Center. The case study presents an analysis of annual reports and strategic planning documents along with other sources of evidence to illustrate the evolution of center organizational approaches in response to evaluations by external review panels, center evaluators, program managers, and other external stakeholders. We conclude with suggestions for how evaluators may help centers ease the cost of learning and reduce the likelihood of a vicious circle. 2010 Elsevier Ltd. All rights reserved.

Cost-benefit analysis of drug treatment services: review of the literature*

PubMed

Cartwright, William S.

2000-03-01

BACKGROUND: How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost-benefit analysis attempts to answer these questions in a standard analytic framework. AIMS: This paper reviews cost-benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes. METHOD: Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports. RESULTS: Cost-benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost-benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost-benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use. DISCUSSION: Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost-benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States. CONCLUSION: Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Finding a positive net social benefit should assist policy-makers with decisions related to drug abuse treatment expenditures. Additional work on allocation of budget dollars across various drug treatment services will be needed. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Government agencies and other stakeholders in national health care systems must realize that cost-benefit studies are an important tool for decision-making. Rational strategies can only be addressed by examining alternatives for the efficient allocation and equitable distribution of scarce resources. IMPLICATIONS FOR FURTHER RESEARCH: Future research should focus on standardizing the methods used in the cost-benefit analysis. Extensions should examine methods related to the willingness-to-pay approach. Studies are needed for drug abuse treatment targeted to adolescents and women. More studies should be published in the scientific literature.

The Effect of Drag and Attachment Site of External Tags on Swimming Eels: Experimental Quantification and Evaluation Tool

PubMed Central

Tudorache, Christian; Burgerhout, Erik; Brittijn, Sebastiaan; van den Thillart, Guido

2014-01-01

Telemetry studies on aquatic animals often use external tags to monitor migration patterns and help to inform conservation effort. However, external tags are known to impair swimming energetics dramatically in a variety of species, including the endangered European eel. Due to their high swimming efficiency, anguilliform swimmers are very susceptibility for added drag. Using an integration of swimming physiology, behaviour and kinematics, we investigated the effect of additional drag and site of externally attached tags on swimming mode and costs. The results show a significant effect of a) attachment site and b) drag on multiple energetic parameters, such as Cost Of Transport (COT), critical swimming speed (Ucrit) and optimal swimming speed (Uopt), possibly due to changes in swimming kinematics. Attachment at 0.125 bl from the tip of the snout is a better choice than at the Centre Of Mass (0.35 bl), as it is the case in current telemetry studies. Quantification of added drag effect on COT and Ucrit show a (limited) correlation, suggesting that the Ucrit test can be used for evaluating external tags for telemetry studies until a certain threshold value. Uopt is not affected by added drag, validating previous findings of telemetry studies. The integrative methodology and the evaluation tool presented here can be used for the design of new studies using external telemetry tags, and the (re-) evaluation of relevant studies on anguilliform swimmers. PMID:25409179

The effect of drag and attachment site of external tags on swimming eels: experimental quantification and evaluation tool.

PubMed

Tudorache, Christian; Burgerhout, Erik; Brittijn, Sebastiaan; van den Thillart, Guido

2014-01-01

Telemetry studies on aquatic animals often use external tags to monitor migration patterns and help to inform conservation effort. However, external tags are known to impair swimming energetics dramatically in a variety of species, including the endangered European eel. Due to their high swimming efficiency, anguilliform swimmers are very susceptibility for added drag. Using an integration of swimming physiology, behaviour and kinematics, we investigated the effect of additional drag and site of externally attached tags on swimming mode and costs. The results show a significant effect of a) attachment site and b) drag on multiple energetic parameters, such as Cost Of Transport (COT), critical swimming speed (Ucrit) and optimal swimming speed (Uopt), possibly due to changes in swimming kinematics. Attachment at 0.125 bl from the tip of the snout is a better choice than at the Centre Of Mass (0.35 bl), as it is the case in current telemetry studies. Quantification of added drag effect on COT and Ucrit show a (limited) correlation, suggesting that the Ucrit test can be used for evaluating external tags for telemetry studies until a certain threshold value. Uopt is not affected by added drag, validating previous findings of telemetry studies. The integrative methodology and the evaluation tool presented here can be used for the design of new studies using external telemetry tags, and the (re-) evaluation of relevant studies on anguilliform swimmers.

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

PubMed

Lopert, Ruth; Ruiz, Francis; Chalkidou, Kalipso

2013-10-01

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

The MAGEC system for spinal lengthening in children with scoliosis: A NICE Medical Technology Guidance.

PubMed

Jenks, Michelle; Craig, Joyce; Higgins, Joanne; Willits, Iain; Barata, Teresa; Wood, Hannah; Kimpton, Christine; Sims, Andrew

2014-12-01

Scoliosis-structural lateral curvature of the spine-affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18).

The cost-effectiveness of a child nutrition education programme in Peru.

PubMed

Waters, Hugh R; Penny, Mary E; Creed-Kanashiro, Hilary M; Robert, Rebecca C; Narro, Rocío; Willis, Jeff; Caulfield, Laura E; Black, Robert E

2006-07-01

This article reports impact and cost results from a health facility-based nutrition education programme targeting children less than 2 years of age in Trujillo, Peru. Key elements of the programme included participative complementary feeding demonstrations, growth monitoring sessions and an accreditation process. Data were collected from six intervention and six control health facilities to measure utilization and costs associated with the intervention. To calculate the unit costs of services, these costs are allocated using activity-based costing. To measure the effects of the intervention, 338 children were followed through household surveys at regular intervals from birth until the age of 18 months. The intervention had a clear positive impact both on the use of nutrition-related services and on children's growth outcomes. Children in the intervention areas made 17.6 visits to health facilities in the first 18 months of life, compared with 14.1 visits for children in the control areas (P < 0.001). This pattern holds true for all socioeconomic groups. The intervention prevented 11.1 cases of stunting per 100 children. In multivariate logistic regression analysis, children in the intervention were 0.33 times as likely to be stunted as the controls (P = 0.002). The marginal cost of the intervention - including external costs, training, health education materials and extra travel and equipment - is 6.12 US dollars per child reached and 55.16 US dollars per case of stunting prevented. The estimated marginal cost of the intervention per death averted is 1952 US dollars.

Economic analysis of the global polio eradication initiative.

PubMed

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Linkins, Jennifer; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

2010-12-16

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative. Copyright © 2010 Elsevier Ltd. All rights reserved.

Prostate tumor alignment and continuous, real-time adaptive radiation therapy using electromagnetic fiducials: clinical and cost-utility analyses.

PubMed

Quigley, Martin M; Mate, Timothy P; Sylvester, John E

2009-01-01

To evaluate the accuracy, utility, and cost effectiveness of a new electromagnetic patient positioning and continuous, real-time monitoring system, which uses permanently implanted resonant transponders in the target (Calypso 4D Localization System and Beacon transponders, Seattle, WA) to continuously monitor tumor location and movement during external beam radiation therapy of the prostate. This clinical trial studied 43 patients at 5 sites. All patients were implanted with 3 transponders each. In 41 patients, the system was used for initial alignment at each therapy session. Thirty-five patients had continuous monitoring during their radiation treatment. Over 1,000 alignment comparisons were made to a commercially available kV X-ray positioning system (BrainLAB ExacTrac, Munich, Germany). Using decision analysis and Markov processes, the outcomes of patients were simulated over a 5-year period and measured in terms of costs from a payer's perspective and quality-adjusted life years (QALYs). All patients had satisfactory transponder implantations for monitoring purposes. In over 75% of the treatment sessions, the correction to conventional positioning (laser and tattoos) directed by an electromagnetic patient positioning and monitoring system was greater than 5 mm. Ninety-seven percent (34/35) of the patients who underwent continuous monitoring had target motion that exceeded preset limits at some point during the course of their radiation therapy. Exceeding preset thresholds resulted in user intervention at least once during the therapy in 80% of the patients (28/35). Compared with localization using ultrasound, electronic portal imaging devices (EPID), or computed tomography (CT), localization with the electromagnetic patient positioning and monitoring system yielded superior gains in QALYs at comparable costs. Most patients positioned with conventional tattoos and lasers for prostate radiation therapy were found by use of the electromagnetic patient positioning and monitoring system to have alignment errors exceeding 5 mm. Almost all patients undergoing external beam radiation of the prostate have been shown to have target organ movement exceeding 3 mm during radiation therapy delivery. The ability of the electromagnetic technology to monitor tumor target location during the same time as radiation therapy is being delivered allows clinicians to provide real time adaptive radiation therapy for prostate cancer. This permits clinicians to intervene when the prostate moves outside the radiation isocenter, which should decrease adverse events and improve patient outcomes. Additionally, a cost-utility analysis has demonstrated that the electromagnetic patient positioning and monitoring system offers patient outcome benefits at a cost that falls well within the payer's customary willingness to pay (WTP) threshold of $50,000 per QALY.

Recovery Act: Low Cost Integrated Substrate for OLED Lighting Development

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

Benton, Scott; Bhandari, Abhinav

2012-12-26

PPG pursued the development of an integrated substrate, including the anode, external, and internal extraction layers. The objective of PPG's program was to achieve cost reductions by displacing the existing expensive borosilicate or double-side polished float glass substrates and developing alternative electrodes and scalable light extraction layer technologies through focused and short-term applied research. One of the key highlights of the project was proving the feasibility of using PPG's high transmission Solarphire® float glass as a substrate to consistently achieve organic lightemitting diode (OLED) devices with good performance and high yields. Under this program, four low-cost alternatives to the Indiummore » Tin Oxide (ITO) anode were investigated using pilot-scale magnetron sputtered vacuum deposition (MSVD) and chemical vapor deposition (CVD) technologies. The anodes were evaluated by fabricating small and large phosphorescent organic lightemitting diode (PHOLED) devices at Universal Display Corporation (UDC). The device performance and life-times comparable to commercially available ITO anodes were demonstrated. A cost-benefit analysis was performed to down-select two anodes for further low-cost process development. Additionally, PPG developed and evaluated a number of scalable and compatible internal and external extraction layer concepts such as scattering layers on the outside of the glass substrate or between the transparent anode and the glass interface. In one external extraction layer (EEL) approach, sol-gel sprayed pyrolytic coatings were deposited using lab scale equipment by hand or automated spraying of sol-gel solutions on hot glass, followed by optimizing of scattering with minimal absorption. In another EEL approach, PPG tested large-area glass texturing by scratching a glass surface with an abrasive roller and acid etching. Efficacy enhancements of 1.27x were demonstrated using white PHOLED devices for 2.0mm substrates which are at par with the standard diffuser sheets used by OLED manufacturers. For an internal extraction layer (IEL), PPG tested two concepts combining nanoparticles either in a solgel coating inserted between the anode and OLED or anode and glass interface, or incorporated into the internal surface of the glass. Efficacy enhancements of 1.31x were demonstrated using white PHOLED devices for the IEL by itself and factors of 1.73x were attained for an IEL in combination of thick acrylic block as an EEL. Recent offline measurements indicate that, with further optimization, factors over 2.0x could be achieved through an IEL alone.« less

Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania.

PubMed

Chaudhury, Sumona; Arlington, Lauren; Brenan, Shelby; Kairuki, Allan Kaijunga; Meda, Amunga Robson; Isangula, Kahabi G; Mponzi, Victor; Bishanga, Dunstan; Thomas, Erica; Msemo, Georgina; Azayo, Mary; Molinier, Alice; Nelson, Brett D

2016-12-01

Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.

Belgian guidelines for budget impact analyses.

PubMed

Neyt, M; Cleemput, I; Sande, S Van De; Thiry, N

2015-06-01

To develop methodological guidelines for budget impact analysis submitted to the Belgian health authorities as part of a reimbursement request. A review of the literature was performed and provided the basis for preliminary budget impact guidelines. These guidelines were improved after discussion with health economists from the Belgian Health Care Knowledge Centre (KCE) and different Belgian stakeholders from both government and industry. Preliminary guidelines were also discussed in a workshop with health economists from The German Institute for Quality and Efficiency in Healthcare. Finally, the guidelines were also externally validated by three external experts. The guidelines give explicit guidance for the following components of a budget impact analysis: perspective of the evaluation, target population, comparator, costs, time horizon, modeling, handling uncertainty and discount rate. Special attention is given to handling varying target population sizes over time, applying a time horizon up to the steady state instead of short-term predictions, and similarities and differences between budget impact analysis and economic evaluations. The guidelines provide a framework for both researchers and assessors to set up budget impact analyses that are transparent, relevant, of high quality and apply a consistent methodology. This might improve the extent to which such evaluations can reliably and consistently be used in the reimbursement decision making process.

TEAM-HF Cost-Effectiveness Model: A Web-Based Program Designed to Evaluate the Cost-Effectiveness of Disease Management Programs in Heart Failure

PubMed Central

Reed, Shelby D.; Neilson, Matthew P.; Gardner, Matthew; Li, Yanhong; Briggs, Andrew H.; Polsky, Daniel E.; Graham, Felicia L.; Bowers, Margaret T.; Paul, Sara C.; Granger, Bradi B.; Schulman, Kevin A.; Whellan, David J.; Riegel, Barbara; Levy, Wayne C.

2015-01-01

Background Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable. Methods We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics, use of evidence-based medications, and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model (SHFM). Projections of resource use and quality of life are modeled using relationships with time-varying SHFM scores. The model can be used to evaluate parallel-group and single-cohort designs and hypothetical programs. Simulations consist of 10,000 pairs of virtual cohorts used to generate estimates of resource use, costs, survival, and incremental cost-effectiveness ratios from user inputs. Results The model demonstrated acceptable internal and external validity in replicating resource use, costs, and survival estimates from 3 clinical trials. Simulations to evaluate the cost-effectiveness of heart failure disease management programs across 3 scenarios demonstrate how the model can be used to design a program in which short-term improvements in functioning and use of evidence-based treatments are sufficient to demonstrate good long-term value to the health care system. Conclusion The TEAM-HF Cost-Effectiveness Model provides researchers and providers with a tool for conducting long-term cost-effectiveness analyses of disease management programs in heart failure. PMID:26542504

Kids and Foreclosures: New York City

ERIC Educational Resources Information Center

Been, Vicki; Ellen, Ingrid Gould; Schwartz, Amy Ellen; Stiefel, Leanna; Weinstein, Meryle

2010-01-01

The mortgage foreclosure crisis has affected millions of households around the country. Researchers and policy makers have begun to pay attention to the external costs that these foreclosures impose on surrounding properties and neighborhoods (Schuetz et al., 2008; Harding et al., 2009). But few have considered the collateral costs for children,…

Unintended Consequences of Cost Recovery

ERIC Educational Resources Information Center

Piercey, David

2010-01-01

An Alberta school district that used a cost-recovery model to finance school services for 20 years is finding that the model produces unintended negative results. Some schools didn't spend this money on services but used it for other school operations. Some spent the money on external consultants. Professional relationships were damaged, and…

Space Shuttle - Bringing cryohydrogen technology down to earth. [details of LH2 and LO2 technology and External Tank design

NASA Technical Reports Server (NTRS)

Odom, J. B.

1978-01-01

The External Tank must provide a safe storage container for both LH2 and LO2, a means of maintaining propellant quality in order to meet the engine pump net positive suction pressure requirements, and a structural strong-back for the Space Shuttle system, all at the minimum recurring cost and weight, while maintaining quality and reliability. The present paper summarizes External Tank design features and discusses the advantages of using LH2 and LO2 for the Space Shuttle system.

Incentives for wellness: tackling issues of effectiveness, biology, scope, and cost shifting.

PubMed

Cawley, John

2014-01-01

Morgan Downey raises several interesting issues in his essay. We agree on several points, for example, that current regulations are "really quite porous," with the result that enrollees will be able to get the rewards even if they do not alter their health behaviors. There are also several areas of disagreement that merit further discussion, and I focus on those in this essay. To provide context, my position is that financial incentives for healthy behavior can improve social welfare by internalizing the external costs of risky behaviors and help people with time-inconsistent preferences to adhere to a healthier lifestyle. To achieve the goal of increasing social welfare, the penalties for risky health behaviors should be set equal to the external costs. The design of the rewards (in terms of their frequency, salience, and the amount of loss aversion they invoke) may be critical in determining their effectiveness.

Coming out ahead: the cost effectiveness of external cephalic version using spinal anesthesia

PubMed Central

2014-01-01

Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. External cephalic version (ECV) is recommended at term by most professional organizations in an effort to reduce the prospect of cesarean deliveries. The authors propose the use of regional anesthesia to increase efficacy and reduce cost in the care of patients who undergo ECV in an effort to convert a breech presentation to a vertex counterpart. Despite emerging evidence of the advantages, obstacles to more comprehensive implementation of this approach continue to exist, which include patient acceptance, provider experience, and safety concerns. The addition of tocolytics and use of regional anesthesia for secondary ECV efforts have also been considered as options to increase success and reduce cost. This is a commentary on http://www.ijhpr.org/content/3/1/5. PMID:24565024

External marketing. How it can build a dental practice.

PubMed

Ascher, S

1988-01-01

This article gives a general introduction to external marketing as it befits the image of the dental professional. Research and various media opportunities are discussed, highlighting their advantages and pointing out the pros and cons of each. The latest trends in advertising philosophy are intertwined with concrete advice regarding cost effectiveness. This article is helpful to solo as well as group practitioners.

Temporary clamping of external carotid artery in convexity, parasagittal and temporal base meningioma.

PubMed

Yadav, Yad Ram; Parihar, Vijay; Agarwal, Moneet; Bhatele, Pushp Raj

2012-01-01

The management of intraoperative bleeding during removal of a large hyper vascular meningioma is crucial for safe and efficient surgery. Preoperative embolization of meningioma is the best way to reduce vascularity of meningiomas but this technique is not readily available, costly and has its own limitations. The study is aimed to evaluate the use of temporary clamping of external carotid artery to reduce blood loss and operating time during excision of large convexity, parasagittal or temporal base meningiomas. A prospective study of 115 consecutively operated meningiomas of size 5 cms or more were operated from January 2002 to December2010. Temporary clamping of external carotid artery was done in 61 while 51 cases were managed without clamping. There was significant reduction of blood loss, operative time and blood transfusion given in the temporary clipping group compared to non clipping group. There was stitch abscess in two patients each in clamping, and non clamping group. There was no scalp necrosis or mortality in any of the group. Temporary clamping of external carotid artery is a safe, simple and cost-effective alternative to embolization for the surgery of large meningiomas. This can be practiced at all the centers.

Parafricta Bootees and Undergarments to Reduce Skin Breakdown in People with or at Risk of Pressure Ulcers: A NICE Medical Technologies Guidance.

PubMed

Meads, Catherine; Glover, Matthew; Dimmock, Paul; Pokhrel, Subhash

2016-12-01

As part of the development of the National Institute for Health and Care Excellence (NICE) Medical Technologies Guidance on Parafricta Bootees and Undergarments to reduce skin breakdown in people with, or at risk of, pressure ulcers, the manufacturer (APA Parafricta Ltd) submitted clinical and economic evidence, which was critically appraised by an External Assessment Centre (EAC) and subsequently used by the Medical Technologies Advisory Committee (MTAC) to develop recommendations for further research. The University of Birmingham and Brunel University, acting as a consortium, were commissioned to act as the EAC, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance. Very little comparative evidence was submitted to demonstrate the effectiveness of Parafricta Bootees or Undergarments. The sponsor submitted a simple cost analysis to estimate the costs of using Parafricta in addition to current practice-in comparison with current practice alone-in hospital and community settings separately. The analysis took a National Health Service (NHS) perspective. The basis of the analysis was a previously published comparative study, which showed no statistical difference in average lengths of stay between patients who wore Parafricta Undergarments and Bootees, and those who did not. The economic model incorporated the costs of Parafricta but assumed shorter lengths of stay with Parafricta. The sponsor concluded that Parafricta was cost saving relative to the comparators. The EAC made amendments to the sponsor's analysis to correct for errors and to reflect alternative assumptions. Parafricta remained cost saving in most analyses, and the savings per prevalent case ranged from £757 in the hospital model to £3455 in the community model. All analyses were severely limited by the available data on effectiveness-in particular, a lack of good-quality comparative studies.

Incorporating Externalities and Uncertainty into Life-Cycle Cost Analysis

DTIC Science & Technology

2012-03-01

operating, maintaining, and (eventually) disposing of the building system( s ) over a given study period (usually related to the life of the project...which is rarely the case with environmental decisions that are often irreversible. For example, the extinction of a species, the authors argue, is...O x So ci al C os t o f S O 2 U H H Z1 10 22 5 $1 12 ,0 00 38 76 0 10 0. 0% $1 $4 ,7 07 $1 10 SG BP 12 00 38 $3 75 ,0 67 47 72 4 10 0. 0% $3 $1 1, 42

National Mass Drug Administration Costs for Lymphatic Filariasis Elimination

PubMed Central

Goldman, Ann S.; Guisinger, Victoria H.; Aikins, Moses; Amarillo, Maria Lourdes E.; Belizario, Vicente Y.; Garshong, Bertha; Gyapong, John; Kabali, Conrad; Kamal, Hussein A.; Kanjilal, Sanjat; Kyelem, Dominique; Lizardo, Jefrey; Malecela, Mwele; Mubyazi, Godfrey; Nitièma, P. Abdoulaye; Ramzy, Reda M. R.; Streit, Thomas G.; Wallace, Aaron; Brady, Molly A.; Rheingans, Richard; Ottesen, Eric A.; Haddix, Anne C.

2007-01-01

Background Because lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk. Methodology/Principal Findings To obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented – generally 60%–90% of program operation costs, excluding costs of donated medications. Conclusions/Significance MDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones. PMID:17989784

An interactive method based on the live wire for segmentation of the breast in mammography images.

PubMed

Zewei, Zhang; Tianyue, Wang; Li, Guo; Tingting, Wang; Lu, Xu

2014-01-01

In order to improve accuracy of computer-aided diagnosis of breast lumps, the authors introduce an improved interactive segmentation method based on Live Wire. This paper presents the Gabor filters and FCM clustering algorithm is introduced to the Live Wire cost function definition. According to the image FCM analysis for image edge enhancement, we eliminate the interference of weak edge and access external features clear segmentation results of breast lumps through improving Live Wire on two cases of breast segmentation data. Compared with the traditional method of image segmentation, experimental results show that the method achieves more accurate segmentation of breast lumps and provides more accurate objective basis on quantitative and qualitative analysis of breast lumps.

Efficient management of marine resources in conflict: an empirical study of marine sand mining, Korea.

PubMed

Kim, Tae-Goun

2009-10-01

This article develops a dynamic model of efficient use of exhaustible marine sand resources in the context of marine mining externalities. The classical Hotelling extraction model is applied to sand mining in Ongjin, Korea and extended to include the estimated marginal external costs that mining imposes on marine fisheries. The socially efficient sand extraction plan is compared with the extraction paths suggested by scientific research. If marginal environmental costs are correctly estimated, the developed efficient extraction plan considering the resource rent may increase the social welfare and reduce the conflicts among the marine sand resource users. The empirical results are interpreted with an emphasis on guidelines for coastal resource management policy.

Explanation of Change (EoC) Study: Approach and Findings

NASA Technical Reports Server (NTRS)

Bitten, Robert E.; Emmons, Debra L.; Bordi, Francesco; Scolese, Christopher

2013-01-01

This study investigated thirty historical NASA science missions to explain the cost change experienced. The study included investigation of historical milestone and monthly status report documentation followed by interviews with key project personnel. Based on the information collected, the reasons for cost change were binned, at the highest level, into four separate categories: NASA External, Project External, Internal Planning, and Internal Execution. The results identified that roughly a third of the change is outside of the project's control, a third is due to assumptions made in project planning, and a third is due to the inherent difficulty of building highly complex, one-of-a-kind, cutting edge, Earth and space science missions.

Methods for external event screening quantification: Risk Methods Integration and Evaluation Program (RMIEP) methods development

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

Ravindra, M.K.; Banon, H.

1992-07-01

In this report, the scoping quantification procedures for external events in probabilistic risk assessments of nuclear power plants are described. External event analysis in a PRA has three important goals; (1) the analysis should be complete in that all events are considered; (2) by following some selected screening criteria, the more significant events are identified for detailed analysis; (3) the selected events are analyzed in depth by taking into account the unique features of the events: hazard, fragility of structures and equipment, external-event initiated accident sequences, etc. Based on the above goals, external event analysis may be considered as amore » three-stage process: Stage I: Identification and Initial Screening of External Events; Stage II: Bounding Analysis; Stage III: Detailed Risk Analysis. In the present report, first, a review of published PRAs is given to focus on the significance and treatment of external events in full-scope PRAs. Except for seismic, flooding, fire, and extreme wind events, the contributions of other external events to plant risk have been found to be negligible. Second, scoping methods for external events not covered in detail in the NRC's PRA Procedures Guide are provided. For this purpose, bounding analyses for transportation accidents, extreme winds and tornadoes, aircraft impacts, turbine missiles, and chemical release are described.« less

Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis.

