[Effect of water storage and aquaculture on Oncomelania hupensis control in tidal flats wetlands of islet-beach type area of Dantu section of lower reaches of Yangtze River].

PubMed

Li, Ye-fang; Huang, Yi-xin; Wang, He-sheng; Hang, De-rong; Chen, Xiang-ping; Xie, Yi-feng; Zhang, Lian-heng

2015-12-01

To evaluate the effect and the benefits of the projects of water storage and aquaculture on Oncomelania hupensis snail control in the tidal flats wetlands of islet-beach type area of lower reaches of the Yangtze River. The projects of water storage and aquaculture on 0. hupensis snail control were implemented in the tidal flats wetlands of islet-beach type of lower reaches of the Yangtze River. The breed situation of the snails was investigated by the conventional method before and after the project implementation and the effect of control and elimination of the snails by the projects were evaluated. At the same time, the cost-benefit analysis of two projects among them was performed by the static benefit-cost ratio method. All of 0. hupensis snails were eliminated in the first year after the implementation of seven water storage and aquaculture projects. The costs of detection and control of snails saved by each project was 69.20 thousand yuan a year on average. The annual net benefits of the "Nanhao Group 10 beach" project and "Wutao Group 6-14 beach" project were 2 039.40 thousand yuan and 955.00 thousand yuan respectively, and the annual net benefit-cost ratios were 1.09: 1 and 1.07: 1 respectively. The O. hupensis snails could be rapidly eliminated by the water storage and aquaculture, and the economic benefit is obvious, but the wetland ecological protection and flood control safety should be considered in the tidal flats wetlands of islet-beach type area of lower reaches of the Yangtze River.

A financing model to solve financial barriers for implementing green building projects.

PubMed

Lee, Sanghyo; Lee, Baekrae; Kim, Juhyung; Kim, Jaejun

2013-01-01

Along with the growing interest in greenhouse gas reduction, the effect of greenhouse gas energy reduction from implementing green buildings is gaining attention. The government of the Republic of Korea has set green growth as its paradigm for national development, and there is a growing interest in energy saving for green buildings. However, green buildings may have financial barriers that have high initial construction costs and uncertainties about future project value. Under the circumstances, governmental support to attract private funding is necessary to implement green building projects. The objective of this study is to suggest a financing model for facilitating green building projects with a governmental guarantee based on Certified Emission Reduction (CER). In this model, the government provides a guarantee for the increased costs of a green building project in return for CER. And this study presents the validation of the model as well as feasibility for implementing green building project. In addition, the suggested model assumed governmental guarantees for the increased cost, but private guarantees seem to be feasible as well because of the promising value of the guarantee from CER. To do this, certification of Clean Development Mechanisms (CDMs) for green buildings must be obtained.

A Financing Model to Solve Financial Barriers for Implementing Green Building Projects

PubMed Central

Lee, Baekrae; Kim, Juhyung; Kim, Jaejun

2013-01-01

Along with the growing interest in greenhouse gas reduction, the effect of greenhouse gas energy reduction from implementing green buildings is gaining attention. The government of the Republic of Korea has set green growth as its paradigm for national development, and there is a growing interest in energy saving for green buildings. However, green buildings may have financial barriers that have high initial construction costs and uncertainties about future project value. Under the circumstances, governmental support to attract private funding is necessary to implement green building projects. The objective of this study is to suggest a financing model for facilitating green building projects with a governmental guarantee based on Certified Emission Reduction (CER). In this model, the government provides a guarantee for the increased costs of a green building project in return for CER. And this study presents the validation of the model as well as feasibility for implementing green building project. In addition, the suggested model assumed governmental guarantees for the increased cost, but private guarantees seem to be feasible as well because of the promising value of the guarantee from CER. To do this, certification of Clean Development Mechanisms (CDMs) for green buildings must be obtained. PMID:24376379

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

NASA Technical Reports Server (NTRS)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

Modeling of enterprise information systems implementation: a preliminary investigation

NASA Astrophysics Data System (ADS)

Yusuf, Yahaya Y.; Abthorpe, M. S.; Gunasekaran, Angappa; Al-Dabass, D.; Onuh, Spencer

2001-10-01

The business enterprise has never been in greater need of Agility and the current trend will continue unabated well into the future. It is now recognized that information system is both the foundation and a necessary condition for increased responsiveness. A successful implementation of Enterprise Resource Planning (ERP) can help a company to move towards delivering on its competitive objectives as it enables suppliers to reach out to customers beyond the borders of traditional market defined by geography. The cost of implementation, even when it is successful, could be significant. Bearing in mind the potential strategic benefits, it is important that the implementation project is managed effectively. To this end a project cost model against which to benchmark ongoing project expenditure versus activities completed has been proposed in this paper.

Technical Progress Report on Application and Development of Appropriate Tools and Technologies for Cost-Effective Carbon Sequestration

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

Bill Stanley; Patrick Gonzalez; Sandra Brown

2006-06-30

The Nature Conservancy is participating in a Cooperative Agreement with the Department of Energy (DOE) National Energy Technology Laboratory (NETL) to explore the compatibility of carbon sequestration in terrestrial ecosystems and the conservation of biodiversity. The title of the research project is ''Application and Development of Appropriate Tools and Technologies for Cost-Effective Carbon Sequestration''. The objectives of the project are to: (1) improve carbon offset estimates produced in both the planning and implementation phases of projects; (2) build valid and standardized approaches to estimate project carbon benefits at a reasonable cost; and (3) lay the groundwork for implementing cost-effective projects,more » providing new testing ground for biodiversity protection and restoration projects that store additional atmospheric carbon. This Technical Progress Report discusses preliminary results of the six specific tasks that The Nature Conservancy is undertaking to answer research needs while facilitating the development of real projects with measurable greenhouse gas reductions. The research described in this report occurred between April 1st and July 30th 2006. The specific tasks discussed include: Task 1: carbon inventory advancements; Task 2: emerging technologies for remote sensing of terrestrial carbon; Task 3: baseline method development; Task 4: third-party technical advisory panel meetings; Task 5: new project feasibility studies; and Task 6: development of new project software screening tool. Work is being carried out in Brazil, Belize, Chile, Peru and the USA.« less

Design Tools for Cost-Effective Implementation of Planetary Protection Requirements

NASA Technical Reports Server (NTRS)

Hamlin, Louise; Belz, Andrea; Evans, Michael; Kastner, Jason; Satter, Celeste; Spry, Andy

2006-01-01

Since the Viking missions to Mars in the 1970s, accounting for the costs associated with planetary protection implementation has not been done systematically during early project formulation phases, leading to unanticipated costs during subsequent implementation phases of flight projects. The simultaneous development of more stringent planetary protection requirements, resulting from new knowledge about the limits of life on Earth, together with current plans to conduct life-detection experiments on a number of different solar system target bodies motivates a systematic approach to integrating planetary protection requirements and mission design. A current development effort at NASA's Jet Propulsion Laboratory is aimed at integrating planetary protection requirements more fully into the early phases of mission architecture formulation and at developing tools to more rigorously predict associated cost and schedule impacts of architecture options chosen to meet planetary protection requirements.

Earned Value Management (EVM) Implementation Handbook

NASA Technical Reports Server (NTRS)

Terrell, Stefanie M.; Richards, Brad W.

2018-01-01

The purpose of this handbook is to provide Earned Value Management (EVM) guidance for the effective application, implementation, and utilization of EVM on NASA programs, projects, major contracts and subcontracts in a consolidated reference document. EVM is a project management process that effectively integrates a project?s scope of work with schedule and cost elements for optimum project planning and control. The goal is to achieve timely and accurate quantification of progress that will facilitate management by exception and enable early visibility into the nature and the magnitude of technical problems as well as the intended course and success of corrective actions.

The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India

PubMed Central

Guinness, L; Kumaranayake, L; Reddy, Bhaskar; Govindraj, Y; Vickerman, P; Alary, M

2010-01-01

Background The India AIDS Initiative (Avahan) project is involved in rapid scale-up of HIV-prevention interventions in high-risk populations. This study examines the cost variation of 107 non-governmental organisations (NGOs) implementing targeted interventions, over the start up (defined as period from project inception until services to the key population commenced) and first 2 years of intervention. Methods The Avahan interventions for female and male sex workers and their clients, in 62 districts of four southern states were costed for the financial years 2004/2005 and 2005/2006 using standard costing techniques. Data sources include financial and economic costs from the lead implementing partners (LPs) and subcontracted local implementing NGOs retrospectively and prospectively collected from a provider perspective. Ingredients and step-down allocation processes were used. Outcomes were measured using routinely collected project data. The average costs were estimated and a regression analysis carried out to explore causes of cost variation. Costs were calculated in US$ 2006. Results The total number of registered people was 134 391 at the end of 2 years, and 124 669 had used STI services during that period. The median average cost of Avahan programme for this period was $76 per person registered with the project. Sixty-one per cent of the cost variation could be explained by scale (positive association), number of NGOs per district (negative), number of LPs in the state (negative) and project maturity (positive) (p<0.0001). Conclusions During rapid scale-up in the initial phase of the Avahan programme, a significant reduction in average costs was observed. As full scale-up had not yet been achieved, the average cost at scale is yet to be realised and the extent of the impact of scale on costs yet to be captured. Scale effects are important to quantify for planning resource requirements of large-scale interventions. The average cost after 2 years is within the range of global scale-up costs estimates and other studies in India. PMID:20167740

The effects of scale on the costs of targeted HIV prevention interventions among female and male sex workers, men who have sex with men and transgenders in India.

PubMed

Chandrashekar, S; Guinness, L; Kumaranayake, L; Reddy, Bhaskar; Govindraj, Y; Vickerman, P; Alary, M

2010-02-01

The India AIDS Initiative (Avahan) project is involved in rapid scale-up of HIV-prevention interventions in high-risk populations. This study examines the cost variation of 107 non-governmental organisations (NGOs) implementing targeted interventions, over the start up (defined as period from project inception until services to the key population commenced) and first 2 years of intervention. The Avahan interventions for female and male sex workers and their clients, in 62 districts of four southern states were costed for the financial years 2004/2005 and 2005/2006 using standard costing techniques. Data sources include financial and economic costs from the lead implementing partners (LPs) and subcontracted local implementing NGOs retrospectively and prospectively collected from a provider perspective. Ingredients and step-down allocation processes were used. Outcomes were measured using routinely collected project data. The average costs were estimated and a regression analysis carried out to explore causes of cost variation. Costs were calculated in US$ 2006. The total number of registered people was 134,391 at the end of 2 years, and 124,669 had used STI services during that period. The median average cost of Avahan programme for this period was $76 per person registered with the project. Sixty-one per cent of the cost variation could be explained by scale (positive association), number of NGOs per district (negative), number of LPs in the state (negative) and project maturity (positive) (p<0.0001). During rapid scale-up in the initial phase of the Avahan programme, a significant reduction in average costs was observed. As full scale-up had not yet been achieved, the average cost at scale is yet to be realised and the extent of the impact of scale on costs yet to be captured. Scale effects are important to quantify for planning resource requirements of large-scale interventions. The average cost after 2 years is within the range of global scale-up costs estimates and other studies in India.

Progress report on a multi-service family planning mobile unit September, 1981.

PubMed

1981-12-01

In 1979, the National Family Planning Program's (NFPP) multiservice mobile unit pilot project was implemented to deliver a full complement of clinical and nonclinical family planning services to remote Thai villages by transporting nurses, physicians, and supplies by van. 15 provinces with the lowest family planning achievement in 1978 were selected to participate in the project for 1 year; one refused. Funding was allocated for mobile unit trips and promotional billboards. Implementation at the time of data analysis averaged 9.8 province-months, sufficient to reveal trends in project achievement. 9579 new acceptors were reported after 805 mobile trips in the 14 provinces, an average of 12 new acceptors/trip. New acceptor recruitment costs were estimated at $6.20/client. Based on Thai data for continuation rates, an estimated 18,238 couples years of protection (CYP) were achieved by the mobile unit. In comparison to other family planning services' mobile units, the multiservice unit had the lowest operating costs, but the most expensive cost/CYP. The effectiveness of the promotional billboards was assessed by comparing acceptor rates in provinces with and without billboards. Overall, the provinces with billboards showed less of an increase in new acceptors. When months of project implementation are controlled, a positive effect of the billboards is suggested. While demonstrating that all modern contraception can be delivered via mobile units to remote villages, there is inadequate acceptance of the highly effective family planning methods to justify the cost of transporting staff and equipment.

NCMS ESS 2000 Project

NASA Technical Reports Server (NTRS)

Gibbel, Mark; Bellamy, Marvin; DeSantis, Charlie; Hess, John; Pattok, Tracy; Quintero, Andrew; Silver, R.

1996-01-01

ESS 2000 has the vision of enhancing the knowledge necessary to implement cost-effective, leading-edge ESS technologies and procedures in order to increase U.S. electronics industry competitiveness. This paper defines EES and discusses the factors driving the project, the objectives of the project, its participants, the three phases of the project, the technologies involved, and project deliverables.

Integrating Cost-effective Rollover Protective Structure Installation in High School Agricultural Mechanics: A Feasibility Study.

PubMed

Mazur, Joan; Vincent, Stacy; Watson, Jennifer; Westneat, Susan

2015-01-01

This study with three Appalachian county agricultural education programs examined the feasibility, effectiveness, and impact of integrating a cost-effective rollover protective structure (CROPS) project into high school agricultural mechanics classes. The project aimed to (1) reduce the exposure to tractor overturn hazards in three rural counties through the installation of CROPS on seven tractors within the Cumberland Plateau in the east region; (2) increase awareness in the targeted rural communities of cost-effective ROPS designs developed by the National Institution for Occupational Safety and Health (NIOSH) to encourage ROPS installations that decrease the costs of a retrofit; (3) test the feasibility of integration of CROPS construction and installations procedures into the required agricultural mechanics classes in these agricultural education programs; and (4) explore barriers to the implementation of this project in high school agricultural education programs. Eighty-two rural students and three agricultural educators participated in assembly and installation instruction. Data included hazard exposure demographic data, knowledge and awareness of CROPS plans, and pre-post knowledge of construction and assessment of final CROPS installation. Findings demonstrated the feasibility and utility of a CROPS education program in a professionally supervised secondary educational setting. The project promoted farm safety and awareness of availability and interest in the NIOSH Cost-effective ROPS plans. Seven CROPS were constructed and installed. New curriculum and knowledge measures also resulted from the work. Lessons learned and recommendations for a phase 2 implementation and further research are included.

Earned Value Management (EVM) Implementation Handbook

NASA Technical Reports Server (NTRS)

2013-01-01

The purpose of this handbook is to provide Earned Value Management (EVM) guidance for the effective application, implementation, and utilization of EVM on NASA programs, projects, major contracts and subcontracts in a consolidated reference document. EVM is a project management process that effectively integrates a project s scope of work with schedule and cost elements for optimum project planning and control. The goal is to achieve timely and accurate quantification of progress that will facilitate management by exception and enable early visibility into the nature and the magnitude of technical problems as well as the intended course and success of corrective actions.

Low-cost rural surface alternatives : demonstration project.

DOT National Transportation Integrated Search

2015-06-01

The goals of this project were to implement several stabilization methods for preventing or mitigating freeze-thaw damage to : granular surfaced roads and identify the most effective and economical methods for the soil and climate conditions of Iowa....

Cost-effective implementation of intelligent systems

NASA Technical Reports Server (NTRS)

Lum, Henry, Jr.; Heer, Ewald

1990-01-01

Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.

Student Support that Works: A Solid Approach.

ERIC Educational Resources Information Center

Lang, Kathy J.; Bielejeski, Ruth

The College of Saint Benedict and Saint John's University (Minnesota), two coordinate, liberal arts colleges, have implemented a cost-effective student information technology (IT) support system. Project IMPACT (Implementing Academic Technology), a 5-year, $10 million plan to upgrade the technology for student and faculty use, was implemented in…

Effect of the implementation of the fluvial performance standard on maintenance of bridges and culverts.

DOT National Transportation Integrated Search

2013-08-01

The objective of this project was to determine what factors influence maintenance cost of Oregon Department of Transportation (ODOT) stream-crossing structures. Data acquired for the project included structure characteristics, stream characteristics,...

Improved cost monitoring and control through the Earned Value Management System

NASA Astrophysics Data System (ADS)

Hunter, Howard; Fitzgerald, Richard; Barlow, Dewey

2014-01-01

As economic pressure and competition for budget among federal agencies has increased, there has been an increasing need for more granular data and robust management information systems. This is especially true for the execution of major civilian space programs. This need has resulted in new program management requirements being implemented in an attempt to limit cost and schedule growth. In particular, NASA Procedural Requirements (NPR) 7120.5D requires the implementation of an Earned Value Management System (EVMS) compliant with the requirements of American National Standards Institute (ANSI)/Electronic Industries Alliance Standard 748-B. The Radiation Belt Storm Probes (RBSP) program management team at The Johns Hopkins University Applied Physics Laboratory (JHU/APL) made a decision to implement an EVMS on RBSP during Phase B—a year earlier than specified in the contractual Phase C reporting requirement as defined in the NPR. This decision was made so that the project would have the benefit of 12 months of training and hands-on implementation during Phase B. Although there were a number of technical and process hurdles encountered during Phase B and into Phase C, the system was working well when the Integrated Baseline Review (IBR) was held in August 2009. The IBR was a success because it met the review requirements. It was also clear to all IBR participants that the EVMS was providing value to the project management team. Although the IBR pointed out some areas of concern regarding process and ANSI compliance, the system had markedly improved the project's ability to monitor cost and schedule. This, in turn, allowed the project team to foresee problems in advance, formulate corrective actions, and implement course corrections without causing significant adverse impact to the project. Opponents of EVMS systems often communicate the unfavorable opinion that EVMS systems create unnecessary cost and administration. Although it is undeniable that EVMS implementation does not occur without cost, the cost is minimal in comparison to the benefits of successful implementation. This paper will focus on the implementation of EVMS on the RBSP project, explain EV processes and the implementation's cost, and analyze the benefits of EVMS to provide insight into cost/benefit considerations for other projects considering EVMS implementation. This paper will do this by focusing on the following points: (1) RBSP is the first full-up implementation of earned value management (EVM) at JHU/APL; (2) RBSP EVM started in Phase B; (3) RBSP EVM implementation has been working well in Phase C/D; (4) RBSP EVM implementation has been recognized by Goddard Space Flight Center and NASA Headquarters as successful; and (5) an assessment of the benefits of EVMS to the project management team and sponsor shows that the system's benefits outweigh the cost of implementation.

Multi-level, Multi-stage and Stochastic Optimization Models for Energy Conservation in Buildings for Federal, State and Local Agencies

NASA Astrophysics Data System (ADS)

Champion, Billy Ray

Energy Conservation Measure (ECM) project selection is made difficult given real-world constraints, limited resources to implement savings retrofits, various suppliers in the market and project financing alternatives. Many of these energy efficient retrofit projects should be viewed as a series of investments with annual returns for these traditionally risk-averse agencies. Given a list of ECMs available, federal, state and local agencies must determine how to implement projects at lowest costs. The most common methods of implementation planning are suboptimal relative to cost. Federal, state and local agencies can obtain greater returns on their energy conservation investment over traditional methods, regardless of the implementing organization. This dissertation outlines several approaches to improve the traditional energy conservations models. . Any public buildings in regions with similar energy conservation goals in the United States or internationally can also benefit greatly from this research. Additionally, many private owners of buildings are under mandates to conserve energy e.g., Local Law 85 of the New York City Energy Conservation Code requires any building, public or private, to meet the most current energy code for any alteration or renovation. Thus, both public and private stakeholders can benefit from this research. . The research in this dissertation advances and presents models that decision-makers can use to optimize the selection of ECM projects with respect to the total cost of implementation. A practical application of a two-level mathematical program with equilibrium constraints (MPEC) improves the current best practice for agencies concerned with making the most cost-effective selection leveraging energy services companies or utilities. The two-level model maximizes savings to the agency and profit to the energy services companies (Chapter 2). An additional model presented leverages a single congressional appropriation to implement ECM projects (Chapter 3). Returns from implemented ECM projects are used to fund additional ECM projects. In these cases, fluctuations in energy costs and uncertainty in the estimated savings severely influence ECM project selection and the amount of the appropriation requested. A risk aversion method proposed imposes a minimum on the number of "of projects completed in each stage. A comparative method using Conditional Value at Risk is analyzed. Time consistency was addressed in this chapter. This work demonstrates how a risk-based, stochastic, multi-stage model with binary decision variables at each stage provides a much more accurate estimate for planning than the agency's traditional approach and deterministic models. Finally, in Chapter 4, a rolling-horizon model allows for subadditivity and superadditivity of the energy savings to simulate interactive effects between ECM projects. The approach makes use of inequalities (McCormick, 1976) to re-express constraints that involve the product of binary variables with an exact linearization (related to the convex hull of those constraints). This model additionally shows the benefits of learning between stages while remaining consistent with the single congressional appropriations framework.

Why projects often fail even with high cost contingencies

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

Kujawski, Edouard

2002-02-28

In this note we assume that the individual risks have been adequately quantified and the total project cost contingency adequately computed to ensure an agreed-to probability or confidence level that the total project cost estimate will not be exceeded. But even projects that implement such a process are likely to result in significant cost overruns and/or project failure if the project manager allocates the contingencies to the individual subsystems. The intuitive and mathematically valid solution is to maintain a project-wide contingency and to distribute it to the individual risks on an as-needed basis. Such an approach ensures cost-efficient risk management,more » and projects that implement it are more likely to succeed and to cost less. We illustrate these ideas using a simplified project with two independent risks. The formulation can readily be extended to multiple risks.« less

The Cost-Effectiveness of Distance Education for Teacher Training. BRIDGES Research Report Series No. 9.

ERIC Educational Resources Information Center

Nielsen, H. Dean; And Others

This study, conducted by the Basic Research and Implementation in DevelopinG Education Systems (BRIDGES) Project, demonstrates a relatively inexpensive way for governments to increase the effectiveness of their teaching force. The report describes distance teacher education programs in Sri Lanka and Indonesia as being cost-effective (the low…

Energy savings in Polish buildings

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

Markel, L.C.; Gula, A.; Reeves, G.

1995-12-31

A demonstration of low-cost insulation and weatherization techniques was a part of phase 1 of the Krakow Clean Fossil Fuels and Energy Efficient Project. The objectives were to identify a cost-effective set of measures to reduce energy used for space heating, determine how much energy could be saved, and foster widespread implementation of those measures. The demonstration project focused on 4 11-story buildings in a Krakow housing cooperative. Energy savings of over 20% were obtained. Most important, the procedures and materials implemented in the demonstration project have been adapted to Polish conditions and applied to other housing cooperatives, schools, andmore » hospitals. Additional projects are being planned, in Krakow and other cities, under the direction of FEWE-Krakow, the Polish Energie Cities Network, and Biuro Rozwoju Krakowa.« less

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20-29 in Zimbabwe.

PubMed

Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie; Njeuhmeli, Emmanuel

2016-01-01

Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined. Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups. When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

A detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery.

PubMed

Ament, Stephanie M C; de Kok, Mascha; van de Velde, Cornelis J H; Roukema, Jan A; Bell, Toine V R J; van der Ent, Fred W; van der Weijden, Trudy; von Meyenfeldt, Maarten F; Dirksen, Carmen D

2015-05-27

Despite the increased attention for assessing the effectiveness of implementation strategies, most implementation studies provide little or no information on its associated costs. The focus of the current study was to provide a detailed report of the resource use and costs associated with implementation of a short stay programme for breast cancer surgery in four Dutch hospitals. The analysis was performed alongside a multi-centre implementation study. The process of identification, measurement and valuation of the implementation activities was based on recommendations for the design, analysis and reporting of health technology assessments. A scoring form was developed to prospectively determine the implementation activities at professional and implementation expert level. A time horizon of 5 years was used to calculate the implementation costs per patient. Identified activities were consisted of development and execution of the implementation strategy during the implementation project. Total implementation costs over the four hospitals were €83.293. Mean implementation costs, calculated for 660 patients treated over a period of 5 years, were €25 per patient. Subgroup analyses showed that the implementation costs ranged from €3.942 to €32.000 on hospital level. From a local hospital perspective, overall implementation costs were €21 per patient, after exclusion of the costs made by the expert centre. We provided a detailed case description of how implementation costs can be determined. Notable differences in implementation costs between hospitals were observed. ISRCTN77253391.

Assessing the Implementation and Cost of High Quality Early Care and Education: A Review of the Literature. OPRE Report 2016-31

ERIC Educational Resources Information Center

Caronongan, Pia; Kirby, Gretchen; Boller, Kimberly; Modlin, Emily; Lyskawa, Julia

2016-01-01

This report summarizes the findings of a literature review conducted as part of the Assessing the Implementation and Cost of High-Quality Early Care and Education (ECE-ICHQ) project. The project's goal is to create a technically sound and feasible instrument that will provide consistent, systematic measures of the implementation and costs of…

[Changes of agroecosystem services value under effects of land consolidation].

PubMed

Zhang, Zhen; Gao, Jin-Quan; Wei, Chao-Fu

2010-03-01

This paper quantitatively described the changes of agroecosystem functions before (2003) and after (2007) the implementation of Gaolong land consolidation project in Hechuan of Chongqing. Engineering design and shadow price were integrated to quantify the effects of the project on the functions, and cost-benefit analysis was used to further explain the economic meanings of the functions, and to analyze the changes of the agroecosystem services value under effects of the project. Compared with that before the land consolidation, the agroecosystem services value after the land consolidation was somewhat improved, with the largest increment of nutrient cycling function and the smallest change of soil conservation function. In the implementation of the project, the changes of the agroecosystem services value induced by farmland water conservancy, field road building, and land-leveling engineering mainly manifested in the change of disturbance function. From the 7th to 35th year after the project, the cost benefit would have a rapid increase, and tended to be stable after then, giving a weak ecological pressure and little services value loss, and benefiting the improvement of regional ecological environment.

PACS project management utilizing web-based tools

NASA Astrophysics Data System (ADS)

Patel, Sunil; Levin, Brad; Gac, Robert J., Jr.; Harding, Douglas, Jr.; Chacko, Anna K.; Radvany, Martin; Romlein, John R.

2000-05-01

As Picture Archiving and Communications Systems (PACS) implementations become more widespread, the management of deploying large, multi-facility PACS will become a more frequent occurrence. The tools and usability of the World Wide Web to disseminate project management information obviates time, distance, participant availability, and data format constraints, allowing for the effective collection and dissemination of PACS planning, implementation information, for a potentially limitless number of concurrent PACS sites. This paper will speak to tools, such as (1) a topic specific discussion board, (2) a 'restricted' Intranet, within a 'project' Intranet. We will also discuss project specific methods currently in use in a leading edge, regional PACS implementation concerning the sharing of project schedules, physical drawings, images of implementations, site-specific data, point of contacts lists, project milestones, and a general project overview. The individual benefits realized for the end user from each tool will also be covered. These details will be presented, balanced with a spotlight on communication as a critical component of any project management undertaking. Using today's technology, the web arguably provides the most cost and resource effective vehicle to facilitate the broad based, interactive sharing of project information.

I-95 Corridor Coalition Project #3 (95-003) : surveillance requirements/technology

DOT National Transportation Integrated Search

1995-06-23

The purpose of this Surveillance Requirements/Technology (SR/T) Project is to develop an : implementation plan for a Corridor-wide traffic and environmental surveillance system using state-of-the-art and cost-effective technologies. To fulfill this p...

Assessing the cost of fuel reduction treatments: a critical review

Treesearch

Bob Rummer

2008-01-01

The basic costs of the operations for implementing fuel reduction treatments are used to evaluate treatment effectiveness, select among alternatives, estimate total project costs, and build national program strategies. However, a review of the literature indicates that there is questionable basis for many of the general estimates used to date. Different approaches to...

Results of a NASA Kennedy Space Center Earned Value Management Pilot Project

NASA Technical Reports Server (NTRS)

Delgado, Hector N.; Rhodeside, Glenn R.

2004-01-01

The Earn Value Management Pilot provided a tremendous amount of data on the strengths and weaknesses of the new financial system, the ability to support EVM from many viewpoints, the lack of tools for small to medium projects implementing EVM, and the training and environment necessary to successfully deploy EVM to all projects. This data along with other pilots will prove invaluable. Deploying EVM should not be taken lightly - a full assessment of capabilities and supporting infrastructure should be done prior to any deployment, and some very basic questions should be asked. For instance, will sufficient training be provided? Can the project managers readily and easily obtain all the necessary data? If EVM is to thrive in all projects regardless of cost, the transition should be as seamless as possible, minimizing cost and effort, and with the end user in mind. In setting up an EVM implementation, the question, "How does the project manager benefit from this process?" must remain at the forefront. Further research in this area is needed to answer the question,"Is EVM cost effective in small projects?" The authors welcome knowledge sharing with other organizations that are striving to gain the benefits of EVM on small projects.

A required course in the development, implementation, and evaluation of clinical pharmacy services.

PubMed

Skomo, Monica L; Kamal, Khalid M; Berdine, Hildegarde J

2008-10-15

To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care.

A Required Course in the Development, Implementation, and Evaluation of Clinical Pharmacy Services

PubMed Central

Kamal, Khalid M.; Berdine, Hildegarde J.