PubMed

Cooperberg, Matthew R; Ramakrishna, Naren R; Duff, Steven B; Hughes, Kathleen E; Sadownik, Sara; Smith, Joseph A; Tewari, Ashutosh K

2013-03-01

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to 11.3 for low-risk patients, 9.6-10.5 for intermediate-risk patients and 7.8-9.3 for high-risk patients. There were no statistically significant differences among surgical methods, which tended to be more effective than RT methods, with the exception of combined external beam + brachytherapy for high-risk disease. RT methods were consistently more expensive than surgical methods; costs ranged from $19 901 (robot-assisted prostatectomy for low-risk disease) to $50 276 (combined RT for high-risk disease). These findings were robust to an extensive set of sensitivity analyses. Our analysis found small differences in outcomes and substantial differences in payer and patient costs across treatment alternatives. These findings may inform future policy discussions about strategies to improve efficiency of treatment selection for localised prostate cancer. © 2012 BJU International.

Cost shared wildfire risk mitigation in Log Hill Mesa, Colorado: Survey evidence on participation and willingness to pay

Treesearch

James R. Meldrum; Patricia A. Champ; Travis Warziniack; Hannah Brenkert-Smith; Christopher M. Barth; Lilia C. Falk

2014-01-01

Wildland-urban interface (WUI) homeowners who do not mitigate the wildfire risk on their properties impose a negative externality on society. To reduce the social costs of wildfire and incentivise homeowners to take action, cost sharing programs seek to reduce the barriers that impede wildfire risk mitigation. Using survey data from a WUI community in western Colorado...

Joint Direct Attack Munition (JDAM)

DTIC Science & Technology

2015-12-01

February 19, 2015 and the O&S cost are based on an ICE dated August 28, 2014 Confidence Level Confidence Level of cost estimate for current APB: 50% A...mathematically derived confidence level was not computed for this Life-Cycle Cost Estimate (LCCE). This LCCE represents the expected value, taking into...consideration relevant risks, including ordinary levels of external and unforeseen events. It aims to provide sufficient resources to execute the

Refining and validating a two-stage and web-based cancer risk assessment tool for village doctors in China.

PubMed

Shen, Xing-Rong; Chai, Jing; Feng, Rui; Liu, Tong-Zhu; Tong, Gui-Xian; Cheng, Jing; Li, Kai-Chun; Xie, Shao-Yu; Shi, Yong; Wang, De-Bin

2014-01-01

The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..

Hidden Costs of Energy: Unpriced Consequences of Energy Production and Use

NASA Astrophysics Data System (ADS)

National Research Council

2011-11-01

The U.S. Congress directed the U.S. Department of the Treasury to arrange for a review by the National Academy of Sciences to define and evaluate the health, environmental, security, and infrastructural external costs and benefits associated with the production and consumption of energy--costs and benefits that are not or may not be fully incorporated into the market price of energy, into the federal tax or fee, or into other applicable revenue measures related to production and consumption of energy. In response, the National Research Council established the Committee on Health, Environmental, and Other External Costs and Benefits of Energy Production and Consumption, which prepared the report summarized in this chapter. The report estimates dollar values for several major components of these costs. The damages the committee was able to quantify were an estimated $120 billion in the U.S. in 2005, a number that reflects primarily health damages from air pollution associated with electricity generation and motor vehicle transportation. The figure does not include damages from climate change, harm to ecosystems, effects of some air pollutants such as mercury, and risks to national security, which the report examines but does not monetize.

External Validation Study of First Trimester Obstetric Prediction Models (Expect Study I): Research Protocol and Population Characteristics.

PubMed

Meertens, Linda Jacqueline Elisabeth; Scheepers, Hubertina Cj; De Vries, Raymond G; Dirksen, Carmen D; Korstjens, Irene; Mulder, Antonius Lm; Nieuwenhuijze, Marianne J; Nijhuis, Jan G; Spaanderman, Marc Ea; Smits, Luc Jm

2017-10-26

A number of first-trimester prediction models addressing important obstetric outcomes have been published. However, most models have not been externally validated. External validation is essential before implementing a prediction model in clinical practice. The objective of this paper is to describe the design of a study to externally validate existing first trimester obstetric prediction models, based upon maternal characteristics and standard measurements (eg, blood pressure), for the risk of pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), small-for-gestational-age (SGA) infants, and large-for-gestational-age (LGA) infants among Dutch pregnant women (Expect Study I). The results of a pilot study on the feasibility and acceptability of the recruitment process and the comprehensibility of the Pregnancy Questionnaire 1 are also reported. A multicenter prospective cohort study was performed in The Netherlands between July 1, 2013 and December 31, 2015. First trimester obstetric prediction models were systematically selected from the literature. Predictor variables were measured by the Web-based Pregnancy Questionnaire 1 and pregnancy outcomes were established using the Postpartum Questionnaire 1 and medical records. Information about maternal health-related quality of life, costs, and satisfaction with Dutch obstetric care was collected from a subsample of women. A pilot study was carried out before the official start of inclusion. External validity of the models will be evaluated by assessing discrimination and calibration. Based on the pilot study, minor improvements were made to the recruitment process and online Pregnancy Questionnaire 1. The validation cohort consists of 2614 women. Data analysis of the external validation study is in progress. This study will offer insight into the generalizability of existing, non-invasive first trimester prediction models for various obstetric outcomes in a Dutch obstetric population. An impact study for the evaluation of the best obstetric prediction models in the Dutch setting with respect to their effect on clinical outcomes, costs, and quality of life-Expect Study II-is being planned. Netherlands Trial Registry (NTR): NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143 (Archived by WebCite at http://www.webcitation.org/6t8ijtpd9). ©Linda Jacqueline Elisabeth Meertens, Hubertina CJ Scheepers, Raymond G De Vries, Carmen D Dirksen, Irene Korstjens, Antonius LM Mulder, Marianne J Nieuwenhuijze, Jan G Nijhuis, Marc EA Spaanderman, Luc JM Smits. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.10.2017.

Financial competitiveness of organic agriculture on a global scale

PubMed Central

Crowder, David W.; Reganold, John P.

2015-01-01

To promote global food and ecosystem security, several innovative farming systems have been identified that better balance multiple sustainability goals. The most rapidly growing and contentious of these systems is organic agriculture. Whether organic agriculture can continue to expand will likely be determined by whether it is economically competitive with conventional agriculture. Here, we examined the financial performance of organic and conventional agriculture by conducting a meta-analysis of a global dataset spanning 55 crops grown on five continents. When organic premiums were not applied, benefit/cost ratios (−8 to −7%) and net present values (−27 to −23%) of organic agriculture were significantly lower than conventional agriculture. However, when actual premiums were applied, organic agriculture was significantly more profitable (22–35%) and had higher benefit/cost ratios (20–24%) than conventional agriculture. Although premiums were 29–32%, breakeven premiums necessary for organic profits to match conventional profits were only 5–7%, even with organic yields being 10–18% lower. Total costs were not significantly different, but labor costs were significantly higher (7–13%) with organic farming practices. Studies in our meta-analysis accounted for neither environmental costs (negative externalities) nor ecosystem services from good farming practices, which likely favor organic agriculture. With only 1% of the global agricultural land in organic production, our findings suggest that organic agriculture can continue to expand even if premiums decline. Furthermore, with their multiple sustainability benefits, organic farming systems can contribute a larger share in feeding the world. PMID:26034271

Costing Analysis of National HIV Treatment and Care Program in Vietnam

PubMed Central

Duong, Anh Thuy; Bales, Sarah; Do, Nhan Thi; Minh Nguyen, Thu Thi; Thanh Cao, Thuy Thi; Nguyen, Long Thanh

2014-01-01

Background: Vietnam achieved rapid scale-up of antiretroviral therapy (ART), although external funds are declining sharply. To achieve and sustain universal access to HIV services, evidence-based planning is essential. To date, there had been limited HIV treatment and care cost data available in Vietnam. Methods: Cost data of outpatient and inpatient HIV care were extracted at 21 sentinel facilities (17 adult and 4 pediatric) that epitomize the national program. Step-down costing for administration costs and bottom-up resource costing for drugs, diagnostics, and labor were used. Records of 1401 adults and 527 pediatric patients were reviewed. Results: Median outpatient care costs per patient-year for pre-ART, first year ART, later year ART, and second-line ART were US $100, US $316, US $303, and US $1557 for adults; and US $171, US $387, US $320, and US $1069 for children, respectively. Median inpatient care cost per episode was US $162 for adults and US $142 for children. Non-antiretroviral (ARV) costs in adults at stand-alone facilities were 44% (first year ART) and 24% (later year ART) higher than those at integrated facilities. Adults who started ART with CD4 count ≤100 cells per cubic millimeter had 47% higher non-ARV costs in the first year ART than those with CD4 count >100 cells per cubic millimeter. Adult ARV drug costs at government sites were from 66% to 85% higher than those at donor-supported sites in the first year ART. Conclusions: The study found that HIV treatment and care costs in Vietnam are economical, yet there is potential to further promote efficiency through strengthening competitive procurement, integrating HIV services, and promoting earlier ART initiation. PMID:23846564

Taxation of United States general aviation

NASA Astrophysics Data System (ADS)

Sobieralski, Joseph Bernard

General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and injuries attributed to general aviation accidents in the United States, understanding the costs to society is of great importance. This chapter estimates the direct and indirect costs associated with general aviation accidents in the United States. The indirect costs are estimated via the human capital approach in addition to the willingness-to-pay approach. The average annual accident costs attributed to general aviation are found to be 2.32 billion and 3.81 billion (2006 US) utilizing the human capital approach and willingness-to-pay approach, respectively. These values appear to be fairly robust when subjected to a sensitivity analysis. These costs highlight the large societal benefits from accident and fatality reduction. The final chapter derives a second-best optimal aviation gasoline tax developed from previous general equilibrium frameworks. This optimal tax reflects both the lead pollution and accident externalities, as well as the balance between excise taxes and labor taxes to finance government spending. The calculated optimal tax rate is 4.07 per gallon, which is over 20 times greater than the current tax rate and 5 times greater than the Federal Aviation Administration proposed tax rate. The calculated optimal tax rate is also over 3 times greater than automobile gasoline optimal tax rates calculated by previous studies. The Pigovian component is 1.36, and we observe that the accident externality is taxed more severely than the pollution externality. The largest component of the optimal tax rate is the Ramsey component. At 2.70, the Ramsey component reflects the ability of the government to raise revenue aviation gasoline which is price inelastic. The calculated optimal tax is estimated to reduce lead emissions by over 10 percent and reduce accidents by 20 percent. Although unlikely to be adopted by policy makers, the optimal tax benefits are apparent and it sheds light on the need to reduce these negative externalities via policy changes.

A review on the applications of portable near-infrared spectrometers in the agro-food industry.

PubMed

dos Santos, Cláudia A Teixeira; Lopo, Miguel; Páscoa, Ricardo N M J; Lopes, João A

2013-11-01

Industry has created the need for a cost-effective and nondestructive quality-control analysis system. This requirement has increased interest in near-infrared (NIR) spectroscopy, leading to the development and marketing of handheld devices that enable new applications that can be implemented in situ. Portable NIR spectrometers are powerful instruments offering several advantages for nondestructive, online, or in situ analysis: small size, low cost, robustness, simplicity of analysis, sample user interface, portability, and ergonomic design. Several studies of on-site NIR applications are presented: characterization of internal and external parameters of fruits and vegetables; conservation state and fat content of meat and fish; distinguishing among and quality evaluation of beverages and dairy products; protein content of cereals; evaluation of grape ripeness in vineyards; and soil analysis. Chemometrics is an essential part of NIR spectroscopy manipulation because wavelength-dependent scattering effects, instrumental noise, ambient effects, and other sources of variability may complicate the spectra. As a consequence, it is difficult to assign specific absorption bands to specific functional groups. To achieve useful and meaningful results, multivariate statistical techniques (essentially involving regression techniques coupled with spectral preprocessing) are therefore required to extract the information hidden in the spectra. This work reviews the evolution of the use of portable near-infrared spectrometers in the agro-food industry.

The insights of health and welfare professionals on hurdles that impede economic evaluations of welfare interventions.

PubMed

Schepers, J; Plaete, J; De Bourdeaudhuij, I; Annemans, L; Simoens, S

2017-08-01

Four hurdles associated with economic evaluations in welfare interventions were identified and discussed in a previous published literature review. These hurdles include (i) 'Ignoring the impact of condition-specific outcomes', (ii) 'Ignoring the impact of QoL externalities', (iii) 'Calculation of costs from a too narrow perspective' and (iv) 'The lack of well-described & standardized interventions'. This study aims to determine how healthcare providers and social workers experience and deal with these hurdles in practice and what solutions or new insights they would suggest. Twenty-two professionals of welfare interventions carried out in Flanders, were interviewed about the four described hurdles using a semi-structured interview. A thematic framework was developed to enable the qualitative analysis. The analysis of the semi-structured interviews was facilitated through the use of the software program QRS NVivo 10. The interviews revealed a clear need to tackle these hurdles. The interviewees confirmed that further study of condition-specific outcomes in economic evaluations are needed, especially in the field of mental health and stress. The proposed dimensions for the condition-specific questionnaires varied however between the groups of interviewees (i.e. general practitioners vs social workers). With respect to QoL externalities, the interviewees confirmed that welfare interventions have an impact on the social environment of the patient (friends and family). There was however no consensus on how this impact of QoL externalities should be taken into account in welfare interventions. Professionals also suggested that besides health care costs, the impact of welfare interventions on work productivity, the patients' social life and other items should be incorporated. Standardization appears to be of limited added value for most of the interviewees because they need a certain degree of freedom to interpret the intervention. Furthermore, the target population of the interventions is diverse which requires a tailor-made approach. This qualitative research demonstrated that these hurdles occur in practice. The proposed solutions for these hurdles can contribute to the improvement of the methodological quality of economic evaluations of welfare interventions.

Raspberry Pi: a 35-dollar device for viewing DICOM images.

PubMed

Paiva, Omir Antunes; Moreira, Renata de Oliveira

2014-01-01

Raspberry Pi is a low-cost computer created with educational purposes. It uses Linux and, most of times, freeware applications, particularly a software for viewing DICOM images. With an external monitor, the supported resolution (1920 × 1200 pixels) allows for the set up of simple viewing workstations at a reduced cost.

Raspberry Pi: a 35-dollar device for viewing DICOM images*

PubMed Central

Paiva, Omir Antunes; Moreira, Renata de Oliveira

2014-01-01

Raspberry Pi is a low-cost computer created with educational purposes. It uses Linux and, most of times, freeware applications, particularly a software for viewing DICOM images. With an external monitor, the supported resolution (1920 × 1200 pixels) allows for the set up of simple viewing workstations at a reduced cost. PMID:25741057

A 3D paper-based enzymatic fuel cell for self-powered, low-cost glucose monitoring.

PubMed

Fischer, Christopher; Fraiwan, Arwa; Choi, Seokheun

2016-05-15

In this work, we demonstrate a novel low-cost, self-powered paper-based biosensor for glucose monitoring. The device operating mechanism is based on a glucose/oxygen enzymatic fuel cell using an electrochemical energy conversion as a transducing element for glucose monitoring. The self-powered glucose biosensor features (i) a 3D origami paper-based structure for easy system integration onto paper, (ii) an air-cathode on paper for low-cost production and easy operation, and (iii) a screen printed chitosan/glucose oxidase anode for stable current generation as an analytical signal for glucose monitoring. The sensor showed a linear range of output current at 1-5mM glucose (R(2)=0.996) with a sensitivity of 0.02 µA mM(-1). The advantages offered by such a device, including a low cost, lack of external power sources/sophisticated external transducers, and the capacity to rapidly generate reliable results, are well suited for the clinical and social settings of the developing world. Copyright © 2015 Elsevier B.V. All rights reserved.

Cost and Precision of Brownian Clocks

NASA Astrophysics Data System (ADS)

Barato, Andre C.; Seifert, Udo

2016-10-01

Brownian clocks are biomolecular networks that can count time. A paradigmatic example are proteins that go through a cycle, thus regulating some oscillatory behavior in a living system. Typically, such a cycle requires free energy often provided by ATP hydrolysis. We investigate the relation between the precision of such a clock and its thermodynamic costs. For clocks driven by a constant thermodynamic force, a given precision requires a minimal cost that diverges as the uncertainty of the clock vanishes. In marked contrast, we show that a clock driven by a periodic variation of an external protocol can achieve arbitrary precision at arbitrarily low cost. This result constitutes a fundamental difference between processes driven by a fixed thermodynamic force and those driven periodically. As a main technical tool, we map a periodically driven system with a deterministic protocol to one subject to an external protocol that changes in stochastic time intervals, which simplifies calculations significantly. In the nonequilibrium steady state of the resulting bipartite Markov process, the uncertainty of the clock can be deduced from the calculable dispersion of a corresponding current.

The use of NaCl addition for the improvement of polyhydroxyalkanoate production by Cupriavidus necator.

PubMed

Passanha, Pearl; Kedia, Gopal; Dinsdale, Richard M; Guwy, Alan J; Esteves, Sandra R

2014-07-01

External stress factors in the form of ionic species or temperature increases have been shown to produce a stress response leading to enhanced PHA production. The effect of five different NaCl concentrations, namely 3.5, 6.5, 9, 12 and 15 g/l NaCl on PHA productivity using Cupriavidus necator has been investigated alongside a control (no added NaCl). A dielectric spectroscopy probe was used to measure PHA accumulation online in conjunction with the chemical offline analysis of PHA. The highest PHA production was obtained with the addition of 9 g/l NaCl, which yielded 30% higher PHA than the control. Increasing the addition of NaCl to 15 g/l was found to inhibit the production of PHA. NaCl addition can therefore be used as a simple, low cost, sustainable, non toxic and non reactive external stress strategy for increasing PHA productivity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Self-audit of lockout/tagout in manufacturing workplaces: A pilot study.

PubMed

Yamin, Samuel C; Parker, David L; Xi, Min; Stanley, Rodney

2017-05-01

Occupational health and safety (OHS) self-auditing is a common practice in industrial workplaces. However, few audit instruments have been tested for inter-rater reliability and accuracy. A lockout/tagout (LOTO) self-audit checklist was developed for use in manufacturing enterprises. It was tested for inter-rater reliability and accuracy using responses of business self-auditors and external auditors. Inter-rater reliability at ten businesses was excellent (κ = 0.84). Business self-auditors had high (100%) accuracy in identifying elements of LOTO practice that were present as well those that were absent (81% accuracy). Reliability and accuracy increased further when problematic checklist questions were removed from the analysis. Results indicate that the LOTO self-audit checklist would be useful in manufacturing firms' efforts to assess and improve their LOTO programs. In addition, a reliable self-audit instrument removes the need for external auditors to visit worksites, thereby expanding capacity for outreach and intervention while minimizing costs. © 2017 Wiley Periodicals, Inc.

Financing the response to AIDS: some fiscal and macroeconomic considerations.

PubMed

Haacker, Markus

2008-07-01

This article examines the international response to AIDS from a fiscal perspective: first the financing of the international response to AIDS, especially the role of external financing, and second, a more comprehensive perspective on the costs of the national response to AIDS relevant for fiscal policy. The second half of the article focuses on the effectiveness of the response to AIDS. We find that there is little basis for concerns about macroeconomic constraints to scaling up, in light of the moderate scale of AIDS-related aid flows relative to overall aid. Regarding sectoral constraints, the picture is more differentiated. Many countries with high prevalence rates have also achieved high rates of access to treatment, but most of these are middle-income countries. Our econometric analysis credits external aid as a key factor that has enabled higher-prevalence countries to cope with the additional demands for health services. At the same time, gross domestic product per capita and health sector capacities are important determinants of access to treatment.

Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County.

PubMed

McCullough, J Mac; Fowle, Nicole; Sylvester, Tammy; Kretschmer, Melissa; Ayala, Aurimar; Popescu, Saskia; Weiss, Jolie; England, Bob

2018-06-20

To generate estimates of the direct costs of mounting simultaneous emergency preparedness and response activities to respond to 3 major public health events. A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs. Maricopa County Department of Public Health (MCDPH) in Arizona. The nation's third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa's more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015. Time data were sought from all MCDPH staff who participated in activities related to any of the 3 relevant responses. In addition, time data were sought from partners at the state health department and a community hospital involved in response activities. Time estimates were received from 128 individuals (response rate 88%). Time and cost to MCDPH for each response and overall. Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224 484 (>5800 hours). The majority was for personnel ($203 743) and the costliest response was measles ($122 626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period. Funding for public health departments remains limited, yet public health responses can be cost- and time-intensive. To effectively plan for future public health responses, it may be necessary to share experiences and financial lessons learned from similar public health responses. External partnerships represent a key contribution for responses such as those examined. It can be expensive for local public health departments to mount effective responses, especially when multiple responses occur simultaneously.

Electrical service reliability: the customer perspective

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

Samsa, M.E.; Hub, K.A.; Krohm, G.C.

1978-09-01

Electric-utility-system reliability criteria have traditionally been established as a matter of utility policy or through long-term engineering practice, generally with no supportive customer cost/benefit analysis as justification. This report presents results of an initial study of the customer perspective toward electric-utility-system reliability, based on critical review of over 20 previous and ongoing efforts to quantify the customer's value of reliable electric service. A possible structure of customer classifications is suggested as a reasonable level of disaggregation for further investigation of customer value, and these groups are characterized in terms of their electricity use patterns. The values that customers assign tomore » reliability are discussed in terms of internal and external cost components. A list of options for effecting changes in customer service reliability is set forth, and some of the many policy issues that could alter customer-service reliability are identified.« less

Air Force Reusable Booster System: A Quick-look, Design Focused Modeling and Cost Analysis Study

NASA Technical Reports Server (NTRS)

Zapata, Edgar

2011-01-01

This paper presents a method and an initial analysis of the costs of a reusable booster system (RBS) as envisioned by the US Department of Defense (DoD) and numerous initiatives that form the concept of Operationally Responsive Space (ORS). This paper leverages the knowledge gained from decades of experience with the semi-reusable NASA Space Shuttle to understand how the costs of a military next generation semi-reusable space transport might behave in the real world - and how it might be made as affordable as desired. The NASA Space Shuttle had a semi-expendable booster, that being the reusable Solid Rocket MotorslBoosters (SRMlSRB) and the expendable cryogenic External Tank (ET), with a reusable cargo and crew capable orbiter. This paper will explore DoD concepts that invert this architectural arrangement, using a reusable booster plane that flies back to base soon after launch, with the in-space elements of the launch system being the expendable portions. Cost estimating in the earliest stages of any potential, large scale program has limited usefulness. As a result, the emphasis here is on developing an approach, a structure, and the basic concepts that could continue to be matured as the program gains knowledge. Where cost estimates are provided, these results by necessity carry many caveats and assumptions, and this analysis becomes more about ways in which drivers of costs for diverse scenarios can be better understood. The paper is informed throughout with a design-for-cost philosophy whereby the design and technology features of the proposed RBS (who and what, the "architecture") are taken as linked at the hip to a desire to perform a certain mission (where and when), and together these inform the cost, responsiveness, performance and sustainability (how) of the system. Concepts for developing, acquiring, producing or operating the system will be shown for their inextricable relationship to the "architecture" of the system, and how these too relate to costs. Design and technology features bear special relevance to early program research and development directions. Given the uncertainties involved in both their actual performance promise and their relation to costs of operational systems, this later relationship is also given special attention.

Methods for external event screening quantification: Risk Methods Integration and Evaluation Program (RMIEP) methods development

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

Ravindra, M.K.; Banon, H.

1992-07-01

In this report, the scoping quantification procedures for external events in probabilistic risk assessments of nuclear power plants are described. External event analysis in a PRA has three important goals; (1) the analysis should be complete in that all events are considered; (2) by following some selected screening criteria, the more significant events are identified for detailed analysis; (3) the selected events are analyzed in depth by taking into account the unique features of the events: hazard, fragility of structures and equipment, external-event initiated accident sequences, etc. Based on the above goals, external event analysis may be considered as amore » three-stage process: Stage I: Identification and Initial Screening of External Events; Stage II: Bounding Analysis; Stage III: Detailed Risk Analysis. In the present report, first, a review of published PRAs is given to focus on the significance and treatment of external events in full-scope PRAs. Except for seismic, flooding, fire, and extreme wind events, the contributions of other external events to plant risk have been found to be negligible. Second, scoping methods for external events not covered in detail in the NRC`s PRA Procedures Guide are provided. For this purpose, bounding analyses for transportation accidents, extreme winds and tornadoes, aircraft impacts, turbine missiles, and chemical release are described.« less

Evaluation of a Tool for Producing and Presenting Interactive Videodisc Job Aids

DTIC Science & Technology

1994-03-01

and MacroMind Director, which lacks some authoring capablities (Macromedia Inc, approximate cost of Sinclude systems in Macintosh format such as...HyperCair (Claris Corp., approximate cost of $199) or SuperCmd (Aldus Corp., approximate cost of $299) and systems in Windows format such as Guide 3.1...scripting language to be used with a wide variety of hardware components. The ELVIS hypermedia system uses manufaturers ’ external commands to control

Ireland and the Defense of Western Europe. Issues and Implications.