2008-01-01

Objective To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Design Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. Assessment One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. Conclusion The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care. PMID:19214263

Cost of individual peer counselling for the promotion of exclusive breastfeeding in Uganda

PubMed Central

2011-01-01

Background Exclusive breastfeeding (EBF) for 6 months is the recommended form of infant feeding. Support of mothers through individual peer counselling has been proved to be effective in increasing exclusive breastfeeding prevalence. We present a costing study of an individual peer support intervention in Uganda, whose objective was to raise exclusive breastfeeding rates at 3 months of age. Methods We costed the peer support intervention, which was offered to 406 breastfeeding mothers in Uganda. The average number of counselling visits was about 6 per woman. Annual financial and economic costs were collected in 2005-2008. Estimates were made of total project costs, average costs per mother counselled and average costs per peer counselling visit. Alternative intervention packages were explored in the sensitivity analysis. We also estimated the resources required to fund the scale up to district level, of a breastfeeding intervention programme within a public health sector model. Results Annual project costs were estimated to be US$56,308. The largest cost component was peer supporter supervision, which accounted for over 50% of total project costs. The cost per mother counselled was US$139 and the cost per visit was US$26. The cost per week of EBF was estimated to be US$15 at 12 weeks post partum. We estimated that implementing an alternative package modelled on routine public health sector programmes can potentially reduce costs by over 60%. Based on the calculated average costs and annual births, scaling up modelled costs to district level would cost the public sector an additional US$1,813,000. Conclusion Exclusive breastfeeding promotion in sub-Saharan Africa is feasible and can be implemented at a sustainable cost. The results of this study can be incorporated in cost effectiveness analyses of exclusive breastfeeding promotion programmes in sub-Saharan Africa. PMID:21714877

Cost-Effectiveness of Capping Freeways for Use as Parks: The New York Cross-Bronx Expressway Case Study

PubMed Central

Zafari, Zafar; Bellanger, Martine; Muennig, Peter Alexander

2018-01-01

Objectives. To examine health benefits and cost-effectiveness of implementing a freeway deck park to increase urban green space. Methods. Using the Cross-Bronx Expressway in New York City as a case study, we explored the cost-effectiveness of implementing deck parks. We built a microsimulation model that included increased exercise, fewer accidents, and less pollution as well as the cost of implementation and maintenance of the park. We estimated both the quality-adjusted life years gained and the societal costs for 2017. Results. Implementation of a deck park over sunken parts of Cross-Bronx Expressway appeared to save both lives and money. Savings were realized for 84% of Monte Carlo simulations. Conclusions. In a rapidly urbanizing world, reclaiming green space through deck parks can bring health benefits alongside economic savings over the long term. Public Health Implications. Policymakers are seeking ways to create cross-sectorial synergies that might improve both quality of urban life and health. However, such projects are very expensive, and there is little information on their return of investment. Our analysis showed that deck parks produce exceptional value when implemented over below-grade sections of road. PMID:29345999

A bottom-up approach to estimating cost elements of REDD+ pilot projects in Tanzania

PubMed Central

2012-01-01

Background Several previous global REDD+ cost studies have been conducted, demonstrating that payments for maintaining forest carbon stocks have significant potential to be a cost-effective mechanism for climate change mitigation. These studies have mostly followed highly aggregated top-down approaches without estimating the full range of REDD+ costs elements, thus underestimating the actual costs of REDD+. Based on three REDD+ pilot projects in Tanzania, representing an area of 327,825 ha, this study explicitly adopts a bottom-up approach to data assessment. By estimating opportunity, implementation, transaction and institutional costs of REDD+ we develop a practical and replicable methodological framework to consistently assess REDD+ cost elements. Results Based on historical land use change patterns, current region-specific economic conditions and carbon stocks, project-specific opportunity costs ranged between US$ -7.8 and 28.8 tCOxxxx for deforestation and forest degradation drivers such as agriculture, fuel wood production, unsustainable timber extraction and pasture expansion. The mean opportunity costs for the three projects ranged between US$ 10.1 – 12.5 tCO2. Implementation costs comprised between 89% and 95% of total project costs (excluding opportunity costs) ranging between US$ 4.5 - 12.2 tCO2 for a period of 30 years. Transaction costs for measurement, reporting, verification (MRV), and other carbon market related compliance costs comprised a minor share, between US$ 0.21 - 1.46 tCO2. Similarly, the institutional costs comprised around 1% of total REDD+ costs in a range of US$ 0.06 – 0.11 tCO2. Conclusions The use of bottom-up approaches to estimate REDD+ economics by considering regional variations in economic conditions and carbon stocks has been shown to be an appropriate approach to provide policy and decision-makers robust economic information on REDD+. The assessment of opportunity costs is a crucial first step to provide information on the economic baseline situation of deforestation and forest degradation agents and on the economic incentives required to halt unsustainable land use. Since performance based REDD+ carbon payments decrease over time (as deforestation rates drop and for each saved ha of forest payments occur once), investments in REDD+ implementation have a crucial role in triggering sustainable land use systems by investing in the underlying assets and the generation of sustainable revenue streams to compensate for opportunity costs of land use change. With a potential increase in the land value due to effective REDD+ investments, expenditures in an enabling institutional environment for REDD+ policies are crucial to avoid higher deforestation pressure on natural forests. PMID:22877419

Sociocultural Behavior Research and Engineering in the Department of Defense Context

DTIC Science & Technology

2011-09-01

return on investment. Section IV provides a set of principles and practices to ensure that DoD investments are cost effective and have high...projects. The U.S. Army Training and Doctrine Command (TRADOC) Analysis Center (TRAC), the Naval Postgraduate School (NPS), the OSD’s Cost Assessment... cost -effectively allocating resources targeted toward relevant problems. The OSD HSCB Modeling Program is using that approach to rapidly implement a

Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America

PubMed Central

Ravasi, Giovanni; Grinsztejn, Beatriz; Baruch, Ricardo; Guanira, Juan Vicente; Luque, Ricardo; Cáceres, Carlos F; Ghidinelli, Massimo

2016-01-01

Introduction Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. Discussion Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. Conclusions PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes. PMID:27760687

Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America.

PubMed

Ravasi, Giovanni; Grinsztejn, Beatriz; Baruch, Ricardo; Guanira, Juan Vicente; Luque, Ricardo; Cáceres, Carlos F; Ghidinelli, Massimo

2016-01-01

Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes.

Project #10404 - Scoping Study for Implementation of the Highway Safety Manual in Alabama

DOT National Transportation Integrated Search

2012-08-01

This report outlines a cost-effective and thoughtful way to implement the Highway Safety Manual (HSM) in Alabama. The HSM was published by the American Association of State Highway and Transportation Officials, and it was prepared by the Transportati...

Energy savings opportunity survey at Walter Reed Army Medical Center, Washington, DC. Final Submittal report

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

NONE

1987-10-22

This Energy Savings Opportunity Survey (ESOS) was performed for sixteen (16) buildings at Walter Reed Army Medical Center (WPAMC) in Washington, D.C. This survey was intended to reevaluate and update projects from a previous Energy Engineering Analysis Program (EEAP) survey performed at WRAMC. However, the previous EEAP survey was determined by the contracting officer to be incomplete and not worthy of further consideration. Therefore, this survey involved the complete reevaluation of the buildings to determine their potential energy cost savings. Six (6) projects and nine (9) low cost/no cost energy conservation opportunities (ECO`s) are recommended for implementation in the buildings.more » These projects and ECO`s are projected to annually save $448,263 at an implementation cost of $891,659. The simple payback (i.e., implementation cost divided by cost savings) for the recommendations in the survey is 1.99 years. The two (2) projects with the greatest cost savings are a stack heat recovery system (Project Number 5) and HVAC modifications (Project Number 1). These two (2) projects will provide 67% of the projected total savings for the survey. The sixteen (16) buildings in this survey represent only 22% of the total floor area of the Walter Reed Army Medical Center complex. It is believed that significant potential energy cost savings amounting to two (2) million dollars may be achieved in the remaining buildings in the complex not included in this survey. Specifically it is believed the main hospital building contains many opportunities for substantial cost savings.« less

Developing and Implementing a Voluntary Personal Computer Program in the Business School: One College's Experience.

ERIC Educational Resources Information Center

Darter, Marvin E.; Wise, Donald E.

1989-01-01

Describes the experiences of Rider College School of Business Administration in implementing the use of microcomputers for courses in the business curriculum. Topics discussed include student purchase of microcomputers; cost effectiveness; software considerations; security for student equipment; printers; large screen projection facilities; and…

[Cost analysis of patient blood management].

PubMed

Kleinerüschkamp, A G; Zacharowski, K; Ettwein, C; Müller, M M; Geisen, C; Weber, C F; Meybohm, P

2016-06-01

Patient blood management (PBM) is a multidisciplinary approach focusing on the diagnosis and treatment of preoperative anaemia, the minimisation of blood loss, and the optimisation of the patient-specific anaemia reserve to improve clinical outcomes. Economic aspects of PBM have not yet been sufficiently analysed. The aim of this study is to analyse the costs associated with the clinical principles of PBM and the project costs associated with the implementation of a PBM program from an institutional perspective. Patient-related costs of materials and services were analysed at the University Hospital Frankfurt for 2013. Personnel costs of all major processes were quantified based on the time required to perform each step. Furthermore, general project costs of the implementation phase were determined. Direct costs of transfusing a single unit of red blood cells can be calculated to a minimum of €147.43. PBM-associated costs varied depending on individual patient requirements. The following costs per patient were calculated: diagnosis of preoperative anaemia €48.69-123.88; treatment of preoperative anaemia (including iron-deficiency anaemia and megaloblastic anaemia) €12.61-127.99; minimising perioperative blood loss (including point-of-care diagnostics, coagulation management and cell salvage) €3.39-1,901.81; and costs associated with the optimisation of the tolerance to anaemia (including patient monitoring and volume therapy) €28.62. General project costs associated with the implementation of PBM were €24,998.24. PBM combines various alternatives to the transfusion of red blood cells and improves clinical outcome. Costs of PBM vary from institution to institution and depend on the extent to which different aspects of PBM have been implemented. The quantification of costs associated with PBM is essential in order to assess the economic impact of PBM, and thereby, to efficiently re-allocate health care resources. Costs were determined at a single university hospital. Thus, further analyses of both the costs of transfusion and the costs of PBM-principles will be necessary to evaluate the cost-effectiveness of PBM.

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.

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

PubMed

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

2018-02-01

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

Benefits and Costs of Brine Extraction for Increasing Injection Efficiency In geologic CO2 Sequestration

DOE PAGES

Davidson, Casie L.; Watson, David J.; Dooley, James J.; ...

2014-12-31

Pressure increases attendant with CO2 injection into the subsurface drive many of the risk factors associated with commercial-scale CCS projects, impacting project costs and liabilities in a number of ways. The area of elevated pressure defines the area that must be characterized and monitored; pressure drives fluid flow out of the storage reservoir along higher-permeability pathways that might exist through the caprock into overlying aquifers or hydrocarbon reservoirs; and pressure drives geomechanical changes that could potentially impact subsurface infrastructure or the integrity of the storage system itself. Pressure also limits injectivity, which can increase capital costs associated with installing additionalmore » wells to meet a given target injection rate. The ability to mitigate pressure increases in storage reservoirs could have significant value to a CCS project, but these benefits are offset by the costs of the pressure mitigation technique itself. Of particular interest for CO2 storage operators is the lifetime cost of implementing brine extraction at a CCS project site, and the relative value of benefits derived from the extraction process. This is expected to vary from site to site and from one implementation scenario to the next. Indeed, quantifying benefits against costs could allow operators to optimize their return on project investment by calculating the most effective scenario for pressure mitigation. This work builds on research recently submitted for publication by the authors examining the costs and benefits of brine extraction across operational scenarios to evaluate the effects of fluid extraction on injection rate to assess the cost effectiveness of several options for reducing the number of injection wells required. Modeling suggests that extracting at 90% of the volumetric equivalent of injection rate resulted in a 1.8% improvement in rate over a non-extraction base case; a four-fold increase in extraction rate results in a 7.6% increase in injection rate over the no-extraction base case. However, the practical impacts on capital costs suggest that this strategy is fiscally ineffective when evaluated solely on this metric, with extraction reducing injection well needs by only one per 56 (1x case) or one per 13 (4x case).« less

Benefits and Costs of Brine Extraction for Increasing Injection Efficiency In geologic CO2 Sequestration

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

Davidson, Casie L.; Watson, David J.; Dooley, James J.

Pressure increases attendant with CO2 injection into the subsurface drive many of the risk factors associated with commercial-scale CCS projects, impacting project costs and liabilities in a number of ways. The area of elevated pressure defines the area that must be characterized and monitored; pressure drives fluid flow out of the storage reservoir along higher-permeability pathways that might exist through the caprock into overlying aquifers or hydrocarbon reservoirs; and pressure drives geomechanical changes that could potentially impact subsurface infrastructure or the integrity of the storage system itself. Pressure also limits injectivity, which can increase capital costs associated with installing additionalmore » wells to meet a given target injection rate. The ability to mitigate pressure increases in storage reservoirs could have significant value to a CCS project, but these benefits are offset by the costs of the pressure mitigation technique itself. Of particular interest for CO2 storage operators is the lifetime cost of implementing brine extraction at a CCS project site, and the relative value of benefits derived from the extraction process. This is expected to vary from site to site and from one implementation scenario to the next. Indeed, quantifying benefits against costs could allow operators to optimize their return on project investment by calculating the most effective scenario for pressure mitigation. This work builds on research recently submitted for publication by the authors examining the costs and benefits of brine extraction across operational scenarios to evaluate the effects of fluid extraction on injection rate to assess the cost effectiveness of several options for reducing the number of injection wells required. Modeling suggests that extracting at 90% of the volumetric equivalent of injection rate resulted in a 1.8% improvement in rate over a non-extraction base case; a four-fold increase in extraction rate results in a 7.6% increase in injection rate over the no-extraction base case. However, the practical impacts on capital costs suggest that this strategy is fiscally ineffective when evaluated solely on this metric, with extraction reducing injection well needs by only one per 56 (1x case) or one per 13 (4x case).« less

Walnut Creek and Squaw Creek Watersheds, Iowa: National Institute of Food and Agriculture-Conservation Effects Assessment Project

USDA-ARS?s Scientific Manuscript database

The Walnut Creek Watershed NIFA-CEAP Watershed project was designed to assess water quality benefits and economic costs from the adoption of a prairie ecosystem (conservation practice implementation) at a watershed scale. This chapter describes and summarizes the paired watershed (Walnut Creek and S...

Performance evaluation of court in construction claims settlement of litigation

NASA Astrophysics Data System (ADS)

Hayati, Kemala; Latief, Yusuf; Rarasati, Ayomi Dita; Siddik, Arief

2017-06-01

Claim construction has a major influence on the implementation of projects, such as the cost and time. The success of the construction project is highly dependent on the effective resolution of claims. Although it has been recognized that litigation or court is not the best way because it may reduce or eliminate profits and damage the relationship, it is a method of resolving claims and disputes that is common in the world of construction. The method of resolving claims and disputes through litigation or court may solve the problem in an alternative method, namely the implementation of the judgment which can be enforced effectively against the losing party and the ruling which has the force of law of the country where the claims and disputes are examined. However, litigation or court may take longer time and require high cost. Thus, it is necessary to identify factors affecting the performance of the court and to develop a system capable of improving an existing system in order to run more effectively and efficiently. Resolution in the claims management of construction projects with the method of litigation is a procedure that can be used by the courts in order to shorten the time in order to reduce the cost. The scope of this research is directed to all parties involved in the construction, both the owners and the contractors as implementers and practitioners, as well as experts who are experienced in construction law.

Implementation of methadone therapy for opioid use disorder in Russia - a modeled cost-effectiveness analysis.

PubMed

Idrisov, Bulat; Murphy, Sean M; Morrill, Tyler; Saadoun, Mayada; Lunze, Karsten; Shepard, Donald

2017-01-20

Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD. We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%. Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million. Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa.

PubMed

Aranda-Jan, Clara B; Mohutsiwa-Dibe, Neo; Loukanova, Svetla

2014-02-21

Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Forty-four studies on mHealth projects in Africa were included and classified as: "patient follow-up and medication adherence" (n = 19), "staff training, support and motivation" (n = 2), "staff evaluation, monitoring and guidelines compliance" (n = 4), "drug supply-chain and stock management" (n = 2), "patient education and awareness" (n = 1), "disease surveillance and intervention monitoring" (n = 4), "data collection/transfer and reporting" (n = 10) and "overview of mHealth projects" (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources. mHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.

Industrial Technology Modernization Program. Project 44. Modernize Facility Equipment and Processes. Volume 2. Revision 2. Phase 2

DTIC Science & Technology

1988-05-01

not be implemented. A change in foreign exchange rates (which increase the equipment cost) and a reduction in marketing forecast resulted in an...project will not be implemented due to unfavorable changes in foreign exchange rates (which increase the equipment costs) and a reduction in market

The NGEE Arctic Data Archive -- Portal for Archiving and Distributing Data and Documentation

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

Boden, Thomas A; Palanisamy, Giri; Devarakonda, Ranjeet

2014-01-01

The Next-Generation Ecosystem Experiments (NGEE Arctic) project is committed to implementing a rigorous and high-quality data management program. The goal is to implement innovative and cost-effective guidelines and tools for collecting, archiving, and sharing data within the project, the larger scientific community, and the public. The NGEE Arctic web site is the framework for implementing these data management and data sharing tools. The open sharing of NGEE Arctic data among project researchers, the broader scientific community, and the public is critical to meeting the scientific goals and objectives of the NGEE Arctic project and critical to advancing the mission ofmore » the Department of Energy (DOE), Office of Science, Biological and Environmental (BER) Terrestrial Ecosystem Science (TES) program.« less

Adoption of Building Information Modelling in project planning risk management

NASA Astrophysics Data System (ADS)

Mering, M. M.; Aminudin, E.; Chai, C. S.; Zakaria, R.; Tan, C. S.; Lee, Y. Y.; Redzuan, A. A.

2017-11-01

An efficient and effective risk management required a systematic and proper methodology besides knowledge and experience. However, if the risk management is not discussed from the starting of the project, this duty is notably complicated and no longer efficient. This paper presents the adoption of Building Information Modelling (BIM) in project planning risk management. The objectives is to identify the traditional risk management practices and its function, besides, determine the best function of BIM in risk management and investigating the efficiency of adopting BIM-based risk management during the project planning phase. In order to obtain data, a quantitative approach is adopted in this research. Based on data analysis, the lack of compliance with project requirements and failure to recognise risk and develop responses to opportunity are the risks occurred when traditional risk management is implemented. When using BIM in project planning, it works as the tracking of cost control and cash flow give impact on the project cycle to be completed on time. 5D cost estimation or cash flow modeling benefit risk management in planning, controlling and managing budget and cost reasonably. There were two factors that mostly benefit a BIM-based technology which were formwork plan with integrated fall plan and design for safety model check. By adopting risk management, potential risks linked with a project and acknowledging to those risks can be identified to reduce them to an acceptable extent. This means recognizing potential risks and avoiding threat by reducing their negative effects. The BIM-based risk management can enhance the planning process of construction projects. It benefits the construction players in various aspects. It is important to know the application of BIM-based risk management as it can be a lesson learnt to others to implement BIM and increase the quality of the project.

Field Evaluation of Fracture Control in Tunnel Blasting

DOT National Transportation Integrated Search

1979-12-01

The objective of this research was to implement fracture control procedures in a tunnel project and to assess the practicality, advantages, disadvantages, performance and cost effectiveness of fracture control methods against smooth blasting procedur...

Evaluation of a multimedia information system for endoscopy

NASA Astrophysics Data System (ADS)

Enning, C. John W.; Siersema, Peter D.; van Blankenstein, Mark; van Boven, Gert-Jan; van Gennip, Elisabeth M.

1996-05-01

In a cooperation between the University Hospital Rotterdam (AZR) and HISCOM, HIS supplier, a multimedia information system for endoscopy (ENSIS) has been developed in a project funded by the Dutch Ministry of Health Care. An integral part of this project was an evaluation of costs and effects of this system. The system has been implemented on the gastroenterology department and the internal medicine ward in the AZR. The results indicate that the anatomical knowledge of requesting physicians improved with the system. Both the response time and availability of endoscopy images improved greatly. Because of the use of off-the-shelve technology (possible because of the relatively small resolution requirements of endoscopy images) ENSIS can be implemented at relatively low costs.

Cost-effectiveness of hypertension therapy according to 2014 guidelines.

PubMed

Moran, Andrew E; Odden, Michelle C; Thanataveerat, Anusorn; Tzong, Keane Y; Rasmussen, Petra W; Guzman, David; Williams, Lawrence; Bibbins-Domingo, Kirsten; Coxson, Pamela G; Goldman, Lee

2015-01-29

On the basis of the 2014 guidelines for hypertension therapy in the United States, many eligible adults remain untreated. We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines. We used the Cardiovascular Disease Policy Model to simulate drug-treatment and monitoring costs, costs averted for the treatment of cardiovascular disease, and quality-adjusted life-years (QALYs) gained by treating previously untreated adults between the ages of 35 and 74 years from 2014 through 2024. We assessed cost-effectiveness according to age, hypertension level, and the presence or absence of chronic kidney disease or diabetes. The full implementation of the new hypertension guidelines would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. The projections showed that the treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. The treatment of stage 1 hypertension was cost-effective (defined as <$50,000 per QALY) for all men and for women between the ages of 45 and 74 years, whereas treating women between the ages of 35 and 44 years with stage 1 hypertension but without cardiovascular disease had intermediate or low cost-effectiveness. The implementation of the 2014 hypertension guidelines for U.S. adults between the ages of 35 and 74 years could potentially prevent about 56,000 cardiovascular events and 13,000 deaths annually, while saving costs. Controlling hypertension in all patients with cardiovascular disease or stage 2 hypertension could be effective and cost-saving. (Funded by the National Heart, Lung, and Blood Institute and others.).

Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

PubMed Central

2014-01-01

Background Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. Methods A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Results Forty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources. Conclusions mHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system. PMID:24555733

A Process Evaluation of Project Developmental Continuity. Interim Report IV, Volume 2: Development of the Implementation and Cost Studies.

ERIC Educational Resources Information Center

Smith, Allen G.; And Others

This interim report describes the development of program implementation and cost studies for Year II of the process evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. Specific areas focused…

Design and Implementation of a Mechanical Control System for the Scanning Microwave Limb Sounder

NASA Technical Reports Server (NTRS)

Bowden, William

2011-01-01

The Scanning Microwave Limb Sounder (SMLS) will use technological improvements in low noise mixers to provide precise data on the Earth's atmospheric composition with high spatial resolution. This project focuses on the design and implementation of a real time control system needed for airborne engineering tests of the SMLS. The system must coordinate the actuation of optical components using four motors with encoder readback, while collecting synchronized telemetric data from a GPS receiver and 3-axis gyrometric system. A graphical user interface for testing the control system was also designed using Python. Although the system could have been implemented with a FPGA-based setup, we chose to use a low cost processor development kit manufactured by XMOS. The XMOS architecture allows parallel execution of multiple tasks on separate threads-making it ideal for this application and is easily programmed using XC (a subset of C). The necessary communication interfaces were implemented in software, including Ethernet, with significant cost and time reduction compared to an FPGA-based approach. For these reasons, the XMOS technology is an attractive, cost effective, alternative to FPGA-based technologies for this design and similar rapid prototyping projects.

River and riparian restoration in the southwest: Results of the National River Restoration Science Synthesis project

USGS Publications Warehouse

Follstad, Shah J.J.; Dahm, Clifford N.; Gloss, S.P.; Bernhardt, E.S.

2007-01-01

Restoration activity has exponentially increased across the Southwest since 1990. Over 37,000 records were compiled into the National River Restoration Science Synthesis (NRRSS) database to summarize restoration trends and assess project effectiveness. We analyzed data from 576 restoration projects in the Southwest (NRRSS-SW). More than 50% of projects were less than or equal to 3 km in length. The most common restoration project intent categories were riparian management, water quality management, in-stream habitat improvement, and flow modification. Common project activities were well matched to goals. Conservative estimates of total restoration costs exceeded $500 million. Most restoration dollars have been allocated to flow modification and water quality management. Monitoring was linked to 28% of projects across the Southwest, as opposed to just 10% nationwide. Mean costs were statistically similar whether or not projects were monitored. Results from 48 telephone interviews provided validation of NRRSS-SW database analyses but showed that project costs are often underreported within existing datasets. The majority of interviewees considered their projects to be successful, most often based upon observed improvements to biota or positive public reaction rather than evaluation of field data. The efficacy of restoration is difficult to ascertain given the dearth of information contained within most datasets. There is a great need for regional entities that not only track information on project implementation but also maintain and analyze monitoring data associated with restoration. Agencies that fund or regulate restoration should reward projects that emphasize monitoring and evaluation as much as project implementation. ?? 2007 Society for Ecological Restoration International.

The costs and cost-efficiency of providing food through schools in areas of high food insecurity.

PubMed

Gelli, Aulo; Al-Shaiba, Najeeb; Espejo, Francisco

2009-03-01

The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity. To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP). Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs. The choice of program objectives will to a large degree dictate the food modality (biscuits, cooked meals, or take-home rations) and associated implementation costs. Fortified biscuits can provide substantial nutritional inputs at a fraction of the cost of school meals, making them an appealing option for service delivery in food-insecure contexts. Both costs and effects should be considered carefully when designing the appropriate school-based intervention. The costs estimates in this analysis do not include all school-level costs and are therefore lower-bound estimates of full implementation costs.

33 CFR 385.13 - Projects implemented under additional program authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementation Report is prepared and approved in accordance with § 385.26; and (3) Not exceed a total cost of... RESTORATION PLAN CERP Implementation Processes § 385.13 Projects implemented under additional program authority. (a) To expedite implementation of the Plan, the Corps of Engineers and non-Federal sponsors may...

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

NASA Astrophysics Data System (ADS)

Fryling, Meg

2010-11-01

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

Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs

PubMed Central

Conti, Matthew S

2013-01-01

Objective To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. Data National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. Study Design A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Data Extraction Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. Principal Findings In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. Conclusions States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. PMID:23278435

Effect of Medicaid disease management programs on emergency admissions and inpatient costs.

PubMed

Conti, Matthew S

2013-08-01

To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.

A cost effective bioremediation strategy using low technology resources for reclamation of dry land hydrocarbon contamination: A case study

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

Robb, A.J. III; Hoggatt, P.R.

Hydrocarbon containing soil was bioremediated at a combination wastewater and slop oil skim evaporation pond utilizing cost effective low technology resources. Fluids and sludge from the football field-sized pond were extraction procedure toxicity and purgeable organics tested, and total petroleum hydrocarbon (TPH) concentrations determined. An impact risk analysis was performed, and a corrective action plan developed and implemented. The three year project was closely coordinated with the Kansas Corporation Commission (KCC) and the Kansas Department of Health and Environment (KDHE) who established the closure level. The impacted soils at the pond were completely excavated and closure was immediately granted bymore » KDHE for the excavated area. The 24,000 cubic yards of excavated soil were then surface spread on adjacent Mobil property. A nutrient and microbial base was applied to bioaugment the soil. The preapplication land surface and the subsequently land farmed soil was periodically disced and chiseled. A job safety plan including industrial hygiene measures to eliminate workforce exposure was developed and implemented. The final remediation cost analysis amounts to $1.48 per cubic yard compared to the $30 to $150 per cubic yard industry o estimates for similar projects. Several factors were critical in ailing costs to remain so low: (1) assessment and implementation by local in-house staff, (2) conservative remedial action plan and sampling strategy; (3) local contractors; (4) locally available soil amendment; and (5) effective regulatory coordination. The methods described can be used to cost effectively characterize and bioremediate other sites where hydrocarbon-impacted soils exist in similar dry-land environments.« less

The role of policy in improving diets: experiences from the Pacific Obesity Prevention in Communities food policy project.

PubMed

Thow, A M; Snowdon, W; Schultz, J T; Leeder, S; Vivili, P; Swinburn, B A

2011-11-01

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

Financial management of a hospice program.

PubMed

Simione, Robert J; Simione, Kathleen A

2002-07-01

Agencies interested in starting hospice programs or maximizing the benefits of existing programs need to implement and maintain accurate and effective internal cost accounting systems. Once established, a cost accounting system provides the administrators of the hospice program with information to prepare budget projections, perform break-even analysis, and develop other reports to assist in making sound business decisions to ensure success.

Bidding cost evaluation with fuzzy methods on building project in Jakarta

NASA Astrophysics Data System (ADS)

Susetyo, Budi; Utami, Tin Budi

2017-11-01

National construction companies today demanded to become more competitive to face increasingly competition. Every construction company especially the contractor must work better than ever. Ability to prepare cost of the work that represents the efficiency and effectiveness of the implementation of the work necessary to produce cost - competitive. The project is considered successful if the target meets the quality, cost and time. From the aspect of cost, the project has been designed in accordance with certain technical criteria to be taken into account based on standard costs. To ensure the cost efficiency of the bidding process carried out meet the rules of a fairly and competitive. The research objective is to formulate the proper way to compare several deals with the standard cost of the work. The fuzzy technique is used as a evaluation methods to decision making. The evaluation not merely based on the lowest prices. The methods is looking for the most valuable and reasonable prices. The comparison is conducted to determine the most cost-competitive and reasonable as the winner of the bidding.