DTIC Science & Technology

1988-05-01

domestic or external pressure to do so. In fact, neutrality is widely supported and could be abandoned only at a prohibitive political cost . Many...makes the costs of Irish membership outweigh any benefits? Her geographic location, as well as certain of her physical characteristics, would make her...peacetime must be weighed against the considerable costs involved. The obvious question then is, what would Ireland do in wartime? This is a question other

Load Carriage Capacity of the Dismounted Combatant - A Commanders’ Guide

DTIC Science & Technology

2012-10-01

predictive model has been used throughout this document to predict the physiological burden (i.e. energy cost ) of representative load carriage...scenarios. As a general guide this model indicates that a 10 kg increase in external load is metabolically equivalent (i.e. energy cost ) to an increase...larger increases in energy cost for a load carriage task. The multi-factorial nature of human load carriage capacity makes it difficult to set

Unlearned History: The Ineffectual Application of U.S. Broad Economic Sanctions Against Syria

DTIC Science & Technology

2015-10-30

fundamentally due to the high cost of compliance required of Syrian leaders, external third party support sustaining the Syrian government, and the Syrian...rate, especially as applied to autocratic regimes, are the cost of compliance, access to third party support, and the ability to redistribute the...of the sanctions policy. The political cost that the target state weighs must be high enough to extract the concessions demanded of the sending

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

PubMed

Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

2016-09-13

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses. The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

The social cost of drugs in France in 2010.

PubMed

Kopp, Pierre; Ogrodnik, Marysia

2017-09-01

The social cost of drugs is the monetary cost of both the consequences of their trade and their consumption. In this paper, drugs considered are tobacco and alcohol, which are legal, plus those that are illegal. The social cost is the sum of the external cost: value of loss in quality of life, value of years of life lost and value of loss in productivity, plus public expenditure. Public expenditure consists of public spending on medical care, prevention, and law enforcement, minus savings from unpaid pensions and taxes levied on tobacco and alcohol. The parameters for the calculations have used the recommendations of a French governmental working group (2013) Quinet, L'évaluation socioéconomique des investissements publics [Internet], Centre d'Analyse Stratégique, 2013, http://www.strategie.gouv.fr/sites/strategie.gouv.fr/files/archives/CGSP_Evaluation_socioeconomique_17092013.pdf , and the health data were derived from the scientific literature. The social costs are €122 billion for tobacco, €118 billion for alcohol, and €8.7 billion for illegal drugs. The largest fraction of the costs (53, 56, and 31 %, respectively) derives from the number of deaths, 79,000 for tobacco, 49,000 for alcohol, and 1600 for illegal drugs, given the high cost of a year of life lost (€115,000). The external cost corresponds to 86, 97, and 68 % of the social cost, respectively, for tobacco, alcohol, and illegal drugs. The annual drug-related net expenditure represents €13.9, €3.0, and €2.3 billion, respectively, for tobacco, alcohol, and illegal drugs. The tax revenues on tobacco and alcohol, €10.4 and €3.2 billion, represent less than half of the corresponding healthcare costs, which are €25.9 and €7.7 billion.

Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh.

PubMed

Hayford, K; Uddin, M J; Koehlmoos, T P; Bishai, D M

2014-04-25

To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention. Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs. The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable. Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results. Copyright © 2014. Published by Elsevier Ltd.

Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement.

PubMed

Hartzler, Robert U; Steen, Brandon M; Hussey, Michael M; Cusick, Michael C; Cottrell, Benjamin J; Clark, Rachel E; Frankle, Mark A

2015-11-01

Some patients unexpectedly have poor functional improvement after reverse shoulder arthroplasty (RSA) for massive rotator cuff tear without glenohumeral arthritis. Our aim was to identify risk factors for this outcome. We also assessed the value of RSA for cases with poor functional improvement vs. The study was a retrospective case-control analysis for primary RSA performed for massive rotator cuff tear without glenohumeral arthritis with minimum 2-year follow-up. Cases were defined as Simple Shoulder Test (SST) score improvement of ≤1, whereas controls improved SST score ≥2. Risk factors were chosen on the basis of previous association with poor outcomes after shoulder arthroplasty. Latissimus dorsi tendon transfer results were analyzed as a subgroup. Value was defined as improvement in American Shoulder and Elbow Surgeons (ASES) score per $10,000 hospital cost. In a multivariate binomial logistic regression analysis, neurologic dysfunction (P = .006), age <60 years (P = .02), and high preoperative SST score (P = .03) were independently associated with poor functional improvement. Latissimus dorsi tendon transfer patients significantly improved in active external rotation (-0.3° to 38.7°; P < .01). The value of RSA (ΔASES/$10,000 cost) for cases was 0.8 compared with 17.5 for controls (P < .0001). Young age, high preoperative function, and neurologic dysfunction were associated with poor functional improvement. Surgeons should consider these associations in counseling and selection of patients. Concurrent latissimus dorsi transfer was successful in restoring active external rotation in a subgroup of patients. The critical economic importance of improved patient selection is emphasized by the very low value of the procedure in the case group. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Biofuel production system with operation flexibility: Evaluation of economic and environmental performance under external disturbance

NASA Astrophysics Data System (ADS)

Kou, Nannan

Biomass derived liquid hydrocarbon fuel (biofuel) has been accepted as an effective way to mitigate the reliance on petroleum and reduce the greenhouse gas emissions. An increasing demand for second generation biofuels, produced from ligno-cellulosic feedstock and compatible with current infrastructure and vehicle technologies, addresses two major challenges faced by the current US transportation sector: energy security and global warming. However, biofuel production is subject to internal disturbances (feedstock supply and commodity market) and external factors (energy market). The biofuel industry has also heavily relied on government subsidy during the early development stages. In this dissertation, I investigate how to improve the economic and environmental performance of biorefineries (and biofuel plant), as well as enhance its survivability under the external disturbances. Three types of disturbance are considered: (1) energy market fluctuation, (2) subsidy policy uncertainty, and (3) extreme weather conditions. All three factors are basically volatile, dynamic, and even unpredictable, which makes them difficult to model and have been largely ignored to date. Instead, biofuel industry and biofuel research are intensively focused on improving feedstock conversion efficiency and capital cost efficiency while assuming these advancements alone will successfully generate higher profit and thus foster the biofuel industry. The collapse of the largest corn ethanol biofuel company, Verasun Energy, in 2008 calls into question this efficiency-driven approach. A detailed analysis has revealed that although the corn ethanol plants operated by Verasun adopted the more efficient (i.e. higher ethanol yield per bushel of corn and lower capital cost) dry-mill technology, they could not maintain a fair profit margin under fluctuating market condition which made ethanol production unprofitable. This is because dry-mill plant converts a single type of biomass feedstock (corn grain) into a single primary product (ethanol). The traditional lower efficient (i.e. lower ethanol yield per bushel of corn and higher capital cost) wet-mill plant has a more diverse and adjustable product portfolio i.e. corn syrup, starch, and ethanol. The fact that only the dry-mill corn ethanol plants have bankrupted while the wet-mill corn ethanol plants have survived the late 2000s economy recession suggests that the higher conversion efficiency achieved by the dry-mill production mode has jeopardized operational flexibility, a design operational feature I agree that is indispensable for the biofuel plant's long term profit and viability. Based on the analysis of corn ethanol production, operational flexibility has been proposed as a key strategy for the next generation biofuel plants to improve its lifetime economic performance, as well as to enhance its survivability under external disturbances. This strategy requires the biofuel plant to adopt a flexible feedstock management, making it possible to utilize alternative types of biomass feedstock when the primary feedstock supply is disturbed. Biofuel plants also need to produce a wider range of final products that could meet the preference variation that either comes from the energy market or from the subsidy policy. Aspen Plus model based numerical simulations have been carried out for a thermochemical ethanol plant and a Fischer Tropsch plant (both are assumed to be located in southwest Indiana) to test this strategy under the external disturbances of extreme weather impact, different energy price projections and various subsidy policy combinations. For the thermochemical ethanol plant, effects of extreme weather conditions are mainly evaluated. It has been shown that this strategy could effectively increase the net present value of the biofuel plant and significantly decrease the GHG emission comparing with the traditional single-feedstock strategy, when the extreme weather conditions are considered. It has also been demonstrated that this strategy could significantly decrease the possibility for the biofuel plant to bankrupt. For the Fischer Tropsch diesel plant, all the three external disturbances have been examined. It has been learned that operational flexibility through full capacity power co-generation, flexible feedstock management and hydrogen production by natural gas autothermal reforming could maximize the net present value under the influence of the external disturbances. Thus it is suggested that the future biofuel plant should adopt operational flexibility to increase the lifetime economic performance and to enhance the survivability under the influence of external disturbance.

Collaborative localization in wireless sensor networks via pattern recognition in radio irregularity using omnidirectional antennas.

PubMed

Jiang, Joe-Air; Chuang, Cheng-Long; Lin, Tzu-Shiang; Chen, Chia-Pang; Hung, Chih-Hung; Wang, Jiing-Yi; Liu, Chang-Wang; Lai, Tzu-Yun

2010-01-01

In recent years, various received signal strength (RSS)-based localization estimation approaches for wireless sensor networks (WSNs) have been proposed. RSS-based localization is regarded as a low-cost solution for many location-aware applications in WSNs. In previous studies, the radiation patterns of all sensor nodes are assumed to be spherical, which is an oversimplification of the radio propagation model in practical applications. In this study, we present an RSS-based cooperative localization method that estimates unknown coordinates of sensor nodes in a network. Arrangement of two external low-cost omnidirectional dipole antennas is developed by using the distance-power gradient model. A modified robust regression is also proposed to determine the relative azimuth and distance between a sensor node and a fixed reference node. In addition, a cooperative localization scheme that incorporates estimations from multiple fixed reference nodes is presented to improve the accuracy of the localization. The proposed method is tested via computer-based analysis and field test. Experimental results demonstrate that the proposed low-cost method is a useful solution for localizing sensor nodes in unknown or changing environments.

Peak capacity analysis of coal power in China based on full-life cycle cost model optimization

NASA Astrophysics Data System (ADS)

Yan, Xiaoqing; Zhang, Jinfang; Huang, Xinting

2018-02-01

13th five-year and the next period are critical for the energy and power reform of China. In order to ease the excessive power supply, policies have been introduced by National Energy Board especially toward coal power capacity control. Therefore the rational construction scale and scientific development timing for coal power are of great importance and paid more and more attentions. In this study, the comprehensive influence of coal power reduction policies is analyzed from diverse point of views. Full-life cycle cost model of coal power is established to fully reflect the external and internal cost. Then this model is introduced in an improved power planning optimization theory. The power planning and diverse scenarios production simulation shows that, in order to meet the power, electricity and peak balance of power system, China’s coal power peak capacity is within 1.15 ∼ 1.2 billion kilowatts before or after 2025. The research result is expected to be helpful to the power industry in 14th and 15th five-year periods, promoting the efficiency and safety of power system.

Dynamic Modeling of ALS Systems

NASA Technical Reports Server (NTRS)

Jones, Harry

2002-01-01

The purpose of dynamic modeling and simulation of Advanced Life Support (ALS) systems is to help design them. Static steady state systems analysis provides basic information and is necessary to guide dynamic modeling, but static analysis is not sufficient to design and compare systems. ALS systems must respond to external input variations and internal off-nominal behavior. Buffer sizing, resupply scheduling, failure response, and control system design are aspects of dynamic system design. We develop two dynamic mass flow models and use them in simulations to evaluate systems issues, optimize designs, and make system design trades. One model is of nitrogen leakage in the space station, the other is of a waste processor failure in a regenerative life support system. Most systems analyses are concerned with optimizing the cost/benefit of a system at its nominal steady-state operating point. ALS analysis must go beyond the static steady state to include dynamic system design. All life support systems exhibit behavior that varies over time. ALS systems must respond to equipment operating cycles, repair schedules, and occasional off-nominal behavior or malfunctions. Biological components, such as bioreactors, composters, and food plant growth chambers, usually have operating cycles or other complex time behavior. Buffer sizes, material stocks, and resupply rates determine dynamic system behavior and directly affect system mass and cost. Dynamic simulation is needed to avoid the extremes of costly over-design of buffers and material reserves or system failure due to insufficient buffers and lack of stored material.

Methods for evaluating and ranking transportation energy conservation programs

NASA Astrophysics Data System (ADS)

Santone, L. C.

1981-04-01

The energy conservation programs are assessed in terms of petroleum savings, incremental costs to consumers probability of technical and market success, and external impacts due to environmental, economic, and social factors. Three ranking functions and a policy matrix are used to evaluate the programs. The net present value measure which computes the present worth of petroleum savings less the present worth of costs is modified by dividing by the present value of DOE funding to obtain a net present value per program dollar. The comprehensive ranking function takes external impacts into account. Procedures are described for making computations of the ranking functions and the attributes that require computation. Computations are made for the electric vehicle, Stirling engine, gas turbine, and MPG mileage guide program.

Potential pros and cons of external healthcare performance evaluation systems: real-life perspectives on Iranian hospital evaluation and accreditation program

PubMed Central

Jaafaripooyan, Ebrahim

2014-01-01

Background: Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. Methods: A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Results: Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs’ over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Conclusion: Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs. PMID:25279381

Potential pros and cons of external healthcare performance evaluation systems: real-life perspectives on Iranian hospital evaluation and accreditation program.

PubMed

Jaafaripooyan, Ebrahim

2014-09-01

Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs' over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs.

The Costs and Benefits of Active Coping for Adolescents Residing in Urban Poverty.

PubMed

Carothers, Kristin J; Arizaga, Jessica A; Carter, Jocelyn Smith; Taylor, Jeremy; Grant, Kathryn E

2016-07-01

The present study addresses the lack of specificity and diversity highlighted in recent stress literature reviews by examining active coping in relationships between exposure to violence and internalizing and externalizing symptoms in a sample of urban youth from predominantly low-income, African American and Latino backgrounds. Two hundred and forty-one youth (mean age at Time 1 = 13 years; 66 % female; 41 % African American, 28 % Latino, 14 % European American, 6 % Asian American, 7 % mixed/biracial, 1 % American Indian/native American, .5 % Hawaiian/Pacific Islander, 2 % other) and their parents participated in this three-wave study. Hierarchical regression analyses tested for moderation, and a cross lag panel path analysis tested for mediation. The results provide greater support for active coping as a variable that changes the relationship between exposure to community violence and externalizing symptoms, or moderation, rather than one that explains or mediates it. Further, specificity did not emerge for type of psychological outcome but did emerge for gender, such that active coping exacerbated the association between exposure to community violence and both internalizing and externalizing symptoms for girls, but not boys. These findings highlight the importance of contextual and demographic factors in influencing stress and coping processes during adolescence.

Desktop Systems for Manufacturing Carbon Nanotube Films by Chemical Vapor Deposition

DTIC Science & Technology

2007-06-01

existing low cost tube furnace designs limit the researcher’s ability to fully separate critical reaction parameters such as temperature and flow...Often heated using an external resistive heater coil, a typical configuration, shown in Figure 4, might place a tube made of a non- reactive ...researcher’s ability to fully separate critical parameters such as temperature and flow profiles. Additionally, the use of heating elements external to

Approaches to developing the capacity of health policy analysis institutes: a comparative case study.

PubMed

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj

2012-03-05

To review and assess (i) the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and (ii) the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (3 from Asia and 3 from Africa) were conducted. In each region an NGO institute, an institute linked to government and a university based institute were included. Data collection comprised document review, semi-structured interviews with stakeholders and discussion of preliminary findings with institute staff. The findings are organized around four key themes: (i) Financial resources: three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: the retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. In particular staff often moved to better paid positions elsewhere once having acquired necessary skills and experience, leaving remaining senior staff with heavy workloads. (iii) Governance and management: board structures and roles varied according to the nature of institute ownership. Boards made important contributions to organizational capacity through promoting continuity, independence and fund raising. Routine management systems were typically perceived to be strong. (iv) Networks: linkages to policy makers helped promote policy influences. External networks with other research organizations, particularly where these were longer term institutional collaborations helped promote capacity. The development of strong in-country analytical and research capacity to guide health policy development is critical, yet many health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted. Specific recommendations to funders and institutes are provided.

Modeling ARRM Xenon Tank Pressurization Using 1D Thermodynamic and Heat Transfer Equations

NASA Technical Reports Server (NTRS)

Gilligan, Patrick; Tomsik, Thomas

2016-01-01

As a first step in understanding what ground support equipment (GSE) is required to provide external cooling during the loading of 5,000 kg of xenon into 4 aluminum lined composite overwrapped pressure vessels (COPVs), a modeling analysis was performed using Microsoft Excel. The goals of the analysis were to predict xenon temperature and pressure throughout loading at the launch facility, estimate the time required to load one tank, and to get an early estimate of what provisions for cooling xenon might be needed while the tanks are being filled. The model uses the governing thermodynamic and heat transfer equations to achieve these goals. Results indicate that a single tank can be loaded in about 15 hours with reasonable external coolant requirements. The model developed in this study was successfully validated against flight and test data. The first data set is from the Dawn mission which also utilizes solar electric propulsion with xenon propellant, and the second is test data from the rapid loading of a hydrogen cylindrical COPV. The main benefit of this type of model is that the governing physical equations using bulk fluid solid temperatures can provide a quick and accurate estimate of the state of the propellant throughout loading which is much cheaper in terms of computational time and licensing costs than a Computation Fluid Dynamics (CFD) analysis while capturing the majority of the thermodynamics and heat transfer.

Modeling Xenon Tank Pressurization using One-Dimensional Thermodynamic and Heat Transfer Equations

NASA Technical Reports Server (NTRS)

Gilligan, Ryan P.; Tomsik, Thomas M.

2017-01-01

As a first step in understanding what ground support equipment (GSE) is required to provide external cooling during the loading of 5,000 kg of xenon into 4 aluminum lined composite overwrapped pressure vessels (COPVs), a modeling analysis was performed using Microsoft Excel. The goals of the analysis were to predict xenon temperature and pressure throughout loading at the launch facility, estimate the time required to load one tank, and to get an early estimate of what provisions for cooling xenon might be needed while the tanks are being filled. The model uses the governing thermodynamic and heat transfer equations to achieve these goals. Results indicate that a single tank can be loaded in about 15 hours with reasonable external coolant requirements. The model developed in this study was successfully validated against flight and test data. The first data set is from the Dawn mission which also utilizes solar electric propulsion with xenon propellant, and the second is test data from the rapid loading of a hydrogen cylindrical COPV. The main benefit of this type of model is that the governing physical equations using bulk fluid solid temperatures can provide a quick and accurate estimate of the state of the propellant throughout loading which is much cheaper in terms of computational time and licensing costs than a Computation Fluid Dynamics (CFD) analysis while capturing the majority of the thermodynamics and heat transfer.

Cost-effectiveness simulation and analysis of colorectal cancer screening in Hong Kong Chinese population: comparison amongst colonoscopy, guaiac and immunologic fecal occult blood testing.

PubMed

Wong, Carlos K H; Lam, Cindy L K; Wan, Y F; Fong, Daniel Y T

2015-10-15

The aim of this study was to evaluate the cost-effectiveness of CRC screening strategies from the healthcare service provider perspective based on Chinese population. A Markov model was constructed to compare the cost-effectiveness of recommended screening strategies including annual/biennial guaiac fecal occult blood testing (G-FOBT), annual/biennial immunologic FOBT (I-FOBT), and colonoscopy every 10 years in Chinese aged 50 year over a 25-year period. External validity of model was tested against data retrieved from published randomized controlled trials of G-FOBT. Recourse use data collected from Chinese subjects among staging of colorectal neoplasm were combined with published unit cost data ($USD in 2009 price values) to estimate a stage-specific cost per patient. Quality-adjusted life-years (QALYs) were quantified based on the stage duration and SF-6D preference-based value of each stage. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per life-years (LY) and costs per QALYs gained. In base-case scenario, the non-dominated strategies were annual and biennial I-FOBT. Compared with no screening, the ICER presented $20,542/LYs and $3155/QALYs gained for annual I-FOBT, and $19,838/LYs gained and $2976/QALYs gained for biennial I-FOBT. The optimal screening strategy was annual I-FOBT that attained the highest ICER at the threshold of $50,000 per LYs or QALYs gained. The Markov model informed the health policymakers that I-FOBT every year may be the most effective and cost-effective CRC screening strategy among recommended screening strategies, depending on the willingness-to-pay of mass screening for Chinese population. ClinicalTrials.gov Identifier NCT02038283.

Cost-effectiveness of Project ADAM: a project to prevent sudden cardiac death in high school students.

PubMed

Berger, S; Whitstone, B N; Frisbee, S J; Miner, J T; Dhala, A; Pirrallo, R G; Utech, L M; Sachdeva, R C

2004-01-01

Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.

WeaselBoard :

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

Mulder, John C.; Schwartz, Moses Daniel; Berg, Michael J.

2013-10-01

Critical infrastructures, such as electrical power plants and oil refineries, rely on programmable logic controllers (PLCs) to control essential processes. State of the art security cannot detect attacks on PLCs at the hardware or firmware level. This renders critical infrastructure control systems vulnerable to costly and dangerous attacks. WeaselBoard is a PLC backplane analysis system that connects directly to the PLC backplane to capture backplane communications between modules. WeaselBoard forwards inter-module traffic to an external analysis system that detects changes to process control settings, sensor values, module configuration information, firmware updates, and process control program (logic) updates. WeaselBoard provides zero-daymore » exploit detection for PLCs by detecting changes in the PLC and the process. This approach to PLC monitoring is protected under U.S. Patent Application 13/947,887.« less

Naver: a PC-cluster-based VR system

NASA Astrophysics Data System (ADS)

Park, ChangHoon; Ko, HeeDong; Kim, TaiYun

2003-04-01

In this paper, we present a new framework NAVER for virtual reality application. The NAVER is based on a cluster of low-cost personal computers. The goal of NAVER is to provide flexible, extensible, scalable and re-configurable framework for the virtual environments defined as the integration of 3D virtual space and external modules. External modules are various input or output devices and applications on the remote hosts. From the view of system, personal computers are divided into three servers according to its specific functions: Render Server, Device Server and Control Server. While Device Server contains external modules requiring event-based communication for the integration, Control Server contains external modules requiring synchronous communication every frame. And, the Render Server consists of 5 managers: Scenario Manager, Event Manager, Command Manager, Interaction Manager and Sync Manager. These managers support the declaration and operation of virtual environment and the integration with external modules on remote servers.

Recruitment of mental health survey participants using Internet advertising: content, characteristics and cost effectiveness.

PubMed

Batterham, Philip J

2014-06-01

Postal and telephone survey research is threatened by declining response rates and high cost. Online recruitment is becoming more popular, although there is little empirical evidence about its cost-effectiveness or the representativeness of online samples. There is also limited research on optimal strategies for developing advertising content for online recruitment. The present study aimed to assess these aspects of online recruitment. Two mental health surveys used advertisements within a social network website (Facebook) to recruit adult Australian participants. The initial survey used advertisements linking directly to an external survey website, and recruited 1283 participants at $9.82 per completed survey. A subsequent survey used advertisements linking to a Facebook page that featured links to the external survey, recruiting 610 participants at $1.51 per completion. Both surveys were more cost-effective than similar postal surveys conducted previously, which averaged $19.10 per completion. Online and postal surveys both had somewhat unrepresentative samples. However, online surveys tended to be more successful in recruiting hard-to-reach populations. Advertising using "problem" terminology was more effective than "positive" terminology, while there was no significant effect of altruistic versus self-gain terminology. Online recruitment is efficient, flexible and cost-effective, suggesting that online recruitment has considerable potential for specific research designs. Copyright © 2014 John Wiley & Sons, Ltd.

Distributed Optimization for a Class of Nonlinear Multiagent Systems With Disturbance Rejection.

PubMed

Wang, Xinghu; Hong, Yiguang; Ji, Haibo

2016-07-01

The paper studies the distributed optimization problem for a class of nonlinear multiagent systems in the presence of external disturbances. To solve the problem, we need to achieve the optimal multiagent consensus based on local cost function information and neighboring information and meanwhile to reject local disturbance signals modeled by an exogenous system. With convex analysis and the internal model approach, we propose a distributed optimization controller for heterogeneous and nonlinear agents in the form of continuous-time minimum-phase systems with unity relative degree. We prove that the proposed design can solve the exact optimization problem with rejecting disturbances.

Freedom Star tows a barge with an SLWT into Port Canaveral for the first time

NASA Technical Reports Server (NTRS)

1998-01-01

Freedom Star, one of NASA's two solid rocket booster recovery ships, tows a barge containing the third Space Shuttle super lightweight external tank (SLWT) into Port Canaveral. This SLWT will be used to launch the orbiter Discovery on mission STS-95 in October. This first-time towing arrangement, part of a cost savings plan by NASA to prudently manage existing resources, began June 12 from the Michoud Assembly Facility in New Orleans where the Shuttle's external tanks are manufactured. The barge will now be transported up the Banana River to the LC-39 turn basin using a conventional tugboat. Previously, NASA relied on an outside contractor to provide external tank towing services at a cost of about $120,000 per trip. The new plan allows NASA's Space Flight Operations contractor, United Space Alliance (USA), to provide the same service directly to NASA using the recovery ships during their downtime between Shuttle launches. Studies show a potential savings of about $50,000 per trip. The cost of the necessary ship modifications should be paid back by the fourteenth tank delivery. The other recovery ship, Liberty Star, has also undergone deck strengthening enhancements and will soon have the necessary towing winch installed. The other recovery vessel, Liberty Star, has undergone deck strengthening enhancements along with Freedom Star and will soon have the necessary towing winch installed.

An economic analysis of conservative management versus active treatment for men with localized prostate cancer.

PubMed

Perlroth, Daniella J; Bhattacharya, Jay; Goldman, Dana P; Garber, Alan M

2012-12-01

Comparative effectiveness research suggests that conservative management (CM) strategies are no less effective than active initial treatment for many men with localized prostate cancer. We estimate longer-term costs of initial management strategies and potential US health expenditure savings by increased use of conservative management for men with localized prostate cancer. Five-year total health expenditures attributed to initial management strategies for localized prostate cancer were calculated using commercial claims data from 1998 to 2006, and savings were estimated from a US population health-care expenditure model. Our analysis finds that patients receiving combinations of active treatments have the highest additional costs over conservative management at $63 500, followed by $48 550 for intensity-modulated radiation therapy, $37 500 for primary androgen deprivation therapy, and $28 600 for brachytherapy. Radical prostatectomy ($15 200) and external beam radiation therapy ($18 900) were associated with the lowest costs. The population model estimated that US health expenditures could be lowered by 1) use of initial CM over all active treatment ($2.9-3.25 billion annual savings), 2) shifting patients receiving intensity-modulated radiation therapy to CM ($680-930 million), 3) foregoing primary androgen deprivation therapy($555 million), 4) reducing the use of adjuvant androgen deprivation in addition to local therapies ($630 million), and 5) using single treatments rather than combination local treatment ($620-655 million). In conclusion, we find that all active treatments are associated with higher longer-term costs than CM. Substantial savings, representing up to 30% of total costs, could be realized by adopting CM strategies, including active surveillance, for initial management of men with localized prostate cancer.

A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda.

PubMed

Ngabo, Fidèle; Levin, Ann; Wang, Susan A; Gatera, Maurice; Rugambwa, Celse; Kayonga, Celestin; Donnen, Philippe; Lepage, Philippe; Hutubessy, Raymond

2015-12-16

Detailed cost evaluations of delivery of new vaccines such as pneumococcal conjugate, human papillomavirus (HPV), and rotavirus vaccines in low and middle-income countries are scarce. This paper differs from others by comparing the costs of introducing multiple vaccines in a single country and then assessing the financial and economic impact at the time and implications for the future. The objective of the analysis was to understand the introduction and delivery cost per dose or per child of the three new vaccines in Rwanda to inform domestic and external financial resource mobilization. Start-up, recurrent, and capital costs from a government perspective were collected in 2012. Since pneumococcal conjugate and HPV vaccines had already been introduced, cost data for those vaccines were collected retrospectively while prospective (projected) costing was done for rotavirus vaccine. The financial unit cost per fully immunized child (or girl for HPV vaccine) of delivering 3 doses of each vaccine (without costs related to vaccine procurement) was $0.37 for rotavirus (RotaTeq(®)) vaccine, $0.54 for pneumococcal (Prevnar(®)) vaccine in pre-filled syringes, and $10.23 for HPV (Gardasil (®)) vaccine. The financial delivery costs of Prevnar(®) and RotaTeq(®) were similar since both were delivered using existing health system infrastructure to deliver infant vaccines at health centers. The total financial cost of delivering Gardasil(®) was higher than those of the two infant vaccines due to greater resource requirements associated with creating a new vaccine delivery system in for a new target population of 12-year-old girls who have not previously been served by the existing routine infant immunization program. The analysis indicates that service delivery strategies have an important influence on costs of introducing new vaccines and costs per girl reached with HPV vaccine are higher than the other two vaccines because of its delivery strategy. Documented information on financial commitments for new vaccines, particularly from government sources, is a useful input into country policy dialogue on sustainable financing and co-financing of new vaccines, as well as for policy decisions by donors such as Gavi, the Vaccine Alliance. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Health economic research on vaccinations and immunisation practices--an introductory primer.

PubMed

Szucs, Thomas D

2005-03-18

The economic importance of vaccines lies partly in the burden of disease that can be avoided and partly in the competition for resources between vaccines and other interventions. Up to the 1980s only few economic evaluations had been carried out. Since then the confrontation of most countries with escalating health care costs and tighter budgets have awakened the interest in pharmacoeconomic analysis. Resources used to provide health care are vast but not limitless. When clinicians are asked to participate in decisions for large groups of patients (in a managed care context, in an institution, or at the level of local health authorities), the balance between consumption of resources and the benefits of an intervention is important. Clinicians may use cost-effectiveness and cost-benefit studies to inform such decisions (but not to make them). Because of differences in methods, the presentation of results, and country-specific parameters, economic evaluations of the same vaccination strategy by different groups may have divergent results. Vaccines differ from classical medicines in at least three ways: firstly, there is a longer tradition of economic evaluations for vaccines than for medicines. Some of the most earliest economic studies were carried out in the field of vaccines in the public health arena. Secondly, comparatively fewer central decision makers need to be convinced as compared to drugs. The reason for this being a more centralised process of recommending vaccines and vaccination policies. Thirdly, externalities are more relevant in the field of vaccines. Such externalities may be positive or negative. Positive externalities are present in the case where herd immunity prevents the spread of the disease in the community. We are now undoubtedly in an era of assessment and accountability for all new technologies in healthcare. However, sufficient economic data are still lacking to support the formulation of health policy and a particular challenge for the future is to conduct further health economic research on immunisation. Specific areas for such study include: effectiveness under field conditions (i.e., not under the conditions of a randomised controlled trial); the real value of economic production losses; the conditions for implementing novel immunization programmes; cost estimates for more ambitious immunization programmes; the economic benefits of combination vaccines. From this research, it will be important to disseminate the data and to adapt the findings to other countries. Nevertheless, the source of funding for research and its application in clinical trials programmes represent some of the practical problems faced by medical economics today within academia and the industry.

Audit of the annual reports of directors of public health: production methods.

PubMed

Sidhu, K S

1992-07-01

An audit of production methods used for the Directors of Public Health (DsPH) Annual Report of the health of their local population. Postal questionnaire survey. 23 Departments of Public Health in the West Midlands Region. Costs and problems relating to different production techniques used. The majority of DsPH favoured reports with figures and graphs. This led to most DsPH using in-house desktop publishing or employing external graphic designers. Those using the former technique had more problems related to computers and felt they spent too much medical time working on the document. However, they also valued the relative low cost, editorial freedom and the ability to correct mistakes easily. Departments which employed external graphic designers generally paid more, but appreciated the extra time made available by delegating the work. They also felt that the expertise was valuable in document design. However, inaccuracies were cited as being more difficult to correct. Perhaps the best way of producing an annual report is to amalgamate the two commonest production techniques (i.e. external graphic design and in-house desktop publishing).

Large-Scale Physical Models of Thermal Remediation of DNAPL Source Zones in Aquitards

DTIC Science & Technology

2009-05-01

pressure at the bottom of the tank. The higher pressure is reflected in higher measured water levels in external gauges . Figure 63: 3D Cross...than atmospheric. This higher pressure can raise the apparent water level in a sight gauge or external overflow and can even drive more fluid through...the water table. All met or exceeded their goals. Typical turnkey unit costs (including design, permitting, fabrication, mobilization, drilling

The impact of the use of intraoperative radiotherapy on costs, travel time and distance for women with breast cancer in the Mexico City Metropolitan Area.

PubMed

Bargallo-Rocha, Juan Enrique; Soto-Perez-de-Celis, Enrique; Picó-Guzmán, Francisco Javier; Quintero-Rodríguez, Carlos Eduardo; Almog, David; Santiago-Concha, Gabriel; Flores-Balcazar, Christian Haydee; Corona, Jaime; Vazquez-Romo, Rafael; Villarreal-Garza, Cynthia; Mohar, Alejandro

2017-11-01

The low availability and poor access to external beam radiotherapy (EBRT) in developing countries makes it hard for women with breast cancer to receive breast conservation. We studied the effect of providing intraoperative radiotherapy (IORT) on the travel time, distance, and costs of in the Mexico City Metropolitan Area (MCMA). Sixty-nine patients treated between January 2013 and September 2014 were analyzed. Travel distance and transit time was calculated using Google Maps. The time and distance patients living in the MCMA treated with IORT would have spent if they had received EBRT was calculated. Cost analysis for each modality was performed. 71% (n = 49) lived in the MCMA. Sixteen (33%) received additional EBRT and 33 (66%) received IORT only. Mean driving distance and transit time of those 33 women was 132.6 km (SD 25.7) and 66 min (SD 32.9). Patients from the MCMA receiving IORT alone avoided 990 visits, 43 700 km and 65 400 min in transit. IORT led to a 12% reduction in costs per patient. By reducing costs and time needed for patients to receive radiotherapy, IORT could potentially enhance access to breast conservation in resource-limited developing countries. © 2017 Wiley Periodicals, Inc.

Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot.

PubMed

Gil, Joseph; Schiff, Adam P; Pinzur, Michael S

2013-08-01

The negative impact on health-related quality of life in patients with Charcot foot has prompted operative correction of the acquired deformity. Comparative effectiveness financial models are being introduced to provide valuable information to assist clinical decision making. Seventy-six patients with Charcot foot underwent operative correction with the use of circular external fixation. Thirty-eight (50%) had osteomyelitis. A control group was created from 17 diabetic patients who successfully underwent transtibial amputation and prosthetic fitting during the same period. Cost of care during the 12 months following surgery was derived from inpatient hospitalization, placement in a rehabilitation unit or skilled nursing facility, home health care including parenteral antibiotic therapy, physical therapy, and purchase of prosthetic devices or footwear. Fifty-three of the patients with limb salvage (69.7%) did not require inpatient rehabilitation. Their average cost of care was $56,712. Fourteen of the patients with amputation (82.4%) required inpatient rehabilitation, with an average cost of $49,251. Many surgeons now favor operative correction of Charcot foot deformity. This investigation provides preliminary data on the relative cost of transtibial amputation and prosthetic limb fitting compared with limb salvage. The use of comparative effectiveness models such as this simple attempt may provide valuable information in planning resource allocation for similar complex groups of patients. Level III, economic and decision analysis.

Clinical and economic consequences of antibiotic-impregnated cerebrospinal fluid shunt catheters.

PubMed

Eymann, Regina; Chehab, Somar; Strowitzki, Martin; Steudel, Wolf-Ingo; Kiefer, Michael

2008-06-01

The authors evaluated the safety and efficacy of antibiotic-impregnated shunt catheters (AISCs) and determined the cost-benefit ratio related to the fact that AISCs increase the implant costs of a shunt procedure by approximately $400 per patient. The control group comprised 98 adults with chronic hydrocephalus and 22 children, who were treated without AISCs (non-AISCs). In the treatment group, AISCs (Bactiseal, Codman, Johnson & Johnson) were implanted in 171 adults and 26 children. The minimum follow-up period was 6 months. Important risk factors for shunt infections (such as age, comorbidity, cause of hydrocephalus, operating time, and duration of external cerebrospinal fluid drainage prior to shunt placement) did not differ between the study and control groups. In the pediatric AISC group, the frequency of premature, shunt-treated infants and the incidence of external ventricular drainage prior to shunt insertion were actually higher than those in the non-AISC group. When using AISCs, the shunt infection rate dropped from 4 to 0.6% and from 13.6 to 3.8% in the adult and the pediatric cohort, respectively. Overall the infection rate decreased from 5.8 to 1%, which was statistically significant (p = 0.0145). The average costs of a single shunt infection were $17,300 and $13,000 in children and adults, respectively. The cost-benefit calculation assumed to have saved shunt infection-related costs of approximately $50,000 in 197 AISC-treated patients due to the reduction in shunt infection rate in this group compared with costs in the control group. Despite the incremental implant costs associated with the use of AISCs, the overall reduction in infection-related costs made the use of AISCs cost beneficial in the authors' department. From clinical and economic perspectives, AISCs are seemingly a valuable addition in hydrocephalus therapy.

A Total Cost of Ownership Model for Low Temperature PEM Fuel Cells in Combined Heat and Power and Backup Power Applications

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

University of California, Berkeley; Wei, Max; Lipman, Timothy

2014-06-23

A total cost of ownership model is described for low temperature proton exchange membrane stationary fuel cell systems for combined heat and power (CHP) applications from 1-250kW and backup power applications from 1-50kW. System designs and functional specifications for these two applications were developed across the range of system power levels. Bottom-up cost estimates were made for balance of plant costs, and detailed direct cost estimates for key fuel cell stack components were derived using design-for-manufacturing-and-assembly techniques. The development of high throughput, automated processes achieving high yield are projected to reduce the cost for fuel cell stacks to the $300/kWmore » level at an annual production volume of 100 MW. Several promising combinations of building types and geographical location in the U.S. were identified for installation of fuel cell CHP systems based on the LBNL modelling tool DER CAM. Life-cycle modelling and externality assessment were done for hotels and hospitals. Reduced electricity demand charges, heating credits and carbon credits can reduce the effective cost of electricity ($/kWhe) by 26-44percent in locations such as Minneapolis, where high carbon intensity electricity from the grid is displaces by a fuel cell system operating on reformate fuel. This project extends the scope of existing cost studies to include externalities and ancillary financial benefits and thus provides a more comprehensive picture of fuel cell system benefits, consistent with a policy and incentive environment that increasingly values these ancillary benefits. The project provides a critical, new modelling capacity and should aid a broad range of policy makers in assessing the integrated costs and benefits of fuel cell systems versus other distributed generation technologies.« less

Characteristics of the Single-Longitudinal-Mode Planar-Waveguide External Cavity Diode Laser at 1064 nm

NASA Technical Reports Server (NTRS)

Numata, Kenji; Alalusi, Mazin; Stolpner, Lew; Margaritis, Georgios; Camp, Jordan; Krainak, Michael

2014-01-01

We describe the characteristics of the planar-waveguide external cavity diode laser (PW-ECL). To the best of our knowledge, it is the first butterfly-packaged 1064 nm semiconductor laser that is stable enough to be locked to an external frequency reference. We evaluated its performance from the viewpoint of precision experiments. Using a hyperfine absorption line of iodine, we suppressed its frequency noise by a factor of up to 104 at 10 mHz. The PWECL's compactness and low cost make it a candidate to replace traditional Nd:YAG nonplanar ring oscillators and fiber lasers in applications that require a single longitudinal mode.

Cost-effectiveness of rotavirus vaccination in Albania.

PubMed

Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia

2015-05-07

Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases and deaths were based on plausible minimum estimates. Introduction of RV1 would yield similar benefits at lower cost. Copyright © 2015 Elsevier Ltd. All rights reserved.

P-8A Poseidon Multi Mission Maritime Aircraft (P-8A)

DTIC Science & Technology

2015-12-01

focus also includes procurement of depot and intermediate level maintenance capabilities, full scale fatigue testing, and continued integration and... Level Confidence Level of cost estimate for current APB: 50% The current APB cost estimate provided sufficient resources to execute the program under...normal conditions, encountering average levels of technical, schedule, and programmatic risk and external interference. It was consistent with

Efficient Use of Terrestrial Economic Services: A Case Study in South Korea

NASA Astrophysics Data System (ADS)

Nguyen, T. T.; Tenhunen, J.; Hoang, V. N.; Koellner, T.; Shin, H.; Pham, V. D.; Seo, B.

2012-04-01

Understanding the linkages between social and ecological systems is crucial for managing potential responses to global change. Agricultural production requires resources, is determined by ecological processes, and results in economic goods and services for society. However, production leads at the same time to both positive and negative externalities. The externalities can be enhanced or mitigated by human behavior in management, which is mainly driven by expectations related to economic gains and losses. Ecological and economic processes are interrelated, and continuously interact in a complex manner. Therefore, understanding potential economic gains and losses in response to global change is a fundamental consideration in order to carry out well-informed decision-making. The International Research and Training Group TERRECO at the University of Bayreuth has intensively investigated ecological systems and processes in forested and agricultural landscapes as well as at regional scale in South Korea. These ongoing efforts provide a unique opportunity to examine the economic gains, losses and trade-offs that may occur with future climate and land-use change. Within this framework, we first investigated the environmental and economic efficiency of rice farms in Kangwon Province of South Korea, since rice is the most important food crop in this country. We then expanded our analysis to include dry farm highland vegetable crops in an intensively farmed region of the country, Haean Catchment. Our main objectives are (1) to categorize different types of farms, (2) determine their economic and environmental efficiency, and (3) to determine the trade-offs that occur in economic and environmental efficiencies under alternative management schemes and alternative climate regimes. Our preliminary analysis for rice farms yielded several important findings. First, both the production cost and environmental pollution by rice farms could be reduced significantly. Improvements in technical efficiency would result in both lower production costs and better environmental performance. Secondly, it is not without cost for farms to move from their current operation to an environmentally efficient operation. On average, this shift would increase production costs by 119%, but benefit water resources by a 69% reduction in eutrophication. It was estimated that the average cost of each kg of aggregate nutrient reduction would cost approximately 1.2 thousand won. These findings have several important policy implications. First, without major policy intervention, rice farms could still improve their economic and environmental performance by being more technically efficient. Training programs for rice farmers that focus on how to manage inputs and how to use the nutrients more efficiently would help farms to consume fewer inputs and cause less eutrophication problems. Second, opportunities exist for policy makers to intervene into the markets to adjust the prices of inputs so that farms, by minimizing their production costs, also improve their environmental performance. Further investigation into such policy options (such as introduction of taxes on fertilizer use, removal of subsidies or provision of incentive schemes) is being conducted.

Opportunities in SMR Emergency Planning

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

Moe, Wayne L.

2014-10-01

Using year 2014 cost information gathered from twenty different locations within the current commercial nuclear power station fleet, an assessment was performed concerning compliance costs associated with the offsite emergency Planning Standards contained in 10 CFR 50.47(b). The study was conducted to quantitatively determine the potential cost benefits realized if an emergency planning zone (EPZ) were reduced in size according to the lowered risks expected to accompany small modular reactors (SMR). Licensees are required to provide a technical basis when proposing to reduce the surrounding EPZ size to less than the 10 mile plume exposure and 50 mile ingestion pathwaymore » distances currently being used. To assist licensees in assessing the savings that might be associated with such an action, this study established offsite emergency planning costs in connection with four discrete EPZ boundary distances, i.e., site boundary, 2 miles, 5 miles and 10 miles. The boundary selected by the licensee would be based on where EPA Protective Action Guidelines are no longer likely to be exceeded. Additional consideration was directed towards costs associated with reducing the 50 mile ingestion pathway EPZ. The assessment methodology consisted of gathering actual capital costs and annual operating and maintenance costs for offsite emergency planning programs at the surveyed sites, partitioning them according to key predictive factors, and allocating those portions to individual emergency Planning Standards as a function of EPZ size. Two techniques, an offsite population-based approach and an area-based approach, were then employed to calculate the scaling factors which enabled cost projections as a function of EPZ size. Site-specific factors that influenced source data costs, such as the effects of supplemental funding to external state and local agencies for offsite response organization activities, were incorporated into the analysis to the extent those factors could be representatively apportioned.« less

Use of Six Sigma Worksheets for assessment of internal and external failure costs associated with candidate quality control rules for an ADVIA 120 hematology analyzer.

PubMed

Cian, Francesco; Villiers, Elisabeth; Archer, Joy; Pitorri, Francesca; Freeman, Kathleen

2014-06-01

Quality control (QC) validation is an essential tool in total quality management of a veterinary clinical pathology laboratory. Cost-analysis can be a valuable technique to help identify an appropriate QC procedure for the laboratory, although this has never been reported in veterinary medicine. The aim of this study was to determine the applicability of the Six Sigma Quality Cost Worksheets in the evaluation of possible candidate QC rules identified by QC validation. Three months of internal QC records were analyzed. EZ Rules 3 software was used to evaluate candidate QC procedures, and the costs associated with the application of different QC rules were calculated using the Six Sigma Quality Cost Worksheets. The costs associated with the current and the candidate QC rules were compared, and the amount of cost savings was calculated. There was a significant saving when the candidate 1-2.5s, n = 3 rule was applied instead of the currently utilized 1-2s, n = 3 rule. The savings were 75% per year (£ 8232.5) based on re-evaluating all of the patient samples in addition to the controls, and 72% per year (£ 822.4) based on re-analyzing only the control materials. The savings were also shown to change accordingly with the number of samples analyzed and with the number of daily QC procedures performed. These calculations demonstrated the importance of the selection of an appropriate QC procedure, and the usefulness of the Six Sigma Costs Worksheet in determining the most cost-effective rule(s) when several candidate rules are identified by QC validation. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

Hood River Passive House, Hood River, Oregon (Fact Sheet)

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

None, None

2014-02-01

The Hood River Passive Project was developed by Root Design Build of Hood River Oregon using the Passive House Planning Package (PHPP) to meet all of the requirements for certification under the European Passive House standards. The Passive House design approach has been gaining momentum among residential designers for custom homes and BEopt modeling indicates that these designs may actually exceed the goal of the U.S. Department of Energy's (DOE) Building America program to "reduce home energy use by 30%-50%" (compared to 2009 energy codes for new homes). This report documents the short term test results of the Shift Housemore » and compares the results of PHPP and BEopt modeling of the project. The design includes high R-Value assemblies, extremely tight construction, high performance doors and windows, solar thermal DHW, heat recovery ventilation, moveable external shutters and a high performance ductless mini-split heat pump. Cost analysis indicates that many of the measures implemented in this project did not meet the BA standard for cost neutrality. The ductless mini-split heat pump, lighting and advanced air leakage control were the most cost effective measures. The future challenge will be to value engineer the performance levels indicated here in modeling using production based practices at a significantly lower cost.« less

Estimating the environmental and resource costs of leakage in water distribution systems: A shadow price approach.

PubMed

Molinos-Senante, María; Mocholí-Arce, Manuel; Sala-Garrido, Ramon

2016-10-15

Water scarcity is one of the main problems faced by many regions in the XXIst century. In this context, the need to reduce leakages from water distribution systems has gained almost universal acceptance. The concept of sustainable economic level of leakage (SELL) has been proposed to internalize the environmental and resource costs within economic level of leakage calculations. However, because these costs are not set by the market, they have not often been calculated. In this paper, the directional-distance function was used to estimate the shadow price of leakages as a proxy of their environmental and resource costs. This is a pioneering approach to the economic valuation of leakage externalities. An empirical application was carried out for the main Chilean water companies. The estimated results indicated that for 2014, the average shadow price of leakages was approximately 32% of the price of the water delivered. Moreover, as a sensitivity analysis, the shadow prices of the leakages were calculated from the perspective of the water companies' managers and the regulator. The methodology and findings of this study are essential for supporting the decision process of reducing leakage, contributing to the improvement of economic, social and environmental efficiency and sustainability of urban water supplies. Copyright © 2016 Elsevier B.V. All rights reserved.

Hidden Costs: the ethics of cost-effectiveness analyses for health interventions in resource-limited settings

PubMed Central

Rutstein, Sarah E.; Price, Joan T.; Rosenberg, Nora E.; Rennie, Stuart M.; Biddle, Andrea K.; Miller, William C.

2017-01-01

Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritizing interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of healthcare resources, directly influencing morbidity and mortality for the world’s most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights; implications of CEA thresholds in light of economic uncertainty; and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings. PMID:27141969

New Whole-House Solutions Case Study: Hood River Passive House

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

None

2014-02-01

The Hood River Passive Project was developed by Root Design Build of Hood River Oregon using the Passive House Planning Package (PHPP) to meet all of the requirements for certification under the European Passive House standards. The Passive House design approach has been gaining momentum among residential designers for custom homes and BEopt modeling indicates that these designs may actually exceed the goal of the U.S. Department of Energy's (DOE) Building America program to "reduce home energy use by 30%-50%" (compared to 2009 energy codes for new homes). This report documents the short term test results of the Shift Housemore » and compares the results of PHPP and BEopt modeling of the project. The design includes high R-Value assemblies, extremely tight construction, high performance doors and windows, solar thermal DHW, heat recovery ventilation, moveable external shutters and a high performance ductless mini-split heat pump. Cost analysis indicates that many of the measures implemented in this project did not meet the BA standard for cost neutrality. The ductless mini-split heat pump, lighting and advanced air leakage control were the most cost effective measures. The future challenge will be to value engineer the performance levels indicated here in modeling using production based practices at a significantly lower cost.« less

Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings.

PubMed

Rutstein, Sarah E; Price, Joan T; Rosenberg, Nora E; Rennie, Stuart M; Biddle, Andrea K; Miller, William C

2017-10-01

Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritising interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of health-care resources, directly influencing morbidity and mortality for the world's most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights, implications of CEA thresholds in light of economic uncertainty, and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings.

Study of alternate space shuttle concepts

NASA Technical Reports Server (NTRS)

1971-01-01

A study of alternate space shuttle concepts was conducted to examine the stage-and-one-half concept and its potential for later conversion and use in the two stage reusable shuttle system. A study of external hydrogen tank concepts was conducted to determine the issues involved in the design and production of a low-cost expendable tank system. The major objectives of the study were to determine: (1) realistic drop tank program cost estimates, (2) estimated drop tank program cost for selected specific designs, and (3) change in program cost due to variations in design and manufacturing concepts and changes in program assumptions.

Identification of Uvaria sp by barcoding coupled with high-resolution melting analysis (Bar-HRM).