Technical Report on Application and Development of Appropriate Tools and Technologies for Cost-Effective Carbon Sequestration

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

Bill Stanley; Sandra Brown; Zoe Kant

2009-01-07

The Nature Conservancy participated in a Cooperative Agreement with the Department of Energy (DOE) National Energy Technology Laboratory (NETL) to explore the compatibility of carbon sequestration in terrestrial ecosystems and the conservation of biodiversity. The title of the research project was 'Application and Development of Appropriate Tools and Technologies for Cost-Effective Carbon Sequestration'. The objectives of the project were to: (1) improve carbon offset estimates produced in both the planning and implementation phases of projects; (2) build valid and standardized approaches to estimate project carbon benefits at a reasonable cost; and (3) lay the groundwork for implementing cost-effective projects, providingmore » new testing ground for biodiversity protection and restoration projects that store additional atmospheric carbon. This Final Technical Report discusses the results of the six tasks that The Nature Conservancy undertook to answer research needs while facilitating the development of real projects with measurable greenhouse gas reductions. The research described in this report occurred between July 1st 2001 and July 10th 2008. The specific tasks discussed include: Task 1: carbon inventory advancements; Task 2: emerging technologies for remote sensing of terrestrial carbon; Task 3: baseline method development; Task 4: third-party technical advisory panel meetings; Task 5: new project feasibility studies; and Task 6: development of new project software screening tool. The project occurred in two phases. The first was a focused exploration of specific carbon measurement and monitoring methodologies and pre-selected carbon sequestration opportunities. The second was a more systematic and comprehensive approach to compare various competing measurement and monitoring methodologies, and assessment of a variety of carbon sequestration opportunities in order to find those that are the lowest cost with the greatest combined carbon and other environmental benefits. In the first phase we worked in the U.S., Brazil, Belize, Bolivia, Peru, and Chile to develop and refine specific carbon inventory methods, pioneering a new remote-sensing method for cost-effectively measuring and monitoring terrestrial carbon sequestration and system for developing carbon baselines for both avoided deforestation and afforestation/reforestation projects. We evaluated the costs and carbon benefits of a number of specific terrestrial carbon sequestration activities throughout the U.S., including reforestation of abandoned mined lands in southwest Virginia, grassland restoration in Arizona and Indiana, and reforestation in the Mississippi Alluvial Delta. The most cost-effective U.S. terrestrial sequestration opportunity we found through these studies was reforestation in the Mississippi Alluvial Delta. In Phase II we conducted a more systematic assessment and comparison of several different measurement and monitoring approaches in the Northern Cascades of California, and a broad 11-state Northeast regional assessment, rather than pre-selected and targeted, analysis of terrestrial sequestration costs and benefits. Work was carried out in Brazil, Belize, Chile, Peru and the USA. Partners include the Winrock International Institute for Agricultural Development, The Sampson Group, Programme for Belize, Society for Wildlife Conservation (SPVS), Universidad Austral de Chile, Michael Lefsky, Colorado State University, UC Berkeley, the Carnegie Institution of Washington, ProNaturaleza, Ohio State University, Stephen F. Austin University, Geographical Modeling Services, Inc., WestWater, Los Alamos National Laboratory, Century Ecosystem Services, Mirant Corporation, General Motors, American Electric Power, Salt River Project, Applied Energy Systems, KeySpan, NiSource, and PSEG. This project, 'Application and Development of Appropriate Tools and Technologies for Cost-Effective Carbon Sequestration', has resulted in over 50 presentations and reports, available publicly through the Department of Energy or by visiting the links listed in Appendix 1. More important than the reports, the project has helped to lead to the development of on-the-ground projects in Southwestern Virginia, Louisiana, and Chile while informing policy development in Virginia, the Regional Greenhouse Gas Initiative, the California Climate Action Registry and U.S. and international programs.« less

Construction of crack-free bridge decks.

DOT National Transportation Integrated Search

2017-04-01

This serves as the final report on Transportation Pooled-Fund Program Project No. TPF-5(174), Construction : of Crack-Free Bridge Decks. The goal of the study was to implement the most cost-effective techniques for : improving bridge deck life ...

Influence of the economy crisis on project cost management

NASA Astrophysics Data System (ADS)

Simankina, Tatyana; Ćetković, Jasmina; Verstina, Natalia; Evseev, Evgeny

2017-10-01

Economy crisis significantly affects primarily the project cost management. The article considers the problems of project management in the field of housing under conditions of economy crisis. Project budgets are reduced, their mutual interference grows and framework of risks changes. Apparently, specific approaches are required to be developed to optimize the expenses and guarantee the project implementation within the approved budget. There is considered domestic and foreign experience in terms of project cost management with involvement of BIM technologies.

Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

PubMed

Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

2017-08-01

Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

A methodology for the evaluation of program cost and schedule risk for the SEASAT program

NASA Technical Reports Server (NTRS)

Abram, P.; Myers, D.

1976-01-01

An interactive computerized project management software package (RISKNET) is designed to analyze the effect of the risk involved in each specific activity on the results of the total SEASAT-A program. Both the time and the cost of each distinct activity can be modeled with an uncertainty interval so as to provide the project manager with not only the expected time and cost for the completion of the total program, but also with the expected range of costs corresponding to any desired level of significance. The nature of the SEASAT-A program is described. The capabilities of RISKNET and the implementation plan of a RISKNET analysis for the development of SEASAT-A are presented.

Clinical and financial considerations for implementing an ICU telemedicine program.

PubMed

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

2014-06-01

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

The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review.

PubMed

Zhou, Carrol; Crawford, Allison; Serhal, Eva; Kurdyak, Paul; Sockalingam, Sanjeev

2016-10-01

Project Extension for Community Healthcare Outcomes (ECHO) uses tele-education to bridge knowledge gaps between specialists at academic health centers and primary care providers from remote areas. It has been implemented to address multiple medical conditions. The authors examined evidence of the impact of all Project ECHO programs on participant and patient outcomes. The authors searched PubMed, MEDLINE, EMBASE, PsycINFO, and ProQuest from January 2000 to August 2015 and the reference lists of identified reviews. Included studies were limited to those published in English, peer-reviewed articles or indexed abstracts, and those that primarily focused on Project ECHO. Editorials, commentaries, gray literature, and non-peer-reviewed articles were excluded. The authors used Moore's evaluation framework to organize study outcomes for quality assessment. The authors identified 39 studies describing Project ECHO's involvement in addressing 17 medical conditions. Evaluations of Project ECHO programs generally were limited to outcomes from Levels 1 (number of participants) to 4 (providers' competence) of Moore's framework (n = 22 studies, with some containing data from multiple levels). Studies also suggested that Project ECHO changed provider behavior (n = 1), changed patient outcomes (n = 6), and can be cost-effective (n = 2). Project ECHO is an effective and potentially cost-saving model that increases participant knowledge and patient access to health care in remote locations, but further research examining its efficacy is needed. Identifying and addressing potential barriers to Project ECHO's implementation will support the dissemination of this model as an education and practice improvement initiative.

Risk Analysis of Underestimate Cost Offer to The Project Quality in Aceh Province

NASA Astrophysics Data System (ADS)

Rani, Hafnidar A.

2016-11-01

The possibility of errors in the process of offer price determination could be enormous, so it can affect the possibility of project underestimate cost which can impact and reduce the profit if being implementing. Government Equipment/Service Procurement Policy Institution (LKPP) assesses that the practices of cheaper price in the government equipment/service procurement are still highly found and can be potential to decrease the project quality. This study aimed to analyze the most dominant factors happened in underestimate cost offer practice, to analyze the relationship of underestimate cost offer risk factors to road construction project quality in Aceh Province and to analyze the most potential factors of underestimate cost offer risk affecting road construction project quality in Aceh Province. Road construction projects observed the projects which have been implemented in Aceh Province since 2013 - 2015. This study conducted by interviewing Government Budget Authority (KPA), and distributing the questionnaire to the road construction contractors with the qualification of K1, K2, K3, M1, M2 and B1. Based on the data from Construction Service Development Institution (LPJK) of Aceh Province on 2016, the populations obtained are 2,717 constructors. By using Slovin Equation, the research samples obtained are 97 contractors. The most dominant factors in underestimate cost offer risk of the road construction projects in Aceh Province is Contingency Cost Factor which the mean is 4.374.

Estimating the Cost to do a Cost Estimate

NASA Technical Reports Server (NTRS)

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

1998-01-01

This article provides a model for estimating the cost required to do a cost estimate. Overruns may lead to concellation of a project. In 1991, we completed a study on the cost of doing cost estimates for the class of projects normally encountered in the development and implementation of equipment at the network of tracking stations operated by the Jet Propulsion Laboratory (JPL) for NASA.

Managing laboratory automation in a changing pharmaceutical industry

PubMed Central

Rutherford, Michael L.

1995-01-01

The health care reform movement in the USA and increased requirements by regulatory agencies continue to have a major impact on the pharmaceutical industry and the laboratory. Laboratory management is expected to improve effciency by providing more analytical results at a lower cost, increasing customer service, reducing cycle time, while ensuring accurate results and more effective use of their staff. To achieve these expectations, many laboratories are using robotics and automated work stations. Establishing automated systems presents many challenges for laboratory management, including project and hardware selection, budget justification, implementation, validation, training, and support. To address these management challenges, the rationale for project selection and implementation, the obstacles encountered, project outcome, and learning points for several automated systems recently implemented in the Quality Control Laboratories at Eli Lilly are presented. PMID:18925014

Vital signs: melanoma incidence and mortality trends and projections - United States, 1982-2030.

PubMed

Guy, Gery P; Thomas, Cheryll C; Thompson, Trevor; Watson, Meg; Massetti, Greta M; Richardson, Lisa C

2015-06-05

Melanoma incidence rates have continued to increase in the United States, and risk behaviors remain high. Melanoma is responsible for the most skin cancer deaths, with about 9,000 persons dying from it each year. CDC analyzed current (2011) melanoma incidence and mortality data, and projected melanoma incidence, mortality, and the cost of treating newly diagnosed melanomas through 2030. Finally, CDC estimated the potential melanoma cases and costs averted through 2030 if a comprehensive skin cancer prevention program was implemented in the United States. In 2011, the melanoma incidence rate was 19.7 per 100,000, and the death rate was 2.7 per 100,000. Incidence rates are projected to increase for white males and females through 2019. Death rates are projected to remain stable. The annual cost of treating newly diagnosed melanomas was estimated to increase from $457 million in 2011 to $1.6 billion in 2030. Implementation of a comprehensive skin cancer prevention program was estimated to avert 230,000 melanoma cases and $2.7 billion in initial year treatment costs from 2020 through 2030. If additional prevention efforts are not undertaken, the number of melanoma cases is projected to increase over the next 15 years, with accompanying increases in health care costs. Much of this morbidity, mortality, and health care cost can be prevented. Substantial reductions in melanoma incidence, mortality, and cost can be achieved if evidence-based comprehensive interventions that reduce ultraviolet (UV) radiation exposure and increase sun protection are fully implemented and sustained.

Prototyping a bedside documentation system.

PubMed

Bachand, P; Bobis, K

1993-01-01

The implementation of a comprehensive bedside documentation system is a major project that demands careful analysis and planning. Since the cost of a typical bedside system can easily exceed $3 million, a design oversight could have disastrous effects on the benefits of the system.

Evaluation of cost effective protective coatings for ODOT snow & ice equipment.

DOT National Transportation Integrated Search

2016-04-01

Current estimates suggest that the United States loses over $220 billion dollars due to corrosion each year. The research results from this project further ODOTs effort to implement a corrosion prevention strategy that will increase public safety ...

Implementing Effective Mission Systems Engineering Practices During Early Project Formulation Phases

NASA Technical Reports Server (NTRS)

Moton, Tryshanda

2016-01-01

Developing and implementing a plan for a NASA space mission can be a complicated process. The needs, goals, and objectives of any proposed mission or technology must be assessed early in the Project Life Cycle. The key to successful development of a space mission or flight project is the inclusion of systems engineering in early project formulation, namely during Pre-phase A, Phase A, and Phase B of the NASA Project Life Cycle. When a space mission or new technology is in pre-development, or "pre-Formulation", feasibility must be determined based on cost, schedule, and risk. Inclusion of system engineering during project formulation is key because in addition to assessing feasibility, design concepts are developed and alternatives to design concepts are evaluated. Lack of systems engineering involvement early in the project formulation can result in increased risks later in the implementation and operations phases of the project. One proven method for effective systems engineering practice during the pre-Formulation Phase is the use of a mission conceptual design or technology development laboratory, such as the Mission Design Lab (MDL) at NASA's Goddard Space Flight Center (GSFC). This paper will review the engineering process practiced routinely in the MDL for successful mission or project development during the pre-Formulation Phase.

JPL's Approach for Helping Flight Project Managers Meet Today's Management Challenges

NASA Technical Reports Server (NTRS)

Leising, Charles J.

2004-01-01

All across NASA project managers are facing tough new challenges. NASA has imposed increased oversight and the number of projects at Centers such as JPL has exploded from a handful of large projects to a much greater number of smaller ones. Experienced personnel are retiring at increasing rates and younger, less experienced managers are being rapidly promoted up the ladder. Budgets are capped, competition among NASA Centers and Federally Funded Research and Development Centers (FFRDCs) has increased significantly and there is no longer any tolerance to cost overruns. On top of all this, implementation schedules have been reduced by 25 to 50% to reduce run-out costs, making it even more difficult to define requirements, validate heritage assumptions and make accurate cost estimates during the early phases of the life-cycle.JPL's executive management, under the leadership of the Associate Director for Flight Projects and Mission Success, have attempted to meet these challenges by improving operations in five areas: (1) increased standardization, where it is judged to have significant benefit; (2) better balance and more effective partnering between projects and the line management; (3) increased infrastructure support; (4) improved management training; and (5) more effective review and oversight.

The cost-savings of implementing kangaroo mother care in Nicaragua.

PubMed

Broughton, Edward I; Gomez, Ivonne; Sanchez, Nieves; Vindell, Concepción

2013-09-01

To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010 The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (P = 0.017) and 71% were exclusively breastfed (P < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1 - 2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.

Reengineering the Project Design Process

NASA Technical Reports Server (NTRS)

Casani, E.; Metzger, R.

1994-01-01

In response to NASA's goal of working faster, better and cheaper, JPL has developed extensive plans to minimize cost, maximize customer and employee satisfaction, and implement small- and moderate-size missions. These plans include improved management structures and processes, enhanced technical design processes, the incorporation of new technology, and the development of more economical space- and ground-system designs. The Laboratory's new Flight Projects Implementation Office has been chartered to oversee these innovations and the reengineering of JPL's project design process, including establishment of the Project Design Center and the Flight System Testbed. Reengineering at JPL implies a cultural change whereby the character of its design process will change from sequential to concurrent and from hierarchical to parallel. The Project Design Center will support missions offering high science return, design to cost, demonstrations of new technology, and rapid development. Its computer-supported environment will foster high-fidelity project life-cycle development and cost estimating.

Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association.

PubMed

Ovbiagele, Bruce; Goldstein, Larry B; Higashida, Randall T; Howard, Virginia J; Johnston, S Claiborne; Khavjou, Olga A; Lackland, Daniel T; Lichtman, Judith H; Mohl, Stephanie; Sacco, Ralph L; Saver, Jeffrey L; Trogdon, Justin G

2013-08-01

Stroke is a leading cause of disability, cognitive impairment, and death in the United States and accounts for 1.7% of national health expenditures. Because the population is aging and the risk of stroke more than doubles for each successive decade after the age of 55 years, these costs are anticipated to rise dramatically. The objective of this report was to project future annual costs of care for stroke from 2012 to 2030 and discuss potential cost reduction strategies. The American Heart Association/American Stroke Association developed methodology to project the future costs of stroke-related care. Estimates excluded costs associated with other cardiovascular diseases (hypertension, coronary heart disease, and congestive heart failure). By 2030, 3.88% of the US population>18 years of age is projected to have had a stroke. Between 2012 and 2030, real (2010$) total direct annual stroke-related medical costs are expected to increase from $71.55 billion to $183.13 billion. Real indirect annual costs (attributable to lost productivity) are projected to rise from $33.65 billion to $56.54 billion over the same period. Overall, total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129%. These projections suggest that the annual costs of stroke will increase substantially over the next 2 decades. Greater emphasis on implementing effective preventive, acute care, and rehabilitative services will have both medical and societal benefits.

Cheap and Nasty? The Potential Perils of Using Management Costs to Identify Global Conservation Priorities

PubMed Central

McCreless, Erin; Visconti, Piero; Carwardine, Josie; Wilcox, Chris; Smith, Robert J.

2013-01-01

The financial cost of biodiversity conservation varies widely around the world and such costs should be considered when identifying countries to best focus conservation investments. Previous global prioritizations have been based on global models for protected area management costs, but this metric may be related to other factors that negatively influence the effectiveness and social impacts of conservation. Here we investigate such relationships and first show that countries with low predicted costs are less politically stable. Local support and capacity can mitigate the impacts of such instability, but we also found that these countries have less civil society involvement in conservation. Therefore, externally funded projects in these countries must rely on government agencies for implementation. This can be problematic, as our analyses show that governments in countries with low predicted costs score poorly on indices of corruption, bureaucratic quality and human rights. Taken together, our results demonstrate that using national-level estimates for protected area management costs to set global conservation priorities is simplistic, as projects in apparently low-cost countries are less likely to succeed and more likely to have negative impacts on people. We identify the need for an improved approach to develop global conservation cost metrics that better capture the true costs of avoiding or overcoming such problems. Critically, conservation scientists must engage with practitioners to better understand and implement context-specific solutions. This approach assumes that measures of conservation costs, like measures of conservation value, are organization specific, and would bring a much-needed focus on reducing the negative impacts of conservation to develop projects that benefit people and biodiversity. PMID:24260502

Economic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer.

PubMed

Marshall, Deborah A; Lopatina, Elena; Lacny, Sarah; Emery, Carolyn A

2016-11-01

There is randomised controlled trial (RCT) evidence that neuromuscular training (NMT) programmes can reduce the risk of injury in youth soccer. We evaluated the cost-effectiveness of such an NMT prevention strategy compared to a standard of practice warm-up. A cost-effectiveness analysis was conducted alongside a cluster RCT. Injury incidence rates were adjusted for cluster using Poisson regression analyses. Direct healthcare costs and injury incidence proportions were adjusted for cluster using bootstrapping. The joint uncertainty surrounding the cost and injury rate and proportion differences was estimated using bootstrapping with 10 000 replicates. Along with a 38% reduction in injury risk (rate difference=-1.27/1000 player hours (95% CI -0.33 to -2.2)), healthcare costs were reduced by 43% in the NMT group (-$689/1000 player hours (95% CI -$1741 to $234)) compared with the control group. 90% of the bootstrapped ratios were in the south-west quadrant of the cost-effectiveness plane, showing that the NMT programme was dominant (more effective and less costly) over standard warm-up. Projecting results onto 58 100 Alberta youth soccer players, an estimated 4965 injuries and over $2.7 million in healthcare costs would be conservatively avoided in one season with implementation of a neuromuscular training prevention programme. Implementation of an NMT prevention programme in youth soccer is effective in reducing the burden of injury and leads to considerable reduction in costs. These findings inform practice and policy supporting the implementation of NMT prevention strategies in youth soccer nationally and internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Perverse effects of carbon markets on HFC-23 and SF6 abatement projects in Russia

NASA Astrophysics Data System (ADS)

Schneider, Lambert; Kollmuss, Anja

2015-12-01

Carbon markets are considered a key policy tool to achieve cost-effective climate mitigation. Project-based carbon market mechanisms allow private sector entities to earn tradable emissions reduction credits from mitigation projects. The environmental integrity of project-based mechanisms has been subject to controversial debate and extensive research, in particular for projects abating industrial waste gases with a high global warming potential (GWP). For such projects, revenues from credits can significantly exceed abatement costs, creating perverse incentives to increase production or generation of waste gases as a means to increase credit revenues from waste gas abatement. Here we show that all projects abating HFC-23 and SF6 under the Kyoto Protocol’s Joint Implementation mechanism in Russia increased waste gas generation to unprecedented levels once they could generate credits from producing more waste gas. Our results suggest that perverse incentives can substantially undermine the environmental integrity of project-based mechanisms and that adequate regulatory oversight is crucial. Our findings are critical for mechanisms in both national jurisdictions and under international agreements.

Financial Implications of Implementing an E-Learning Project

ERIC Educational Resources Information Center

Sharma, Kunal

2011-01-01

Purpose: This paper aims to outline the financial implications, while deploying information and communication technologies for implementing e-learning, and to elucidate them, while implementing an e-learning project in a conventional university environment. Design/methodology/approach: The paper is a descriptive account of the various cost factors…

Improving Newborn Survival in Southern Tanzania (INSIST) trial; community-based maternal and newborn care economic analysis

PubMed Central

Manzi, Fatuma; Daviaud, Emmanuelle; Schellenberg, Joanna; Lawn, Joy E; John, Theopista; Msemo, Georgina; Owen, Helen; Barger, Diana; Hanson, Claudia; Borghi, Josephine

2017-01-01

Abstract Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home-based counselling programme in southern Tanzania. Financial costs of the programme were extracted from project accounts. Ministry of Health and Social Welfare costs associated with programme implementation were collected based on staff and project monthly activity plans. Household costs associated with facility-based delivery were also estimated based on exit interviews with post-natal women. Time spent on the programme by implementers was assessed by interviews conducted with volunteers and health staff. The programme involved substantial design and set-up costs. The main drivers of set-up costs were activities related to volunteer training. Total annualized costs (design, set-up and implementation) amounted to nearly US$300 000 for financial costs and just over US$400 000 for economic costs. Volunteers (n = 842) spent just under 14 hours per month on programme-related activities. When volunteer time was valued under economic costs, this input amounted to just under half of the costs of implementation. The economic consequences of increased service use to households were estimated at US$36 985. The intervention cost per mother–newborn pair visited was between US$12.60 and US$19.50, and the incremental cost per additional facility-based delivery ranged from US$85.50 to US$137.20 for financial and economic costs (with household costs). Three scale-up scenarios were considered, with the financial cost per home visit respectively varying from $1.44 to $3.21 across scenarios. Cost-effectiveness compares well with supply-side initiatives to increase coverage of facility-based deliveries, and the intervention would benefit from substantial economies of scale. PMID:27335165

Improving Newborn Survival in Southern Tanzania (INSIST) trial; community-based maternal and newborn care economic analysis.

PubMed

Manzi, Fatuma; Daviaud, Emmanuelle; Schellenberg, Joanna; Lawn, Joy E; John, Theopista; Msemo, Georgina; Owen, Helen; Barger, Diana; Hanson, Claudia; Borghi, Josephine

2017-10-01

Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home-based counselling programme in southern Tanzania. Financial costs of the programme were extracted from project accounts. Ministry of Health and Social Welfare costs associated with programme implementation were collected based on staff and project monthly activity plans. Household costs associated with facility-based delivery were also estimated based on exit interviews with post-natal women. Time spent on the programme by implementers was assessed by interviews conducted with volunteers and health staff. The programme involved substantial design and set-up costs. The main drivers of set-up costs were activities related to volunteer training. Total annualized costs (design, set-up and implementation) amounted to nearly US$300 000 for financial costs and just over US$400 000 for economic costs. Volunteers (n = 842) spent just under 14 hours per month on programme-related activities. When volunteer time was valued under economic costs, this input amounted to just under half of the costs of implementation. The economic consequences of increased service use to households were estimated at US$36 985. The intervention cost per mother-newborn pair visited was between US$12.60 and US$19.50, and the incremental cost per additional facility-based delivery ranged from US$85.50 to US$137.20 for financial and economic costs (with household costs). Three scale-up scenarios were considered, with the financial cost per home visit respectively varying from $1.44 to $3.21 across scenarios. Cost-effectiveness compares well with supply-side initiatives to increase coverage of facility-based deliveries, and the intervention would benefit from substantial economies of scale. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Process Research ON Semix Silicon Materials (PROSSM)

NASA Astrophysics Data System (ADS)

Wohlgemuth, J. H.; Warfield, D. B.

1982-02-01

A cost effective process sequence was identified, equipment was designed to implement a 6.6 MW per year automated production line, and a cost analysis projected a $0.56 per watt cell add-on cost for this line. Four process steps were developed for this program: glass beads back clean-up, hot spray antireflective coating, wave soldering of fronts, and ion milling for edging. While spray dopants were advertised as an off the shelf developed product, they were unreliable with shorter than advertised shelf life.

Process Research ON Semix Silicon Materials (PROSSM)

NASA Technical Reports Server (NTRS)

Wohlgemuth, J. H.; Warfield, D. B.

1982-01-01

A cost effective process sequence was identified, equipment was designed to implement a 6.6 MW per year automated production line, and a cost analysis projected a $0.56 per watt cell add-on cost for this line. Four process steps were developed for this program: glass beads back clean-up, hot spray antireflective coating, wave soldering of fronts, and ion milling for edging. While spray dopants were advertised as an off the shelf developed product, they were unreliable with shorter than advertised shelf life.

Multisite cost analysis of a school-based voluntary alcohol and drug prevention program.

PubMed

Kilmer, Beau; Burgdorf, James R; D'Amico, Elizabeth J; Miles, Jeremy; Tucker, Joan

2011-09-01

This article estimates the societal costs of Project CHOICE, a voluntary after-school alcohol and other drug prevention program for adolescents. To our knowledge, this is the first cost analysis of an after-school program specifically focused on reducing alcohol and other drug use. The article uses microcosting methods based on the societal perspective and includes a number of sensitivity analyses to assess how the results change with alternative assumptions. Cost data were obtained from surveys of participants, facilitators, and school administrators; insights from program staff members; program expenditures; school budgets; the Bureau of Labor Statistics; and the National Center for Education Statistics. From the societal perspective, the cost of implementing Project CHOICE in eight California schools ranged from $121 to $305 per participant (Mdn = $238). The major cost drivers included labor costs associated with facilitating Project CHOICE, opportunity costs of displaced class time (because of in-class promotions for Project CHOICE and consent obtainment), and other efforts to increase participation. Substituting nationally representative cost information for wages and space reduced the range to $100-$206 (Mdn = $182), which is lower than the Substance Abuse and Mental Health Services Administration's estimate of $262 per pupil for the "average effective school-based program in 2002." Denominating national Project CHOICE costs by enrolled students instead of participants generates a median per-pupil cost of $21 (range: $14-$28). Estimating the societal costs of school-based prevention programs is crucial for efficiently allocating resources to reduce alcohol and other drug use. The large variation in Project CHOICE costs across schools highlights the importance of collecting program cost information from multiple sites.

Multisite Cost Analysis of a School-Based Voluntary Alcohol and Drug Prevention Program*

PubMed Central

Kilmer, Beau; Burgdorf, James R.; D'amico, Elizabeth J.; Miles, Jeremy; Tucker, Joan

2011-01-01

Objective: This article estimates the societal costs of Project CHOICE, a voluntary after-school alcohol and other drug prevention program for adolescents. To our knowledge, this is the first cost analysis of an after-school program specifically focused on reducing alcohol and other drug use. Method: The article uses microcosting methods based on the societal perspective and includes a number of sensitivity analyses to assess how the results change with alternative assumptions. Cost data were obtained from surveys of participants, facilitators, and school administrators; insights from program staff members; program expenditures; school budgets; the Bureau of Labor Statistics; and the National Center for Education Statistics. Results: From the societal perspective, the cost of implementing Project CHOICE in eight California schools ranged from $121 to $305 per participant (Mdn = $238). The major cost drivers included labor costs associated with facilitating Project CHOICE, opportunity costs of displaced class time (because of in-class promotions for Project CHOICE and consent obtainment), and other efforts to increase participation. Substituting nationally representative cost information for wages and space reduced the range to $100–$206 (Mdn = $182), which is lower than the Substance Abuse and Mental Health Services Administration's estimate of $262 per pupil for the "average effective school-based program in 2002." Denominating national Project CHOICE costs by enrolled students instead of participants generates a median per-pupil cost of $21 (range: $14—$28). Conclusions: Estimating the societal costs of school-based prevention programs is crucial for efficiently allocating resources to reduce alcohol and other drug use. The large variation in Project CHOICE costs across schools highlights the importance of collecting program cost information from multiple sites. PMID:21906509

Manned Spacecraft Requirements for Materials and Processes

NASA Technical Reports Server (NTRS)

Vaughn, Timothy P.

2006-01-01

A major cause of project failure can be attributed to an emphasized focus on end products and inadequate attention to resolving development risks during the initial phases of a project. The initial phases of a project, which we will call the "study period", are critical to determining project scope and costs, and can make or break most projects. If the requirements are not defined adequately, how can the scope be adequately determined, also how can the costs of the entire project be effectively estimated, and how can the risk of project success be accurately assessed? Using the proper material specifications and standards and incorporating these specifications and standards in the design process should be considered inherently crucial to the technical success of a project as just as importantly, crucial to the cost and schedule success. This paper will intertwine several important aspects or considerations for project success: 1) Characteristics of a "Good Material Requirement"; 2) Linking material requirements to the implementation of "Design for Manufacturing"; techniques and 3) The importance of decomposing materials requirements during the study phase/development phase to mitigate project risk for the maturation of technologies before the building of hardware.