PubMed

Osathanunkul, M; Madesis, P; Ounjai, S; Pumiputavon, K; Somboonchai, R; Lithanatudom, P; Chaowasku, T; Wipasa, J; Suwannapoom, C

2016-01-13

DNA barcoding, which was developed about a decade ago, relies on short, standardized regions of the genome to identify plant and animal species. This method can be used to not only identify known species but also to discover novel ones. Numerous sequences are stored in online databases worldwide. One of the ways to save cost and time (by omitting the sequencing step) in species identification is to use available barcode data to design optimized primers for further analysis, such as high-resolution melting analysis (HRM). This study aimed to determine the effectiveness of the hybrid method Bar-HRM (DNA barcoding combined with HRM) to identify species that share similar external morphological features, rather than conduct traditional taxonomic identification that require major parts (leaf, flower, fruit) of the specimens. The specimens used for testing were those, which could not be identified at the species level and could either be Uvaria longipes or Uvaria wrayias, indicated by morphological identification. Primer pairs derived from chloroplast regions (matK, psbA-trnH, rbcL, and trnL) were used in the Bar-HRM. The results obtained from psbA-trnH primers were good enough to help in identifying the specimen while the rest were not. Bar-HRM analysis was proven to be a fast and cost-effective method for plant species identification.

An evaluation of data-driven motion estimation in comparison to the usage of external-surrogates in cardiac SPECT imaging

PubMed Central

Mukherjee, Joyeeta Mitra; Hutton, Brian F; Johnson, Karen L; Pretorius, P Hendrik; King, Michael A

2014-01-01

Motion estimation methods in single photon emission computed tomography (SPECT) can be classified into methods which depend on just the emission data (data-driven), or those that use some other source of information such as an external surrogate. The surrogate-based methods estimate the motion exhibited externally which may not correlate exactly with the movement of organs inside the body. The accuracy of data-driven strategies on the other hand is affected by the type and timing of motion occurrence during acquisition, the source distribution, and various degrading factors such as attenuation, scatter, and system spatial resolution. The goal of this paper is to investigate the performance of two data-driven motion estimation schemes based on the rigid-body registration of projections of motion-transformed source distributions to the acquired projection data for cardiac SPECT studies. Comparison is also made of six intensity based registration metrics to an external surrogate-based method. In the data-driven schemes, a partially reconstructed heart is used as the initial source distribution. The partially-reconstructed heart has inaccuracies due to limited angle artifacts resulting from using only a part of the SPECT projections acquired while the patient maintained the same pose. The performance of different cost functions in quantifying consistency with the SPECT projection data in the data-driven schemes was compared for clinically realistic patient motion occurring as discrete pose changes, one or two times during acquisition. The six intensity-based metrics studied were mean-squared difference (MSD), mutual information (MI), normalized mutual information (NMI), pattern intensity (PI), normalized cross-correlation (NCC) and entropy of the difference (EDI). Quantitative and qualitative analysis of the performance is reported using Monte-Carlo simulations of a realistic heart phantom including degradation factors such as attenuation, scatter and system spatial resolution. Further the visual appearance of motion-corrected images using data-driven motion estimates was compared to that obtained using the external motion-tracking system in patient studies. Pattern intensity and normalized mutual information cost functions were observed to have the best performance in terms of lowest average position error and stability with degradation of image quality of the partial reconstruction in simulations. In all patients, the visual quality of PI-based estimation was either significantly better or comparable to NMI-based estimation. Best visual quality was obtained with PI-based estimation in 1 of the 5 patient studies, and with external-surrogate based correction in 3 out of 5 patients. In the remaining patient study there was little motion and all methods yielded similar visual image quality. PMID:24107647

Why Educational Vouchers May Be Bad Economics.

ERIC Educational Resources Information Center

Krashinsky, Michael

1986-01-01

Arguments for and against educational vouchers are examined by looking at underlying economic assumptions. It is argued that externalities and transaction costs have often been ignored by voucher advocates. (MT)

[Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

PubMed

Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

2017-10-01

Background  In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods  To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results  Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion  For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

Socially optimal replacement of conventional with electric vehicles for the US household fleet

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

Kontou, Eleftheria; Yin, Yafeng; Lin, Zhenhong

In this study, a framework is proposed for minimizing the societal cost of replacing gas-powered household passenger cars with battery electric ones (BEVs). The societal cost consists of operational costs of heterogeneous driving patterns' cars, the government investments for charging deployment, and monetized environmental externalities. The optimization framework determines the timeframe needed for conventional vehicles to be replaced with BEVs. It also determines the BEVs driving range during the planning timeframe, as well as the density of public chargers deployed on a linear transportation network over time. We leverage datasets that represent U.S. household driving patterns, as well as themore » automobile and the energy markets, to apply the model. Results indicate that it takes 8 years for 80% of our conventional vehicle sample to be replaced with electric vehicles, under the base case scenario. The socially optimal all-electric driving range is 204 miles, with chargers placed every 172 miles on a linear corridor. All of the public chargers should be deployed at the beginning of the planning horizon to achieve greater savings over the years. Sensitivity analysis reveals that the timeframe for the socially optimal conversion of 80% of the sample varies from 6 to 12 years. The optimal decision variables are sensitive to battery pack and vehicle body cost, gasoline cost, the discount rate, and conventional vehicles' fuel economy. In conclusion, faster conventional vehicle replacement is achieved when the gasoline cost increases, electricity cost decreases, and battery packs become cheaper over the years.« less

Socially optimal replacement of conventional with electric vehicles for the US household fleet

DOE PAGES

Kontou, Eleftheria; Yin, Yafeng; Lin, Zhenhong; ...

2017-04-05

In this study, a framework is proposed for minimizing the societal cost of replacing gas-powered household passenger cars with battery electric ones (BEVs). The societal cost consists of operational costs of heterogeneous driving patterns' cars, the government investments for charging deployment, and monetized environmental externalities. The optimization framework determines the timeframe needed for conventional vehicles to be replaced with BEVs. It also determines the BEVs driving range during the planning timeframe, as well as the density of public chargers deployed on a linear transportation network over time. We leverage datasets that represent U.S. household driving patterns, as well as themore » automobile and the energy markets, to apply the model. Results indicate that it takes 8 years for 80% of our conventional vehicle sample to be replaced with electric vehicles, under the base case scenario. The socially optimal all-electric driving range is 204 miles, with chargers placed every 172 miles on a linear corridor. All of the public chargers should be deployed at the beginning of the planning horizon to achieve greater savings over the years. Sensitivity analysis reveals that the timeframe for the socially optimal conversion of 80% of the sample varies from 6 to 12 years. The optimal decision variables are sensitive to battery pack and vehicle body cost, gasoline cost, the discount rate, and conventional vehicles' fuel economy. In conclusion, faster conventional vehicle replacement is achieved when the gasoline cost increases, electricity cost decreases, and battery packs become cheaper over the years.« less

When and why do old adults outsource control to the environment?

PubMed

Mayr, Ulrich; Spieler, Daniel H; Hutcheon, Thomas G

2015-09-01

Old adults' tendency to rely on information present in the environment rather than internal representations has been frequently noted, but is not well understood. The fade-out paradigm provides a useful model situation to study this internal-to-external shift across the life span: Subjects need to transition from an initial, cued task-switching phase to a fade-out phase where only 1 task remains relevant. Old adults exhibit large response-time "fade-out costs," mainly because they continue to consult the task cues. Here we show that age differences in fade-out costs remain very large even when we insert between the task-switching and the fade-out phase 20 single-task trials without task cues (during which even old adults' performance becomes highly fluent; Experiment 1), but costs in old adults are eliminated when presenting an on-screen instruction to focus on the 1 remaining task at the transition point between the task-switching and fade-out phase (Experiment 2). Furthermore, old adults, but not young adults, also exhibited "fade-in costs" when they were instructed to perform an initial single-task phase that would be followed by the cued task-switching phase (Experiment 3). Combined, these results show that old adults' tendency to overutilize external support is not a problem of perseverating earlier-relevant control settings. Instead, old adults seem less likely to initiate the necessary reconfiguration process when transitioning from 1 phase to the next because they use underspecified task models that lack the higher-level distinction between those contexts that do and that do not require external support. (c) 2015 APA, all rights reserved).

Life cycle costing of waste management systems: overview, calculation principles and case studies.

PubMed

Martinez-Sanchez, Veronica; Kromann, Mikkel A; Astrup, Thomas Fruergaard

2015-02-01

This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, and each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding terminology. The presented cost model was implemented in two case study scenarios assessing the costs involved in the source segregation of organic waste from 100,000 Danish households and the subsequent co-digestion of organic waste with animal manure. Overall, source segregation resulted in higher financial costs than the alternative of incinerating the organic waste with the residual waste: 1.6 M€/year, of which 0.9 M€/year was costs for extra bins and bags used by the households, 1.0 M€/year for extra collections and -0.3 M€/year saved on incineration. Copyright © 2014 Elsevier Ltd. All rights reserved.

Analysis of External Treatment Methods and Technical Characteristics of External Treatment

NASA Astrophysics Data System (ADS)

Zhang, Rui; Miao, Mingsan; Bai, Ming

2018-01-01

Chinese medicine external therapy is a treatment method of Chinese medicine with Chinese characteristics. The effect of traditional Chinese medicine external treatment, convenient operation, external treatment and technology has great prospects for development. The traditional Chinese medicine external treatment method and technical characteristics were analyzed.

Investigation of availability and accessibility of community automated external defibrillators in a territory in Hong Kong.

PubMed

Ho, C L; Lui, C T; Tsui, K L; Kam, C W

2014-10-01

To evaluate the availability and accessibility of community automated external defibrillators in a territory in Hong Kong. Cross-sectional study. Two public hospitals in New Territories West Cluster in Hong Kong. Information about the locations of community automated external defibrillators was obtained from automated external defibrillator suppliers and through community search. Data on locations of out-of-hospital cardiac arrests from August 2010 to September 2013 were obtained from the local cardiac arrest registry of the emergency departments of two hospitals. Sites of both automated external defibrillators and out-of-hospital cardiac arrests were geographically coded and mapped. The number of out-of-hospital cardiac arrests within 100 m of automated external defibrillators per year and the proportion of out-of-hospital cardiac arrests with accessible automated external defibrillators (100 m) were calculated. The number of community automated external defibrillators per 10,000 population and public access defibrillation rate were also calculated and compared with those in other countries. There were a total of 207 community automated external defibrillators in the territory. The number of automated external defibrillators per 10,000 population was 1.942. All facilities with automated external defibrillators in this territory had more than 0.2 out-of-hospital cardiac arrests per automated external defibrillator per year within 100 m. Among all out-of-hospital cardiac arrests, 25.2% could have an automated external defibrillator reachable within 100 m. The public access defibrillation rate was 0.168%. The number and accessibility of community automated external defibrillators in this territory are comparable to those in other developed countries. The placement site of community automated external defibrillators is cost-effective. However, the public access defibrillation rate is low.

The analysis of the transient pressure response of the shuttle EPS-ECS cryogenic tanks with external pressurization systems

NASA Technical Reports Server (NTRS)

Barton, J. E.; Patterson, H. W.

1973-01-01

An analysis of transient pressures in externally pressurized cryogenic hydrogen and oxygen tanks was conducted and the effects of design variables on pressure response determined. The analysis was conducted with a computer program which solves the compressible viscous flow equations in two-dimensional regions representing the tank and external loop. The external loop volume, thermal mass, and heat leak were the dominant design variables affecting the system pressure response. No significant temperature stratification occurred in the fluid contained in the tank.

External Dependencies-Driven Architecture Discovery and Analysis of Implemented Systems

NASA Technical Reports Server (NTRS)

Ganesan, Dharmalingam; Lindvall, Mikael; Ron, Monica

2014-01-01

A method for architecture discovery and analysis of implemented systems (AIS) is disclosed. The premise of the method is that architecture decisions are inspired and influenced by the external entities that the software system makes use of. Examples of such external entities are COTS components, frameworks, and ultimately even the programming language itself and its libraries. Traces of these architecture decisions can thus be found in the implemented software and is manifested in the way software systems use such external entities. While this fact is often ignored in contemporary reverse engineering methods, the AIS method actively leverages and makes use of the dependencies to external entities as a starting point for the architecture discovery. The AIS method is demonstrated using the NASA's Space Network Access System (SNAS). The results show that, with abundant evidence, the method offers reusable and repeatable guidelines for discovering the architecture and locating potential risks (e.g. low testability, decreased performance) that are hidden deep in the implementation. The analysis is conducted by using external dependencies to identify, classify and review a minimal set of key source code files. Given the benefits of analyzing external dependencies as a way to discover architectures, it is argued that external dependencies deserve to be treated as first-class citizens during reverse engineering. The current structure of a knowledge base of external entities and analysis questions with strategies for getting answers is also discussed.

External human factors in incident management team decisionmaking and their effect on large fire suppression expenditures

Treesearch

Janie Canton-Tompson; Krista M. Gebert; Brooke Thompson; Greg Jones; David Calkin; Geoff Donovan

2008-01-01

Large wildland fires are complex, costly events influenced by a vast array of physical, climatic, and social factors. Changing climate, fuel buildup due to past suppression, and increasing populations in the wildland-urban interface have all been blamed for the extreme fire seasons and rising suppression expenditures of recent years. With each high-cost year comes a...

Correlating mechanical work with energy consumption during gait throughout pregnancy.

PubMed

Krkeljas, Zarko; Moss, Sarah Johanna

2015-11-20

Measures of mechanical work may be useful in evaluating efficiency of walking during pregnancy. Various adaptations in the body during pregnancy lead to altered gait, consequently contributing to the total energy cost of walking. Measures of metabolic energy expenditure may not be reliable for measuring energetic cost of gait during pregnancy as pregnancy results in numerous metabolic changes resulting from foetal development. Therefore, the aim of this study is to determine if mechanical work prediction equations correlate with the metabolic energy cost of gait during pregnancy. Thirty-five (35) women (27.5 ± 6.1 years) gave informed consent for participation in the study at different weeks of gestation pregnancy. Gas exchange and gait data were recorded while walking at a fixed self-selected walking speed. External (Wext) work was estimated assuming no energy transfer between segments, while internal work (Wint) assumed energy transfer between segments. Hence total energy of the body (Wtot) was calculated based on the segmental changes relative to the surrounding, and relative to the centre of mass of the whole body. Equations for mechanical work were correlated with net and gross O2 rate, and O2 cost. External, internal and total mechanical energy showed significant positive relationship with gross O2 rate (r = 0.48, r = 0.35; and r = 0.49 respectively), and gross O2 cost (r = 0.42; r = 0.70, and r = 0.62, respectively). In contrast, external, internal and total mechanical energy had no significant relationship with net O2 rate (r = 0.19, r = 0.24, and r = 0.24, respectively). Net O2 cost was significant related Wext (r = 0.49) Wint (r = 0.66) and Wtot (r = 0.62). Energy recovery improved with increase in gait speed. Measures of mechanical work, when adjusted for resting energy expenditure, and walking speed may be useful in comparing metabolic energy consumption between women during pregnancy, or assessment or gait changes of the same individual throughout pregnancy.

Facilitation of an end-of-life care programme into practice within UK nursing care homes: A mixed-methods study.

PubMed

Kinley, Julie; Preston, Nancy; Froggatt, Katherine

2018-06-01

The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. A mixed-methods study. Nursing care homes in south-east England. Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by 'following a thread'. This paper reports study data in relation to facilitation. Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and 'being present' facilitation. 'Being present' facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a 'being present' approach to facilitation. Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study 'being present' facilitation, when supported by multi-layered learning, was the only approach that initiated the change required. Copyright © 2018. Published by Elsevier Ltd.

Biomarker discovery study design for type 1 diabetes in The Environmental Determinants of Diabetes in the Young (TEDDY) study.

PubMed

Lee, Hye-Seung; Burkhardt, Brant R; McLeod, Wendy; Smith, Susan; Eberhard, Chris; Lynch, Kristian; Hadley, David; Rewers, Marian; Simell, Olli; She, Jin-Xiong; Hagopian, Bill; Lernmark, Ake; Akolkar, Beena; Ziegler, Anette G; Krischer, Jeffrey P

2014-07-01

The Environmental Determinants of Diabetes in the Young planned biomarker discovery studies on longitudinal samples for persistent confirmed islet cell autoantibodies and type 1 diabetes using dietary biomarkers, metabolomics, microbiome/viral metagenomics and gene expression. This article describes the details of planning The Environmental Determinants of Diabetes in the Young biomarker discovery studies using a nested case-control design that was chosen as an alternative to the full cohort analysis. In the frame of a nested case-control design, it guides the choice of matching factors, selection of controls, preparation of external quality control samples and reduction of batch effects along with proper sample allocation. Our design is to reduce potential bias and retain study power while reducing the costs by limiting the numbers of samples requiring laboratory analyses. It also covers two primary end points (the occurrence of diabetes-related autoantibodies and the diagnosis of type 1 diabetes). The resulting list of case-control matched samples for each laboratory was augmented with external quality control samples. Copyright © 2013 John Wiley & Sons, Ltd.

External Pulsed Plasma Propulsion (EPPP) Analysis Maturation

NASA Technical Reports Server (NTRS)

Bonometti, Joesph A.; Morton, P. Jeff; Schmidt, George R. (Technical Monitor)

2000-01-01

External Pulsed Plasma Propulsion (EPPP) systems are at the stage of engineering infancy with evolving paradigms for application. performance and general characteristics. Recent efforts have focused on an approach that employs existing technologies with near term EPPP development for usage in interplanetary exploration and asteroid/comet deflection. if mandated. The inherent advantages of EPPP are discussed and its application to a variety of propulsion concepts is explored. These include, but are not limited to, utilizing energy sources such as fission. fusion and antimatter, as well as, improved chemical explosives. A mars mission scenario is presented as a demonstration of its capability using existing technologies. A suggested alternate means to improve EPPP efficiencies could also lead to a heavy lift (non-nuclear) launch vehicle capability. Conceivably, true low-cost, access to space is possible using advanced explosive propellants and/or coupling the EPPP vehicle to a "beam propellant" concept. EPPP systems appear to offer an approach that can potentially cover ETO through interstellar transportation capability. A technology roadmap is presented that shows mutual benefits pertaining to a substantial number of existing space propulsion and research areas.

EoC Study Update to Examine the Cost, Schedule and Technical Changes to NASA Projects

NASA Technical Reports Server (NTRS)

Bitten, Bob; Emmons, Debra; Shinn, Stephen; Scolese, Chris

2018-01-01

The original National Aeronautics and Space Administration (NASA) Explanation of Change (EoC) study was conducted in 2010 to understand the underlying causes of cost and schedule growth. The first study consisted of 25 missions launched from 2000 to 2010 and looked at the events that led to growth. These events were categorized into different bins that were rolled up to quantify whether the growth was due to internal planning, or internal execution, or from external forces and found that the growth was evenly distributed among those three categories. The result of the study presented nine considerations focused at reducing growth due to project external events and internal planning events. Although no one 'magic bullet' consideration was discovered in the previous work, the nine considerations taken as a whole were postulated to help reduce cost and schedule change in future NASA missions. A recent update was conducted that included investigating 8 missions developed since the previous study to determine if the results were different. Cost, schedule, and mass increases were analyzed from the start of Phase B through Preliminary Design Review and Critical Design Review to Launch. As shown in this paper, the results are better with overall cost and schedule growth being reduced. The paper will show a comparison of the previous results to the updated results to show specific reductions and provide an explanation of which recommendations were followed.

Automated external defibrillators in schools?

PubMed

Cornelis, Charlotte; Calle, Paul; Mpotos, Nicolas; Monsieurs, Koenraad

2015-06-01

Automated external defibrillators (AEDs) placed in public locations can save lives of cardiac arrest victims. In this paper, we try to estimate the cost-effectiveness of AED placement in Belgian schools. This would allow school policy makers to make an evidence-based decision about an on-site AED project. We developed a simple mathematical model containing literature data on the incidence of cardiac arrest with a shockable rhythm; the feasibility and effectiveness of defibrillation by on-site AEDs and the survival benefit. This was coupled to a rough estimation of the minimal costs to initiate an AED project. According to the model described above, AED projects in all Belgian schools may save 5 patients annually. A rough estimate of the minimal costs to initiate an AED project is 660 EUR per year. As there are about 6000 schools in Belgium, a national AED project in all schools would imply an annual cost of at least 3960 000 EUR, resulting in 5 lives saved. As our literature survey shows that AED use in schools is feasible and effective, the placement of these devices in all Belgian schools is undoubtedly to be considered. The major counter-arguments are the very low incidence and the high costs to set up a school-based AED programme. Our review may fuel the discussion about Whether or not school-based AED projects represent good value for money and should be preferred above other health care interventions.

Analysis of the costs of veterinary education and factors associated with financial stress among veterinary students in Australia.

PubMed

Gregory, K P; Matthew, S M; Baguley, J A

2018-01-01

To investigate the course-related and other costs involved in obtaining a veterinary education in Australia and how these costs are met. The study also aimed to identify sociodemographic and course-related factors associated with increased financial stress. Students from seven Australian veterinary schools were surveyed using an online questionnaire. A total of 443 students participated (response rate 17%). Responses to survey items relating to finances, employment and course-related costs were compared with sociodemographic factors and prior research in the area of student financial stress. Respondents reported spending a median of A$300 per week on living costs and a median of A$2,000 per year on course-related expenses. Over half of respondents received the majority of their income from their parents or Youth Allowance (56%). A similar proportion (55%) reported that they needed to work to meet basic living expenses. Circumstances and sociodemographic factors linked to perceived financial stress included requiring additional finances to meet unexpected costs during the course; sourcing additional finances from external loans; an expected tuition debt at graduation over A$40,000; being 22 years or older; working more than 12 hours per week; living costs above A$300 per week; and being female. The costs involved in obtaining a veterinary education in Australia are high and over half of respondents are reliant on parental or Government income support. Respondents with certain sociodemographic profiles are more prone to financial stress. These findings may have implications for the psychological health, diversity and career plans of veterinary students in Australia. © 2017 Australian Veterinary Association.

The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population.

PubMed

Tscheulin, Dieter K; Drevs, Florian

2010-04-01

The potential of secondary prevention measures, such as cancer screening, to produce cost savings in the healthcare sector is a controversial issue in healthcare economics. Potential savings are calculated by comparing treatment costs with the cost of a prevention program. When survivors' subsequent unrelated health care costs are included in the calculation, however, the overall cost of disease prevention rises. What have not been studied to date are the secondary effects of fatal disease prevention measures on social security systems. From the perspective of a policy maker responsible for a social security system budget, it is not only future healthcare costs that are relevant for budgeting, but also changes in the contributions to, and expenditures from, statutory pension insurance and health insurance systems. An examination of the effect of longer life expectancies on these insurance systems can be justified by the fact that European social security systems are regulated by the state, and there is no clear separation between the financing of individual insurance systems due to cross-subsidisation. This paper looks at how the results of cost-comparison analyses vary depending on the inclusion or exclusion of future healthcare and non-healthcare costs, using the example of colorectal cancer screening in the German general population. In contrast to previous studies, not only are future unrelated medical costs considered, but also the effects on the social security system. If a German colorectal cancer screening program were implemented, and unrelated future medical care were excluded from the cost-benefit analysis, savings of up to 548 million euros per year would be expected. The screening program would, at the same time, generate costs in the healthcare sector as well as in the social security system of 2,037 million euros per year. Because the amount of future contributions and expenditures in the social security system depends on the age and gender of the recipients of the screening program (i.e. survivors of a typically fatal condition), the impact of age and gender on the results of a cost-comparison analysis of colorectal cancer screening are presented and discussed. Our study shows that colorectal cancer screening generates individual cost savings in the social security system up to a life expectancy of 60 years. Beyond that age, the balance between a recipient's social security contributions and insurance system expenditure is negative. The paper clarifies the relevance of healthcare costs not related to the prevented disease to the economic evaluation of prevention programs, particularly in the case of fatal diseases such as colorectal cancer. The results of the study imply that, from an economic perspective, the participation of at-risk individuals in disease prevention programs should be promoted.

A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

PubMed

OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

2017-04-01

The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

Characteristics of the Single-Longitudinal-Mode Planar-Waveguide External Cavity Diode Laser at 1064 nm

NASA Technical Reports Server (NTRS)

Numata, Kenji; Alalusi, Mazin; Stolpner, Lew; Margaritis, Georgios; Camp, Jordan B.; Krainak, Michael A.

2014-01-01

We describe the characteristics of the planar-waveguide external cavity diode laser (PW-ECL). To the best of our knowledge, it is the first butterfly-packaged 1064-nm semiconductor laser that is stable enough to be locked to an external frequency reference. We evaluated its performance from the viewpoint of precision experiments. Especially, using a hyperfine absorption line of iodine, we suppressed its frequency noise by a factor of up to104 at 10 mHz. The PW-ECLs compactness and low cost make it a candidate to replace traditional Nd:YAGnon-planar ring oscillators and fiber lasers in applications which require a single longitudinal-mode.

78 FR 37537 - Centralized Capacity Markets in Regional Transmission Organizations and Independent System...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

... existing centralized capacity markets (e.g., resource adequacy, long-term price signals, fixed-cost[email protected] . Sarah McKinley (Logistical Information), Office of External Affairs, Federal Energy...

An assessment of external biosecurity on Southern Ontario swine farms and its application to surveillance on a geographic level.

PubMed

Bottoms, Kate; Poljak, Zvonimir; Friendship, Robert; Deardon, Rob; Alsop, Janet; Dewey, Cate

2013-10-01

Risk-based surveillance is becoming increasingly important in the veterinary and public health fields. It serves as a means of increasing surveillance sensitivity and improving cost-effectiveness in an increasingly resource-limited environment. Our approach for developing a tool for the risk-based geographical surveillance of contagious diseases of swine incorporates information about animal density and external biosecurity practices within swine herds in southern Ontario. The objectives of this study were to group the sample of herds into discrete biosecurity groups, to develop a map of southern Ontario that can be used as a tool in the risk-based geographical surveillance of contagious swine diseases, and to identify significant predictors of biosecurity group membership. A subset of external biosecurity variables was selected for 2-step cluster analysis and latent class analysis (LCA). It was determined that 4 was the best number of groups to describe the data, using both analytical approaches. The authors named these groups: i) high biosecurity herds that were open with respect to replacement animals; ii) high biosecurity herds that were closed with respect to replacement animals; iii) moderate biosecurity herds; and iv) low biosecurity herds. The risk map was developed using information about the geographic distribution of herds in the biosecurity groups, as well as the density of swine sites and of grower-finisher pigs in the study region. Finally, multinomial logistic regression identified heat production units (HPUs), number of incoming pig shipments per month, and herd type as significant predictors of biosecurity group membership. It was concluded that the ability to identify areas of high and low risk for disease may improve the success of surveillance and eradication projects.

Estimating externalities of biomass fuel cycles, Report 7

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

Barnthouse, L.W.; Cada, G.F.; Cheng, M.-D.

1998-01-01

This report documents the analysis of the biomass fuel cycle, in which biomass is combusted to produce electricity. The major objectives of this study were: (1) to implement the methodological concepts which were developed in the Background Document (ORNL/RFF 1992) as a means of estimating the external costs and benefits of fuel cycles, and by so doing, to demonstrate their application to the biomass fuel cycle; (2) to develop, given the time and resources, a range of estimates of marginal (i.e., the additional or incremental) damages and benefits associated with selected impact-pathways from a new wood-fired power plant, using amore » representative benchmark technology, at two reference sites in the US; and (3) to assess the state of the information available to support energy decision making and the estimation of externalities, and by so doing, to assist in identifying gaps in knowledge and in setting future research agendas. The demonstration of methods, modeling procedures, and use of scientific information was the most important objective of this study. It provides an illustrative example for those who will, in the future, undertake studies of actual energy options and sites. As in most studies, a more comprehensive analysis could have been completed had budget constraints not been as severe. Particularly affected were the air and water transport modeling, estimation of ecological impacts, and economic valuation. However, the most important objective of the study was to demonstrate methods, as a detailed example for future studies. Thus, having severe budget constraints was appropriate from the standpoint that these studies could also face similar constraints. Consequently, an important result of this study is an indication of what can be done in such studies, rather than the specific numerical estimates themselves.« less

An assessment of external biosecurity on southern Ontario swine farms and its application to surveillance on a geographic level

PubMed Central

Bottoms, Kate; Poljak, Zvonimir; Friendship, Robert; Deardon, Rob; Alsop, Janet; Dewey, Cate

2013-01-01

Risk-based surveillance is becoming increasingly important in the veterinary and public health fields. It serves as a means of increasing surveillance sensitivity and improving cost-effectiveness in an increasingly resource-limited environment. Our approach for developing a tool for the risk-based geographical surveillance of contagious diseases of swine incorporates information about animal density and external biosecurity practices within swine herds in southern Ontario. The objectives of this study were to group the sample of herds into discrete biosecurity groups, to develop a map of southern Ontario that can be used as a tool in the risk-based geographical surveillance of contagious swine diseases, and to identify significant predictors of biosecurity group membership. A subset of external biosecurity variables was selected for 2-step cluster analysis and latent class analysis (LCA). It was determined that 4 was the best number of groups to describe the data, using both analytical approaches. The authors named these groups: i) high biosecurity herds that were open with respect to replacement animals; ii) high biosecurity herds that were closed with respect to replacement animals; iii) moderate biosecurity herds; and iv) low biosecurity herds. The risk map was developed using information about the geographic distribution of herds in the biosecurity groups, as well as the density of swine sites and of grower-finisher pigs in the study region. Finally, multinomial logistic regression identified heat production units (HPUs), number of incoming pig shipments per month, and herd type as significant predictors of biosecurity group membership. It was concluded that the ability to identify areas of high and low risk for disease may improve the success of surveillance and eradication projects. PMID:24124266

Visual display and alarm system for wind tunnel static and dynamic loads

NASA Technical Reports Server (NTRS)

Hanly, Richard D.; Fogarty, James T.

1987-01-01

A wind tunnel balance monitor and alarm system developed at NASA Ames Research Center will produce several beneficial results. The costs of wind tunnel delays because of inadvertent balance damage and the costs of balance repair or replacement can be greatly reduced or eliminated with better real-time information on the balance static and dynamic loading. The wind tunnel itself will have enhanced utility with the elimination of overly cautious limits on test conditions. The microprocessor-based system features automatic scaling and 16 multicolored LED bargraphs to indicate both static and dynamic components of the signals from eight individual channels. Five individually programmable alarm levels are available with relay closures for internal or external visual and audible warning devices and other functions such as automatic activation of external recording devices, model positioning mechanisms, or tunnel shutdown.

Visual display and alarm system for wind tunnel static and dynamic loads

NASA Technical Reports Server (NTRS)

Hanly, Richard D.; Fogarty, James T.

1987-01-01

A wind tunnel balance monitor and alarm system developed at NASA Ames Research Center will produce several beneficial results. The costs of wind tunnel delays because of inadvertent balance damage and the costs of balance repair or replacement can be greatly reduced or eliminated with better real-time information on the balance static and dynamic loading. The wind tunnel itself will have enhanced utility with the elimination of overly cautious limits on test conditions. The microprocessor-based system features automatic scaling and 16 multicolored LED bargraphs to indicate both static and dynamic components of the signals from eight individual channels. Five individually programmable alarm levels are available with relay closures for internal or external visual and audible warning devices and other functions such as automatic activation of external recording devices, model positioning mechanism, or tunnel shutdown.

An economy of scales: A selective review of obesity's economic causes, consequences, and solutions.

PubMed

Cawley, John

2015-09-01

This paper reviews the economic research on obesity, covering topics such as the measurement of, and trends in, obesity, the economic causes of obesity (e.g. the monetary price and time cost of food, food assistance programs, income, education, macroeconomic conditions, and peer effects), and the economic consequences of obesity (e.g. lower wages, a lower probability of employment, and higher medical care costs). It also examines the extent to which obesity imposes negative externalities, and economic interventions that could potentially internalize such externalities, such as food taxes, subsidies for school-based physical activity programs, and financial rewards for weight loss. It discusses other economic rationales for government intervention with respect to obesity, such as imperfect information, time inconsistent preferences, and irrational behavior. It concludes by proposing a research agenda for the field. Overall, the evidence suggests that there is no single dominant economic cause of obesity; a wide variety of factors may contribute a modest amount to the risk. There is consistent evidence regarding the economic consequences of obesity, which are lower wages and higher medical care costs that impose negative externalities through health insurance. Studies of economic approaches to preventing obesity, such as menu labeling, taxes on energy-dense foods, and financial rewards for weight loss find only modest effects on weight and thus a range of policies may be necessary to have a substantial effect on the prevalence of obesity. Copyright © 2015. Published by Elsevier B.V.

Economic feasibility study for improving drinking water quality: a case study of arsenic contamination in rural Argentina.

PubMed

Molinos-Senante, María; Perez Carrera, Alejo; Hernández-Sancho, Francesc; Fernández-Cirelli, Alicia; Sala-Garrido, Ramón

2014-12-01

Economic studies are essential in evaluating the potential external investment support and/or internal tariffs available to improve drinking water quality. Cost-benefit analysis (CBA) is a useful tool to assess the economic feasibility of such interventions, i.e. to take some form of action to improve the drinking water quality. CBA should involve the market and non-market effects associated with the intervention. An economic framework was proposed in this study, which estimated the health avoided costs and the environmental benefits for the net present value of reducing the pollutant concentrations in drinking water. We conducted an empirical application to assess the economic feasibility of removing arsenic from water in a rural area of Argentina. Four small-scale methods were evaluated in our study. The results indicated that the inclusion of non-market benefits was integral to supporting investment projects. In addition, the application of the proposed framework will provide water authorities with more complete information for the decision-making process.

A techno-economic comparison of fuel processors utilizing diesel for solid oxide fuel cell auxiliary power units

NASA Astrophysics Data System (ADS)

Nehter, Pedro; Hansen, John Bøgild; Larsen, Peter Koch

Ultra-low sulphur diesel (ULSD) is the preferred fuel for mobile auxiliary power units (APU). The commercial available technologies in the kW-range are combustion engine based gensets, achieving system efficiencies about 20%. Solid oxide fuel cells (SOFC) promise improvements with respect to efficiency and emission, particularly for the low power range. Fuel processing methods i.e., catalytic partial oxidation, autothermal reforming and steam reforming have been demonstrated to operate on diesel with various sulphur contents. The choice of fuel processing method strongly affects the SOFC's system efficiency and power density. This paper investigates the impact of fuel processing methods on the economical potential in SOFC APUs, taking variable and capital cost into account. Autonomous concepts without any external water supply are compared with anode recycle configurations. The cost of electricity is very sensitive on the choice of the O/C ratio and the temperature conditions of the fuel processor. A sensitivity analysis is applied to identify the most cost effective concept for different economic boundary conditions. The favourite concepts are discussed with respect to technical challenges and requirements operating in the presence of sulphur.

Prohibition, regulation or laissez faire: The policy trade-offs of cannabis policy.

PubMed

Rogeberg, Ole

2018-06-01

Trade-offs are central to the cannabis policy debate. Prohibition and strict regulation may help reduce the physical, mental and social harms of cannabis consumption, but at the cost of increasing the harms from illegal markets and reducing consumption benefits. An economic model clarifies how these costs and benefits relate to policy and connects them to observable prices and tax-levels given the assumptions of the analysis. These model- based arguments are related to the ongoing academic policy debate. While some arguments from this literature modify the interpretation of the model (e.g., due to dependence, cognitive biases and market structure), the literature often fails to appropriately account for the magnitude of the policy costs and benefits identified. Taking various caveats into account, the framework indicates that a strict regulation would likely be preferable to prohibition given current estimates of excess harms (externalities and internalities) from cannabis use. While cannabis prohibition appears difficult to justify within an economic regulatory framework, risks from industry influence, policy ratchet effects, and human "decision-making flaws" speak to the need for caution and strong regulation when implementing legal regimes. Copyright © 2018 The Author. Published by Elsevier B.V. All rights reserved.

Activity-based analyses lead to better decision making.

PubMed

Player, S

1998-08-01

Activity-based costing (ABC) and activity-based management (ABM) are cost-management tools that are relatively new to the healthcare industry. ABC is used for strategic decision making. It assesses the costs associated with specific activities and resources and links those costs to specific internal and external customers of the healthcare enterprise (e.g., patients, service lines, and physician groups) to determine the costs associated with each customer. This cost information then can be adjusted to account for anticipated changes and to predict future costs. ABM, on the other hand, supports operations by focusing on the causes of costs and how costs can be reduced. It assesses cost drivers that directly affect the cost of a product or service, and uses performance measures to evaluate the financial or nonfinancial benefit an activity provides. By identifying each cost driver and assessing the value the element adds to the healthcare enterprise, ABM provides a basis for selecting areas that can be changed to reduce costs.

Rapid quantification and sex determination of forensic evidence materials.

PubMed

Andréasson, Hanna; Allen, Marie

2003-11-01

DNA quantification of forensic evidence is very valuable for an optimal use of the available biological material. Moreover, sex determination is of great importance as additional information in criminal investigations as well as in identification of missing persons, no suspect cases, and ancient DNA studies. While routine forensic DNA analysis based on short tandem repeat markers includes a marker for sex determination, analysis of samples containing scarce amounts of DNA is often based on mitochondrial DNA, and sex determination is not performed. In order to allow quantification and simultaneous sex determination on minute amounts of DNA, an assay based on real-time PCR analysis of a marker within the human amelogenin gene has been developed. The sex determination is based on melting curve analysis, while an externally standardized kinetic analysis allows quantification of the nuclear DNA copy number in the sample. This real-time DNA quantification assay has proven to be highly sensitive, enabling quantification of single DNA copies. Although certain limitations were apparent, the system is a rapid, cost-effective, and flexible assay for analysis of forensic casework samples.

Simultaneous Classification and Multidimensional Scaling with External Information

ERIC Educational Resources Information Center

Kiers, Henk A. L.; Vicari, Donatella; Vichi, Maurizio

2005-01-01

For the exploratory analysis of a matrix of proximities or (dis)similarities between objects, one often uses cluster analysis (CA) or multidimensional scaling (MDS). Solutions resulting from such analyses are sometimes interpreted using external information on the objects. Usually the procedures of CA, MDS and using external information are…

Economic aspects of advanced coal-fired gas turbine locomotives

NASA Technical Reports Server (NTRS)

Liddle, S. G.; Bonzo, B. B.; Houser, B. C.

1983-01-01

Increases in the price of such conventional fuels as Diesel No. 2, as well as advancements in turbine technology, have prompted the present economic assessment of coal-fired gas turbine locomotive engines. A regenerative open cycle internal combustion gas turbine engine may be used, given the development of ceramic hot section components. Otherwise, an external combustion gas turbine engine appears attractive, since although its thermal efficiency is lower than that of a Diesel engine, its fuel is far less expensive. Attention is given to such a powerplant which will use a fluidized bed coal combustor. A life cycle cost analysis yields figures that are approximately half those typical of present locomotive engines.

Elastic-Plastic Finite Element Analysis of Fatigue Crack Growth in Mode 1 and Mode 2 Conditions

NASA Technical Reports Server (NTRS)

Nakagaki, M.; Atluri, S. N.

1978-01-01

Presented is an alternate cost-efficient and accurate elastic-plastic finite element procedure to analyze fatigue crack closure and its effects under general spectrum loading. Both Modes 1 and 2 type cycling loadings are considered. Also presented are the results of an investigation, using the newly developed procedure, of various factors that cause crack growth acceleration or retardation and delay effects under high-to-low, low-to-high, single overload, and constant amplitude type cyclic loading in a Mode 1 situation. Further, the results of an investigation of a centercracked panel under external pure shear (Mode 2) cyclic loading, of constant amplitude, are reported.

A behavioral economics perspective on tobacco taxation.

PubMed

Cherukupalli, Rajeev

2010-04-01

Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco's hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country's circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.

Manufacturing Process for OLED Integrated Substrate

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

Hung, Cheng-Hung; McCamy, James; Ashtosh, Ganjoo

2017-01-27

The primary objective of this project is to demonstrate manufacturing processes for technologies that will enable commercialization of a large-area and low-cost “integrated substrate” product for rigid OLED SSL lighting. The integrated substrate product will consist of a low cost, float glass substrate combined with a transparent conductive anode film layer, and light out-coupling (internal and external extraction layers) structures. In combination, these design elements will enable an integrated substrate meeting or exceeding 2015 performance targets for cost ($60/m2), extraction efficiency (50%) and sheet resistance (<10 ohm/sq).

Development of novel 3D-printed robotic prosthetic for transradial amputees.

PubMed

Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A

2016-06-01

Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.

A Web-based cost-effective training tool with possible application to brain injury rehabilitation.

PubMed

Wang, Peijun; Kreutzer, Ina Anna; Bjärnemo, Robert; Davies, Roy C

2004-06-01

Virtual reality (VR) has provoked enormous interest in the medical community. In particular, VR offers therapists new approaches for improving rehabilitation effects. However, most of these VR assistant tools are not very portable, extensible or economical. Due to the vast amount of 3D data, they are not suitable for Internet transfer. Furthermore, in order to run these VR systems smoothly, special hardware devices are needed. As a result, existing VR assistant tools tend to be available in hospitals but not in patients' homes. To overcome these disadvantages, as a case study, this paper proposes a Web-based Virtual Ticket Machine, called WBVTM, using VRML [VRML Consortium, The Virtual Reality Modeling Language: International Standard ISO/IEC DIS 14772-1, 1997, available at ], Java and EAI (External Authoring Interface) [Silicon Graphics, Inc., The External Authoring Interface (EAI), available at ], to help people with acquired brain injury (ABI) to relearn basic living skills at home at a low cost. As these technologies are open standard and feature usability on the Internet, WBVTM achieves the goals of portability, easy accessibility and cost-effectiveness.

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

PubMed

Hartwell, T D; Steele, P; French, M T; Potter, F J; Rodman, N F; Zarkin, G A

1996-06-01

Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

Variable polarity plasma arc welding on the Space Shuttle external tank

NASA Technical Reports Server (NTRS)

Nunes, A. C., Jr.; Bayless, E. O., Jr.; Jones, C. S., III; Munafo, P. M.; Biddle, A. P.; Wilson, W. A.

1984-01-01

Variable polarity plasma arc (VPPA) techniques used at NASA's Marshall Space Flight Center for the fabrication of the Space Shuttle External Tank are presentedd. The high plasma arc jet velocities of 300-2000 m/s are produced by heating the plasma gas as it passes through a constraining orifice, with the plasma arc torch becoming a miniature jet engine. As compared to the GTA jet, the VPPA has the following advantages: (1) less sensitive to contamination, (2) a more symmetrical fusion zone, and (3) greater joint penetration. The VPPA welding system is computerized, operating with a microprocessor, to set welding variables in accordance with set points inputs, including the manipulator and wire feeder, as well as torch control and power supply. Some other VPPA welding technique advantages are: reduction in weld repair costs by elimination of porosity; reduction of joint preparation costs through elimination of the need to scrape or file faying surfaces; reduction in depeaking costs; eventual reduction of the 100 percent-X-ray inspection requirements. The paper includes a series of schematic and block diagrams.

High-speed machining of Space Shuttle External Tank (ET) panels

NASA Technical Reports Server (NTRS)

Miller, J. A.

1983-01-01

Potential production rates and project cost savings achieved by converting the conventional machining process in manufacturing shuttle external tank panels to high speed machining (HSM) techniques were studied. Savings were projected from the comparison of current production rates with HSM rates and with rates attainable on new conventional machines. The HSM estimates were also based on rates attainable by retrofitting existing conventional equipment with high speed spindle motors and rates attainable using new state of the art machines designed and built for HSM.

Laboratory manager's financial handbook. Cost accounting: the road map to financial success.

PubMed

Travers, E M

1996-01-01

Cost accounting is the most basic element of the laboratory's financial management structure. Historically, cost accounting in the nonmedical world referred to accumulating and assigning costs to units of production and departments, primarily for inventory valuation and income determination. In the health industry, microcost accounting is distinguishable from macrocost (management/internal) accounting and serves multiple purposes. Microcost accounting pertains to gathering and providing information for decision making. The range of decisions include managing recurring operations, making nonrecurring strategic decisions, and formulating major organizational policies. Macrocost accounting fulfills the legal requirements of reporting to stockholders, auditors, governmental agencies, and other external parties.

Biomedical Waste Management : An Infrastructural Survey of Hospitals.

PubMed

Rao, Skm; Ranyal, R K; Bhatia, S S; Sharma, V R

2004-10-01

The Ministry of Environment & Forests notified the Biomedical Waste (management & handling) Rules, 1998" (BMW Mgt) in July 1998. In accordance with the rules, every hospital generating BMW needs to set up requisite BMW treatment facilities on site or ensure requisite treatment of waste at common treatment facility. No untreated BMW shall be kept stored beyond a period of 48 hours. The cost of construction, operation and maintenance of system for managing BMW represents a significant part of overall budget of a hospital if the BMW rules have to be implemented in their true spirit. Two types of costs are required to be incurred by hospitals for BMW Mgt, internal and external. Internal cost is the cost for segregation, mutilation, disinfection, internal storage and transportation including hidden cost of protective equipment. External costs are off site transportation, treatment and final disposal. A study of hospitals was carried out from various sectors like Govt, Private, Charitable institutions etc. to assess the infrastructural requirement for BMW Mgt. Cost was worked out for a hospital where all the infrastructure as per each and every requirement of BMW rules had been implemented and then it was compared with other hospitals where hospitals have made compromises on each stage of BMW Mgt. Capital cost incurred by benchmarked hospital of 1047 beds was Rs.3 lakh 59 thousand excluding cost of incinerator and hospital is incurring Rs. 656/- per day as recurring expenditure. Pune city has common regional facility for BMW final disposal. Facility is charging Rs.20 per kg of infectious waste. As on Dec 2001 there were 400 institutions including nursing homes, labs and blood banks which were registered. After analyzing the results of study it was felt that there is an urgent need to standardize the infrastructural requirement so that hospitals following BMW rules strictly do not suffer additional costs.

Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study.

PubMed

Schnur, Julie B; Graff Zivin, Joshua; Mattson, David M K; Green, Sheryl; Jandorf, Lina H; Wernicke, A Gabriella; Montgomery, Guy H

2012-12-01

Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures. A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment. Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need. Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs. In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.

Delivery of antiretroviral treatment services in India: Estimated costs incurred under the National AIDS Control Programme.

PubMed

Agarwal, Reshu; Rewari, Bharat Bhushan; Shastri, Suresh; Nagaraja, Sharath Burugina; Rathore, Abhilakh Singh

2017-04-01

Competing domestic health priorities and shrinking financial support from external agencies necessitates that India's National AIDS Control Programme (NACP) brings in cost efficiencies to sustain the programme. In addition, current plans to expand the criteria for eligibility for antiretroviral therapy (ART) in India will have significant financial implications in the near future. ART centres in India provide comprehensive services to people living with HIV (PLHIV): those fulfilling national eligibility criteria and receiving ART and those on pre-ART care, i.e. not on ART. ART centres are financially supported (i) directly by the NACP; and (ii) indirectly by general health systems. This study was conducted to determine (i) the cost incurred per patient per year of pre-ART and ART services at ART centres; and (ii) the proportion of this cost incurred by the NACP and by general health systems. The study used national data from April 2013 to March 2014, on ART costs and non-ART costs (human resources, laboratory tests, training, prophylaxis and management of opportunistic infections, hospitalization, operational, and programme management). Data were extracted from procurement records and reports, statements of expenditure at national and state level, records and reports from ART centres, databases of the National AIDS Control Organisation, and reports on use of antiretroviral drugs. The analysis estimates the cost for ART services as US$ 133.89 (?8032) per patient per year, of which 66% (US$ 88.66, ?5320) is for antiretroviral drugs and 34% (US$ 45.23, ?2712) is for non-ART recurrent expenditure, while the cost for pre-ART care is US$ 33.05 (?1983) per patient per year. The low costs incurred for patients in ART and pre-ART care services can be attributed mainly to the low costs of generic drugs. However, further integration with general health systems may facilitate additional cost saving, such as in human resources.

Effect of a food waste disposer policy on solid waste and wastewater management with economic implications of environmental externalities.

PubMed

Maalouf, Amani; El-Fadel, Mutasem

2017-11-01

In this study, the carbon footprint of introducing a food waste disposer (FWD) policy was examined in the context of its implications on solid waste and wastewater management with economic assessment of environmental externalities emphasizing potential carbon credit and increased sludge generation. For this purpose, a model adopting a life cycle inventory approach was developed to integrate solid waste and wastewater management processes under a single framework and test scenarios for a waste with high organic food content typical of developing economies. For such a waste composition, the results show that a FWD policy can reduce emissions by nearly ∼42% depending on market penetration, fraction of food waste ground, as well as solid waste and wastewater management schemes, including potential energy recovery. In comparison to baseline, equivalent economic gains can reach ∼28% when environmental externalities including sludge management and emissions variations are considered. The sensitivity analyses on processes with a wide range in costs showed an equivalent economic impact thus emphasizing the viability of a FWD policy although the variation in the cost of sludge management exhibited a significant impact on savings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Potential approaches to the management of third-party impacts from groundwater transfers

NASA Astrophysics Data System (ADS)

Skurray, James H.; Pannell, David J.

2012-08-01

Groundwater extraction can have varied and diffuse effects. Negative external effects may include costs imposed on other groundwater users and on surrounding ecosystems. Environmental damages are commonly not reflected in market transactions. Groundwater transfers have the potential to cause spatial redistribution, concentration, and qualitative transformation of the impacts from pumping. An economically and environmentally sound groundwater transfer scheme would ensure that marginal costs from trades do not exceed marginal benefits, accounting for all third-party impacts, including those of a non-monetary nature as well as delayed effects. This paper proposes a menu of possible management strategies that would help preclude unacceptable impacts by restricting transfers with certain attributes, ideally ensuring that permitted transfers are at least welfare-neutral. Management tools would require that transfers limit or reduce environmental impacts, and provide for the compensation of financial impacts. Three management tools are described. While these tools can limit impacts from a given level of extraction, they cannot substitute for sustainable overall withdrawal limits. Careful implementation of transfer limits and exchange rates, and the strategic use of management area boundaries, may enable a transfer system to restrict negative externalities mainly to monetary costs. Provision for compensation of these costs could be built into the system.