Implementation of Pharmaceutical Practice Guidelines by a Project Model Based

PubMed Central

Mahmoudi, Laleh; Karamikhah, Razieh; Mahdavinia, Azadeh; Samiei, Hasan; Petramfar, Peyman; Niknam, Ramin

2015-01-01

Abstract All around the world a few studies have been found on the effect of guideline implementation on direct medications’ expenditure. The goal of this study was to evaluate cost savings of guideline implementation among patients who had to receive 3 costly medications including albumin, enoxaparin, and pantoprazole in a tertiary hospital in Shiraz, Iran. An 8-month prospective study was performed in 2 groups; group 1 as an observational group (control group) in 4 months from June to September 2014 and group 2 as an interventional group from October 2014 to January 2015. For group 1 the pattern of costly medications usage was determined without any intervention. For group 2, after guideline implementation, the economic impact was evaluated by making comparisons between the data achieved from the 2 groups. A total of 12,680 patients were evaluated during this study (6470 in group 1; 6210 in group 2). The reduction in the total value of costly administered drugs was 56% after guideline implementation. Such reduction in inappropriate prescribing accounts for the saving of 85,625 United States dollars (USD) monthly and estimated 1,027,500 USD annually. Guideline implementation could improve the adherence of evidence-based drug utilization and resulted in significant cost savings in a major teaching medical center via a decrease in inappropriate prescribing of costly medications. PMID:26496288

Low cost solar array project production process and equipment task. A Module Experimental Process System Development Unit (MEPSDU)

NASA Technical Reports Server (NTRS)

1981-01-01

Technical readiness for the production of photovoltaic modules using single crystal silicon dendritic web sheet material is demonstrated by: (1) selection, design and implementation of solar cell and photovoltaic module process sequence in a Module Experimental Process System Development Unit; (2) demonstration runs; (3) passing of acceptance and qualification tests; and (4) achievement of a cost effective module.

A Socio-Technical Exploration for Reducing & Mitigating the Risk of Retained Foreign Objects

PubMed Central

Corrigan, Siobhán; Kay, Alison; O’Byrne, Katie; Slattery, Dubhfeasa; Sheehan, Sharon; McDonald, Nick; Smyth, David; Mealy, Ken; Cromie, Sam

2018-01-01

A Retained Foreign Object (RFO) is a fairly infrequent but serious adverse event. An accurate rate of RFOs is difficult to establish due to underreporting but it has been estimated that incidences range between 1/1000 and 1/19,000 procedures. The cost of a RFO incident may be substantial and three-fold: (i) the cost to the patient of physical and/or psychological harm; (ii) the reputational cost to an institution and/or healthcare provider; and (iii) the financial cost to the taxpayer in the event of a legal claim. This Health Research Board-funded project aims to analyse and understand the problem of RFOs in surgical and maternity settings in Ireland and develop hospital-specific foreign object management processes and implementation roadmaps. This project will deploy an integrated evidence-based assessment methodology for social-technical modelling (Supply, Context, Organising, Process & Effects/ SCOPE Analysis Cube) and bow tie methodologies that focuses on managing the risks in effectively implementing and sustaining change. It comprises a multi-phase research approach that involves active and ongoing collaboration with clinical and other healthcare staff through each phase of the research. The specific objective of this paper is to present the methodological approach and outline the potential to produce generalisable results which could be applied to other health-related issues. PMID:29642646

ESP IMPROVEMENTS AT POWER PLANTS

EPA Science Inventory

An on-going ORD and OIA collaborative project in the Newly Independent States (NIS) is designed to upgrade ESPs used in NIS power plants and has laid the foundation for implementing cost-effective ESP modernization efforts at power plants. Thus far, state-of-the-art ESP performan...

Existing Whole-House Solutions Case Study: Islip Housing Authority Energy Efficiency Turnover Protocols, Islip, New York

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

J. Dentz, F. Conlin, D. Podorson, and K. Alaigh

2014-08-01

In this project, Building America team ARIES worked with two public housing authorities (PHA) to develop packages of energy efficiency retrofit measures the PHAs can cost effectively implement at the time when units are refurbished between occupancies.

Lessons learned from training peer-leaders to conduct Body Project workshops.

PubMed

Vanderkruik, Rachel; Strife, Samantha; Dimidjian, Sona

2017-01-01

The Body Project is a cognitive-dissonance intervention that is effective in improving body satisfaction for high school and college aged women. The Body Project can be implemented by trained peers, thus increasing its potential for broad and cost-effective dissemination. Little is known, however, about peer-leaders' perceptions of their training needs and preferences to deliver prevention programs. This qualitative study explored the perceptions of training strengths and areas of improvement among 14 Body Project peer-leaders at a college campus through a series of focus groups. Recommendations are made to inform training for the Body Project as well as peer-led prevention and treatment interventions more broadly.

Fuelcell-Hybrid Mine loader (LHD)

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

James L Dippo; Tim Erikson; Kris Hess

2009-07-10

The fuel cell hybrid mine loader project, sponsored by a government-industry consortium, was implemented to determine the viability of proton exchange membrane (PEM) fuel cells in underground mining applications. The Department of Energy (DOE) sponsored this project with cost-share support from industry. The project had three main goals: (1) to develop a mine loader powered by a fuel cell, (2) to develop associated metal-hydride storage and refueling systems, and (3) to demonstrate the fuel cell hybrid loader in an underground mine in Nevada. The investigation of a zero-emissions fuel cell power plant, the safe storage of hydrogen, worker health advantagesmore » (over the negative health effects associated with exposure to diesel emissions), and lower operating costs are all key objectives for this project.« less

Comprehensive Cost Planning Yields Successful Tech Projects

ERIC Educational Resources Information Center

Breeding, Marshall

2006-01-01

In this article, the author calls for librarians to find ways to implement technology projects with very limited budgets and to consider all the cost components of a technology project amidst the economic pressures. The author offers some perspective on what is involved in trying to accomplish important work with limited resources while…

34 CFR 280.32 - How is priority given to applicants?

Code of Federal Regulations, 2010 CFR

2010-07-01

... part, by considering— (1) The costs of fully implementing the magnet schools project as proposed; (2) The resources available to the applicant to carry out the project if funds under the program were not provided; (3) The extent to which the costs of the project exceed the applicant's resources; and (4) The...

The cost of implementing inpatient bar code medication administration.

PubMed

Sakowski, Julie Ann; Ketchel, Alan

2013-02-01

To calculate the costs associated with implementing and operating an inpatient bar-code medication administration (BCMA) system in the community hospital setting and to estimate the cost per harmful error prevented. This is a retrospective, observational study. Costs were calculated from the hospital perspective and a cost-consequence analysis was performed to estimate the cost per preventable adverse drug event averted. Costs were collected from financial records and key informant interviews at 4 not-for profit community hospitals. Costs included direct expenditures on capital, infrastructure, additional personnel, and the opportunity costs of time for existing personnel working on the project. The number of adverse drug events prevented using BCMA was estimated by multiplying the number of doses administered using BCMA by the rate of harmful errors prevented by interventions in response to system warnings. Our previous work found that BCMA identified and intercepted medication errors in 1.1% of doses administered, 9% of which potentially could have resulted in lasting harm. The cost of implementing and operating BCMA including electronic pharmacy management and drug repackaging over 5 years is $40,000 (range: $35,600 to $54,600) per BCMA-enabled bed and $2000 (range: $1800 to $2600) per harmful error prevented. BCMA can be an effective and potentially cost-saving tool for preventing the harm and costs associated with medication errors.

Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project.

PubMed

Andrade, Mônica Viegas; Maia, Ana Carolina; Cardoso, Clareci Silva; Alkmim, Maria Beatriz; Ribeiro, Antônio Luiz Pinho

2011-10-01

Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.

Cost-Effectiveness of Breast Cancer Screening in Turkey, a Developing Country: Results from Bahçeşehir Mammography Screening Project.

PubMed

Özmen, Vahit; Gürdal, Sibel Ö; Cabioğlu, Neslihan; Özcinar, Beyza; Özaydın, A Nilüfer; Kayhan, Arda; Arıbal, Erkin; Sahin, Cennet; Saip, Pınar; Alagöz, Oğuzhan

2017-07-01

We used the results from the first three screening rounds of Bahcesehir Mammography Screening Project (BMSP), a 10-year (2009-2019) and the first organized population-based screening program implemented in a county of Istanbul, Turkey, to assess the potential cost-effectiveness of a population-based mammography screening program in Turkey. Two screening strategies were compared: BMSP (includes three biennial screens for women between 40-69) and Turkish National Breast Cancer Registry Program (TNBCRP) which includes no organized population-based screening. Costs were estimated using direct data from the BMSP project and the reimbursement rates of Turkish Social Security Administration. The life-years saved by BMSP were estimated using the stage distribution observed with BMSP and TNBCRP. A total of 67 women (out of 7234 screened women) were diagnosed with breast cancer in BMSP. The stage distribution for AJCC stages O, I, II, III, IV was 19.4%, 50.8%, 20.9%, 7.5%, 1.5% and 4.9%, 26.6%, 44.9%, 20.8%, 2.8% with BMSP and TNBCRP, respectively. The BMSP program is expected to save 279.46 life years over TNBCRP with an additional cost of $677.171, which implies an incremental cost-effectiveness ratio (ICER) of $2.423 per saved life year. Since the ICER is smaller than the Gross Demostic Product (GDP) per capita in Turkey ($10.515 in 2014), BMSP program is highly cost-effective and remains cost-effective in the sensitivity analysis. Mammography screening may change the stage distribution of breast cancer in Turkey. Furthermore, an organized population-based screening program may be cost-effective in Turkey and in other developing countries. More research is needed to better estimate life-years saved with screening and further validate the findings of our study.

Removing Dams: Project-Level Policy and Scientific Research Needs (Invited)

NASA Astrophysics Data System (ADS)

Graber, B.

2010-12-01

More than 800 dams have been removed around the country, mostly “small” dams, under 25 feet in height. The total number of removals, however, is small relative to the number of deteriorating dams and the ecological impacts those structures continue to have on native riverine species and natural river function. The number of dam removal projects is increasing as aging dams continue to deteriorate and riverine species continue to decline. Practitioners and regulators need to find cost-effective project approaches that minimize short-term environmental impacts and maximize long-term benefits while keeping project costs manageable. Dam removals can be a regulatory challenge because they inherently have short-term impacts in order to achieve larger, self-sustaining, long-term benefits. These short-term impacts include sediment movement, construction access roads, and habitat conversion from lacustrine to riverine. Environmental regulations are designed to prevent degradation and have presented challenges for projects designed to benefit the environment. For example, a short-term release of sediment may exceed water quality standards for some period of time, but lead to a long-term beneficial project. Other regulatory challenges include permitting the loss of wetland area for increased native river function, or allowing the release of some level of contaminated sediment when the downstream sediment is similarly contaminated. Dam removal projects raise a range of engineering and scientific questions on effective implementation techniques such as appropriate sediment management approaches, construction equipment access approaches, invasive species management, channel/floodplain reconstruction, and active versus passive habitat rehabilitation. While practitioners have learned and refined implementation approaches over the last decade, more input is needed from researchers to help assess the effectiveness of those techniques, and to provide more effective techniques. Applied research is needed to provide management tools for practitioners on questions such as: How do we determine the quantity of sediment that is acceptable to release downstream without causing long-term harm to habitat? How can we estimate how much sediment rivers naturally carry in places where there are no sediment gauges? Will the release of coarse-grain sediment help build habitat structure downstream or will it smother habitat? What is the trajectory of habitat quality in an impoundment wetland and is it justifiable to use self-sustainability as an argument to allow a reduction in wetland area for native river habitat? Will having construction equipment working in the flowing river channel do less harm than dewatering a river channel for a longer period of time? American Rivers staff have collectively had an active involvement in more than one hundred dam removal projects. In this presentation, an American Rivers geomorphologist will pose the questions that need to be answered to reduce project-level policy challenges and allow the implementation of cost-effective dam removal projects.

Improvement of the cost-benefit analysis algorithm for high-rise construction projects

NASA Astrophysics Data System (ADS)

Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

2018-03-01

The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

Maintenance Decision Support System: Pilot Study and Cost-Benefit Analysis (Phase 2.5)

DOT National Transportation Integrated Search

2014-07-01

This project focused on several tasks: development of in-vehicle hardware that permits implementation of an MDSS, development of software to collect and process road and weather data, a cost-benefit study, and pilot-scale implementation. Two Automati...

Maintenance Decision Support System : Pilot Study and Cost-Benefit Analysis (Phase 2)

DOT National Transportation Integrated Search

2014-07-01

This project focused on several tasks: development of in-vehicle hardware that permits implementation of an MDSS, development of software to collect and process road and weather data, a cost-benefit study, and pilot-scale implementation. Two Automati...

RADON MITIGATION STUDIES: NASHVILLE DEMONSTRATION

EPA Science Inventory

The report gives results of an EPA radon mitigation demonstration project involving 14 houses in the Nashville, TN, area with indoor radon levels of 5.6-47.6 pCi/L, using a variety of techniques, designed to be the most cost effective methods possible to implement, and yet adequa...

Evaluation of Effectiveness and Cost-Benefits of Woolen Roadside Reclamation Products : Implementation Report

DOT National Transportation Integrated Search

2017-12-01

The research project started by reviewing sixteen existing wool products that might be readily adapted for roadside reclamation uses. None of these products showed promise either due to the difficulty in importing them to the U.S., or as a result of ...

Hydrologic analysis of a residential green infrastructure project Cincinnati OH, USA

EPA Science Inventory

•Context –current strains on municipal budgets throughout the US •Goal –demonstrate effective implementation of low-cost methods to reduce some typical impacts of urbanization on stormwater discharge, such as: •increased flashiness •decreased infiltration •degraded water qu...

Health Economic Evaluation of a Strict Glucose Control Guideline Implemented Using Point-of-Care Testing in Three Intensive Care Units in The Netherlands.

PubMed

van Hooijdonk, Roosmarijn T M; Steuten, Lotte M G; Kip, Michelle M A; Monteban, Helma; Mulder, Marianne R; van Braam Houckgeest, Floris; van der Sluijs, Johannes P; Abu-Hanna, Ameen; Spronk, Peter E; Schultz, Marcus J

2015-08-01

Point-of-care testing of blood glucose (BG-POCT) is essential for safe and effective insulin titrations in critically ill patients under glucose control with insulin. The costs associated with this practice are considered substantial, especially when more frequent blood glucose (BG) testing is needed, as with more strict glucose control (SGC) aiming for lower BG levels. The objective of this study was to estimate, from a hospital perspective, the incremental cost effectiveness of an SGC guideline, aiming for BG levels of 4.4-6.1 mmol/L, compared to the situation before implementation of that guideline (aiming for BG levels <8.3 mmol/L), both using BG-POCT. This is a secondary analysis of a guideline implementation project aiming for implementation of a guideline of SGC in three intensive care units in The Netherlands. A Markov model including the four health states 'target glucose', 'hyperglycaemia' (defined as BG levels >6.1 mmol/L), 'hypoglycaemia' (defined as BG levels <4.4 mmol/L) and 'in-hospital death' was developed to compare expected costs, number of patients within target and number of life-years saved before and after implementation of the SGC guideline. The effectiveness estimates are based on empirical data from 3195 patients 12 and 24 months before and after implementation of the guideline, respectively. All costs have been converted to price year 2013, and are estimated based on hospital data, the literature and available price lists. The number of BG-POCT increased from 4.8 [interquartile range (IQR) 2.6-6.7] to 8.0 [IQR 4.1-11.2] per patient per day, accruing 58% higher costs for BG-POCT (€13.56 vs. €8.57 per patient) in the SGC protocol versus the situation before implementation. When taking total hospital costs and clinical effects into account, implementation of the SGC guideline increased total hospital costs per patient by 1.8%, i.e., €355 (from €20,617 to €20,972) during the inpatient stay, while the number of patients in target glucose levels increased by 1.4% (i.e., from 881 to 895 per 1000 patients). This translates to an incremental cost-effectiveness ratio of €25 per additional patient within the target glucose level. The model outcomes are most sensitive to changes in ICU length of stay. The increase in the number of patients and time within target glucose levels is achieved with a small increase in total direct hospital costs.

43 CFR 45.73 - How will the bureau analyze a proposed alternative and formulate its modified condition or...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., distribution, cost, and use; (2) Flood control; (3) Navigation; (4) Water supply; (5) Air quality; and (6..., including: (1) Any evidence on the implementation costs or operational impacts for electricity production of...) Cost significantly less to implement; or (ii) Result in improved operation of the project works for...

Simulations Show Diagnostic Testing For Malaria In Young African Children Can Be Cost-Saving Or Cost-Effective

PubMed Central

Phillips, Victoria; Njau, Joseph; Li, Shang; Kachur, Patrick

2015-01-01

Malaria imposes a substantial global disease burden. It disproportionately affects sub-Saharan Africans, particularly young children. In an effort to improve disease management, the World Health Organization (WHO) recommended in 2010 that countries test children younger than age five who present with suspected malaria fever to confirm the diagnosis instead of treating them presumptively with antimalarial drugs. Costs and concerns about the overall health impact of such diagnostic testing for malaria in children remain barriers to full implementation. Using data from national Malaria Indicator Surveys, we estimated two-stage microsimulation models for Angola, Tanzania, and Uganda to assess the policy’s cost-effectiveness. We found that diagnostic testing for malaria in children younger than five is cost-saving in Angola. In Tanzania and Uganda the cost per life-year gained is $5.54 and $94.28, respectively. The costs projected for Tanzania and Uganda are less than the WHO standard of $150 per life-year gained. Our results were robust under varying assumptions about cost, prevalence of malaria, and behavior, and they strongly suggest the pursuit of policies that facilitate full implementation of testing for malaria in children younger than five. PMID:26153315

National Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

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

Thornton, Brian; Halverson, Mark A.; Myer, Michael

Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components,more » initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.« less

Cost-effectiveness of ASHRAE Standard 90.1-2010 Compared to ASHRAE Standard 90.1-2007

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

Thornton, Brian A.; Halverson, Mark A.; Myer, Michael

Pacific Northwest National Laboratory (PNNL) completed this project for the U.S. Department of Energy’s (DOE’s) Building Energy Codes Program (BECP). DOE’s BECP supports upgrading building energy codes and standards, and the states’ adoption, implementation, and enforcement of upgraded codes and standards. Building energy codes and standards set minimum requirements for energy-efficient design and construction for new and renovated buildings, and impact energy use and greenhouse gas emissions for the life of buildings. Continuous improvement of building energy efficiency is achieved by periodically upgrading energy codes and standards. Ensuring that changes in the code that may alter costs (for building components,more » initial purchase and installation, replacement, maintenance and energy) are cost-effective encourages their acceptance and implementation. ANSI/ASHRAE/IESNA Standard 90.1 is the energy standard for commercial and multi-family residential buildings over three floors.« less

The PMS project: Poor man's supercomputer

NASA Astrophysics Data System (ADS)

Csikor, F.; Fodor, Z.; Hegedüs, P.; Horváth, V. K.; Katz, S. D.; Piróth, A.

2001-02-01

We briefly describe the Poor Man's Supercomputer (PMS) project carried out at Eötvös University, Budapest. The goal was to construct a cost effective, scalable, fast parallel computer to perform numerical calculations of physical problems that can be implemented on a lattice with nearest neighbour interactions. To this end we developed the PMS architecture using PC components and designed a special, low cost communication hardware and the driver software for Linux OS. Our first implementation of PMS includes 32 nodes (PMS1). The performance of PMS1 was tested by Lattice Gauge Theory simulations. Using pure SU(3) gauge theory or the bosonic part of the minimal supersymmetric extention of the standard model (MSSM) on PMS1 we obtained 3 / Mflops and 0.60 / Mflops price-to-sustained performance ratio for double and single precision operations, respectively. The design of the special hardware and the communication driver are freely available upon request for non-profit organizations.

An Integrated Data-Driven Strategy for Safe-by-Design Nanoparticles: The FP7 MODERN Project.

PubMed

Brehm, Martin; Kafka, Alexander; Bamler, Markus; Kühne, Ralph; Schüürmann, Gerrit; Sikk, Lauri; Burk, Jaanus; Burk, Peeter; Tamm, Tarmo; Tämm, Kaido; Pokhrel, Suman; Mädler, Lutz; Kahru, Anne; Aruoja, Villem; Sihtmäe, Mariliis; Scott-Fordsmand, Janeck; Sorensen, Peter B; Escorihuela, Laura; Roca, Carlos P; Fernández, Alberto; Giralt, Francesc; Rallo, Robert

2017-01-01

The development and implementation of safe-by-design strategies is key for the safe development of future generations of nanotechnology enabled products. The safety testing of the huge variety of nanomaterials that can be synthetized is unfeasible due to time and cost constraints. Computational modeling facilitates the implementation of alternative testing strategies in a time and cost effective way. The development of predictive nanotoxicology models requires the use of high quality experimental data on the structure, physicochemical properties and bioactivity of nanomaterials. The FP7 Project MODERN has developed and evaluated the main components of a computational framework for the evaluation of the environmental and health impacts of nanoparticles. This chapter describes each of the elements of the framework including aspects related to data generation, management and integration; development of nanodescriptors; establishment of nanostructure-activity relationships; identification of nanoparticle categories; hazard ranking and risk assessment.

Security Approaches in Using Tablet Computers for Primary Data Collection in Clinical Research

PubMed Central

Wilcox, Adam B.; Gallagher, Kathleen; Bakken, Suzanne

2013-01-01

Next-generation tablets (iPads and Android tablets) may potentially improve the collection and management of clinical research data. The widespread adoption of tablets, coupled with decreased software and hardware costs, has led to increased consideration of tablets for primary research data collection. When using tablets for the Washington Heights/Inwood Infrastructure for Comparative Effectiveness Research (WICER) project, we found that the devices give rise to inherent security issues associated with the potential use of cloud-based data storage approaches. This paper identifies and describes major security considerations for primary data collection with tablets; proposes a set of architectural strategies for implementing data collection forms with tablet computers; and discusses the security, cost, and workflow of each strategy. The paper briefly reviews the strategies with respect to their implementation for three primary data collection activities for the WICER project. PMID:25848559

Security approaches in using tablet computers for primary data collection in clinical research.

PubMed

Wilcox, Adam B; Gallagher, Kathleen; Bakken, Suzanne

2013-01-01

Next-generation tablets (iPads and Android tablets) may potentially improve the collection and management of clinical research data. The widespread adoption of tablets, coupled with decreased software and hardware costs, has led to increased consideration of tablets for primary research data collection. When using tablets for the Washington Heights/Inwood Infrastructure for Comparative Effectiveness Research (WICER) project, we found that the devices give rise to inherent security issues associated with the potential use of cloud-based data storage approaches. This paper identifies and describes major security considerations for primary data collection with tablets; proposes a set of architectural strategies for implementing data collection forms with tablet computers; and discusses the security, cost, and workflow of each strategy. The paper briefly reviews the strategies with respect to their implementation for three primary data collection activities for the WICER project.

Design, implementation and migration of security systems as an extreme project.

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

Scharmer, Carol; Trujillo, David

2010-08-01

Decision Trees, algorithms, software code, risk management, reports, plans, drawings, change control, presentations, and analysis - all useful tools and efforts but time consuming, resource intensive, and potentially costly for projects that have absolute schedule and budget constraints. What are necessary and prudent efforts when a customer calls with a major security problem that needs to be fixed with a proven, off-the-approval-list, multi-layered integrated system with high visibility and limited funding and expires at the end of the Fiscal Year? Whether driven by budget cycles, safety, or by management decree, many such projects begin with generic scopes and funding allocatedmore » based on a rapid management 'guestimate.' Then a Project Manager (PM) is assigned a project with a predefined and potentially limited scope, compressed schedule, and potentially insufficient funding. The PM is tasked to rapidly and cost effectively coordinate a requirements-based design, implementation, test, and turnover of a fully operational system to the customer, all while the customer is operating and maintaining an existing security system. Many project management manuals call this an impossible project that should not be attempted. However, security is serious business and the reality is that rapid deployment of proven systems via an 'Extreme Project' is sometimes necessary. Extreme Projects can be wildly successful but require a dedicated team of security professionals lead by an experienced project manager using a highly-tailored and agile project management process with management support at all levels, all combined with significant interface with the customer. This paper does not advocate such projects or condone eliminating the valuable analysis and project management techniques. Indeed, having worked on a well-planned project provides the basis for experienced team members to complete Extreme Projects. This paper does, however, provide insight into what it takes for projects to be successfully implemented and accepted when completed under extreme conditions.« less

Design implementation and migration of security systems as an extreme project.

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

Scharmer, Carol

2010-10-01

Decision Trees, algorithms, software code, risk management, reports, plans, drawings, change control, presentations, and analysis - all useful tools and efforts but time consuming, resource intensive, and potentially costly for projects that have absolute schedule and budget constraints. What are necessary and prudent efforts when a customer calls with a major security problem that needs to be fixed with a proven, off-the-approval-list, multi-layered integrated system with high visibility and limited funding and expires at the end of the Fiscal Year? Whether driven by budget cycles, safety, or by management decree, many such projects begin with generic scopes and funding allocatedmore » based on a rapid management 'guestimate.' Then a Project Manager (PM) is assigned a project with a predefined and potentially limited scope, compressed schedule, and potentially insufficient funding. The PM is tasked to rapidly and cost effectively coordinate a requirements-based design, implementation, test, and turnover of a fully operational system to the customer, all while the customer is operating and maintaining an existing security system. Many project management manuals call this an impossible project that should not be attempted. However, security is serious business and the reality is that rapid deployment of proven systems via an 'Extreme Project' is sometimes necessary. Extreme Projects can be wildly successful but require a dedicated team of security professionals lead by an experienced project manager using a highly-tailored and agile project management process with management support at all levels, all combined with significant interface with the customer. This paper does not advocate such projects or condone eliminating the valuable analysis and project management techniques. Indeed, having worked on a well-planned project provides the basis for experienced team members to complete Extreme Projects. This paper does, however, provide insight into what it takes for projects to be successfully implemented and accepted when completed under extreme conditions.« less

Identifying and explaining the variability in development and implementation costs of disease management programs in the Netherlands.

PubMed

Tsiachristas, Apostolos; Waters, Bethany Hipple; Adams, Samantha A; Bal, Roland; Mölken, Maureen P M M Rutten-van

2014-10-26

In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics that impact these. The data was analyzed using a mixed methods approach. Descriptive statistical analysis explored the variability in D&I costs as measured by a self-developed costing instrument and investigated the drivers. In addition, qualitative research, including document analysis and interviews, was conducted to explain the possible underlying reasons of cost variability. The development costs varied from €5,891 to €274,783 and the implementation costs varied from €7,278 to €387,879 across DMPs. Personnel costs were the main component of development. Development costs were strongly correlated with the implementation costs (ρ = 0.55), development duration (ρ = 0.74), and number of FTEs dedicated DMP development. Organizations with large size and high level of care prior to the implementation of a DMP had relatively low development costs. These findings were in line with the cross-case qualitative comparison where programs with a longer history, more experienced project leadership, previously established ICT systems, and less complex patient populations had lower D&I costs. There is wide variation in D&I costs of DMPs, which is driven primarily by the duration of the development phase and the staff needed to develop and implement a DMP. These drivers are influenced by the attributes of the DMP, characteristics of the target population, project leadership, and ICT involved. There are indications of economies of scale and economies of scope, which may reduce D&I costs.

Funding Mechanisms for Ecosystem Services Projects

NASA Astrophysics Data System (ADS)

Russell, V.

2014-12-01

Ecosystem services projects ideally should be funded through commoditized markets. Where those markets do not exist financing directly from interested private sector parties can be a direct link between business interested in fulfilling sustainability goals and project implementers. Challenges exist, however in 1) linking those interests; 2) carefully quantifying the services produced, their true costs to implement and meeting protocol standards; 3) measuring the success of projects, especially over lengthy periods of time; and 4) balancing issues related to multiple spatial scales for projects and funding to make a difference. Examples from National Forest Foundation's experience implementing carbon and water projects with multiple private sector funders and the USDA Forest Service will highlight experiences and lessons learned in funding and implementing ecosystem service projects.

A system dynamics analysis determining willingness to wait and pay for the implementation of data standards in clinical research

PubMed Central

2010-01-01

Background Industry standards provide rigorous descriptions of required data presentation, with the aim of ensuring compatibility across different clinical studies. However despite their crucial importance, these standards are often not used as expected in the development of clinical research. The reasons for this lack of compliance could be related to the high cost and time-intensive nature of the process of data standards implementation. The objective of this study was to evaluate the value of the extra time and cost required for different levels of data standardisation and the likelihood of researchers to comply with these levels. Since we believe that the cost and time necessary for the implementation of data standards can change over time, System Dynamics (SD) analysis was used to investigate how these variables interact and influence the adoption of data standards by clinical researchers. Methods Three levels of data standards implementation were defined through focus group discussion involving four clinical research investigators. Ten Brazilian and eighteen American investigators responded to an online questionnaire which presented possible standards implementation scenarios, with respondents asked to choose one of two options available in each scenario. A random effects ordered probit model was used to estimate the effect of cost and time on investigators' willingness to adhere to data standards. The SD model was used to demonstrate the relationship between degrees of data standardisation and subsequent variation in cost and time required to start the associated study. Results A preference for low cost and rapid implementation times was observed, with investigators more likely to incur costs than to accept a time delay in project start-up. SD analysis indicated that although initially extra time and cost are necessary for clinical study standardisation, there is a decrease in both over time. Conclusions Future studies should explore ways of creating mechanisms which decrease the time and cost associated with standardisation processes. In addition, the fact that the costs and time necessary for data standards implementation decrease with time should be made known to the wider research community. Policy makers should attempt to match their data standardisation policies better with the expectations of researchers. PMID:21194455

A system dynamics analysis determining willingness to wait and pay for the implementation of data standards in clinical research.