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel

PubMed Central

Liu, Jingzhou; Kochin, Beth F.; Tekle, Yonas I.; Galvani, Alison P.

2012-01-01

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial. PMID:21632611

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel.

PubMed

Liu, Jingzhou; Kochin, Beth F; Tekle, Yonas I; Galvani, Alison P

2012-01-07

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial.

Evolutionary vaccination dynamics with internal support mechanisms

NASA Astrophysics Data System (ADS)

Tang, Guo-Mei; Cai, Chao-Ran; Wu, Zhi-Xi

2017-05-01

This paper reports internal support mechanisms (i.e., without external intervention) to enhance the vaccine coverage in the evolutionary vaccination dynamics. We present two internal support mechanisms, one is global support mechanism in which each individual pays a support cost to build up a public fund and then the public fund is divided by all vaccinated individuals, while another is local support mechanism in which each individual pays a support cost and then this support cost will be divided by its immediate vaccinated neighbors. By means of extensive computer simulations, we show that, in the same strength of support cost, the heterogeneous (local) support mechanism can encourage more people to take vaccination than the homogeneous (global) support mechanism. And then, we study the most general case that includes supporters and troublemakers together, where supporters (troublemakers) mean that the individuals join (do not join) the internal support mechanism, in the population. We surprisingly find that, in scale-free networks, the voluntary vaccination dynamics with the local support mechanism will not degrade into the original voluntary vaccination dynamics, and the vaccination level can still be effectively improved. In view of most social networks are of scale-free degree distribution, we study further in empirical networks and find that the vaccination level can still be improved in the absence of external intervention.

Noise requirements from a military point of view

NASA Technical Reports Server (NTRS)

Crawford, C. C., Jr.

1978-01-01

External and internal aircraft noise requirements are discussed in terms of application to military helicopters. The impact of the application of noise reduction technology to comply with FAA standards on cost and performance is emphasized.

Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke

PubMed Central

Kal, E. C.; van der Kamp, J.; Houdijk, H.; Groet, E.; van Bennekom, C. A. M.; Scherder, E. J. A.

2015-01-01

Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p’s ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients’ attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients’ strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor control after stroke. PMID:26317437

Leading multiple teams: average and relative external leadership influences on team empowerment and effectiveness.

PubMed

Luciano, Margaret M; Mathieu, John E; Ruddy, Thomas M

2014-03-01

External leaders continue to be an important source of influence even when teams are empowered, but it is not always clear how they do so. Extending research on structurally empowered teams, we recognize that teams' external leaders are often responsible for multiple teams. We adopt a multilevel approach to model external leader influences at both the team level and the external leader level of analysis. In doing so, we distinguish the influence of general external leader behaviors (i.e., average external leadership) from those that are directed differently toward the teams that they lead (i.e., relative external leadership). Analysis of data collected from 451 individuals, in 101 teams, reporting to 25 external leaders, revealed that both relative and average external leadership related positively to team empowerment. In turn, team empowerment related positively to team performance and member job satisfaction. However, while the indirect effects were all positive, we found that relative external leadership was not directly related to team performance, and average external leadership evidenced a significant negative direct influence. Additionally, relative external leadership exhibited a significant direct positive influence on member job satisfaction as anticipated, whereas average external leadership did not. These findings attest to the value in distinguishing external leaders' behaviors that are exhibited consistently versus differentially across empowered teams. Implications and future directions for the study and management of external leaders overseeing multiple teams are discussed.

Expanding access to off-grid rural electrification in Africa: An analysis of community-based micro-grids in Kenya

NASA Astrophysics Data System (ADS)

Kirubi, Charles Gathu

Community micro-grids have played a central role in increasing access to off-grid rural electrification (RE) in many regions of the developing world, notably South Asia. However, the promise of community micro-grids in sub-Sahara Africa remains largely unexplored. My study explores the potential and limits of community micro-grids as options for increasing access to off-grid RE in sub-Sahara Africa. Contextualized in five community micro-grids in rural Kenya, my study is framed through theories of collective action and combines qualitative and quantitative methods, including household surveys, electronic data logging and regression analysis. The main contribution of my research is demonstrating the circumstances under which community micro-grids can contribute to rural development and the conditions under which individuals are likely to initiate and participate in such projects collectively. With regard to rural development, I demonstrate that access to electricity enables the use of electric equipment and tools by small and micro-enterprises, resulting in significant improvement in productivity per worker (100--200% depending on the task at hand) and a corresponding growth in income levels in the order of 20--70%, depending on the product made. Access to electricity simultaneously enables and improves delivery of social and business services from a wide range of village-level infrastructure (e.g. schools, markets, water pumps) while improving the productivity of agricultural activities. Moreover, when local electricity users have an ability to charge and enforce cost-reflective tariffs and electricity consumption is closely linked to productive uses that generate incomes, cost recovery is feasible. By their nature---a new technology delivering highly valued services by the elites and other members, limited local experience and expertise, high capital costs---community micro-grids are good candidates for elite-domination. Even so, elite control does not necessarily lead to elite capture. Experiences from different micro-grid settings illustrate the manner in which a coincidence of interest between the elites and the rest of members and access to external support can create incentives and mechanisms to enable community-wide access to scarce services, hence mitigating elite capture. Moreover, access to external support was found to increase the likelihood of participation for the relatively poor households. The policy-relevant message from this research is two-fold. In rural areas with suitable sites for micro-hydro power, the potential for community micro-grids appear considerable to the extent that this option would seem to represent "the road not taken" as far as policies and initiatives aimed at expanding RE are concerned in Kenya and other African countries with comparable settings. However, local participatory initiatives not complimented by external technical assistance run a considerable risk of locking rural households into relatively more costly and poor-quality services. By taking advantage of existing and/or building a dense network of local organizations, including micro-finance agencies, the government and development partners can make available to local communities the necessary support---financial, technical or regulatory---essential for efficient design of micro-grids in addition to facilitating equitable distribution of electricity benefits.

The effects of a prelicensure extern program and nurse residency program on new graduate outcomes and retention.

PubMed

Friday, Laura; Zoller, James S; Hollerbach, Ann D; Jones, Katherine; Knofczynski, Greg

2015-01-01

Organizations are looking to new graduate nurses to fill expected staffing shortages over the next decade. Creative and effective onboarding programs will determine the success or failure of these graduates as they transition from student to professional nurse. This longitudinal quantitative study with repeated measures used the Casey-Fink Graduate Nurse Experience Survey to investigate the effects of offering a prelicensure extern program and postlicensure residency program on new graduate nurses and organizational outcomes versus a residency program alone. Compared with the nurse residency program alone, the combination of extern program and nurse residency program improved neither the transition factors most important to new nurse graduates during their first year of practice nor a measure important to organizations, retention rates. The additional cost of providing an extern program should be closely evaluated when making financially responsible decisions.

Inducing Peer Pressure to Promote Cooperation

PubMed Central

Mani, Ankur; Rahwan, Iyad; Pentland, Alex

2013-01-01

Cooperation in a large society of self-interested individuals is notoriously difficult to achieve when the externality of one individual's action is spread thin and wide on the whole society. This leads to the ‘tragedy of the commons’ in which rational action will ultimately make everyone worse-off. Traditional policies to promote cooperation involve Pigouvian taxation or subsidies that make individuals internalize the externality they incur. We introduce a new approach to achieving global cooperation by localizing externalities to one's peers in a social network, thus leveraging the power of peer-pressure to regulate behavior. The mechanism relies on a joint model of externalities and peer-pressure. Surprisingly, this mechanism can require a lower budget to operate than the Pigouvian mechanism, even when accounting for the social cost of peer pressure. Even when the available budget is very low, the social mechanisms achieve greater improvement in the outcome. PMID:23619166

Inducing peer pressure to promote cooperation.

PubMed

Mani, Ankur; Rahwan, Iyad; Pentland, Alex

2013-01-01

Cooperation in a large society of self-interested individuals is notoriously difficult to achieve when the externality of one individual's action is spread thin and wide on the whole society. This leads to the 'tragedy of the commons' in which rational action will ultimately make everyone worse-off. Traditional policies to promote cooperation involve Pigouvian taxation or subsidies that make individuals internalize the externality they incur. We introduce a new approach to achieving global cooperation by localizing externalities to one's peers in a social network, thus leveraging the power of peer-pressure to regulate behavior. The mechanism relies on a joint model of externalities and peer-pressure. Surprisingly, this mechanism can require a lower budget to operate than the Pigouvian mechanism, even when accounting for the social cost of peer pressure. Even when the available budget is very low, the social mechanisms achieve greater improvement in the outcome.

Inducing Peer Pressure to Promote Cooperation

NASA Astrophysics Data System (ADS)

Mani, Ankur; Rahwan, Iyad; Pentland, Alex

2013-04-01

Cooperation in a large society of self-interested individuals is notoriously difficult to achieve when the externality of one individual's action is spread thin and wide on the whole society. This leads to the `tragedy of the commons' in which rational action will ultimately make everyone worse-off. Traditional policies to promote cooperation involve Pigouvian taxation or subsidies that make individuals internalize the externality they incur. We introduce a new approach to achieving global cooperation by localizing externalities to one's peers in a social network, thus leveraging the power of peer-pressure to regulate behavior. The mechanism relies on a joint model of externalities and peer-pressure. Surprisingly, this mechanism can require a lower budget to operate than the Pigouvian mechanism, even when accounting for the social cost of peer pressure. Even when the available budget is very low, the social mechanisms achieve greater improvement in the outcome.

Essays on the comparison of climate change policies: Land use regulations, taxes, and tradable permits

NASA Astrophysics Data System (ADS)

Heres Del Valle, David R.

The California Global Warming Solutions Act of 2006 requires year 2020 greenhouse gas (GHG) emissions in the state to be reduced back to 1990 levels. Several mitigation strategies have been explored and are expected to be implemented over the next few years. Among others, land use policies have been advocated as an important means to curb GHG emissions through the reduction of vehicle miles traveled (VMT), while an economy-wide cap and trade system would ensure that a certain level of GHG reductions is achieved although at unknown costs. The first essay of this dissertation aims to contribute to the ongoing discussion over the impact of land use policies by implementing a modified two-part model (M2PM) with instrumental variables (IV), a procedure that respectively takes into account the large mass of observations with zero car travel, and the possibility of residential self-selection, both of which could otherwise bias the estimates. The analysis takes advantage of a large dataset on travel patterns and socio-economic characteristics of more than 7,000 households across the 58 counties in the state of California. Results show that although VMT elasticities with respect to residential density are larger than others found in the recent econometric literature, the actual impact of residential density on VMT would not be as large unless very large increases in residential density occur. On the other hand, recent estimates of the elasticity of VMT with respect to the price of gasoline imply that moderate increases in the price of gasoline would suffice to reduce travel by similar magnitudes. The second essay reconsiders the debate over quantity (e.g., tradable permits) and price (e.g., taxes) controls by introducing uncertainty in the damage from the externality under a controlled environment. Economic theory predicts that quantity and price instruments for the control of externalities will produce identical outcomes as long as certain conditions obtain - namely negligible transaction costs and certainty about marginal control costs. This theoretical prediction explicitly renders irrelevant any uncertainties regarding the marginal damages in determining the market equilibrium outcome. Uncertainty about marginal damages may be important in practice, however, due to citizen participation in the permit market or to behavioral considerations. Through a laboratory experiment the instrument's equivalence is tested under different environments (including uncertainty about the marginal damages) that comply with the mentioned conditions. Results from the comparative analysis of a tax and a tradable permit system in a market composed of individuals with heterogeneous marginal abatement costs lend support to the equivalence of instruments.

Overview of NASA Langley's Systems Analysis Capabilities

NASA Technical Reports Server (NTRS)

Cavanaugh, Stephen; Kumar, Ajay; Brewer, Laura; Kimmel, Bill; Korte, John; Moul, Tom

2006-01-01

The Systems Analysis and Concepts Directorate (SACD) has been in the systems analysis business line supporting National Aeronautics and Space Administration (NASA) aeronautics, exploration, space operations and science since the 1960 s. Our current organization structure is shown in Figure 1. SACD mission can be summed up in the following statements: 1. We conduct advanced concepts for Agency decision makers and programs. 2. We provide aerospace systems analysis products such as mission architectures, advanced system concepts, system and technology trades, life cycle cost and risk analysis, system integration and pre-decisional sensitive information. 3. Our work enables informed technical, programmatic and budgetary decisions. SACD has a complement of 114 government employees and approximately 50 on-site contractors which is equally split between supporting aeronautics and exploration. SACD strives for technical excellence and creditability of the systems analysis products delivered to its customers. The Directorate office is continuously building market intelligence and working with other NASA centers and external partners to expand our business base. The Branches strive for technical excellence and credibility of our systems analysis products by seeking out existing and new partnerships that are critical for successful systems analysis. The Directorates long term goal is to grow the amount of science systems analysis business base.

Life cycle costing of waste management systems: Overview, calculation principles and case studies

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

Martinez-Sanchez, Veronica, E-mail: vems@env.dtu.dk; Kromann, Mikkel A.; Astrup, Thomas Fruergaard

2015-02-15

Highlights: • We propose a comprehensive model for cost assessment of waste management systems. • The model includes three types of LCC: Conventional, Environmental and Societal LCCs. • The applicability of the proposed model is tested with two case studies. - Abstract: This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, andmore » each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding terminology. The presented cost model was implemented in two case study scenarios assessing the costs involved in the source segregation of organic waste from 100,000 Danish households and the subsequent co-digestion of organic waste with animal manure. Overall, source segregation resulted in higher financial costs than the alternative of incinerating the organic waste with the residual waste: 1.6 M€/year, of which 0.9 M€/year was costs for extra bins and bags used by the households, 1.0 M€/year for extra collections and −0.3 M€/year saved on incineration.« less

Diagnostic Yield and Economic Assessment of a Diagnostic Protocol With Systematic Use of an External Loop Recorder for Patients With Palpitations.

PubMed

Francisco-Pascual, Jaume; Santos-Ortega, Alba; Roca-Luque, Ivo; Rivas-Gándara, Nuria; Pérez-Rodón, Jordi; Milà-Pascual, Laia; García-Dorado, David; Moya-Mitjans, Àngel

2018-05-24

To assess the diagnostic yield and cost-effectiveness of a diagnostic protocol based on the systematic use of latest-generation external loop recorders (ELRs) compared with the classic diagnostic strategy for patients with recurrent unexplained palpitations. Two cohorts of consecutive patients referred for diagnosis of unexplained palpitations to the outpatient clinic of the arrhythmia unit were compared: a prospective cohort after the implementation of a new diagnostic protocol based on the systematic use of ELRs, and another, retrospective, cohort before the implementation of the protocol. The cost of diagnosis was calculated based on the number of complementary examinations, visits to outpatient clinics, or emergency department visits required to reach a diagnosis, and its costs according the prices published for the local health system. One hundred and forty-nine patients were included (91 in the ELR group, 58 in the control group). The diagnostic yield was higher in the ELR group (79 [86.8%] definitive diagnoses in the ELR group vs 12 [20.7%] in the control group, P < .001). The cost per diagnosis was €375.13 in the ELR group and €5184.75 in the control group (P < .001). The cost-effectiveness study revealed that the systematic use of ELR resulted in a cost reduction of €11.30 for each percentage point of increase in diagnosis yield. In patients with recurrent unexplained palpitations, evaluation by means of a study protocol that considers the systematic use of a latest-generation ELR increases diagnostic yield while reducing the cost per diagnosis. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Welfare implications of energy and environmental policies: A general equilibrium approach

NASA Astrophysics Data System (ADS)

Iqbal, Mohammad Qamar

Government intervention and implementation of policies can impose a financial and social cost. To achieve a desired goal there could be several different alternative policies or routes, and government would like to choose the one which imposes the least social costs or/and generates greater social benefits. Therefore, applied welfare economics plays a vital role in public decision making. This paper recasts welfare measure such as equivalent variation, in terms of the prices of factors of production rather than product prices. This is made possible by using duality theory within a general equilibrium framework and by deriving alternative forms of indirect utility functions and expenditure functions in factor prices. Not only we are able to recast existing welfare measures in factor prices, we are able to perform a true cost-benefit analysis of government policies using comparative static analysis of different equilibria and breaking up monetary measure of welfare change such as equivalent variation into its components. A further advantage of our research is demonstrated by incorporating externalities and public goods in the utility function. It is interesting that under a general equilibrium framework optimal income tax tends to reduce inequalities. Results show that imposition of taxes at socially optimal rates brings a net gain to the society. It was also seen that even though a pollution tax may reduce GDP, it leads to an increase in the welfare of the society if it is imposed at an optimal rate.

Barriers to participation in physical activity and exercise among middle-aged and elderly individuals.

PubMed

Justine, Maria; Azizan, Azliyana; Hassan, Vaharli; Salleh, Zoolfaiz; Manaf, Haidzir

2013-10-01

INTRODUCTION Although the benefits of physical activity and exercise are widely acknowledged, many middle-aged and elderly individuals remain sedentary. This cross-sectional study aimed to identify the external and internal barriers to physical activity and exercise participation among middle-aged and elderly individuals, as well as identify any differences in these barriers between the two groups. METHODS Recruited individuals were categorised into either the middle-aged (age 45-59 years, n = 60) or elderly (age ≥ 60 years, n = 60) group. Data on demographics, anthropometry, as well as external and internal barriers to participation in physical activity and exercise were collected. RESULTS Analysis showed no significant differences in the total scores of all internal barriers between the two groups (p > 0.05). The total scores for most external barriers between the two groups also showed no significant differences (p > 0.05); only 'cost' (p = 0.045) and 'exercise interferes with social/family activities' (p = 0.011) showed significant differences. The most common external barriers among the middle-aged and elderly respondents were 'not enough time' (46.7% vs. 48.4%), 'no one to exercise with' (40.0% vs. 28.3%) and 'lack of facilities' (33.4% vs. 35.0%). The most common internal barriers for middle-aged respondents were 'too tired' (48.3%), 'already active enough' (38.3%), 'do not know how to do it' (36.7%) and 'too lazy' (36.7%), while those for elderly respondents were 'too tired' (51.7%), 'lack of motivation' (38.4%) and 'already active enough' (38.4%). CONCLUSION Middle-aged and elderly respondents presented with similar external and internal barriers to physical activity and exercise participation. These factors should be taken into account when healthcare policies are being designed and when interventions such as the provision of facilities to promote physical activity and exercise among older people are being considered.

Accuracy and feasibility of three different methods for software-based image fusion in whole-body PET and CT.

PubMed

Putzer, Daniel; Henninger, Benjamin; Kovacs, Peter; Uprimny, Christian; Kendler, Dorota; Jaschke, Werner; Bale, Reto J

2016-06-01

Even as PET/CT provides valuable diagnostic information in a great number of clinical indications, availability of hybrid PET/CT scanners is mainly limited to clinical centers. A software-based image fusion would facilitate combined image reading of CT and PET data sets if hardware image fusion is not available. To analyze the relevance of retrospective image fusion of separately acquired PET and CT data sets, we studied the accuracy, practicability and reproducibility of three different image registration techniques. We evaluated whole-body 18F-FDG-PET and CT data sets of 71 oncologic patients. Images were fused retrospectively using Stealth Station System, Treon (Medtronic Inc., Louisville, CO, USA) equipped with Cranial4 Software. External markers fixed to a vacuum mattress were used as reference for exact repositioning. Registration was repeated using internal anatomic landmarks and Automerge software, assessing accuracy for all three methods, measuring distances of liver representation in CT and PET with reference to a common coordinate system. On first measurement of image fusions with external markers, 53 were successful, 16 feasible and 2 not successful. Using anatomic landmarks, 42 were successful, 26 feasible and 3 not successful. Using Automerge Software only 13 were successful. The mean distance between center points in PET and CT was 7.69±4.96 mm on first, and 7.65±4.2 mm on second measurement. Results with external markers correlate very well and inaccuracies are significantly lower (P<0.001) than results using anatomical landmarks (10.38±6.13 mm and 10.83±6.23 mm). Analysis revealed a significantly faster alignment using external markers (P<0.001). External fiducials in combination with immobilization devices and breathing protocols allow for highly accurate image fusion cost-effectively and significantly less time, posing an attractive alternative for PET/CT interpretation when a hybrid scanner is not available.

In-air RBS measurements at the LAMFI external beam setup

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

Silva, T. F.; Added, N.; Moro, M. V.

2014-11-11

This work describes new developments in the external beam setup of the Laboratory of Material Analysis with Ion Beams of the University of São Paulo (LAMFI-USP). This setup was designed to be a versatile analytical station to analyze a broad range of samples. In recent developments, we seek the external beam Rutherford Backscattering Spectroscopy (RBS) analysis to complement the Particle Induced X-ray Emission (PIXE) measurements. This work presents the initial results of the external beam RBS analysis as well as recent developments to improve the energy resolution RBS measurements, in particular tests to seek for sources of resolution degradation. Thesemore » aspects are discussed and preliminary results of in-air RBS analysis of some test samples are presented.« less

Assessment of feasibility of running RSNA's MIRC on a Raspberry Pi: a cost-effective solution for teaching files in radiology.

PubMed

Pereira, Andre; Atri, Mostafa; Rogalla, Patrik; Huynh, Thien; O'Malley, Martin E

2015-11-01

The value of a teaching case repository in radiology training programs is immense. The allocation of resources for putting one together is a complex issue, given the factors that have to be coordinated: hardware, software, infrastructure, administration, and ethics. Costs may be significant and cost-effective solutions are desirable. We chose Medical Imaging Resource Center (MIRC) to build our teaching file. It is offered by RSNA for free. For the hardware, we chose the Raspberry Pi, developed by the Raspberry Foundation: a small control board developed as a low cost computer for schools also used in alternative projects such as robotics and environmental data collection. Its performance and reliability as a file server were unknown to us. For the operational system, we chose Raspbian, a variant of Debian Linux, along with Apache (web server), MySql (database server) and PHP, which enhance the functionality of the server. A USB hub and an external hard drive completed the setup. Installation of software was smooth. The Raspberry Pi was able to handle very well the task of hosting the teaching file repository for our division. Uptime was logged at 100 %, and loading times were similar to other MIRC sites available online. We setup two servers (one for backup), each costing just below $200.00 including external storage and USB hub. It is feasible to run RSNA's MIRC off a low-cost control board (Raspberry Pi). Performance and reliability are comparable to full-size servers for the intended purpose of hosting a teaching file within an intranet environment.

Social withdrawal in children moderates the association between parenting styles and the children's own socioemotional development.

PubMed

Zarra-Nezhad, Maryam; Kiuru, Noona; Aunola, Kaisa; Zarra-Nezhad, Mansour; Ahonen, Timo; Poikkeus, Anna-Maija; Lerkkanen, Marja-Kristiina; Nurmi, Jari-Erik

2014-11-01

Social withdrawal in early childhood is a risk factor for later socioemotional difficulties. This study examined the joint effects of children's social withdrawal and mothers' and fathers' parenting styles on children's socioemotional development. Based on diatheses-stress, vantage sensitivity, and differential susceptibility models, socially withdrawn children were assumed to be more prone to parental influences than others. Teachers rated 314 children on prosocial skills, and internalizing and externalizing behaviors at three points in time between grades 1-3. Mothers (n = 279) and fathers (n = 182) filled in questionnaires measuring their affection, and their behavioral and psychological control at the same points in time. Teacher reports on children's level of social withdrawal were obtained at the end of kindergarten. Panel analysis showed that particularly those children who showed signs of social withdrawal were vulnerable to the negative effects of low maternal affection in terms of externalizing behavior. Moreover, among these children, mothers' and fathers' psychological control predicted high levels of internalizing problem but, at the same time, mothers' psychological control predicted also a high level of prosocial behavior and low levels of externalizing problem. The results supported the diathesis-stress model more than the differential susceptibility model. For example, socially withdrawn children were found to be particularly vulnerable to the negative effects of low maternal affection. Although maternal psychological control had positive effects on the prosocial skills of socially withdrawn children, and reduced the amount of externalizing problems, it was at the same time associated with an increase in their internalizing problems. In this way, socially withdrawn children seem to be at risk of pleasing their mothers at the cost of their own well-being. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

Economic value of U.S. fossil fuel electricity health impacts.

PubMed

Machol, Ben; Rizk, Sarah

2013-02-01

Fossil fuel energy has several externalities not accounted for in the retail price, including associated adverse human health impacts, future costs from climate change, and other environmental damages. Here, we quantify the economic value of health impacts associated with PM(2.5) and PM(2.5) precursors (NO(x) and SO(2)) on a per kilowatt hour basis. We provide figures based on state electricity profiles, national averages and fossil fuel type. We find that the economic value of improved human health associated with avoiding emissions from fossil fuel electricity in the United States ranges from a low of $0.005-$0.013/kWh in California to a high of $0.41-$1.01/kWh in Maryland. When accounting for the adverse health impacts of imported electricity, the California figure increases to $0.03-$0.07/kWh. Nationally, the average economic value of health impacts associated with fossil fuel usage is $0.14-$0.35/kWh. For coal, oil, and natural gas, respectively, associated economic values of health impacts are $0.19-$0.45/kWh, $0.08-$0.19/kWh, and $0.01-$0.02/kWh. For coal and oil, these costs are larger than the typical retail price of electricity, demonstrating the magnitude of the externality. When the economic value of health impacts resulting from air emissions is considered, our analysis suggests that on average, U.S. consumers of electricity should be willing to pay $0.24-$0.45/kWh for alternatives such as energy efficiency investments or emission-free renewable sources that avoid fossil fuel combustion. The economic value of health impacts is approximately an order of magnitude larger than estimates of the social cost of carbon for fossil fuel electricity. In total, we estimate that the economic value of health impacts from fossil fuel electricity in the United States is $361.7-886.5 billion annually, representing 2.5-6.0% of the national GDP. Published by Elsevier Ltd.