PubMed

Cofiel, Luciana; Zammar, Guilherme R; Zaveri, Amrapali J; Shah, Jatin Y; Carvalho, Elias; Nahm, Meredith; Kesselring, Gustavo; Pietrobon, Ricardo

2010-12-31

Industry standards provide rigorous descriptions of required data presentation, with the aim of ensuring compatibility across different clinical studies. However despite their crucial importance, these standards are often not used as expected in the development of clinical research. The reasons for this lack of compliance could be related to the high cost and time-intensive nature of the process of data standards implementation. The objective of this study was to evaluate the value of the extra time and cost required for different levels of data standardisation and the likelihood of researchers to comply with these levels. Since we believe that the cost and time necessary for the implementation of data standards can change over time, System Dynamics (SD) analysis was used to investigate how these variables interact and influence the adoption of data standards by clinical researchers. Three levels of data standards implementation were defined through focus group discussion involving four clinical research investigators. Ten Brazilian and eighteen American investigators responded to an online questionnaire which presented possible standards implementation scenarios, with respondents asked to choose one of two options available in each scenario. A random effects ordered probit model was used to estimate the effect of cost and time on investigators' willingness to adhere to data standards. The SD model was used to demonstrate the relationship between degrees of data standardisation and subsequent variation in cost and time required to start the associated study. A preference for low cost and rapid implementation times was observed, with investigators more likely to incur costs than to accept a time delay in project start-up. SD analysis indicated that although initially extra time and cost are necessary for clinical study standardisation, there is a decrease in both over time. Future studies should explore ways of creating mechanisms which decrease the time and cost associated with standardisation processes. In addition, the fact that the costs and time necessary for data standards implementation decrease with time should be made known to the wider research community. Policy makers should attempt to match their data standardisation policies better with the expectations of researchers.

Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya.

PubMed

Njoroge, Martin; Zurovac, Dejan; Ogara, Esther A A; Chuma, Jane; Kirigia, Doris

2017-02-10

The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

Costs to implement an effective transition-to-parenthood program for couples: analysis of the Family Foundations program.

PubMed

Jones, Damon E; Feinberg, Mark E; Hostetler, Michelle L

2014-06-01

The transition to parenthood involves many stressors that can have implications for the couple relationship as well as the developmental environment of the child. Scholars and policymakers have recognized the potential for interventions that can help couples navigate these stressors to improve parenting and coparenting strategies. Such evidence-based programs are scarcely available, however, and little is known about the resources necessary to carry out these programs. This study examines the costs and resources necessary to implement Family Foundations, a program that addresses the multifaceted issues facing first-time parents through a series of pre- and post-natal classes. Costs were determined using a 6-step analytic process and are based on the first implementation of the program carried out through a five-year demonstration project. This assessment demonstrates how overall costs change across years as new cohorts of families are introduced, and how cost breakdowns differ by category as needs shift from training group leaders to sustaining program services. Information from this cost analysis helps clarify how the program could be made more efficient in subsequent implementations. We also consider how results may be used in future research examining economic benefits of participation in the program. Copyright © 2014 Elsevier Ltd. All rights reserved.

Costs to implement an effective transition-to-parenthood program for couples: Analysis of the Family Foundations program

PubMed Central

Jones, Damon E.; Feinberg, Mark E.; Hostetler, Michelle

2014-01-01

The transition to parenthood involves many stressors that can have implications for the couple relationship as well as the developmental environment of the child. Scholars and policymakers have recognized the potential for interventions that can help couples navigate these stressors to improve parenting and coparenting strategies. Such evidence-based programs are scarcely available, however, and little is known about the resources necessary to carry out these programs. This study examines the costs and resources necessary to implement Family Foundations, a program that addresses the multifaceted issues facing first-time parents through a series of pre- and post-natal classes. Costs were determined using a 6-step analytic process and are based on the first implementation of the program carried out through a five-year demonstration project. This assessment demonstrates how overall costs change across years as new cohorts of families are introduced, and how cost breakdowns differ by category as needs shift from training group leaders to sustaining program services. Information from this cost analysis helps clarify how the program could be made more efficient in subsequent implementations. We also consider how results may be used in future research examining economic benefits of participation in the program. PMID:24603052

Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

PubMed

Moise, Nathalie; Huang, Chen; Rodgers, Anthony; Kohli-Lynch, Ciaran N; Tzong, Keane Y; Coxson, Pamela G; Bibbins-Domingo, Kirsten; Goldman, Lee; Moran, Andrew E

2016-07-01

The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. © 2016 American Heart Association, Inc.

Rationale and design of the PREDICE project: cost-effectiveness of type 2 diabetes prevention among high-risk Spanish individuals following lifestyle intervention in real-life primary care setting.

PubMed

Costa, Bernardo; Cabré, Joan J; Sagarra, Ramon; Solà-Morales, Oriol; Barrio, Francisco; Piñol, Josep L; Cos, Xavier; Bolíbar, Bonaventura; Castell, Conxa; Kissimova-Skarbek, Katarzyna; Tuomilehto, Jaakko

2011-08-04

Type 2 diabetes is an important preventable disease and a growing public health problem. Based on information provided by clinical trials, we know that Type 2 diabetes can be prevented or delayed by lifestyle intervention. In view of translating the findings of diabetes prevention research into real-life it is necessary to carry out community-based evaluations so as to learn about the feasibility and effectiveness of locally designed and implemented programmes. The aim of this project was to assess the effectiveness of an active real-life primary care strategy in high-risk individuals for developing diabetes, and then evaluate its efficiency. Cost-Effectiveness analysis of the DE-PLAN (Diabetes in Europe - Prevention using Lifestyle, physical Activity and Nutritional intervention) project when applied to a Mediterranean population in Catalonia (DE-PLAN-CAT). Multicenter, longitudinal cohort assessment (4 years) conducted in 18 primary health-care centres (Catalan Health Institute). Individuals without diabetes aged 45-75 years were screened using the Finnish Diabetes Risk Score - FINDRISC - questionnaire and a 2-h oral glucose tolerance test. All high risk tested individuals were invited to participate in either a usual care intervention (information on diet and cardiovascular health without individualized programme), or the intensive DE-PLAN educational program (individualized or group) periodically reinforced. Oral glucose tolerance test was repeated yearly to determine diabetes incidence. Besides measuring the accumulated incidence of diabetes, information was collected on economic impact of the interventions in both cohorts (using direct and indirect cost questionnaires) and information on utility measures (Quality Adjusted Life Years). A cost-utility and a cost-effectiveness analysis will be performed and data will be modelled to predict long-term cost-effectiveness. The project was intended to evidence that a substantial reduction in Type 2 diabetes incidence can be obtained at a reasonable cost-effectiveness ratio in real-life primary health care setting by an intensive lifestyle intervention. As far as we know, the DE-PLAN-CAT/PREDICE project represents the first assessment of long-term effectiveness and cost-effectiveness of a public healthcare strategy to prevent diabetes within a European primary care setting.

Recommendations From the International Colorectal Cancer Screening Network on the Evaluation of the Cost of Screening Programs.

PubMed

Subramanian, Sujha; Tangka, Florence K L; Hoover, Sonja; Nadel, Marion; Smith, Robert; Atkin, Wendy; Patnick, Julietta

2016-01-01

Worldwide, colorectal cancer is the fourth leading cause of death from cancer and the incidence is projected to increase. Many countries are exploring the introduction of organized screening programs, but there is limited information on the resources required and guidance for cost-effective implementation. To facilitate the generating of the economics evidence base for program implementation, we collected and analyzed detailed program cost data from 5 European members of the International Colorectal Cancer Screening Network. The cost per person screened estimates, often used to compare across programs as an overall measure, varied significantly across the programs. In addition, there were substantial differences in the programmatic and clinical cost incurred, even when the same type of screening test was used. Based on these findings, several recommendations are provided to enhance the underlying methodology and validity of the comparative economic assessments. The recommendations include the need for detailed activity-based cost information, the use of a comprehensive set of effectiveness measures to adequately capture differences between programs, and the incorporation of data from multiple programs in cost-effectiveness models to increase generalizability. Economic evaluation of real-world colorectal cancer-screening programs is essential to derive valuable insights to improve program operations and ensure optimal use of available resources.

Design-to-cost

NASA Technical Reports Server (NTRS)

Bradley, F. E.

1974-01-01

Attempts made to design to costs equipment, vehicles and subsystems for various space projects are discussed. A systematic approach, based on mission requirement analysis, definition of a mission baseline design, benefit and cost analysis, and a benefit-cost analysis was proposed for implementing the cost control program.

Data Flow in Relation to Life-Cycle Costing of Construction Projects in the Czech Republic

NASA Astrophysics Data System (ADS)

Biolek, Vojtěch; Hanák, Tomáš; Marović, Ivan

2017-10-01

Life-cycle costing is an important part of every construction project, as it makes it possible to take into consideration future costs relating to the operation and demolition phase of a built structure. In this way, investors can optimize the project design to minimize the total project costs. Even though there have already been some attempts to implement BIM software in the Czech Republic, the current state of affairs does not support automated data flow between the bill of costs and applications that support building facility management. The main aim of this study is to critically evaluate the current situation and outline a future framework that should allow for the use of the data contained in the bill of costs to manage building operating costs.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

PubMed

Williams, Allison M; Tompa, Emile; Lero, Donna S; Fast, Janet; Yazdani, Amin; Zeytinoglu, Isik U

2017-09-20

Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and; other nuances at play. It is hypothesized that the benefits of the caregiver-friendly workplace policy intervention(s) will include improvements in caregiver-employees' mental, psychosocial and physical health, as well as evidence of cost-benefit and cost-effectiveness for the employer. The expected project results will provide the research evidence for extensive knowledge translation work, to be carried out in collaboration with our knowledge transition partners, to the employer/human resources and occupational health/safety target populations. ISRCTN16187974 Registered August 25, 2016.

Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention: The Importance of Time Nurses Spend on the Front Line of Implementation.

PubMed

Nuckols, Teryl K; Needleman, Jack; Grogan, Tristan R; Liang, Li-Jung; Worobel-Luk, Pamela; Anderson, Laura; Czypinski, Linda; Coles, Courtney; Walsh, Catherine M

2017-11-01

The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals. Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions. We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year. Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities. Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.

Developing integrated parametric planning models for budgeting and managing complex projects

NASA Technical Reports Server (NTRS)

Etnyre, Vance A.; Black, Ken U.

1988-01-01

The applicability of integrated parametric models for the budgeting and management of complex projects is investigated. Methods for building a very flexible, interactive prototype for a project planning system, and software resources available for this purpose, are discussed and evaluated. The prototype is required to be sensitive to changing objectives, changing target dates, changing costs relationships, and changing budget constraints. To achieve the integration of costs and project and task durations, parametric cost functions are defined by a process of trapezoidal segmentation, where the total cost for the project is the sum of the various project cost segments, and each project cost segment is the integral of a linearly segmented cost loading function over a specific interval. The cost can thus be expressed algebraically. The prototype was designed using Lotus-123 as the primary software tool. This prototype implements a methodology for interactive project scheduling that provides a model of a system that meets most of the goals for the first phase of the study and some of the goals for the second phase.

Optimisation of reconstruction--reprojection-based motion correction for cardiac SPECT.

PubMed

Kangasmaa, Tuija S; Sohlberg, Antti O

2014-07-01

Cardiac motion is a challenging cause of image artefacts in myocardial perfusion SPECT. A wide range of motion correction methods have been developed over the years, and so far automatic algorithms based on the reconstruction--reprojection principle have proved to be the most effective. However, these methods have not been fully optimised in terms of their free parameters and implementational details. Two slightly different implementations of reconstruction--reprojection-based motion correction techniques were optimised for effective, good-quality motion correction and then compared with each other. The first of these methods (Method 1) was the traditional reconstruction-reprojection motion correction algorithm, where the motion correction is done in projection space, whereas the second algorithm (Method 2) performed motion correction in reconstruction space. The parameters that were optimised include the type of cost function (squared difference, normalised cross-correlation and mutual information) that was used to compare measured and reprojected projections, and the number of iterations needed. The methods were tested with motion-corrupt projection datasets, which were generated by adding three different types of motion (lateral shift, vertical shift and vertical creep) to motion-free cardiac perfusion SPECT studies. Method 2 performed slightly better overall than Method 1, but the difference between the two implementations was small. The execution time for Method 2 was much longer than for Method 1, which limits its clinical usefulness. The mutual information cost function gave clearly the best results for all three motion sets for both correction methods. Three iterations were sufficient for a good quality correction using Method 1. The traditional reconstruction--reprojection-based method with three update iterations and mutual information cost function is a good option for motion correction in clinical myocardial perfusion SPECT.

How to renovate a 50-year-old wastewater treating plant: Part 1

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

Hunter, M.L.

1996-01-01

How does an existing refinery cost-effectively renovate wastewater/stormwater treating systems to meet today`s environmental regulations and standards? Faced with solving this problem, Amoco`s Whiting Refinery developed a project team consisting of plant and operations engineers, corporate project and design engineers, contractors and vendors to map out a strategy to re-engineer the existing wastewater treating plant (WWTP) and auxiliary functions. This case history shows how an old refinery limited by existing equipment, building space, operation`s availability requirements and costs divided the project into several design phases. The design team used a proactive approach with empowerment responsibilities to solve construction, equipment usagemore » and regulatory problems throughout the project`s lifetime. Focusing on front-end planning and customer service (the refinery), team members applied value-based engineering designs to keep costs down, implemented safe work practices during construction, used HAZOP reviews to scrutinize proposed designs for operating and maintenance procedures, etc. The result has been the renovation of a 50-year-old WWTP completed under budget, ontime and in compliance with federal mandates.« less

Toward best-practice post-disaster mental health promotion for children: Sri Lanka.

PubMed

Commers, Matthew J; Morival, Marc; Devries, Marten W

2014-03-01

There is a pressing need for low-cost intervention models to promote mental health among children in the wake of natural disasters. This article describes an evaluation of one such model: the Happy/Sad Letter Box (HSLB) Project, a mental health promotion intervention designed to minimize trauma in children, resulting from the Indian Ocean tsunami of 26 December 2004. The HSLB Project was implemented in 68 schools in Sri Lanka's Hambantota District from April 2005 forward. Methods included questionnaires (n = 203), interviews, and group consultation with schoolchildren, teachers, teacher counsellors, principals, educational zone directors and parents. The HSLB intervention was seen as relevant and non-stigmatized, cost-effective if implemented after initial recovery steps, anecdotally effective in identifying and helping resolve trauma, accommodating the full range of children's daily stressors and sustainable. Gender, children's age, school size and the level of the tsunami impact for response were found to correlate with response differences. Along four dimensions previously identified in the literature (ability to triage, matching of intervention timing and focus, ability to accommodate a range of stressors and context compatibility), the HSLB Project is a promising intervention model (1) for children; (2) at group-level; (3) relating to natural disasters. The Nairobi Call to Action [WHO (2009) Nairobi Call to Action for Closing the Implementation Gap in Health Promotion. Geneva: World Health Organization] emphasized the importance of mainstreaming health promotion into priority programme areas, specifically including mental health. The HSLB Project represents the integration of health promotion practice into disaster preparedness mental health infrastructure.

IANUA: a regional project for the determination of costs in HIV-infected patients.

PubMed

Giannini, Barbara; Gazzarata, Roberta; Orcamo, Patrizia; Merlano, Caterina; Cenderello, Giovanni; Venturini, Alberto; Di Biagio, Antonio; Mazzarello, Giovanni; Montefiori, Marcello; Ameri, Marta; Setti, Maurizio; Viscoli, Claudio; Cassola, Giovanni; Giacomini, Mauro

2015-01-01

HIV treatment is based on combined antiretroviral therapy (cART) which has substantially improved survival, thus resulting in an increase in patient life expectancy as well as in the cost of HIV-related medical care. Therefore, several cost effectiveness studies were implemented worldwide, with one specifically in the Liguria region (Italy), to compare the annual economic expense in this area for HIV services, and the related improvement in patients' health. The IANUA project is intended to implement both cost-effectiveness and cost-utility analysis, therefore data related to clinical indicators and perceived health status were collected, the latter using a questionnaire based on the EQ-5D-3L. Information about the antiretroviral drugs and the relative quantity that a patient withdraws from the hospital pharmacy every month were extracted from the regional "F-file". All data gathered were stored in the Ligurian HIV Network, a web platform developed by the DIBRIS - Medinfo laboratory. More than eight hundred questionnaires were collected, and data will be elaborated by economists and psychologists. The first statistical elaborations showed that, as expected, costs increased as the number of therapeutic lines increased. Moreover, the average annual costs for patients whose last CD4 values were below 200 cells/mmc corresponded to the maximum expense recorded, however, the cost for patients with final CD4 counts above 500 cells/mmc was not, as expected, the lowest found. This can be explained by the fact that stabilized patients, who had CD4 values below 500 cells/mmc, did not need very expensive care, while patients with CD4 counts above 500 cells/mmc improved their health status thanks to cART.

Practice points in utilizing local volunteers in community health projects.

PubMed

Muula, Adamson S; Theu, Joe; Hofman, Jan J

2004-07-01

Community volunteers are recruited for many health intervention projects. There are various motivations for the use of the volunteers and these include: the desire to reduce financial costs of projects/programmes; to encourage community ownership; ensure long-term sustainability of the health intervention; and to empower local communities through training offered the project. Health intervention measures working with community volunteers should not be implemented without due consideration of issues regarding mobilization and engagement, skills and motivation of the volunteers and their effectiveness and efficiency towards the attainment of the project goals. This paper discusses some tips that should be considered when community volunteers are used in resource-limited situations.

Albeni Falls Wildlife Mitigation Project, 2008 Annual Report.

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

Soults, Scott

The Albeni Falls Interagency Work Group (AFIWG) was actively involved in implementing wildlife mitigation activities in late 2007, but due to internal conflicts, the AFIWG members has fractionated into a smaller group. Implementation of the monitoring and evaluation program continued across protected lands. As of 2008, The Albeni Falls Interagency Work Group (Work Group) is a coalition comprised of wildlife managers from three tribal entities (Kalispel Tribe, Kootenai Tribe, Coeur d Alene Tribe) and the US Army Corps of Engineers. The Work Group directs where wildlife mitigation implementation occurs in the Kootenai, Pend Oreille and Coeur d Alene subbasins. Themore » Work Group is unique in the Columbia Basin. The Columbia Basin Fish and Wildlife Authority (CBFWA) wildlife managers in 1995, approved what was one of the first two project proposals to implement mitigation on a programmatic basis. The maintenance of this kind of approach through time has allowed the Work Group to implement an effective and responsive habitat protection program by reducing administrative costs associated with site-specific project proposals. The core mitigation entities maintain approximately 9,335 acres of wetland/riparian habitats in 2008.« less

Economic impact of a Medicaid population health management program.

PubMed

Rust, George; Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-10-01

A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003-2004) and performance year one (2006-2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions.

Economic Impact of a Medicaid Population Health Management Program

PubMed Central

Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-01-01

Abstract A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003–2004) and performance year one (2006–2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions. (Population Health Management 2011;14:215–222) PMID:21506728

Cost-effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics

PubMed Central

Fortney, John C; Gifford, Allen L; Rimland, David; Monson, Thomas; Rodriguez-Barradas, Maria C.; Pyne, Jeffrey M

2015-01-01

Objective To examine the cost-effectiveness of the HITIDES intervention. Design Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care. Setting Three Veterans Health Administration (VHA) HIV clinics in the Southern US. Subjects 249 HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care. Intervention HITIDES consisted of an off-site HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines. Main outcome measure(s) Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost effectiveness ratios (ICERs) and net health benefit (NHB). ICER distributions were generated using nonparametric bootstrap with replacement sampling. Results The HITIDES intervention was more effective and cost-saving compared to usual care in 78% of bootstrapped samples. The intervention NHB was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY. Conclusions In HIV clinic settings this intervention was more effective and cost-saving compared to usual care. Implementation of off-site depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients, but also maximizes the efficient use of limited healthcare resources. PMID:26102447

Funding for Library Automation.

ERIC Educational Resources Information Center

Thompson, Ronelle K. H.

This paper provides a brief overview of planning and implementing a project to fund library automation. It is suggested that: (1) proposal budgets should include all costs of a project, such as furniture needed for computer terminals, costs for modifying library procedures, initial supplies, or ongoing maintenance; (2) automation does not save…

Cost-effectiveness of a quality improvement collaborative for obstetric and newborn care in Niger.

PubMed

Broughton, Edward; Saley, Zakari; Boucar, Maina; Alagane, Dondi; Hill, Kathleen; Marafa, Aicha; Asma, Yaroh; Sani, Karimou

2013-01-01

The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high-impact, evidence-based care standards. Intervention costs and cost-effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale-up the intervention to additional sites. Facility-based maternal care outcomes and costs from pre-quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records. The average delivery-cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost-effectiveness was $147/disability-adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost-savings and improved health outcomes can be predicted. The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources. This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.

Tips for Ensuring Successful Software Implementation

ERIC Educational Resources Information Center

Weathers, Robert

2013-01-01

Implementing an enterprise-level, mission-critical software system is an infrastructure project akin to other sizable projects, such as building a school. It's costly and complex, takes a year or more to complete, requires the collaboration of many different parties, involves uncertainties, results in a long-lived asset requiring ongoing…

Pressure ulcers: implementation of evidence-based nursing practice.

PubMed

Clarke, Heather F; Bradley, Chris; Whytock, Sandra; Handfield, Shannon; van der Wal, Rena; Gundry, Sharon

2005-03-01

A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers.

Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting

PubMed Central

Campos, Nicole G; Tsu, Vivien; Jeronimo, Jose; Njama-Meya, Denise; Mvundura, Mercy; Kim, Jane J

2017-01-01

Abstract With the availability of a low-cost HPV DNA test that can be administered by either a healthcare provider or a woman herself, programme planners require information on the costs and cost-effectiveness of implementing cervical cancer screening programmes in low-resource settings under different models of healthcare delivery. Using data from the START-UP demonstration project and a micro-costing approach, we estimated the health and economic impact of once-in-a-lifetime HPV self-collection campaign relative to clinic-based provider-collection of HPV specimens in Uganda. We used an individual-based Monte Carlo simulation model of the natural history of HPV and cervical cancer to estimate lifetime health and economic outcomes associated with screening with HPV DNA testing once in a lifetime (clinic-based provider-collection vs a self-collection campaign). Test performance and cost data were obtained from the START-UP demonstration project using a micro-costing approach. Model outcomes included lifetime risk of cervical cancer, total lifetime costs (in 2011 international dollars [I$]), and life expectancy. Cost-effectiveness ratios were expressed using incremental cost-effectiveness ratios (ICERs). When both strategies achieved 75% population coverage, ICERs were below Uganda’s per capita GDP (self-collection: I$80 per year of life saved [YLS]; provider-collection: I$120 per YLS). When the self-collection campaign achieved coverage gains of 15–20%, it was more effective than provider-collection, and had a lower ICER unless coverage with both strategies was 50% or less. Findings were sensitive to cryotherapy compliance among screen-positive women and relative HPV test performance. The primary limitation of this analysis is that self-collection costs are based on a hypothetical campaign but are based on unit costs from Uganda. Once-in-a-lifetime screening with HPV self-collection may be very cost-effective and reduce cervical cancer risk by > 20% if coverage is high. Demonstration projects will be needed to confirm the validity of our logistical, costing and compliance assumptions. PMID:28369405

Cost-effectiveness of an HPV self-collection campaign in Uganda: comparing models for delivery of cervical cancer screening in a low-income setting.

PubMed

Campos, Nicole G; Tsu, Vivien; Jeronimo, Jose; Njama-Meya, Denise; Mvundura, Mercy; Kim, Jane J

2017-09-01

With the availability of a low-cost HPV DNA test that can be administered by either a healthcare provider or a woman herself, programme planners require information on the costs and cost-effectiveness of implementing cervical cancer screening programmes in low-resource settings under different models of healthcare delivery. Using data from the START-UP demonstration project and a micro-costing approach, we estimated the health and economic impact of once-in-a-lifetime HPV self-collection campaign relative to clinic-based provider-collection of HPV specimens in Uganda. We used an individual-based Monte Carlo simulation model of the natural history of HPV and cervical cancer to estimate lifetime health and economic outcomes associated with screening with HPV DNA testing once in a lifetime (clinic-based provider-collection vs a self-collection campaign). Test performance and cost data were obtained from the START-UP demonstration project using a micro-costing approach. Model outcomes included lifetime risk of cervical cancer, total lifetime costs (in 2011 international dollars [I$]), and life expectancy. Cost-effectiveness ratios were expressed using incremental cost-effectiveness ratios (ICERs). When both strategies achieved 75% population coverage, ICERs were below Uganda's per capita GDP (self-collection: I$80 per year of life saved [YLS]; provider-collection: I$120 per YLS). When the self-collection campaign achieved coverage gains of 15-20%, it was more effective than provider-collection, and had a lower ICER unless coverage with both strategies was 50% or less. Findings were sensitive to cryotherapy compliance among screen-positive women and relative HPV test performance. The primary limitation of this analysis is that self-collection costs are based on a hypothetical campaign but are based on unit costs from Uganda. Once-in-a-lifetime screening with HPV self-collection may be very cost-effective and reduce cervical cancer risk by > 20% if coverage is high. Demonstration projects will be needed to confirm the validity of our logistical, costing and compliance assumptions. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study.

PubMed

Saronga, Happiness Pius; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell Ayindenaba; Wangwe, Peter; Sukums, Felix; Leshabari, Melkizedeck; Blank, Antje; Sauerborn, Rainer; Loukanova, Svetla

2017-08-07

QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.

Cost of Community Integrated Prevention Campaign for Malaria, HIV, and Diarrhea in Rural Kenya

PubMed Central

2011-01-01

Background Delivery of community-based prevention services for HIV, malaria, and diarrhea is a major priority and challenge in rural Africa. Integrated delivery campaigns may offer a mechanism to achieve high coverage and efficiency. Methods We quantified the resources and costs to implement a large-scale integrated prevention campaign in Lurambi Division, Western Province, Kenya that reached 47,133 individuals (and 83% of eligible adults) in 7 days. The campaign provided HIV testing, condoms, and prevention education materials; a long-lasting insecticide-treated bed net; and a water filter. Data were obtained primarily from logistical and expenditure data maintained by implementing partners. We estimated the projected cost of a Scaled-Up Replication (SUR), assuming reliance on local managers, potential efficiencies of scale, and other adjustments. Results The cost per person served was $41.66 for the initial campaign and was projected at $31.98 for the SUR. The SUR cost included 67% for commodities (mainly water filters and bed nets) and 20% for personnel. The SUR projected unit cost per person served, by disease, was $6.27 for malaria (nets and training), $15.80 for diarrhea (filters and training), and $9.91 for HIV (test kits, counseling, condoms, and CD4 testing at each site). Conclusions A large-scale, rapidly implemented, integrated health campaign provided services to 80% of a rural Kenyan population with relatively low cost. Scaling up this design may provide similar services to larger populations at lower cost per person. PMID:22189090

[Collaborative and stepped care for depression: Development of a model project within the Hamburg Network for Mental Health (psychenet.de)].

PubMed

Härter, Martin; Heddaeus, Daniela; Steinmann, Maya; Schreiber, Robert; Brettschneider, Christian; König, Hans-Helmut; Watzke, Birgit

2015-04-01

Depression is one of the most widespread mental disorders in Germany and causes a great suffering and involves high costs. Guidelines recommend stepped and interdisciplinary collaborative care models for the treatment of depression. Stepped and collaborative care models are described regarding their efficacy and cost-effectiveness. A current model project within the Hamburg Network for Mental Health exemplifies how guideline-based stepped diagnostics and treatment incorporating innovative low-intensity interventions are implemented by a large network of health care professionals and clinics. An accompanying evaluation using a cluster randomized controlled design assesses depressive symptom reduction and cost-effectiveness for patients treated within "Health Network Depression" ("Gesundheitsnetz Depression", a subproject of psychenet.de) compared with patients treated in routine care. Over 90 partners from inpatient and outpatient treatment have been successfully involved in recruiting over 600 patients within the stepped care model. Communication in the network was greatly facilitated by the use of an innovative online tool for the supply and reservation of treatment capacities. The participating professionals profit from the improved infrastructure and the implementation of advanced training and quality circle work. New treatment models can greatly improve the treatment of depression owing to their explicit reference to guidelines, the establishment of algorithms for diagnostics and treatment, the integration of practices and clinics, in addition to the implementation of low-intensity treatment alternatives. These models could promote the development of a disease management program for depression.

Problems of increased transport load as a result of implementation of projects of high-rise constructions

NASA Astrophysics Data System (ADS)

Provotorov, Ivan; Gasilov, Valentin; Anisimova, Nadezhda

2018-03-01

The structure of problems of high-rise construction us suggested, which includes the impact on environment, design solutions, transportation problems, financial costs for construction and operation, and others. Positive and negative aspects of high-rise construction are considered. One of the basic problems of high-rise construction is the problem of increased transport load. Construction of the subway on the basis of the concession mechanism, with the use of unmanned control of rolling stock is proposed as the most expedient solution. An evaluation of the effectiveness of this project is presented, it shows quite high performance indicators for a private investor. Main problems that the project implementation may face in conditions of lack of scientific and methodological support are outlined.

Basic Skills and Job Retention. Final Report.

ERIC Educational Resources Information Center

Seminole Community Coll., Sanford, FL.

A project developed an educational model to deliver academic remediation services to small businesses at a cost-effective rate by using a lead instructor and volunteer assistants. The first step was planning and implementing the tutor training segment. The class and accompanying manual were developed, and tutors were identified and trained in a…

A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.