Flow-cytometric identification of vinegars using a multi-parameter analysis optical detection module

NASA Astrophysics Data System (ADS)

Verschooten, T.; Ottevaere, H.; Vervaeke, M.; Van Erps, J.; Callewaert, M.; De Malsche, W.; Thienpont, H.

2015-09-01

We show a proof-of-concept demonstration of a multi-parameter analysis low-cost optical detection system for the flowcytometric identification of vinegars. This multi-parameter analysis system can simultaneously measure laser induced fluorescence, absorption and scattering excited by two time-multiplexed lasers of different wavelengths. To our knowledge no other polymer optofluidic chip based system offers more simultaneous measurements. The design of the optofluidic channels is aimed at countering the effects that viscous fingering, air bubbles, and emulsion samples can have on the correct operation of such a detection system. Unpredictable variations in viscosity and refractive index of the channel content can be turned into a source of information. The sample is excited by two laser diodes that are driven by custom made low-cost laser drivers. The optofluidic chip is built to be robust and easy to handle and is reproducible using hot embossing. We show a custom optomechanical holder for the optofluidic chip that ensures correct alignment and automatic connection to the external fluidic system. We show an experiment in which 92 samples of vinegar are measured. We are able to identify 9 different kinds of vinegar with an accuracy of 94%. Thus we show an alternative approach to the classic optical spectroscopy solution at a lowered. Furthermore, we have shown the possibility of predicting the viscosity and turbidity of vinegars with a goodness-of-fit R2 over 0.947.

Optimization of space manufacturing systems

NASA Technical Reports Server (NTRS)

Akin, D. L.

1979-01-01

Four separate analyses are detailed: transportation to low earth orbit, orbit-to-orbit optimization, parametric analysis of SPS logistics based on earth and lunar source locations, and an overall program option optimization implemented with linear programming. It is found that smaller vehicles are favored for earth launch, with the current Space Shuttle being right at optimum payload size. Fully reusable launch vehicles represent a savings of 50% over the Space Shuttle; increased reliability with less maintenance could further double the savings. An optimization of orbit-to-orbit propulsion systems using lunar oxygen for propellants shows that ion propulsion is preferable by a 3:1 cost margin over a mass driver reaction engine at optimum values; however, ion engines cannot yet operate in the lower exhaust velocity range where the optimum lies, and total program costs between the two systems are ambiguous. Heavier payloads favor the use of a MDRE. A parametric model of a space manufacturing facility is proposed, and used to analyze recurring costs, total costs, and net present value discounted cash flows. Parameters studied include productivity, effects of discounting, materials source tradeoffs, economic viability of closed-cycle habitats, and effects of varying degrees of nonterrestrial SPS materials needed from earth. Finally, candidate optimal scenarios are chosen, and implemented in a linear program with external constraints in order to arrive at an optimum blend of SPS production strategies in order to maximize returns.

Real time chemical exposure and risk monitor

DOEpatents

Thrall, Karla D.; Kenny, Donald V.; Endres, George W. R.; Sisk, Daniel R.

1997-01-01

The apparatus of the present invention is a combination of a breath interface and an external exposure dosimeter interface to a chemical analysis device, all controlled by an electronic processor for quantitatively analyzing chemical analysis data from both the breath interface and the external exposure dosimeter for determining internal tissue dose. The method of the present invention is a combination of steps of measuring an external dose, measuring breath content, then analyzing the external dose and breath content and determining internal tissue dose.

Real time chemical exposure and risk monitor

DOEpatents

Thrall, K.D.; Kenny, D.V.; Endres, G.W.R.; Sisk, D.R.

1997-07-08

The apparatus of the present invention is a combination of a breath interface and an external exposure dosimeter interface to a chemical analysis device, all controlled by an electronic processor for quantitatively analyzing chemical analysis data from both the breath interface and the external exposure dosimeter for determining internal tissue dose. The method of the present invention is a combination of steps of measuring an external dose, measuring breath content, then analyzing the external dose and breath content and determining internal tissue dose. 7 figs.

Reflections on Reference Services.

ERIC Educational Resources Information Center

Brandt, Kerryn A.; And Others

1996-01-01

Describes programmatic changes in reference services at the Johns Hopkins University (Maryland) medical library and speculates on the future. Topics include institutional restructuring and consolidation; improvements in technology infrastructure; external economic pressure; and fiscal accountability, including library funding and cost center…

RT-Syn: A real-time software system generator

NASA Technical Reports Server (NTRS)

Setliff, Dorothy E.

1992-01-01

This paper presents research into providing highly reusable and maintainable components by using automatic software synthesis techniques. This proposal uses domain knowledge combined with automatic software synthesis techniques to engineer large-scale mission-critical real-time software. The hypothesis centers on a software synthesis architecture that specifically incorporates application-specific (in this case real-time) knowledge. This architecture synthesizes complex system software to meet a behavioral specification and external interaction design constraints. Some examples of these external constraints are communication protocols, precisions, timing, and space limitations. The incorporation of application-specific knowledge facilitates the generation of mathematical software metrics which are used to narrow the design space, thereby making software synthesis tractable. Success has the potential to dramatically reduce mission-critical system life-cycle costs not only by reducing development time, but more importantly facilitating maintenance, modifications, and extensions of complex mission-critical software systems, which are currently dominating life cycle costs.

Enhanced hydrolysis of cellulose hydrogels by morphological modification.

PubMed

Alfassi, Gilad; Rein, Dmitry M; Cohen, Yachin

2017-11-01

Cellulose is one of the most abundant bio-renewable materials on earth, yet the potential of cellulosic bio-fuels is not fully exploited, primarily due to the high costs of conversion. Hydrogel particles of regenerated cellulose constitute a useful substrate for enzymatic hydrolysis, due to their porous and amorphous structure. This article describes the influence of several structural aspects of the cellulose hydrogel on its hydrolysis. The hydrogel density was shown to be directly proportional to the cellulose concentration in the initial solution, thus affecting its hydrolysis rate. Using high-resolution scanning electron microscopy, we show that the hydrogel particles in aqueous suspension exhibit a dense external surface layer and a more porous internal network. Elimination of the external surface layer accelerated the hydrolysis rate by up to sixfold and rendered the process nearly independent of cellulose concentration. These findings may be of practical relevance to saccharification processing costs, by reducing required solvent quantities and enzyme load.

[Making a low cost IPSec router on Linux and the assessment for practical use].

PubMed

Amiki, M; Horio, M

2001-09-01

We installed Linux and FreeS/WAN on a PC/AT compatible machine to make an IPSec router. We measured the time of ping/ftp, only in the university, between the university and the external network. Between the university and the external network (the Internet), there were no differences. Therefore, we concluded that CPU load was not remarkable at low speed networks, because packets exchanged via the Internet are small, or compressions of VPN are more effective than encoding and decoding. On the other hand, in the university, the IPSec router performed down about 20-30% compared with normal IP communication, but this is not a serious problem for practical use. Recently, VPN machines are becoming cheaper, but they do not function sufficiently to create a fundamental VPN environment. Therefore, if one wants a fundamental VPN environment at a low cost, we believe you should select a VPN router on Linux.

Arduino: a low-cost multipurpose lab equipment.

PubMed

D'Ausilio, Alessandro

2012-06-01

Typical experiments in psychological and neurophysiological settings often require the accurate control of multiple input and output signals. These signals are often generated or recorded via computer software and/or external dedicated hardware. Dedicated hardware is usually very expensive and requires additional software to control its behavior. In the present article, I present some accuracy tests on a low-cost and open-source I/O board (Arduino family) that may be useful in many lab environments. One of the strengths of Arduinos is the possibility they afford to load the experimental script on the board's memory and let it run without interfacing with computers or external software, thus granting complete independence, portability, and accuracy. Furthermore, a large community has arisen around the Arduino idea and offers many hardware add-ons and hundreds of free scripts for different projects. Accuracy tests show that Arduino boards may be an inexpensive tool for many psychological and neurophysiological labs.

How do high cost-sharing policies for physician care affect inpatient care use and costs among people with chronic disease?

PubMed

Xin, Haichang

2015-01-01

Rapidly rising health care costs continue to be a significant concern in the United States. High cost-sharing strategies thus have been widely used to address rising health care costs. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies for physician care are a good strategy for controlling costs among chronically ill patients, especially whether utilization and costs in inpatient care will increase in response. This study examined whether high cost sharing in physician care affects inpatient care utilization and costs differently between individuals with and without chronic conditions. Findings from this study will contribute to the insurance benefit design that can control care utilization and save costs of chronically ill individuals. Prior studies suffered from gaps that limit both internal validity and external validity of their findings. This study has its unique contributions by filling these gaps jointly. The study used data from the 2007 Medical Expenditure Panel Survey, a nationally representative sample, with a cross-sectional study design. Instrumental variable technique was used to address the endogeneity between health care utilization and cost-sharing levels. We used negative binomial regression to analyze the count data and generalized linear models for costs data. To account for national survey sampling design, weight and variance were adjusted. The study compared the effects of high cost-sharing policies on inpatient care utilization and costs between individuals with and without chronic conditions to answer the research question. The final study sample consisted of 4523 individuals; among them, 752 had hospitalizations. The multivariate analysis demonstrated consistent patterns. Compared with low cost-sharing policies, high cost-sharing policies for physician care were not associated with a greater increase in inpatient care utilization (P = .86 for chronically ill people and P = .67 for healthy people, respectively) and costs (P = .38 for chronically ill people and P = .68 for healthy people, respectively). The sensitivity analysis with a 10% cost-sharing level also generated consistent insignificant results for both chronically ill and healthy groups. Relative to nonchronically ill individuals, chronically ill individuals may increase their utilization and expenditures of inpatient care to a similar extent in response to increased physician care cost sharing. This may be due to cost pressure from inpatient care and short observation window. Although this study did not find evidence that high cost-sharing policies for physician care increase inpatient care differently for individuals with and without chronic conditions, interpretation of this finding should be cautious. It is possible that in the long run, these sick people would demonstrate substantial demands for medical care and there could be a total cost increase for health plans ultimately. Health plans need to be cautious of policies for chronically ill enrollees.

Development and validation of a new population-based simulation model of osteoarthritis in New Zealand.

PubMed

Wilson, R; Abbott, J H

2018-04-01

To describe the construction and preliminary validation of a new population-based microsimulation model developed to analyse the health and economic burden and cost-effectiveness of treatments for knee osteoarthritis (OA) in New Zealand (NZ). We developed the New Zealand Management of Osteoarthritis (NZ-MOA) model, a discrete-time state-transition microsimulation model of the natural history of radiographic knee OA. In this article, we report on the model structure, derivation of input data, validation of baseline model parameters against external data sources, and validation of model outputs by comparison of the predicted population health loss with previous estimates. The NZ-MOA model simulates both the structural progression of radiographic knee OA and the stochastic development of multiple disease symptoms. Input parameters were sourced from NZ population-based data where possible, and from international sources where NZ-specific data were not available. The predicted distributions of structural OA severity and health utility detriments associated with OA were externally validated against other sources of evidence, and uncertainty resulting from key input parameters was quantified. The resulting lifetime and current population health-loss burden was consistent with estimates of previous studies. The new NZ-MOA model provides reliable estimates of the health loss associated with knee OA in the NZ population. The model structure is suitable for analysis of the effects of a range of potential treatments, and will be used in future work to evaluate the cost-effectiveness of recommended interventions within the NZ healthcare system. Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Simulation models in population breast cancer screening: A systematic review.

PubMed

Koleva-Kolarova, Rositsa G; Zhan, Zhuozhao; Greuter, Marcel J W; Feenstra, Talitha L; De Bock, Geertruida H

2015-08-01

The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling. A systematic literature search was performed to identify simulation models with more than one application. A framework for qualitative assessment which incorporated model type; input parameters; modeling approach, transparency of input data sources/assumptions, sensitivity analyses and risk of bias; validation, and outcomes was developed. Predicted mortality reduction (MR) and cost-effectiveness (CE) were compared to estimates from meta-analyses of randomized control trials (RCTs) and acceptability thresholds. Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression (except one model) with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled. The models tended to overestimate the MR (11-24%) due to screening as compared to optimal RCTs 10% (95% CI - 2-21%) MR. Only recently, potential harms due to regular breast cancer screening were reported. Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes. Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening. Copyright © 2015 Elsevier Ltd. All rights reserved.

AN OVERVIEW OF REDUCED ORDER MODELING TECHNIQUES FOR SAFETY APPLICATIONS

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

Mandelli, D.; Alfonsi, A.; Talbot, P.

2016-10-01

The RISMC project is developing new advanced simulation-based tools to perform Computational Risk Analysis (CRA) for the existing fleet of U.S. nuclear power plants (NPPs). These tools numerically model not only the thermal-hydraulic behavior of the reactors primary and secondary systems, but also external event temporal evolution and component/system ageing. Thus, this is not only a multi-physics problem being addressed, but also a multi-scale problem (both spatial, µm-mm-m, and temporal, seconds-hours-years). As part of the RISMC CRA approach, a large amount of computationally-expensive simulation runs may be required. An important aspect is that even though computational power is growing, themore » overall computational cost of a RISMC analysis using brute-force methods may be not viable for certain cases. A solution that is being evaluated to assist the computational issue is the use of reduced order modeling techniques. During the FY2015, we investigated and applied reduced order modeling techniques to decrease the RISMC analysis computational cost by decreasing the number of simulation runs; for this analysis improvement we used surrogate models instead of the actual simulation codes. This article focuses on the use of reduced order modeling techniques that can be applied to RISMC analyses in order to generate, analyze, and visualize data. In particular, we focus on surrogate models that approximate the simulation results but in a much faster time (microseconds instead of hours/days).« less

Executive Functions in Preschool Children with Externalizing Behavior Problems: A Meta-Analysis

ERIC Educational Resources Information Center

Schoemaker, Kim; Mulder, Hanna; Dekovic, Maja; Matthys, Walter

2013-01-01

Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021…

Distinction between Externally vs. Internally Guided Decision-Making: Operational Differences, Meta-Analytical Comparisons and Their Theoretical Implications

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

Most experimental studies of decision-making have specifically examined situations in which a single less-predictable correct answer exists (externally guided decision-making under uncertainty). Along with such externally guided decision-making, there are instances of decision-making in which no correct answer based on external circumstances is available for the subject (internally guided decision-making). Such decisions are usually made in the context of moral decision-making as well as in preference judgment, where the answer depends on the subject’s own, i.e., internal, preferences rather than on external, i.e., circumstantial, criteria. The neuronal and psychological mechanisms that allow guidance of decisions based on more internally oriented criteria in the absence of external ones remain unclear. This study was undertaken to compare decision-making of these two kinds empirically and theoretically. First, we reviewed studies of decision-making to clarify experimental–operational differences between externally guided and internally guided decision-making. Second, using multi-level kernel density analysis, a whole-brain-based quantitative meta-analysis of neuroimaging studies was performed. Our meta-analysis revealed that the neural network used predominantly for internally guided decision-making differs from that for externally guided decision-making under uncertainty. This result suggests that studying only externally guided decision-making under uncertainty is insufficient to account for decision-making processes in the brain. Finally, based on the review and results of the meta-analysis, we discuss the differences and relations between decision-making of these two types in terms of their operational, neuronal, and theoretical characteristics. PMID:22403525

a bare Nanocapillary for DNA Separation and Genotyping analysis in Gel-Free solutions without application of external electric field

PubMed Central

Wang, Xiayan; Wang, Shili; Veerappan, Vijaykumar; Byun, Chang Kyu; Nguyen, Han; Gendhar, Brina; Allen, Randy D.; Liu, Shaorong

2009-01-01

In this work, we demonstrate DNA separation and genotyping analysis in gel-free solutions using a nanocapillary under pressure-driven conditions without application of an external electric field. The nanocapillary is a ~50-cm-long and 500-nm-radius bare fused silica capillary. After a DNA sample is injected, the analytes are eluted out in a chromatographic separation format. The elution order of DNA molecules follows strictly with their sizes, with the longer DNA being eluted out faster than the shorter ones. High resolutions are obtained for both short (a few bases) and long (tens of thousands of base pairs) DNA fragments. Effects of key experimental parameters, such as eluent composition and elution pressure, on separation efficiency and resolution are investigated. We also apply this technique for DNA separations of real-world genotyping samples to demonstrate its feasibility in biological applications. PCR products (without any purification) amplified from Arabidopsis plant genomic DNA crude preparations are directly injected into the nanocapillary, and PCR-amplified DNA fragments are well resolved, allowing for unambiguous identification of samples from heterozygous and homozygous individuals. Since the capillaries used to conduct the separations are uncoated, column lifetime is virtually unlimited. The only material that is consumed in these assays is the eluent, and hence the operation cost is low. PMID:18500828

Continuous particle separation using pressure-driven flow-induced miniaturizing free-flow electrophoresis (PDF-induced μ-FFE).

PubMed

Jeon, Hyungkook; Kim, Youngkyu; Lim, Geunbae

2016-01-28

In this paper, we introduce pressure-driven flow-induced miniaturizing free-flow electrophoresis (PDF-induced μ-FFE), a novel continuous separation method. In our separation system, the external flow and electric field are applied to particles, such that particle movement is affected by pressure-driven flow, electroosmosis, and electrophoresis. We then analyzed the hydrodynamic drag force and electrophoretic force applied to the particles in opposite directions. Based on this analysis, micro- and nano-sized particles were separated according to their electrophoretic mobilities with high separation efficiency. Because the separation can be achieved in a simple T-shaped microchannel, without the use of internal electrodes, it offers the advantages of low-cost, simple device fabrication and bubble-free operation, compared with conventional μ-FFE methods. Therefore, we expect the proposed separation method to have a wide range of filtering/separation applications in biochemical analysis.

Method and apparatus for digitally based high speed x-ray spectrometer

DOEpatents

Warburton, W.K.; Hubbard, B.

1997-11-04

A high speed, digitally based, signal processing system which accepts input data from a detector-preamplifier and produces a spectral analysis of the x-rays illuminating the detector. The system achieves high throughputs at low cost by dividing the required digital processing steps between a ``hardwired`` processor implemented in combinatorial digital logic, which detects the presence of the x-ray signals in the digitized data stream and extracts filtered estimates of their amplitudes, and a programmable digital signal processing computer, which refines the filtered amplitude estimates and bins them to produce the desired spectral analysis. One set of algorithms allow this hybrid system to match the resolution of analog systems while operating at much higher data rates. A second set of algorithms implemented in the processor allow the system to be self calibrating as well. The same processor also handles the interface to an external control computer. 19 figs.

Method and apparatus for digitally based high speed x-ray spectrometer

DOEpatents

Warburton, William K.; Hubbard, Bradley

1997-01-01

A high speed, digitally based, signal processing system which accepts input data from a detector-preamplifier and produces a spectral analysis of the x-rays illuminating the detector. The system achieves high throughputs at low cost by dividing the required digital processing steps between a "hardwired" processor implemented in combinatorial digital logic, which detects the presence of the x-ray signals in the digitized data stream and extracts filtered estimates of their amplitudes, and a programmable digital signal processing computer, which refines the filtered amplitude estimates and bins them to produce the desired spectral analysis. One set of algorithms allow this hybrid system to match the resolution of analog systems while operating at much higher data rates. A second set of algorithms implemented in the processor allow the system to be self calibrating as well. The same processor also handles the interface to an external control computer.

Radiation shielding of the Fermilab 16 GeV proton driver

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

Nikolai V. Mokhov, Alexander I. Drozhdin and Oleg E. Krivosheev

2001-07-12

The radiation transport analysis in the proposed Fermi-lab 1.2 MWProton Driver (PD) [1] is fundamentally important because of the impact on machine performance, conventional facility design, maintenance operations, and related costs. The strategy adopted in the PD design is that the beam losses in the machine are localized and controlled as much as possible via the dedicated beam collimation system, with a high loss rate localized in that section and drastically lower uncontrolled beam loss rate in the rest of the lattice. Results of thorough Monte Carlo calculations of prompt and residual radiation in and around the PD components aremore » presented for realistic assumptions and geometry under normal operation and accidental conditions. This allowed one to conduct shielding design and analysis to meet regulatory requirements [2] for external shielding, hands-on maintenance and ground-water activation.« less

Continuous particle separation using pressure-driven flow-induced miniaturizing free-flow electrophoresis (PDF-induced μ-FFE)

PubMed Central

Jeon, Hyungkook; Kim, Youngkyu; Lim, Geunbae

2016-01-01

In this paper, we introduce pressure-driven flow-induced miniaturizing free-flow electrophoresis (PDF-induced μ-FFE), a novel continuous separation method. In our separation system, the external flow and electric field are applied to particles, such that particle movement is affected by pressure-driven flow, electroosmosis, and electrophoresis. We then analyzed the hydrodynamic drag force and electrophoretic force applied to the particles in opposite directions. Based on this analysis, micro- and nano-sized particles were separated according to their electrophoretic mobilities with high separation efficiency. Because the separation can be achieved in a simple T-shaped microchannel, without the use of internal electrodes, it offers the advantages of low-cost, simple device fabrication and bubble-free operation, compared with conventional μ-FFE methods. Therefore, we expect the proposed separation method to have a wide range of filtering/separation applications in biochemical analysis. PMID:26819221

KAMEDIN: a telemedicine system for computer supported cooperative work and remote image analysis in radiology.

PubMed

Handels, H; Busch, C; Encarnação, J; Hahn, C; Kühn, V; Miehe, J; Pöppl, S I; Rinast, E; Rossmanith, C; Seibert, F; Will, A

1997-03-01

The software system KAMEDIN (Kooperatives Arbeiten und MEdizinische Diagnostik auf Innovativen Netzen) is a multimedia telemedicine system for exchange, cooperative diagnostics, and remote analysis of digital medical image data. It provides components for visualisation, processing, and synchronised audio-visual discussion of medical images. Techniques of computer supported cooperative work (CSCW) synchronise user interactions during a teleconference. Visibility of both local and remote cursor on the conference workstations facilitates telepointing and reinforces the conference partner's telepresence. Audio communication during teleconferences is supported by an integrated audio component. Furthermore, brain tissue segmentation with artificial neural networks can be performed on an external supercomputer as a remote image analysis procedure. KAMEDIN is designed as a low cost CSCW tool for ISDN based telecommunication. However it can be used on any TCP/IP supporting network. In a field test, KAMEDIN was installed in 15 clinics and medical departments to validate the systems' usability. The telemedicine system KAMEDIN has been developed, tested, and evaluated within a research project sponsored by German Telekom.

Designing a Micromixer for Rolling Circle Amplification in Cancer Biomarker Detection

NASA Astrophysics Data System (ADS)

Altural, Hayriye

2015-03-01

Rolling circle amplification (RCA) is an alternative method to the Polymerase Chain Reaction based amplification for point-of-care (POC) diagnosis. In future personalized cancer diagnostic for POC applications, smaller, faster and cheaper methods are needed instead of costly and time-consuming laboratory tests. Microfluidic chips can perform the detection of cancer biomarkers within less analysis time, and provide for improvement in the sensitivity and specificity required for biochemical analysis as well. Rapid mixing is essential in the chips used in cancer diagnostic. The goal of this study is to design a micromixer for rapid RCA-based analysis and develop the assay time in cancer biomarker detection. By combining assays with micromixers, multi-step bioreactions in microfluidic chips may be achieved with minimal external control. Here, simulation results related to the micromixer are obtained by COMSOL software. The Scientific and Technological Research Council of Turkey (TUBITAK) is acknowledged for granting of H. Altural postdoctoral study in the framework of TUBITAK-BIDEB 2219-International Postdoctoral Research Scholarship Program.

The effectiveness of external sensory cues in improving functional performance in individuals with Parkinson's disease: a systematic review with meta-analysis.

PubMed

Cassimatis, Constantine; Liu, Karen P Y; Fahey, Paul; Bissett, Michelle

2016-09-01

A systematic review with meta-analysis was performed to investigate the effect external sensory cued therapy on activities of daily living (ADL) performance that include walking and daily tasks such as dressing for individuals with Parkinson's disease (PD). A detailed computer-aided search of the literature was applied to MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE and PubMed. Studies investigating the effects of external sensory cued therapy on ADL performance for individuals with PD in all stages of disease progression were collected. Relevant articles were critically reviewed and study results were synthesized by two independent researchers. A data-analysis method was used to extract data from selected articles. A meta-analysis was carried out for all randomized-controlled trials. Six studies with 243 individuals with PD were included in this review. All six studies yielded positive findings in favour of external sensory cues. The meta-analysis showed that external sensory cued therapy improved statistically after treatment (P=0.011) and at follow-up (P<0.001) for ADL performance. The results of this review provided evidence of an improvement in ADL performance in general in individuals with PD. It is recommended that clinicians incorporate external sensory into a training programme focused on improving daily task performance.