PubMed

de Groot, Jeanny Ja; Maessen, José Mc; Slangen, Brigitte Fm; Winkens, Bjorn; Dirksen, Carmen D; van der Weijden, Trudy

2015-07-30

Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the needs of organisations and local barriers for change, in comparison with the generic breakthrough strategy that is usually applied in large-scale improvement projects in the Netherlands. All Dutch hospitals authorised to perform major abdominal surgery in gynaecological oncology patients are eligible for inclusion in this cluster randomised controlled trial. The hospitals that already fully implemented the ERAS programme in their local perioperative management or those who predominantly admit gynaecological surgery patients to an external hospital replacement care facility will be excluded. Cluster randomisation will be applied at the hospital level and will be stratified based on tertiary status. Hospitals will be randomly assigned to the stepped implementation strategy or the breakthrough strategy. The control group will receive the traditional breakthrough strategy with three educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities. The intervention group will receive an innovative stepped strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and may build up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far. Both implementation strategies will be completed within 1 year and evaluated on effect, process, and cost-effectiveness. The primary outcome is length of postoperative hospital stay. Additional outcome measures are length of recovery, guideline adherence, and mean implementation costs per patient. This study takes up the challenge to evaluate an efficient strategy for large-scale implementation. Comparing effectiveness and costs of two different approaches, this study will help to define a preferred strategy for nationwide dissemination of best practices. Dutch Trial Register NTR4058.

The Benefits and Costs of National Service: Methods for Benefit Assessment with Application to Three AmeriCorps Programs.

ERIC Educational Resources Information Center

Neumann, George R.; And Others

A study applied the principles of benefit-cost analysis to three prototype grants programs of AmeriCorps: AmeriCorps for Math and Literacy, Project First, and the East Bay Conservation Corps. It studied the methods these projects used and estimated the benefits using data from projects similar in approach and implementation. Benefits received by…

The 100-C-7 Remediation Project. An Overview of One of DOE's Largest Remediation Projects - 13260

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

Post, Thomas C.; Strom, Dean; Beulow, Laura

The U.S. Department of Energy Richland Operations Office (RL), U.S. Environmental Protection Agency (EPA) and Washington Closure Hanford LLC (WCH) completed remediation of one of the largest waste sites in the U.S. Department of Energy complex. The waste site, 100-C-7, covers approximately 15 football fields and was excavated to a depth of 85 feet (groundwater). The project team removed a total of 2.3 million tons of clean and contaminated soil, concrete debris, and scrap metal. 100-C-7 lies in Hanford's 100 B/C Area, home to historic B and C Reactors. The waste site was excavated in two parts as 100-C-7 andmore » 100-C-7:1. The pair of excavations appear like pit mines. Mining engineers were hired to design their tiered sides, with safety benches every 17 feet and service ramps which allowed equipment access to the bottom of the excavations. The overall cleanup project was conducted over a span of almost 10 years. A variety of site characterization, excavation, load-out and sampling methodologies were employed at various stages of remediation. Alternative technologies were screened and evaluated during the project. A new method for cost effectively treating soils was implemented - resulting in significant cost savings. Additional opportunities for minimizing waste streams and recycling were identified and effectively implemented by the project team. During the final phase of cleanup the project team applied lessons learned throughout the entire project to address the final, remaining source of chromium contamination. The C-7 cleanup now serves as a model for remediating extensive deep zone contamination sites at Hanford. (authors)« less

Data Service Provider Cost Estimation Tool

NASA Technical Reports Server (NTRS)

Fontaine, Kathy; Hunolt, Greg; Booth, Arthur L.; Banks, Mel

2011-01-01

The Data Service Provider Cost Estimation Tool (CET) and Comparables Database (CDB) package provides to NASA s Earth Science Enterprise (ESE) the ability to estimate the full range of year-by-year lifecycle cost estimates for the implementation and operation of data service providers required by ESE to support its science and applications programs. The CET can make estimates dealing with staffing costs, supplies, facility costs, network services, hardware and maintenance, commercial off-the-shelf (COTS) software licenses, software development and sustaining engineering, and the changes in costs that result from changes in workload. Data Service Providers may be stand-alone or embedded in flight projects, field campaigns, research or applications projects, or other activities. The CET and CDB package employs a cost-estimation-by-analogy approach. It is based on a new, general data service provider reference model that provides a framework for construction of a database by describing existing data service providers that are analogs (or comparables) to planned, new ESE data service providers. The CET implements the staff effort and cost estimation algorithms that access the CDB and generates the lifecycle cost estimate for a new data services provider. This data creates a common basis for an ESE proposal evaluator for considering projected data service provider costs.

Reengineering the project design process

NASA Astrophysics Data System (ADS)

Kane Casani, E.; Metzger, Robert M.

1995-01-01

In response to the National Aeronautics and Space Administration's goal of working faster, better, and cheaper, the Jet Propulsion Laboratory (JPL) has developed extensive plans to minimize cost, maximize customer and employee satisfaction, and implement small- and moderate-size missions. These plans include improved management structures and processes, enhanced technical design processes, the incorporation of new technology, and the development of more economical space- and ground-system designs. The Laboratory's new Flight Projects Implementation Development Office has been chartered to oversee these innovations and the reengineering of JPL's project design process, including establishment of the Project Design Center (PDC) and the Flight System Testbed (FST). Reengineering at JPL implies a cultural change whereby the character of the Laboratory's design process will change from sequential to concurrent and from hierarchical to parallel. The Project Design Center will support missions offering high science return, design to cost, demonstrations of new technology, and rapid development. Its computer-supported environment will foster high-fidelity project life-cycle development and more accurate cost estimating. These improvements signal JPL's commitment to meeting the challenges of space exploration in the next century.

Cost-effectiveness of environmental management for vector control in resource development projects.

PubMed

Bos, R

1991-01-01

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Science on a Shoestring: Building Nursing Knowledge With Limited Funding.

PubMed

Conn, Vicki S; Topp, Robert; Dunn, Susan L; Hopp, Lisa; Jadack, Rosemary; Jansen, Debra A; Jefferson, Urmeka T; Moch, Susan Diemert

2015-10-01

Building the science for nursing practice has never been more important. However, shrunken federal and state research budgets mean that investigators must find alternative sources of financial support and develop projects that are less costly to carry out. New investigators often build beginning programs of research with limited funding. This article provides an overview of some cost-effective research approaches and gives suggestions for finding other sources of funding. Examples of more cost-effective research approaches include adding complementary questions to existing funded research projects; conducting primary analysis of electronic patient records and social media content; conducting secondary analysis of data from completed studies; reviewing and synthesizing previously completed research; implementing community-based participatory research; participating in collaborative research efforts such as inter-campus team research, practice-based research networks (PBRNs), and involving undergraduate and doctoral students in research efforts. Instead of relying on funding from the National Institutes of Health (NIH) and other government agencies, nurse researchers may be able to find support for research from local sources such as businesses, organizations, or clinical agencies. Investigators will increasingly have to rely on these and other creative approaches to fund and implement their research programs if granting agency budgets do not significantly expand. © The Author(s) 2015.

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

PubMed

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

2017-01-01

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

Project management practice and its effects on project success in Malaysian construction industry

NASA Astrophysics Data System (ADS)

Haron, N. A.; Devi, P.; Hassim, S.; Alias, A. H.; Tahir, M. M.; Harun, A. N.

2017-12-01

The rapid economic development has increased the demand for construction of infrastructure and facilities globally. Sustainable development and globalization are the new ‘Zeitgeist’ of the 21st century. In order to implement these projects successfully and to meet the functional aim of the projects within their lifetime, an efficient project management practice is needed. The aim of this study is to identify the critical success factors (CSFs) and the extent of use of project management practice which affects project success, especially during the implementation stage. Data were obtained from self-administered questionnaires with 232 respondents. A mixed method of data collection was adopted using semi-structured interview and questionnaire approach. The result of the analysis of data obtained showed that new and emerging criteria such as customer satisfaction, competency of the project team, and performance of subcontractors/suppliers are becoming measures of success in addition to the classic iron triangle’s view of time, cost and quality. An insight on the extent of use of different project management practice in the industry was also achieved from the study.

Tailoring Enterprise Systems Engineering Policy for Project Scale and Complexity

NASA Technical Reports Server (NTRS)

Cox, Renee I.; Thomas, L. Dale

2014-01-01

Space systems are characterized by varying degrees of scale and complexity. Accordingly, cost-effective implementation of systems engineering also varies depending on scale and complexity. Recognizing that systems engineering and integration happen everywhere and at all levels of a given system and that the life cycle is an integrated process necessary to mature a design, the National Aeronautic and Space Administration's (NASA's) Marshall Space Flight Center (MSFC) has developed a suite of customized implementation approaches based on project scale and complexity. While it may be argued that a top-level system engineering process is common to and indeed desirable across an enterprise for all space systems, implementation of that top-level process and the associated products developed as a result differ from system to system. The implementation approaches used for developing a scientific instrument necessarily differ from those used for a space station. .

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

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

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

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

Implementation and Performance of Factorized Back projection on Low-Cost Commercial-Off-the-Shelf Hardware

DTIC Science & Technology

performance on a low cost, low size, weight, and power (SWAP) computer : a Raspberry Pi Model B. For a comparison of performance, a baseline implementation...improvement factor of 2-3 compared to filtered backprojection. Execution on a single Raspberry Pi is too slow for real-time imaging. However, factorized...backprojection is easily parallelized, and we include a discussion of parallel implementation across multiple Pis .

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

A quantitative analysis study on the implementation of partnering in the design and build construction project

NASA Astrophysics Data System (ADS)

Halil, F. M.; Nasir, N. M.; Shukur, A. S.; Hashim, H.

2018-02-01

Design and Build construction project involved the biggest scale of the cost of investment as compared to the traditional approach. In Design and Build, the client hires a design professional that will design according to the client’s need and specification. This research aim is to explore the concept of partnering implementation practiced in the design and build procurement approach. Therefore, the selection of design professionals such as Contractors and consultants in the project is crucial to ensure the successful project completion on time, cost, and quality. The methodology adopted using quantitative approach. Administration of the questionnaire was distributed to the public client by using postal survey. Outcomes of the results, the public clients agreed that project management capabilities and commitment to budget as a crucial element of partnering from the design professional in design and build construction project.

New workers' compensation legislation: expected pharmaceutical cost savings.

PubMed

Wilson, Leslie; Gitlin, Matthew

2005-10-01

California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.

Implementation of a management information system for hospital use at the Policlinico Universitario A. Gemelli.

PubMed

Mobilia, G

1996-01-01

First, the experience with the implementation of HISs at the "Policlinico Gemelli", is reported. They were adopted since long for management support. In fact, they are playing an increasingly relevant role in health care facilities. Subsequently, operational applications are described with particular reference to the most recent ones, implemented within European projects with partial EEC financing. They are very useful to the medical and nursing personnel and for patient data management during treatment. Finally, the accounting system for cost centers, using, processing and integrating data of all used information systems, is described. It affords a low cost aggregation of all information about costs and services required for the management of four-hundred elementary operating units which constitute the structure. This system is representative of all managerial information of the "Policlinico" which is included in monthly reports, also described. They are sent to the Direction and managers of the organizational units. The system is a strategic tool of the utmost importance for rapid and effective management.

Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

PubMed

Corriero, Rosemary; Redmon, Ginger

Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. Thirty-eight state immunization programs. Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Brooke, Vanessa; Dyer, Tim; Waller, Cara; King, Richard; Ramsey, Wayne; Mortimer, Duncan

2017-05-25

This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed. Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.

Urban Infrastructure Development Works in India: Delay and Difficulties in Implementation with Reference to a Water Supply Project

NASA Astrophysics Data System (ADS)

Aditya, A. K.; Douglass, David Allen; Bhattacharya, Mahua

2017-09-01

A handsome project is undertaken by the Govt. of India with funding under either foreign investments or from their own resources. Though the projects are targeted to be implemented within a certain time frame these are never achieved because of the frequent delay in implementation. This has caused time and cost overruns as well as delay in delivering the benefits to the commuters. An insight into the critical problems and affairs by the experts who are engaged in the process of execution/implementation through various consultants has brought to light some key recurring issues with remedial measures requiring action from the different stakeholders for such projects.

Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project.

PubMed

Esperato, Alexo; Bishai, David; Hyder, Adnan A

2012-01-01

The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.

Cost-Effectiveness of Access Expansion to Treatment of Hepatitis C Virus Infection Through Primary Care Providers.

PubMed

Rattay, Thilo; Dumont, Ian P; Heinzow, Hauke S; Hutton, David W

2017-12-01

Chronic hepatitis C virus (HCV) infection is a major burden on individuals and health care systems. The Extension for Community Healthcare Outcomes (Project ECHO) enables primary care providers to deliver best-practice care for complex conditions to underserved populations. The US Congress passed the ECHO Act in late 2016, requiring the Department of Health and Human Services to investigate the model. We performed a cost-effectiveness analysis to assess diagnosis and treatment of HCV infection in a primary care patient panel with and without the implementation of Project ECHO. We used Markov models to simulate disease progression, quality of life, and life expectancy among individuals with HCV infection and for the general population. Data from the University of New Mexico's ECHO operation for HCV show an increase in treatment rates. Corresponding increases in survival, quality-adjusted life years (QALYs), costs, and resulting budget impact between ECHO and non-ECHO patients with HCV were then compared. Project ECHO increased costs and QALYs. The incremental cost-effectiveness ratio of ECHO was $10,351 per QALY compared with the status quo; >99.9% of iterations fell below the willingness-to-pay threshold of $100,000 per QALY. We were unable to confirm whether the increase in rates of treatment associated with Project ECHO were due to increased or more targeted screening, higher adherence, or access to treatment. Our sensitivity analyses show that the results are largely independent of the cause. Budget impact analysis shows payers would have to invest an additional $339.54 million over a 5-year period to increase treatment by 4446 patients, per 1 million covered lives. Using a simulated primary care patient panel, we showed that Project ECHO is a cost-effective way to find and treat patients with HCV infection at scale using existing primary care providers. This approach could substantially reduce the burden of chronic HCV infection in the United States, but high budgetary costs suggest that incremental rollout of ECHO may be best. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Endangered species protection and water resource development. [Endangered Species Act and its implementation; case study-survival of the whooping crane

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

Harrington, W.

1980-03-01

The Endangered Species Act and its implementation are reviewed, with special attention given to the Act's recent Amendments. This Act has played a major role in litigation surrounding several recent water resource developments. A case study of one such, the Missouri Basin Power Project, is discussed. In addition to a short case history, issues covered include the following: the link between the Power Project and its impact on the endangered species, its effect on the distribution of water resurces, its effect on future development on the Platte River, and the extent to which a range of preservation options can bemore » considered under the Act. Tentative general conclusions will be drawn concerning the flexibility of the Act, its cost effectiveness, and its implications for future water resource development.« less

40 CFR 35.268 - Award limitations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... for each category; and (5) Significant watershed projects. For watershed projects whose costs exceed $50,000, the work plan also contains: (i) A brief synopsis of the watershed implementation plan...

40 CFR 35.268 - Award limitations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for each category; and (5) Significant watershed projects. For watershed projects whose costs exceed $50,000, the work plan also contains: (i) A brief synopsis of the watershed implementation plan...

40 CFR 35.268 - Award limitations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... for each category; and (5) Significant watershed projects. For watershed projects whose costs exceed $50,000, the work plan also contains: (i) A brief synopsis of the watershed implementation plan...

40 CFR 35.268 - Award limitations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... for each category; and (5) Significant watershed projects. For watershed projects whose costs exceed $50,000, the work plan also contains: (i) A brief synopsis of the watershed implementation plan...

40 CFR 35.268 - Award limitations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... for each category; and (5) Significant watershed projects. For watershed projects whose costs exceed $50,000, the work plan also contains: (i) A brief synopsis of the watershed implementation plan...

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health.

PubMed

Thornton, Rachel L J; Glover, Crystal M; Cené, Crystal W; Glik, Deborah C; Henderson, Jeffrey A; Williams, David R

2016-08-01

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels. Project HOPE—The People-to-People Health Foundation, Inc.

Performance Contracting and Energy Efficiency in the State Government Market

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

Bharvirkar, Ranjit; Goldman, Charles; Gilligan, Donald

There is growing interest in energy efficiency (EE) among state policymakers as a result of increasing environmental concerns, rising electricity and natural gas prices, and lean economic times that motivate states to look more aggressively for cost-saving opportunities in public sector buildings. One logical place for state policymakers to demonstrate their commitment to energy efficiency is to 'lead by example' by developing and implementing strategies to reduce the energy consumption of state government facilities through investments in energy efficient technologies. Traditionally, energy efficiency improvements at state government facilities are viewed as a subset in the general category of building maintenancemore » and construction. These projects are typically funded through direct appropriations. However, energy efficiency projects are often delayed or reduced in scope whereby not all cost-effective measures are implemented because many states have tight capital budgets. Energy Savings Performance Contracting (ESPC) offers a potentially useful strategy for state program and facility managers to proactively finance and develop energy efficiency projects. In an ESPC project, Energy Service Companies (ESCOs) typically guarantee that the energy and cost savings produced by the project will equal or exceed all costs associated with implementing the project over the term of the contract. ESCOs typically provide turnkey design, installation, and maintenance services and also help arrange project financing. Between 1990 and 2006, U.S. ESCOs reported market activity of {approx}$28 Billion, with about {approx}75-80% of that activity concentrated in the institutional markets (K-12 schools, colleges/universities, state/local/federal government and hospitals). In this study, we review the magnitude of energy efficiency investment in state facilities and identify 'best practices' while employing performance contracting in the state government sector. The state government market is defined to include state offices, state universities, correctional facilities, and other state facilities. This study is part of a series of reports prepared by Lawrence Berkeley National Laboratory (LBNL) and the National Association of Energy Services Companies (NAESCO) on the ESCO market and industry trends. The scope of previous reports was much broader: Goldman et al. (2002) analyzed ESCO project costs and savings in public and private sector facilities, Hopper et al. (2005) focused on ESCO project activity in all public and institutional sectors, while Hopper et al (2007) provided aggregate results of a comprehensive survey of ESCOs on current industry activity and future prospects. We decided to focus the current study on ESCO and energy efficiency activity and potential market barriers in the state government market because previous studies suggested that this institutional sector has significant remaining energy efficiency opportunities. Moreover, ESCO activity in the state government market has lagged behind other institutional markets (e.g., K-12 schools, local governments, and the federal market). Our primary objectives were as follows: (1) Assess existing state agency energy information and data sources that could be utilized to develop performance metrics to assess progress among ESPC programs in states; (2) Conduct a comparative review of the performance of selected state ESPC programs in reducing energy usage and costs in state government buildings; and (3) Delineate the extent to which state government sector facilities are implementing energy efficiency projects apart from ESPC programs using other strategies (e.g. utility ratepayer-funded energy efficiency programs, loan funds).« less

Digitizing dissertations for an institutional repository: a process and cost analysis.

PubMed

Piorun, Mary; Palmer, Lisa A

2008-07-01

This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions.

[Cost-effectiveness of the HIV screening program carried out in Guangxi Zhuang Autonomous Region infectious disease special demonstration project areas].

PubMed

Lu, Huaxiang; Luo, Liuhong; Chen, Li; Zhang, Shizhen; Liang, Yingfang; Li, Li; Chen, Zhenqiang; Huo, Xiaoxing; Wu, Xinghua

2015-06-01

To analyze the cost effectiveness of HIV screening project in three Guangxi infectious disease special demonstration project countries in 2013. To calculate the funds used for the HIV screening project and to study the data on HIV/AIDS and HAART. A five-tree markov model was used to evaluate the quality adjusted life year (QALY) of this HIV screening project and to analyze the related cost effectiveness of the project. The cost of HIV screening in Guangxi infectious disease special demonstration project areas was 19.205 million Yuan and having identified 1 218 HIV/AIDS patients. The average costs for HIV/AIDS positive detection in three project countries were 14.562, 18.424 and 14.042 thousand Yuan per case. The QALYs gained from finding a HIV/AIDS case were 12.736, 8.523 and 8.321 on average, with the total number of QALYs gained from the project as 5 973.184, 3 613.752 and 2 704.325. The overall cost effectiveness ratio of the project was 1.562 thousand Yuan per QALY, and 1.143, 2.162 and 1.688 thousand Yuan per QALY in these three project countries. Project country "A" showed better cost effectiveness index than country B and C. The HIV screening project in Guangxi seemed relatively cost-effective but the average cost of HIV/AIDS positive detection was expensive. To strengthen HAART work for HIV/AIDS could improve the cost-effective of the project.

Easy and effective--web-based information systems designed and maintained by physicians: experience with two gynecological projects.

PubMed

Kupka, M S; Dorn, C; Richter, O; van der Ven, H; Baur, M

2003-08-01

It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Cost-Effectiveness of School-Based Prevention of Cannabis Use.

PubMed

Deogan, Charlotte; Zarabi, Natalie; Stenström, Nils; Högberg, Pi; Skärstrand, Eva; Manrique-Garcia, Edison; Neovius, Kristian; Månsdotter, Anna

2015-10-01

Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school. The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3%, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the 'states' of single use, regular use, daily use and use of other illicit drugs, which were associated with 'complications' of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications. The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years. School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated here.

Cost effectiveness of a pentavalent rotavirus vaccine in Oman.

PubMed

Al Awaidy, Salah Thabit; Gebremeskel, Berhanu G; Al Obeidani, Idris; Al Baqlani, Said; Haddadin, Wisam; O'Brien, Megan A

2014-06-17

Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal perspective.

Cost effectiveness of a pentavalent rotavirus vaccine in Oman

PubMed Central

2014-01-01

Background Rotavirus gastroenteritis (RGE) is the leading cause of diarrhea in young children in Oman, incurring substantial healthcare and economic burden. We propose to formally assess the potential cost effectiveness of implementing universal vaccination with a pentavalent rotavirus vaccine (RV5) on reducing the health care burden and costs associated with rotavirus gastroenteritis (RGE) in Oman Methods A Markov model was used to compare two birth cohorts, including children who were administered the RV5 vaccination versus those who were not, in a hypothetical group of 65,500 children followed for their first 5 years of life in Oman. The efficacy of the vaccine in reducing RGE-related hospitalizations, emergency department (ED) and office visits, and days of parental work loss for children receiving the vaccine was based on the results of the Rotavirus Efficacy and Safety Trial (REST). The outcome of interest was cost per quality-adjusted life year (QALY) gained from health care system and societal perspectives. Results A universal RV5 vaccination program is projected to reduce, hospitalizations, ED visits, outpatient visits and parental work days lost due to rotavirus infections by 89%, 80%, 67% and 74%, respectively. In the absence of RV5 vaccination, RGE-related societal costs are projected to be 2,023,038 Omani Rial (OMR) (5,259,899 United States dollars [USD]), including 1,338,977 OMR (3,481,340 USD) in direct medical costs. However, with the introduction of RV5, direct medical costs are projected to be 216,646 OMR (563,280 USD). Costs per QALY saved would be 1,140 OMR (2,964 USD) from the health care payer perspective. An RV5 vaccination program would be considered cost saving, from the societal perspective. Conclusions Universal RV5 vaccination in Oman is likely to significantly reduce the health care burden and costs associated with rotavirus gastroenteritis and may be cost-effective from the payer perspective and cost saving from the societal perspective. PMID:24941946

Comparing Life-Cycle Costs of ESPCs and Appropriations-Funded Energy Projects: An Update to the 2002 Report

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

Shonder, John A; Hughes, Patrick; Atkin, Erica

2006-11-01

A study was sponsored by FEMP in 2001 - 2002 to develop methods to compare life-cycle costs of federal energy conservation projects carried out through energy savings performance contracts (ESPCs) and projects that are directly funded by appropriations. The study described in this report follows up on the original work, taking advantage of new pricing data on equipment and on $500 million worth of Super ESPC projects awarded since the end of FY 2001. The methods developed to compare life-cycle costs of ESPCs and directly funded energy projects are based on the following tasks: (1) Verify the parity of equipmentmore » prices in ESPC vs. directly funded projects; (2) Develop a representative energy conservation project; (3) Determine representative cycle times for both ESPCs and appropriations-funded projects; (4) Model the representative energy project implemented through an ESPC and through appropriations funding; and (5) Calculate the life-cycle costs for each project.« less

Assessing the quality of cost management

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

Fayne, V.; McAllister, A.; Weiner, S.B.

1995-12-31

Managing environmental programs can be effective only when good cost and cost-related management practices are developed and implemented. The Department of Energy`s Office of Environmental Management (EM), recognizing this key role of cost management, initiated several cost and cost-related management activities including the Cost Quality Management (CQM) Program. The CQM Program includes an assessment activity, Cost Quality Management Assessments (CQMAs), and a technical assistance effort to improve program/project cost effectiveness. CQMAs provide a tool for establishing a baseline of cost-management practices and for measuring improvement in those practices. The result of the CQMA program is an organization that has anmore » increasing cost-consciousness, improved cost-management skills and abilities, and a commitment to respond to the public`s concerns for both a safe environment and prudent budget outlays. The CQMA program is part of the foundation of quality management practices in DOE. The CQMA process has contributed to better cost and cost-related management practices by providing measurements and feedback; defining the components of a quality cost-management system; and helping sites develop/improve specific cost-management techniques and methods.« less

Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Beyers, Nulda; Burger, Ronelle

2017-12-02

In South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality. The study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality. The annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102). This study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

30 CFR 1228.107 - Eligible cost of activities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... projects; basic and specialized training for State and tribal participants; and cost of any contractual... for funding and the procedures, timing, and mechanics for implementing Federal funding. [49 FR 37348...

Frito-Lay North America/NREL CRADA: Cooperative Research and Development Final Report, CRADA Number CRD-06-176

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

Walker, A.

2013-06-01

Frito Lay North America (FLNA) requires technical assistance for the evaluation and implementation of renewable energy and energy efficiency projects in production facilities and distribution centers across North America. Services provided by NREL do not compete with those available in the private sector, but rather provide FLNA with expertise to create opportunities for the private sector renewable/efficiency industries and to inform FLNA decision making regarding cost-effective projects. Services include: identifying the most cost-effective project locations based on renewable energy resource data, utility data, incentives and other parameters affecting projects; assistance with feasibility studies; procurement specifications; design reviews; and other servicesmore » to support FNLA in improving resource efficiency at facilities. This Cooperative Research and Development Agreement (CRADA) establishes the terms and conditions under which FLNA may access capabilities unique to the laboratory and required by FLNA. Each subsequent task issued under this umbrella agreement would include a scope-of-work, budget, schedule, and provisions for intellectual property specific to that task.« less

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

Eilert, P.L.; Hoeschele, M.

This paper discussed a market-transformation program to reduce energy use in modular school classrooms, a large part of new construction activities in California's schools. Today's modular classrooms cost more to operate than is necessary to provide effective, comfortable learning conditions for students and teachers. Although past resource acquisition programs have created a demand for efficient products and services, modular classrooms remain poorly differentiated in this respect. The cost-effectiveness of a range of potential energy efficiency measures (EEM's) were evaluated including lighting, alternative HVAC options, and improved envelope features. Viable EEM's were combined in two separate packages. The first includes measuresmore » that can easily be implemented and are projected to reduce operating costs by 30%. The second implements a daylighting system, a two-stage evaporative cooler, and radiant heating, resulting in projected annual energy cost savings over 60%. Transforming the market for modular classrooms is accomplished using natural market forces, rather than financial incentives directed at an entire industry. Proactive efforts are focused on the manufacturing industry's change leaders to commercialize energy-efficient products. Lost market share and peer pressure do the heavy lifting of convincing market followers to upgrade their products. Demand for efficient classrooms is increased by educating schools about the new products' financial advantages, comfort enhancements, and environmental benefits. As new products become established in the marketplace, support will be gradually withdrawn. The relevance of this work extends beyond California, given other States' programs to reduce class size, and the Presidents initiative to reduce class size nationally.« less

PACS for Bhutan: a cost effective open source architecture for emerging countries.

PubMed

Ratib, Osman; Roduit, Nicolas; Nidup, Dechen; De Geer, Gerard; Rosset, Antoine; Geissbuhler, Antoine

2016-10-01

This paper reports the design and implementation of an innovative and cost-effective imaging management infrastructure suitable for radiology centres in emerging countries. It was implemented in the main referring hospital of Bhutan equipped with a CT, an MRI, digital radiology, and a suite of several ultrasound units. They lacked the necessary informatics infrastructure for image archiving and interpretation and needed a system for distribution of images to clinical wards. The solution developed for this project combines several open source software platforms in a robust and versatile archiving and communication system connected to analysis workstations equipped with a FDA-certified version of the highly popular Open-Source software. The whole system was implemented on standard off-the-shelf hardware. The system was installed in three days, and training of the radiologists as well as the technical and IT staff was provided onsite to ensure full ownership of the system by the local team. Radiologists were rapidly capable of reading and interpreting studies on the diagnostic workstations, which had a significant benefit on their workflow and ability to perform diagnostic tasks more efficiently. Furthermore, images were also made available to several clinical units on standard desktop computers through a web-based viewer. • Open source imaging informatics platforms can provide cost-effective alternatives for PACS • Robust and cost-effective open architecture can provide adequate solutions for emerging countries • Imaging informatics is often lacking in hospitals equipped with digital modalities.

30 CFR 1228.107 - Eligible cost of activities.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and other normal administrative activities in direct support of the project or projects; basic and... the procedures, timing, and mechanics for implementing Federal funding. [49 FR 37348, Sept. 21, 1984...

30 CFR 228.107 - Eligible cost of activities.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and other normal administrative activities in direct support of the project or projects; basic and... the procedures, timing, and mechanics for implementing Federal funding. [49 FR 37348, Sept. 21, 1984...

30 CFR 1228.107 - Eligible cost of activities.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and other normal administrative activities in direct support of the project or projects; basic and... the procedures, timing, and mechanics for implementing Federal funding. [49 FR 37348, Sept. 21, 1984...

30 CFR 1228.107 - Eligible cost of activities.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., and other normal administrative activities in direct support of the project or projects; basic and... the procedures, timing, and mechanics for implementing Federal funding. [49 FR 37348, Sept. 21, 1984...

Performance Results for Massachusetts and Rhode Island Deep Energy Retrofit Pilot Community

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

Gates, C.; Neuhauser, K.

2014-03-01

Between December, 2009 and December, 2012 42 deep energy retrofit (DER) projects were completed through a DER pilot program sponsored by National Grid and conducted in Massachusetts and Rhode Island. 37 of these projects were comprehensive retrofits while 5 were partial DERs, meaning that high performance retrofit was implemented for a single major enclosure component or a limited number of major enclosure components. The 42 DER projects represent 60 units of housing. The comprehensive projects all implemented a consistent 'package' of measures in terms of the performance targeted for major building components. Projects exhibited some variations in the approach tomore » implementing the retrofit package. Pre- and post-retrofit air leakage measurements were performed for each of the projects. Each project also reported information about project costs including identification of energy-related costs. Post-retrofit energy-use data was obtained for 29 of the DER projects. Post-retrofit energy use was analyzed based on the net energy used by the DER project regardless of whether the energy was generated on site or delivered to the site. Homeowner surveys were returned by 12 of the pilot participants. Based on the community experience, this DER package is expected to result in yearly source energy use near 110 MMBtu/year or approximately 40% below the Northeast regional average. Larger to medium sized homes that successful implement these retrofits can be expected to achieve source EUI that is comparable to Passive House targets for new construction. The community of DER projects show post-retrofit airtightness below 1.5 ACH50 to be eminently achievable.« less

Effectiveness and cost-effectiveness of telehealthcare for chronic obstructive pulmonary disease: study protocol for a cluster randomized controlled trial.

PubMed

Udsen, Flemming Witt; Lilholt, Pernille Heyckendorff; Hejlesen, Ole; Ehlers, Lars Holger

2014-05-21

Several feasibility studies show promising results of telehealthcare on health outcomes and health-related quality of life for patients suffering from chronic obstructive pulmonary disease, and some of these studies show that telehealthcare may even lower healthcare costs. However, the only large-scale trial we have so far - the Whole System Demonstrator Project in England - has raised doubts about these results since it conclude that telehealthcare as a supplement to usual care is not likely to be cost-effective compared with usual care alone. The present study is known as 'TeleCare North' in Denmark. It seeks to address these doubts by implementing a large-scale, pragmatic, cluster-randomized trial with nested economic evaluation. The purpose of the study is to assess the effectiveness and the cost-effectiveness of a telehealth solution for patients suffering from chronic obstructive pulmonary disease compared to usual practice. General practitioners will be responsible for recruiting eligible participants (1,200 participants are expected) for the trial in the geographical area of the North Denmark Region. Twenty-six municipality districts in the region define the randomization clusters. The primary outcomes are changes in health-related quality of life, and the incremental cost-effectiveness ratio measured from baseline to follow-up at 12 months. Secondary outcomes are changes in mortality and physiological indicators (diastolic and systolic blood pressure, pulse, oxygen saturation, and weight). There has been a call for large-scale clinical trials with rigorous cost-effectiveness assessments in telehealthcare research. This study is meant to improve the international evidence base for the effectiveness and cost-effectiveness of telehealthcare to patients suffering from chronic obstructive pulmonary disease by implementing a large-scale pragmatic cluster-randomized clinical trial. Clinicaltrials.gov, http://NCT01984840, November 14, 2013.

Cost-effectiveness of using social networks to identify undiagnosed HIV infection among minority populations.

PubMed

Shrestha, Ram K; Sansom, Stephanie L; Kimbrough, Lisa; Hutchinson, Angela B; Daltry, Daniel; Maldonado, Waleska; Simpson-May, Georgia M; Illemszky, Sean

2010-01-01

In 2003, the Centers for Disease Control and Prevention launched the Advancing HIV Prevention project to implement new strategies for diagnosing human immunodeficiency virus (HIV) infections outside medical settings and prevent new infections by working with HIV-infected persons and their partners. : To assess the cost and effectiveness of a social network strategy to identify new HIV diagnoses among minority populations. Four community-based organizations (CBOs) in Boston, Philadelphia, and Washington, District of Columbia, implemented a social network strategy for HIV counseling and testing from October 2003 to December 2005. We used standardized cost collection forms to collect program costs attributable to staff time, travel, incentives, test kits, testing supplies, office space, equipment, and utilities. The CBOs used the networks of high-risk and HIV-infected persons (recruiters) who referred their partners and associates for HIV counseling and testing. We obtained HIV-testing outcomes from project databases. Number of HIV tests, number of new HIV-diagnoses notified, total program cost, cost per person tested, cost per person notified of new HIV diagnosis. Two CBOs, both based in Philadelphia, identified 25 and 17 recruiters on average annually and tested 136 and 330 network associates, respectively. Among those tested, 12 and 13 associates were notified of new HIV diagnoses (seropositivity: 9.8%, 4.4%). CBOs in Boston, Massachusetts, and Washington, District of Columbia, identified 26 and 24 recruiters per year on average and tested 228 and 123 network associates. Among those tested, 12 and 11 associates were notified of new HIV diagnoses (seropositivity: 5.1%, 8.7%). The cost per associate notified of a new HIV diagnosis was $11 578 and $12 135 in Philadelphia, and $16 437 and $16 101 in Boston, Massachusetts, and Washington, District of Columbia. The cost of notifying someone with a new HIV diagnosis using social networks varied across sites. Our analysis provides useful information for program planning and evaluation.

Three-dimensional imaging of hold baggage for airport security

NASA Astrophysics Data System (ADS)

Kolokytha, S.; Speller, R.; Robson, S.

2014-06-01

This study describes a cost-effective check-in baggage screening system, based on "on-belt tomosynthesis" (ObT) and close-range photogrammetry, that is designed to address the limitations of the most common system used, conventional projection radiography. The latter's limitations can lead to loss of information and an increase in baggage handling time, as baggage is manually searched or screened with more advanced systems. This project proposes a system that overcomes such limitations creating a cost-effective automated pseudo-3D imaging system, by combining x-ray and optical imaging to form digital tomograms. Tomographic reconstruction requires a knowledge of the change in geometry between multiple x-ray views of a common object. This is uniquely achieved using a close range photogrammetric system based on a small network of web-cameras. This paper presents the recent developments of the ObT system and describes recent findings of the photogrammetric system implementation. Based on these positive results, future work on the advancement of the ObT system as a cost-effective pseudo-3D imaging of hold baggage for airport security is proposed.

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California.

PubMed

Labovitz, Jonathan M; Kominski, Gerald F

2016-05-01

Because value-based care is critical to the Affordable Care Act success, we forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California. We forecasted enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. We evaluated cost in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment. Diabetic patients accounted for 6.6% of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8% take-up rate. We project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3% higher when amputations occurred during the admission and 46.7% higher when discharged to a skilled nursing facility. Meanwhile, 61.0% of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1% with a 10% reduction in admissions and amputations and an additional 1% for every 10% improvement in access to podiatric medical care. When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.

Riparian and Related Values Associated with Flood Control Project Alternatives at Wildcat and San Pablo Creeks

Treesearch

Philip A. Meyer

1989-01-01

This analysis will consider Riparian benefits from alternative project designs at Wildcat and San Pablo Creeks. Particular emphasis will be placed on quantification of riparian values and on the relationship of projects benefits for each project alternative to estimated costs of implementation.

78 FR 24736 - Energy Savings Performance Contracts: Extension of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... legislated and executive-ordered energy, greenhouse gas, and water goals. These are delivered through project..., obtaining, and implementing project funding for energy projects through the use of ESPCs. ESPCs allow Federal agencies to accomplish energy savings projects without up-front capital costs. In an ESPC, a...

Indicators for Assessing Climate Change Resilience Resulting from Emplacement of Green Infrastructure Projects Across an Urban Landscape

NASA Astrophysics Data System (ADS)

Parish, E. S.; Omitaomu, O.; Sylvester, L.; Nugent, P.

2015-12-01

Many U.S. cities are exploring the potential of using green infrastructure (e.g., porous pavements, green roofs, street planters) to reduce urban storm water runoff, which can be both be a nuisance and costly to treat. While tools exist to measure local runoff changes resulting from individual green infrastructure (GI) projects, most municipalities currently have no method of analyzing the collective impact of GI projects on urban stormwater systems under future rainfall scenarios and impervious surface distribution patterns. Using the mid-sized city of Knoxville, Tennessee as a case study, we propose a set of indicators that can be used to monitor and analyze the collective effects of GI emplacement on urban storm water runoff volumes as well as to quantify potential co-benefits of GI projects (e.g., urban heat island reduction, reduced stream scouring) under different climate projection ensembles and population growth scenarios. These indicators are intended to help the city prioritize GI projects as opportunities arise, as well as to track the effectiveness of GI implementation over time. We explore the aggregation of these indicators across different spatial scales (e.g., plot, neighborhood, watershed, city) in order to assess potential changes in climate change resilience resulting from the collective implementation of GI projects across an urban landscape.

Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

PubMed

Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

2018-03-20

No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

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

Neuhauser, K.; Gates, C.

This research project evaluates post-retrofit performance measurements, energy use data and construction costs for 13 projects that participated in the National Grid Deep Energy Retrofit Pilot program. The projects implemented a package of measures defined by performance targets for building enclosure components and building enclosure air tightness. Nearly all of the homes reached a post-retrofit air tightness result of 1.5 ACH 50. Homes that used the chainsaw retrofit technique along with roof insulation, and wall insulation applied to the exterior had the best air tightness results and the lowest heating and cooling source energy use. Analysis of measure costs andmore » project objectives yielded a categorization of costs relative to energy performance objectives. On average about ½ of the energy-related measure costs correspond primarily to energy-related objectives, and 20% of energy-related measure costs relate primarily to non-energy objectives.« less

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

Gates, C.; Neuhauser, K.

This research project evaluates post-retrofit performance measurements, energy use data and construction costs for 13 projects that participated in the National Grid Deep Energy Retrofit Pilot program. The projects implemented a package of measures defined by performance targets for building enclosure components and building enclosure air tightness. Nearly all of the homes reached a post-retrofit air tightness result of 1.5 ACH 50. Homes that used the chainsaw retrofit technique along with roof insulation, and wall insulation applied to the exterior had the best air tightness results and the lowest heating and cooling source energy use. Analysis of measure costs andmore » project objectives yielded a categorization of costs relative to energy performance objectives. On average about 1/2 of the energy-related measure costs correspond primarily to energy-related objectives, and 20% of energy-related measure costs relate primarily to non-energy objectives.« less

Multi-criteria analysis for PM10 planning

NASA Astrophysics Data System (ADS)

Pisoni, Enrico; Carnevale, Claudio; Volta, Marialuisa

To implement sound air quality policies, Regulatory Agencies require tools to evaluate outcomes and costs associated to different emission reduction strategies. These tools are even more useful when considering atmospheric PM10 concentrations due to the complex nonlinear processes that affect production and accumulation of the secondary fraction of this pollutant. The approaches presented in the literature (Integrated Assessment Modeling) are mainly cost-benefit and cost-effective analysis. In this work, the formulation of a multi-objective problem to control particulate matter is proposed. The methodology defines: (a) the control objectives (the air quality indicator and the emission reduction cost functions); (b) the decision variables (precursor emission reductions); (c) the problem constraints (maximum feasible technology reductions). The cause-effect relations between air quality indicators and decision variables are identified tuning nonlinear source-receptor models. The multi-objective problem solution provides to the decision maker a set of not-dominated scenarios representing the efficient trade-off between the air quality benefit and the internal costs (emission reduction technology costs). The methodology has been implemented for Northern Italy, often affected by high long-term exposure to PM10. The source-receptor models used in the multi-objective analysis are identified processing long-term simulations of GAMES multiphase modeling system, performed in the framework of CAFE-Citydelta project.

Implementation and Operational Research: A Cost-Effective, Clinically Actionable Strategy for Targeting HIV Preexposure Prophylaxis to High-Risk Men Who Have Sex With Men.

PubMed

Ross, Eric L; Cinti, Sandro K; Hutton, David W

2016-07-01

Preexposure prophylaxis (PrEP) is effective at preventing HIV infection among men who have sex with men (MSM), but there is uncertainty about how to identify high-risk MSM who should receive PrEP. We used a mathematical model to assess the cost-effectiveness of using the HIV Incidence Risk Index for MSM (HIRI-MSM) questionnaire to target PrEP to high-risk MSM. We simulated strategies of no PrEP, PrEP available to all MSM, and eligibility thresholds set to HIRI-MSM scores between 5 and 45, in increments of 5 (where a higher score predicts greater HIV risk). Based on the iPrEx, IPERGAY, and PROUD trials, we evaluated PrEP efficacies from 44% to 86% and annual costs from $5900 to 8700. We designate strategies with incremental cost-effectiveness ratio (ICER) ≤$100,000/quality-adjusted life-year (QALY) as "cost-effective." Over 20 years, making PrEP available to all MSM is projected to prevent 33.5% of new HIV infections, with an ICER of $1,474,000/QALY. Increasing the HIRI-MSM score threshold reduces the prevented infections, but improves cost-effectiveness. A threshold score of 25 is projected to be optimal (most QALYs gained while still being cost-effective) over a wide range of realistic PrEP efficacies and costs. At low cost and high efficacy (IPERGAY), thresholds of 15 or 20 are optimal across a range of other input assumptions; at high cost and low efficacy (iPrEx), 25 or 30 are generally optimal. The HIRI-MSM provides a clinically actionable means of guiding PrEP use. Using a score of 25 to determine PrEP eligibility could facilitate cost-effective use of PrEP among high-risk MSM who will benefit from it most.

Achieving and sustaining automated health data linkages for learning systems: barriers and solutions.

PubMed

Van Eaton, Erik G; Devlin, Allison B; Devine, Emily Beth; Flum, David R; Tarczy-Hornoch, Peter

2014-01-01

Delivering more appropriate, safer, and highly effective health care is the goal of a learning health care system. The Agency for Healthcare Research and Quality (AHRQ) funded enhanced registry projects: (1) to create and analyze valid data for comparative effectiveness research (CER); and (2) to enhance the ability to monitor and advance clinical quality improvement (QI). This case report describes barriers and solutions from one state-wide enhanced registry project. The Comparative Effectiveness Research and Translation Network (CERTAIN) deployed the commercially available Amalga Unified Intelligence System™ (Amalga) as a central data repository to enhance an existing QI registry (the Automation Project). An eight-step implementation process included hospital recruitment, technical electronic health record (EHR) review, hospital-specific interface planning, data ingestion, and validation. Data ownership and security protocols were established, along with formal methods to separate data management for QI purposes and research purposes. Sustainability would come from lowered chart review costs and the hospital's desire to invest in the infrastructure after trying it. CERTAIN approached 19 hospitals in Washington State operating within 12 unaffiliated health care systems for the Automation Project. Five of the 19 completed all implementation steps. Four hospitals did not participate due to lack of perceived institutional value. Ten hospitals did not participate because their information technology (IT) departments were oversubscribed (e.g., too busy with Meaningful Use upgrades). One organization representing 22 additional hospitals expressed interest, but was unable to overcome data governance barriers in time. Questions about data use for QI versus research were resolved in a widely adopted project framework. Hospitals restricted data delivery to a subset of patients, introducing substantial technical challenges. Overcoming challenges of idiosyncratic EHR implementations required each hospital to devote more IT resources than were predicted. Cost savings did not meet projections because of the increased IT resource requirements and a different source of lowered chart review costs. CERTAIN succeeded in recruiting unaffiliated hospitals into the Automation Project to create an enhanced registry to achieve AHRQ goals. This case report describes several distinct barriers to central data aggregation for QI and CER across unaffiliated hospitals: (1) competition for limited on-site IT expertise, (2) concerns about data use for QI versus research, (3) restrictions on data automation to a defined subset of patients, and (4) unpredictable resource needs because of idiosyncrasies among unaffiliated hospitals in how EHR data are coded, stored, and made available for transmission-even between hospitals using the same vendor's EHR. Therefore, even a fully optimized automation infrastructure would still not achieve complete automation. The Automation Project was unable to align sufficiently with internal hospital objectives, so it could not show a compelling case for sustainability.

Achieving and Sustaining Automated Health Data Linkages for Learning Systems: Barriers and Solutions

PubMed Central

Van Eaton, Erik G.; Devlin, Allison B.; Devine, Emily Beth; Flum, David R.; Tarczy-Hornoch, Peter

2014-01-01

Introduction: Delivering more appropriate, safer, and highly effective health care is the goal of a learning health care system. The Agency for Healthcare Research and Quality (AHRQ) funded enhanced registry projects: (1) to create and analyze valid data for comparative effectiveness research (CER); and (2) to enhance the ability to monitor and advance clinical quality improvement (QI). This case report describes barriers and solutions from one state-wide enhanced registry project. Methods: The Comparative Effectiveness Research and Translation Network (CERTAIN) deployed the commercially available Amalga Unified Intelligence System™ (Amalga) as a central data repository to enhance an existing QI registry (the Automation Project). An eight-step implementation process included hospital recruitment, technical electronic health record (EHR) review, hospital-specific interface planning, data ingestion, and validation. Data ownership and security protocols were established, along with formal methods to separate data management for QI purposes and research purposes. Sustainability would come from lowered chart review costs and the hospital’s desire to invest in the infrastructure after trying it. Findings: CERTAIN approached 19 hospitals in Washington State operating within 12 unaffiliated health care systems for the Automation Project. Five of the 19 completed all implementation steps. Four hospitals did not participate due to lack of perceived institutional value. Ten hospitals did not participate because their information technology (IT) departments were oversubscribed (e.g., too busy with Meaningful Use upgrades). One organization representing 22 additional hospitals expressed interest, but was unable to overcome data governance barriers in time. Questions about data use for QI versus research were resolved in a widely adopted project framework. Hospitals restricted data delivery to a subset of patients, introducing substantial technical challenges. Overcoming challenges of idiosyncratic EHR implementations required each hospital to devote more IT resources than were predicted. Cost savings did not meet projections because of the increased IT resource requirements and a different source of lowered chart review costs. Discussion: CERTAIN succeeded in recruiting unaffiliated hospitals into the Automation Project to create an enhanced registry to achieve AHRQ goals. This case report describes several distinct barriers to central data aggregation for QI and CER across unaffiliated hospitals: (1) competition for limited on-site IT expertise, (2) concerns about data use for QI versus research, (3) restrictions on data automation to a defined subset of patients, and (4) unpredictable resource needs because of idiosyncrasies among unaffiliated hospitals in how EHR data are coded, stored, and made available for transmission—even between hospitals using the same vendor’s EHR. Therefore, even a fully optimized automation infrastructure would still not achieve complete automation. The Automation Project was unable to align sufficiently with internal hospital objectives, so it could not show a compelling case for sustainability. PMID:25848606

Implementing an Information Security Program

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

Glantz, Clifford S.; Lenaeus, Joseph D.; Landine, Guy P.

The threats to information security have dramatically increased with the proliferation of information systems and the internet. Chemical, biological, radiological, nuclear, and explosives (CBRNe) facilities need to address these threats in order to protect themselves from the loss of intellectual property, theft of valuable or hazardous materials, and sabotage. Project 19 of the European Union CBRN Risk Mitigation Centres of Excellence Initiative is designed to help CBRN security managers, information technology/cybersecurity managers, and other decision-makers deal with these threats through the application of cost-effective information security programs. Project 19 has developed three guidance documents that are publically available to covermore » information security best practices, planning for an information security management system, and implementing security controls for information security.« less

Cost effectiveness analysis of elementary school-located vaccination against influenza--results from a randomized controlled trial.

PubMed

Yoo, Byung-Kwang; Humiston, Sharon G; Szilagyi, Peter G; Schaffer, Stanley J; Long, Christine; Kolasa, Maureen

2013-04-19

School-located vaccination against influenza (SLV-I) has been suggested to help meet the need for annual vaccination of large numbers of school-aged children with seasonal influenza vaccine. However, little is known about the cost and cost-effectiveness of SLV-I. We conducted a cost-analysis and a cost-effectiveness analysis based on a randomized controlled trial (RCT) of an SLV-I program implemented in Monroe County, New York during the 2009-2010 vaccination season. We hypothesized that SLV-I is more cost effective, or less-costly, compared to a conventional, office-located influenza vaccination delivery. First and second SLV-I clinics were offered in 21 intervention elementary schools (n=9027 children) with standard of care (no SLV-I) in 11 control schools (n=4534 children). The direct costs, to purchase and administer vaccines, were estimated from our RCT. The effectiveness measure, receipt of ≥1 dose of influenza vaccine, was 13.2 percentage points higher in SLV-I schools than control schools. The school costs ($9.16/dose in 2009 dollars) plus project costs ($23.00/dose) plus vendor costs excluding vaccine purchase ($19.89/dose) was higher in direct costs ($52.05/dose) than the previously reported mean/median cost [$38.23/$21.44 per dose] for providing influenza vaccination in pediatric practices. However SLV-I averted parent costs to visit medical practices ($35.08 per vaccine). Combining direct and averted costs through Monte Carlo Simulation, SLV-I costs were $19.26/dose in net costs, which is below practice-based influenza vaccination costs. The incremental cost-effectiveness ratio (ICER) was estimated to be $92.50 or $38.59 (also including averted parent costs). When additionally accounting for the costs averted by disease prevention (i.e., both reduced disease transmission to household members and reduced loss of productivity from caring for a sick child), the SLV-I model appears to be cost-saving to society, compared to "no vaccination". Our findings support the expanded implementation of SLV-I, but also the need to focus on efficient delivery to reduce direct costs. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Cost analysis of telemedical treatment of stroke].

PubMed

Schenkel, J; Reitmeir, P; Von Reden, S; Holle, R; Boy, S; Haberl, R; Audebert, H

2013-07-01

Telemedicine-enabled stroke networks increase the probability of a good clinical outcome. There is a shortage of evidence about the effects of this new approach on costs for inpatient care and nursing care. We analysed health insurance and nursing care fund data of a statutory health insurance company (AOK Bayern). Data from stroke patients initially treated in a TeleStroke network (TEMPiS - telemedical project for integrative stroke care) between community hospitals and academic stroke centres were compared to data of matched hospitals without specialised stroke care and telemedical support. Costs for nursing care were obtained over a 30-month period after the initial stroke. To rule out pre-existing differences between network and control hospitals, costs of stroke care were also analysed during a time period before network implementation. 1 277 patients (767 in intervention, 510 in control hospitals) were analysed in the post-implementation period. An increased proportion of patients treated in intervention hospitals had a favourable outcome concerning the level of required nursing care. Patients in intervention hospitals had higher costs for acute inpatient care (5 309 € vs. 4 901 €, p=0.04), but lower nursing care fund costs (3 946 € vs. 5 132 €; p=0.04). There was no difference in relation to absolute total costs obtained in the post-implementation period. However, nursing care costs per survived year were significantly lower in intervention hospitals (1 953 € vs. 2 635 €; p=0.005). No significant differences were found in the pre-implementation period. Considering both health insurance and nursing care fund costs, the incremental costs for TeleStroke network care in hospitals are compensated by savings in outpatient care. © Georg Thieme Verlag KG Stuttgart · New York.

Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project.

PubMed

De Smedt, Delphine; Kotseva, Kornelia; De Bacquer, Dirk; Wood, David; De Backer, Guy; Dallongeville, Jean; Seppo, Lehto; Pajak, Andrzej; Reiner, Zeljko; Vanuzzo, Diego; Georgiev, Borislav; Gotcheva, Nina; Annemans, Lieven

2012-11-01

The EUROASPIRE III survey indicated that the guidelines on cardiovascular disease prevention are poorly implemented in patients with established coronary heart disease (CHD). The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in eight EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, and the U.K.). METHODS AND RESULTS The individual risk for subsequent cardiovascular events was estimated, based on published Framingham equations. Based on the EUROASPIRE III data, the type of suboptimal prevention, if any, was identified for each individual, and the effects of optimized tailored prevention (smoking cessation, diet and exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated. Costs of prevention and savings of avoided events were based on country-specific data. A willingness to pay threshold of €30,000/quality-adjusted life year (QALY) was used. The robustness of the results was validated by sensitivity analyses. Overall, the cost-effectiveness analyses for the eight countries showed mainly favourable results with an average incremental cost-effectiveness ratio (ICER) of €12,484 per QALY. Only in the minority of patients at the lowest risk for recurrent events, intensifying preventive therapy seems not cost-effective. Also, the single impact of intensified cholesterol control seems less cost-effective, possibly because their initial 2-year risk was already fairly low, hence the room for improvement is rather limited. These results underscore the societal value of optimizing prevention in most patients with established CHD, but also highlight the need for setting priorities towards patients more at risk and the need for more studies comparing intensified prevention with usual care in these patients.

Wisconsin Elementary Teacher Education Project. Volume VI, Feasibility Study: Pricing and Economic Analysis Study. Final Report.

ERIC Educational Resources Information Center

Wisconsin Univ., Madison.

This document is the second volume of the feasibility study report for the Wisconsin Elementary Teacher Education Project. It provides in part 1 data on program, planning and budgeting, including cost figures for preparing students in the present and new programs, marginal expenses, and costs for implementing the program on other campuses. Part 2…

The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation.

PubMed

Rotter, Thomas; Plishka, Christopher; Hansia, Mohammed Rashaad; Goodridge, Donna; Penz, Erika; Kinsman, Leigh; Lawal, Adegboyega; O'Quinn, Sheryl; Buchan, Nancy; Comfort, Patricia; Patel, Prakesh; Anderson, Sheila; Winkel, Tanya; Lang, Rae Lynn; Marciniuk, Darcy D

2017-11-28

Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context. We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context. We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis. Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017. This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions. Clinicaltrials.gov ( NCT03075709 ). Registered 8 March 2017.

Skilled nursing facilities reform.

PubMed

1998-06-01

The Medicare prospective payment system for skilled nursing facilities will take effect with cost reporting years beginning on or after July 1, 1998. HCFA is working on the implementation details. While final details are not expected to be published until Summer 1998, the following information has been provided through HCFA and/or the Nursing Home Case-Mix and Quality (NHCMQ) Demonstration project (RUGs-III) procedures.

An Evidence-Based Project Demonstrating Increased School Immunization Compliance Following a School Nurse-Initiated Vaccine Compliance Strategy

ERIC Educational Resources Information Center

Swallow, Wendy; Roberts, Jill C.

2016-01-01

During the 2012-2013 school year, only 66% of students at a Northern Indiana High School were in compliance with school immunization requirements. We report here successful implementation of evidence-based, time, and cost-effective methods aimed at increasing school immunization compliance. A three-stage strategy initiated by the school nurse was…

An innovative time-cost-quality tradeoff modeling of building construction project based on resource allocation.

PubMed

Hu, Wenfa; He, Xinhua

2014-01-01

The time, quality, and cost are three important but contradictive objectives in a building construction project. It is a tough challenge for project managers to optimize them since they are different parameters. This paper presents a time-cost-quality optimization model that enables managers to optimize multiobjectives. The model is from the project breakdown structure method where task resources in a construction project are divided into a series of activities and further into construction labors, materials, equipment, and administration. The resources utilized in a construction activity would eventually determine its construction time, cost, and quality, and a complex time-cost-quality trade-off model is finally generated based on correlations between construction activities. A genetic algorithm tool is applied in the model to solve the comprehensive nonlinear time-cost-quality problems. Building of a three-storey house is an example to illustrate the implementation of the model, demonstrate its advantages in optimizing trade-off of construction time, cost, and quality, and help make a winning decision in construction practices. The computational time-cost-quality curves in visual graphics from the case study prove traditional cost-time assumptions reasonable and also prove this time-cost-quality trade-off model sophisticated.

Development of a nurse case management service: a proposed business plan for rural hospitals.

PubMed

Adams, Marsha Howell; Crow, Carolyn S

2005-01-01

The nurse case management service (NCMS) for rural hospitals is an entrepreneurial endeavor designed to provide rural patients with quality, cost-effective healthcare. This article describes the development of an NCMS. A detailed marketing and financial plan, a review of industry trends, and the legal structure and risks associated with the development of the venture are presented. The financial plan projects a minimum savings of 223,200 dollars for rural institutions annually. To improve quality and reduce cost for rural hospitals, the authors recommend implementation of an NCMS.

Internet Implementation in Brazilian K-12 Schools.

ERIC Educational Resources Information Center

Joia, Luiz Antonio

1997-01-01

Presents a framework for implementing the Internet in Brazilian elementary and secondary schools. Topics include schools as assembly lines in the information society; pedagogical uses of the Internet, including research, educational projects, and video conferences; and obstacles to implementing the Internet, including cost, cultural differences,…

A systematic review of studies evaluating Australian indigenous community development projects: the extent of community participation, their methodological quality and their outcomes.

PubMed

Snijder, Mieke; Shakeshaft, Anthony; Wagemakers, Annemarie; Stephens, Anne; Calabria, Bianca

2015-11-21

Community development is a health promotion approach identified as having great potential to improve Indigenous health, because of its potential for extensive community participation. There has been no systematic examination of the extent of community participation in community development projects and little analysis of their effectiveness. This systematic review aims to identify the extent of community participation in community development projects implemented in Australian Indigenous communities, critically appraise the qualitative and quantitative methods used in their evaluation, and summarise their outcomes. Ten electronic peer-reviewed databases and two electronic grey literature databases were searched for relevant studies published between 1990 and 2015. The level of community participation and the methodological quality of the qualitative and quantitative components of the studies were assessed against standardised criteria. Thirty one evaluation studies of community development projects were identified. Community participation varied between different phases of project development, generally high during project implementation, but low during the evaluation phase. For the majority of studies, methodological quality was low and the methods were poorly described. Although positive qualitative or quantitative outcomes were reported in all studies, only two studies reported statistically significant outcomes. Partnerships between researchers, community members and service providers have great potential to improve methodological quality and community participation when research skills and community knowledge are integrated to design, implement and evaluate community development projects. The methodological quality of studies evaluating Australian Indigenous community development projects is currently too weak to confidently determine the cost-effectiveness of community development projects in improving the health and wellbeing of Indigenous Australians. Higher quality studies evaluating community development projects would strengthen the evidence base.

Continuous Risk Management at NASA

NASA Technical Reports Server (NTRS)

Hammer, Theodore F.; Rosenberg, Linda

1999-01-01

NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions. This risk management structure of functions has been taught to projects at all NASA Centers and is being successfully implemented on many projects. This presentation will give project managers the information they need to understand if risk management is to be effectively implemented on their projects at a cost they can afford.

Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings

PubMed Central

Bridges, Daniel J.; Colborn, James; Chan, Adeline S. T.; Winters, Anna M.; Dengala, Dereje; Fornadel, Christen M.; Kosloff, Barry

2014-01-01

High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. PMID:25223943

A Portable Computer System for Auditing Quality of Ambulatory Care

PubMed Central

McCoy, J. Michael; Dunn, Earl V.; Borgiel, Alexander E.

1987-01-01

Prior efforts to effectively and efficiently audit quality of ambulatory care based on comprehensive process criteria have been limited largely by the complexity and cost of data abstraction and management. Over the years, several demonstration projects have generated large sets of process criteria and mapping systems for evaluating quality of care, but these paper-based approaches have been impractical to implement on a routine basis. Recognizing that portable microcomputers could solve many of the technical problems in abstracting data from medical records, we built upon previously described criteria and developed a microcomputer-based abstracting system that facilitates reliable and cost-effective data abstraction.

Industrial Technology Modernization Program. Project 80. Increase Efficiency of Card Test/Device Test Areas by the Usage of Improved Material Handling Systems. Revision 1. Phase 2

DTIC Science & Technology

1988-03-01

INDUSTRY ANALYSIS/FINDINGS 132 12 EQUIPMENT/MACHINERY ALTERNATIVES 134 13 MIS REQUIREMENTS/IMPROVEMENTS 135 14 COST BENEFIT ANALYSIS AND PROCEDURE 137 15...SOFTWARE DIAGRAM 14.0-1 COST BENEFIT ANALYSIS METHODOLOGY 138 14.3-1 PROJECT 80 EXPENDITURE SCHEDULE 141 14.4-1 PROJECT 80 CASH FLOWS 142 15.1-1 PROJECT 80...testing, streamlining work flow, and installation of ergonomically designed work cell/work centers. The benefits associated with the implementation of ITM

49 CFR 256.7 - Financial assistance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... passenger terminal, under subsection 4(i)(2) of the Act, may be expended for the following project costs incurred after the date of final project approval: (1) Acquisition or long-term lease of real property or... project implementation; (2) Final architectural and engineering construction documentation, including all...

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

PubMed Central

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

2017-01-01

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

Dataset Lifecycle Policy

NASA Technical Reports Server (NTRS)

Armstrong, Edward; Tauer, Eric

2013-01-01

The presentation focused on describing a new dataset lifecycle policy that the NASA Physical Oceanography DAAC (PO.DAAC) has implemented for its new and current datasets to foster improved stewardship and consistency across its archive. The overarching goal is to implement this dataset lifecycle policy for all new GHRSST GDS2 datasets and bridge the mission statements from the GHRSST Project Office and PO.DAAC to provide the best quality SST data in a cost-effective, efficient manner, preserving its integrity so that it will be available and usable to a wide audience.

Methodology Of PACS Effectiveness Evaluation As Part Of A Technology Assessment. The Dutch PACS Project Extrapolated.

NASA Astrophysics Data System (ADS)

Andriessen, J. H. T. H.; van der Horst-Bruinsma, I. E.; ter Haar Romeny, B. M.

1989-05-01

The present phase of the clinical evaluation within the Dutch PACS project mainly focuses on the development and evaluation of a PACSystem for a few departments in the Utrecht University hospital (UUH). A report on the first clinical experiences and a detailed cost/savings analysis of the PACSystem in the UUH are presented elsewhere. However, an assessment of the wider fmancial and organizational implications for hospitals and for the health sector is also needed. To this end a model for (financial) cost assessment of PACSystems is being developed by BAZIS. Learning from the actual pilot implementation in UUH we realized that general Technology Assessment (TA) also calls for an extra-polation of the medical and organizational effects. After a short excursion into the various approaches towards TA, this paper discusses the (inter) organizational dimensions relevant to the development of the necessary exttapolationmodels.

Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization.

PubMed

Ho, Jonhan; Ahlers, Stefan M; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L; Kuzmishin, John A; Montalto, Michael C; Parwani, Anil V

2014-01-01

Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology "slide less" clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types. The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.

Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

PubMed Central

Ho, Jonhan; Ahlers, Stefan M.; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L.; Kuzmishin, John A.; Montalto, Michael C.; Parwani, Anil V.

2014-01-01

Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types. Conclusions: The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS. PMID:25250191

Modeling the patient and health system impacts of alternative xpert® MTB/RIF algorithms for the diagnosis of pulmonary tuberculosis in Addis Ababa, Ethiopia.

PubMed

Tesfaye, Abraham; Fiseha, Daniel; Assefa, Dawit; Klinkenberg, Eveline; Balanco, Silvia; Langley, Ivor

2017-05-02

To reduce global tuberculosis (TB) burden, the active disease must be diagnosed quickly and accurately and patients should be treated and cured. In Ethiopia, TB diagnosis mainly relies on spot-morning-spot (SMS) sputum sample smear analysis using Ziehl-Neelsen staining techniques (ZN). Since 2014 targeted use of xpert has been implemented. New diagnostic techniques have higher sensitivity and are likely to detect more cases if routinely implemented. The objective of our study was to project the effects of alternative diagnostic algorithms on the patient, health system, and costs, and identify cost-effective algorithms that increase TB case detection in Addis Ababa, Ethiopia. An observational quantitative modeling framework was applied using the Virtual Implementation approach. The model was designed to represent the operational and epidemiological context of Addis Ababa, the capital city of Ethiopia. We compared eight diagnostic algorithm with ZN microscopy, light emitting diode (LED) fluorescence microscopy and Xpert MTB/RIF. Interventions with an annualized cost per averted disability adjusted life year (DALY) of less than the Gross Domestic Product (GDP) per capita are considered cost-effective interventions. With a cost lower than the average per-capita GDP (US$690 for Ethiopia) for each averted disability adjusted life year (DALY), three of the modeled algorithms are cost-effective. Implementing them would have important patient, health system, and population-level effects in the context of Addis Ababa ❖ The full roll-out of Xpert MTB/RIF as the primary test for all presumptive TB cases would avert 91170 DALYs (95% credible interval [CrI] 54888 - 127448) with an additional health system cost of US$ 11.6 million over the next 10 years. The incremental cost-effectiveness ratio (ICER) is $370 per DALY averted. ❖ Same day LED fluorescence microscopy for all presumptive TB cases combined with Xpert MTB/RIF targeted to HIV-positive and High multidrug resistant (MDR) risk groups would avert 73600 DALYs( 95% CrI 48373 - 99214) with an additional cost of US$5.1 million over the next 10 years. The ICER is $169per DALY averted. ❖ Same-day LED fluorescence microscopy for all presumptive TB cases (and no Xpert MTB/RIF) would avert 43580 DALYs with a reduction cost of US$ 0.2 million over the next 10years. The ICER is $13 per DALY averted. The full roll-out of Xpert MTB/RIF is predicted to be the best option to substantially reduce the TB burden in Addis Ababa and is considered cost effective. However, the investment cost to implement this is far beyond the budget of the national TB control program. Targeted use of Xpert MTB/RIF for HIV positive and high MDR risk groups with same-day LED fluorescence microscopy for all other presumptive TB cases is an affordable alternative.

The MAM'Out project: a randomized controlled trial to assess multiannual and seasonal cash transfers for the prevention of acute malnutrition in children under 36 months in Burkina Faso.

PubMed

Tonguet-Papucci, Audrey; Huybregts, Lieven; Ait Aissa, Myriam; Huneau, Jean-François; Kolsteren, Patrick

2015-08-08

Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries' self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families' expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed. The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as delay in project implementation, switch to e-data collection and implementation of a supervision process. ClinicalTrials.gov, identifier: NCT01866124, registered May 7, 2013.

Collaborative Group Learning and Knowledge Building to Address Information Systems Project Failure

ERIC Educational Resources Information Center

Angelo, Raymond

2011-01-01

Approximately half of the information systems (IS) projects implemented each year are considered failures. These failed projects cost billions of dollars annually. Failures can be due to projects being delivered late, over-budget, abandoned after significant time and resource investment, or failing to achieve desired results. More often than not,…

The Chicago Project: An Alternative Resettlement Approach.

ERIC Educational Resources Information Center

Refugee Policy Group, Washington, DC.

This document reports on a model refugee resettlement project implemented in Chicago by the United States Catholic Conference. The project was initiated to document the incorrectness of the claim that the current dramatic reduction in U.S. refugee admissions is necessary due to the purported high cost of resettlement. The project served all…

Coping with constraints: Achieving effective conservation with limited resources

USGS Publications Warehouse

Walls, Susan

2018-01-01

Conservation resources have become increasingly limited and, along with social, cultural and political complexities, this shortfall frequently challenges effectiveness in conservation. Because conservation can be costly, efforts are often only initiated after a species has declined below a critical threshold and/or when statutory protection is mandated. However, implementing conservation proactively, rather than reactively, is predicted to be less costly and to decrease a species' risk of extinction. Despite these benefits, I document that the number of studies that have implemented proactive conservation around the world are far fewer than those that simply acknowledge the need for such action. I provide examples of proactive actions that can ameliorate shortfalls in funding and other assets, thus helping conservation practitioners and managers cope with the constraints that resource limitation imposes. Not all of these options are new; however, the timing of their implementation is critical for effective conservation, and the need for more proactive conservation is increasingly recognized. These actions are (1) strengthening and diversifying stakeholder involvement in conservation projects; (2) complementing time-consuming and labor-intensive demographic studies with alternative approaches of detecting declines and estimating extinction risk; and (3) minimizing future costly conservation and management by proactively keeping common species common. These approaches may not constitute a cure-all for every conservation crisis. However, given escalating rates of species' losses, perhaps a reminder that these proactive actions can reduce conservation costs, save time, and potentially thwart population declines is warranted.

Yahoo! Compute Coop (YCC). A Next-Generation Passive Cooling Design for Data Centers

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

Robison, AD; Page, Christina; Lytle, Bob

The purpose of the Yahoo! Compute Coop (YCC) project is to research, design, build and implement a greenfield "efficient data factory" and to specifically demonstrate that the YCC concept is feasible for large facilities housing tens of thousands of heat-producing computing servers. The project scope for the Yahoo! Compute Coop technology includes: - Analyzing and implementing ways in which to drastically decrease energy consumption and waste output. - Analyzing the laws of thermodynamics and implementing naturally occurring environmental effects in order to maximize the "free-cooling" for large data center facilities. "Free cooling" is the direct usage of outside air tomore » cool the servers vs. traditional "mechanical cooling" which is supplied by chillers or other Dx units. - Redesigning and simplifying building materials and methods. - Shortening and simplifying build-to-operate schedules while at the same time reducing initial build and operating costs. Selected for its favorable climate, the greenfield project site is located in Lockport, NY. Construction on the 9.0 MW critical load data center facility began in May 2009, with the fully operational facility deployed in September 2010. The relatively low initial build cost, compatibility with current server and network models, and the efficient use of power and water are all key features that make it a highly compatible and globally implementable design innovation for the data center industry. Yahoo! Compute Coop technology is designed to achieve 99.98% uptime availability. This integrated building design allows for free cooling 99% of the year via the building's unique shape and orientation, as well as server physical configuration.« less

Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

NASA Technical Reports Server (NTRS)

Shishko, Robert; Jorgensen, Edward J.

1996-01-01

This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

Project-based physics labs using low-cost open-source hardware

NASA Astrophysics Data System (ADS)

Bouquet, F.; Bobroff, J.; Fuchs-Gallezot, M.; Maurines, L.

2017-03-01

We describe a project-based physics lab, which we proposed to third-year university students. These labs are based on new open-source low-cost equipment (Arduino microcontrollers and compatible sensors). Students are given complete autonomy: they develop their own experimental setup and study the physics topic of their choice. The goal of these projects is to let students to discover the reality of experimental physics. Technical specifications of the acquisition material and case studies are presented for practical implementation in other universities.

10 CFR 420.34 - Matching contributions or cost-sharing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Matching contributions or cost-sharing. 420.34 Section 420.34 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.34 Matching contributions or cost-sharing. DOE may require (as set...

10 CFR 420.34 - Matching contributions or cost-sharing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Matching contributions or cost-sharing. 420.34 Section 420.34 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.34 Matching contributions or cost-sharing. DOE may require (as set...

10 CFR 420.34 - Matching contributions or cost-sharing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Matching contributions or cost-sharing. 420.34 Section 420.34 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.34 Matching contributions or cost-sharing. DOE may require (as set...

10 CFR 420.34 - Matching contributions or cost-sharing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Matching contributions or cost-sharing. 420.34 Section 420.34 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.34 Matching contributions or cost-sharing. DOE may require (as set...

10 CFR 420.34 - Matching contributions or cost-sharing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Matching contributions or cost-sharing. 420.34 Section 420.34 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.34 Matching contributions or cost-sharing. DOE may require (as set...

49 CFR 262.13 - Matching requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION IMPLEMENTATION OF PROGRAM FOR CAPITAL GRANTS FOR RAIL LINE RELOCATION AND... least ten percent of the construction costs of a project that is funded in part by the grant awarded... the State or other non-Federal entity or allowable costs, calculated on the basis of costs incurred by...

How much does it cost to change the behavior of health professionals? A mathematical model and an application to academic detailing.

PubMed

Gandjour, Afschin; Lauterbach, Karl Wilhelm

2005-01-01

Several strategies have shown to be effective at enhancing the implementation of research findings in daily practice. These implementation strategies improve the delivery of preventive or therapeutic care by successfully educating health professionals. On the other hand, little is known about the costs of these implementation strategies. The goal of this article is to present a mathematical model that predicts implementation costs by using published data. As an important feature, the model portrays the relationship between the degree of treatment underuse and implementation costs. Two application examples of outreach programs for the prevention of stroke and coronary disease analyze the relevance of implementation costs with respect to the cost-effectiveness ratio and total costs. They demonstrate that implementation costs may have little impact on the cost-effectiveness ratio but may nevertheless be relevant to a 3rd-party payer who needs to stay within the budget and ensure that care is provided to a large underserved population. The model and its consideration of implementation costs may contribute to a more efficient use of health care resources.

Investments and costs of oral health care for Family Health Care

PubMed Central

Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

2016-01-01

ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team’s operational cost. PMID:27463254

Digitizing Dissertations for an Institutional Repository: A Process and Cost Analysis*

PubMed Central

Piorun, Mary; Palmer, Lisa A.

2008-01-01

Objective: This paper describes the Lamar Soutter Library's process and costs associated with digitizing 300 doctoral dissertations for a newly implemented institutional repository at the University of Massachusetts Medical School. Methodology: Project tasks included identifying metadata elements, obtaining and tracking permissions, converting the dissertations to an electronic format, and coordinating workflow between library departments. Each dissertation was scanned, reviewed for quality control, enhanced with a table of contents, processed through an optical character recognition function, and added to the institutional repository. Results: Three hundred and twenty dissertations were digitized and added to the repository for a cost of $23,562, or $0.28 per page. Seventy-four percent of the authors who were contacted (n = 282) granted permission to digitize their dissertations. Processing time per title was 170 minutes, for a total processing time of 906 hours. In the first 17 months, full-text dissertations in the collection were downloaded 17,555 times. Conclusion: Locally digitizing dissertations or other scholarly works for inclusion in institutional repositories can be cost effective, especially if small, defined projects are chosen. A successful project serves as an excellent recruitment strategy for the institutional repository and helps libraries build new relationships. Challenges include workflow, cost, policy development, and copyright permissions. PMID:18654648

75 FR 4105 - Notice of Lodging of Consent Decree Under the Clean Air Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-26

... implement substantial injunctive relief to reduce pollution by installing new control equipment and... estimated capital cost of all of the pollution control projects to be implemented, is at least $112 million...

An Analysis of Serial Number Tracking Automatic Identification Technology as Used in Naval Aviation Programs

NASA Astrophysics Data System (ADS)

Csorba, Robert

2002-09-01

The Government Accounting Office found that the Navy, between 1996 and 1998, lost 3 billion in materiel in-transit. This thesis explores the benefits and cost of automatic identification and serial number tracking technologies under consideration by the Naval Supply Systems Command and the Naval Air Systems Command. Detailed cost-savings estimates are made for each aircraft type in the Navy inventory. Project and item managers of repairable components using Serial Number Tracking were surveyed as to the value of this system. It concludes that two thirds of the in-transit losses can be avoided with implementation of effective information technology-based logistics and maintenance tracking systems. Recommendations are made for specific steps and components of such an implementation. Suggestions are made for further research.

Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review.

PubMed

Grosse, Scott D; Peterson, Cora; Abouk, Rahi; Glidewell, Jill; Oster, Matthew E

2017-01-01

Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011-2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs.

Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review

PubMed Central

Grosse, Scott D.; Peterson, Cora; Abouk, Rahi; Glidewell, Jill; Oster, Matthew E.

2018-01-01

Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011–2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs. PMID:29376140

Incorporating psychological influences in probabilistic cost analysis

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

Kujawski, Edouard; Alvaro, Mariana; Edwards, William

2004-01-08

Today's typical probabilistic cost analysis assumes an ''ideal'' project that is devoid of the human and organizational considerations that heavily influence the success and cost of real-world projects. In the real world ''Money Allocated Is Money Spent'' (MAIMS principle); cost underruns are rarely available to protect against cost overruns while task overruns are passed on to the total project cost. Realistic cost estimates therefore require a modified probabilistic cost analysis that simultaneously models the cost management strategy including budget allocation. Psychological influences such as overconfidence in assessing uncertainties and dependencies among cost elements and risks are other important considerations thatmore » are generally not addressed. It should then be no surprise that actual project costs often exceed the initial estimates and are delivered late and/or with a reduced scope. This paper presents a practical probabilistic cost analysis model that incorporates recent findings in human behavior and judgment under uncertainty, dependencies among cost elements, the MAIMS principle, and project management practices. Uncertain cost elements are elicited from experts using the direct fractile assessment method and fitted with three-parameter Weibull distributions. The full correlation matrix is specified in terms of two parameters that characterize correlations among cost elements in the same and in different subsystems. The analysis is readily implemented using standard Monte Carlo simulation tools such as {at}Risk and Crystal Ball{reg_sign}. The analysis of a representative design and engineering project substantiates that today's typical probabilistic cost analysis is likely to severely underestimate project cost for probability of success values of importance to contractors and procuring activities. The proposed approach provides a framework for developing a viable cost management strategy for allocating baseline budgets and contingencies. Given the scope and magnitude of the cost-overrun problem, the benefits are likely to be significant.« less

Capturing the multiple benefits associated with nature-based solutions: lessons from natural flood management project in the Cotswolds, UK

NASA Astrophysics Data System (ADS)

Short, Chrisopher; Clarke, Lucy; Uttley, Chris; Smith, Brian

2017-04-01

Following severe flooding in 2007, and subsequent smaller flood events, a decision was taken in 2012 to explore nature-based solutions in 250km2 river catchment in the southern Cotswolds in the UK. A major tributary within the catchment has been designated as rapid response; with a primarily limestone geology limestone and a mixture of spring and surface drained sources along a number of tributaries feeding in the river, with one main population centre where the water bodies converge. The project involves landscape and land management interventions aimed at attenuating high flows to reduce flood risk through changes in land management practices in both agriculture and forestry and slowing peak flows in surface flows through increased infiltration and attenuation areas. After three years of the project it is clear that the threshold for effectiveness requires the majority of the upstream catchment area to be implementing these measures. However, the cost effectiveness of the approach seems to be substantial compared to traditional hard-engineering approaches. The level of community involvement, including local flood forums, is high and the social, and natural, capital has been enhanced through the project. Early results suggest that there have been localized improvements in water quality and biodiversity as well as a reduction in peak flow but such changes are difficult to directly associate to the project. What is clear is the role of communities, landowners and partners to implement natural flood management on a catchment wide scale. In this sense the project has adopted a co-management or adaptive management approach which brings together the knowledges of hydrologists, ecologists, farmers, woodland owners and the local community to implement locally be-spoke solutions within a broader project framework. This paper will outline the initial findings and the governance structure that has assisted in the early success of the project within a theoretical framework of co-management and suggest how this type of framework is suitable for a range of nature-based solutions across Europe. However, the challenge remains of capturing the multiple-benefits that such projects offer as these are often missed through conventional approaches such as cost-benefit analysis and some reflections on this will also be presented along with a potential way forward.

The impact of OSHA regulations on nursing care cost and compliance.

PubMed

Raltz, S; Kozarek, R A; Kim-Deobald, J; Pethigal, P; Moorhouse, M A

1994-01-01

The Occupational Safety and Health Administration (OSHA) requires health care facilities to protect employees from bloodborne pathogens. One of the mandates is to provide personal protective equipment (PPE) to employees at no cost to the employee. In this article, the authors explore the cost and compliance of implementing the new OSHA regulations for nursing staff assisting with colonoscopies over a 6-month period. The data were collected on a total of 461 procedures. The cost of implementing PPE for the nursing staff was $2.98 per procedure. The PPE available for the nursing staff included goggles, splash-proof gown, face mask, shoe covers, and latex gloves. The total cost of implementing the new regulations for the nursing staff assisting with colonoscopies was $2,747.56 and was projected to cost approximately $50,000 yearly if implemented for all GI procedures in the institution. Staff compliance rates for the five pieces of PPE ranged from 6.5 to 97.8%.

Harnessing the power of enhanced data for healthcare quality improvement: lessons from a Minnesota Hospital Association Pilot Project.

PubMed

Pine, Michael; Sonneborn, Mark; Schindler, Joe; Stanek, Michael; Maeda, Jared Lane; Hanlon, Carrie

2012-01-01

The imperative to achieve quality improvement and cost-containment goals is driving healthcare organizations to make better use of existing health information. One strategy, the construction of hybrid data sets combining clinical and administrative data, has strong potential to improve the cost-effectiveness of hospital quality reporting processes, improve the accuracy of quality measures and rankings, and strengthen data systems. Through a two-year contract with the Agency for Healthcare Research and Quality, the Minnesota Hospital Association launched a pilot project in 2007 to link hospital clinical information to administrative data. Despite some initial challenges, this project was successful. Results showed that the use of hybrid data allowed for more accurate comparisons of risk-adjusted mortality and risk-adjusted complications across Minnesota hospitals. These increases in accuracy represent an important step toward targeting quality improvement efforts in Minnesota and provide important lessons that are being leveraged through ongoing projects to construct additional enhanced data sets. We explore the implementation challenges experienced during the Minnesota Pilot Project and their implications for hospitals pursuing similar data-enhancement projects. We also highlight the key lessons learned from the pilot project's success.

Clean Coal Technology Demonstration Program: Program Update 1998

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

Assistant Secretary for Fossil Energy

1999-03-01

Annual report on the Clean Coal Technology Demonstration Program (CCT Program). The report address the role of the CCT Program, implementation, funding and costs, accomplishments, project descriptions, legislative history, program history, environmental aspects, and project contacts. The project descriptions describe the technology and provides a brief summary of the demonstration results.

Wireless Technology in the Library: The RIT Experience: Overview of the Project.

ERIC Educational Resources Information Center

Pitkin, Pat

2001-01-01

Provides an overview of a project at RIT (Rochester Institute of Technology) that experimented with wireless technology, including laptop computers that circulate within the library building. Discusses project requirements, including ease of use, low maintenance, and low cost; motivation, including mobility; implementation; and benefits to the…

A cost-effectiveness analysis evaluating endoscopic surveillance for gastric cancer for populations with low to intermediate risk.

PubMed

Zhou, Hui Jun; Dan, Yock Young; Naidoo, Nasheen; Li, Shu Chuen; Yeoh, Khay Guan

2013-01-01

Gastric cancer (GC) surveillance based on oesophagogastroduodenoscopy (OGD) appears to be a promising strategy for GC prevention. By evaluating the cost-effectiveness of endoscopic surveillance in Singaporean Chinese, this study aimed to inform the implementation of such a program in a population with a low to intermediate GC risk. USING A REFERENCE STRATEGY OF NO OGD INTERVENTION, WE EVALUATED FOUR STRATEGIES: 2-yearly OGD surveillance, annual OGD surveillance, 2-yearly OGD screening and 2-yearly screening plus annual surveillance in Singaporean Chinese aged 50-69 years. From a perspective of the healthcare system, Markov models were built to simulate the life experience of the target population. The models projected discounted lifetime costs ($), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) indicating the cost-effectiveness of each strategy against a Singapore willingness-to-pay of $46,200/QALY. Deterministic and probabilistic sensitivity analyses were used to identify the influential variables and their associated thresholds, and to quantify the influence of parameter uncertainties respectively. With an ICER of $44,098/QALY, the annual OGD surveillance was the optimal strategy while the 2-yearly surveillance was the most cost-effective strategy (ICER = $25,949/QALY). The screening-based strategies were either extendedly dominated or cost-ineffective. The cost-effectiveness heterogeneity of the four strategies was observed across age-gender subgroups. Eight influential parameters were identified each with their specific thresholds to define the choice of optimal strategy. Accounting for the model uncertainties, the probability that the annual surveillance is the optimal strategy in Singapore was 44.5%. Endoscopic surveillance is potentially cost-effective in the prevention of GC for populations at low to intermediate risk. Regarding program implementation, a detailed analysis of influential factors and their associated thresholds is necessary. Multiple strategies should be considered in order to recommend the right strategy for the right population.

Community action against asthma: examining the partnership process of a community-based participatory research project.

PubMed

Parker, Edith A; Israel, Barbara A; Williams, Melina; Brakefield-Caldwell, Wilma; Lewis, Toby C; Robins, Thomas; Ramirez, Erminia; Rowe, Zachary; Keeler, Gerald

2003-07-01

Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. To conduct a process evaluation of the CAAA community-academic partnership. In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. Community setting in Detroit, Michigan. Twenty-three members of the CAAA SC. Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.

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

Seal, Brian; Huque, Aminul; Rogers, Lindsey

In 2011, EPRI began a four-year effort under the Department of Energy (DOE) SunShot Initiative Solar Energy Grid Integration Systems - Advanced Concepts (SEGIS-AC) to demonstrate smart grid ready inverters with utility communication. The objective of the project was to successfully implement and demonstrate effective utilization of inverters with grid support functionality to capture the full value of distributed photovoltaic (PV). The project leveraged ongoing investments and expanded PV inverter capabilities, to enable grid operators to better utilize these grid assets. Developing and implementing key elements of PV inverter grid support capabilities will increase the distribution system’s capacity for highermore » penetration levels of PV, while reducing the cost. The project team included EPRI, Yaskawa-Solectria Solar, Spirae, BPL Global, DTE Energy, National Grid, Pepco, EDD, NPPT and NREL. The project was divided into three phases: development, deployment, and demonstration. Within each phase, the key areas included: head-end communications for Distributed Energy Resources (DER) at the utility operations center; methods for coordinating DER with existing distribution equipment; back-end PV plant master controller; and inverters with smart-grid functionality. Four demonstration sites were chosen in three regions of the United States with different types of utility operating systems and implementations of utility-scale PV inverters. This report summarizes the project and findings from field demonstration at three utility sites.« less

An Innovative Time-Cost-Quality Tradeoff Modeling of Building Construction Project Based on Resource Allocation

PubMed Central

2014-01-01

The time, quality, and cost are three important but contradictive objectives in a building construction project. It is a tough challenge for project managers to optimize them since they are different parameters. This paper presents a time-cost-quality optimization model that enables managers to optimize multiobjectives. The model is from the project breakdown structure method where task resources in a construction project are divided into a series of activities and further into construction labors, materials, equipment, and administration. The resources utilized in a construction activity would eventually determine its construction time, cost, and quality, and a complex time-cost-quality trade-off model is finally generated based on correlations between construction activities. A genetic algorithm tool is applied in the model to solve the comprehensive nonlinear time-cost-quality problems. Building of a three-storey house is an example to illustrate the implementation of the model, demonstrate its advantages in optimizing trade-off of construction time, cost, and quality, and help make a winning decision in construction practices. The computational time-cost-quality curves in visual graphics from the case study prove traditional cost-time assumptions reasonable and also prove this time-cost-quality trade-off model sophisticated. PMID:24672351

Framework for selection and evaluation of bicycle and pedestrian safety projects in Virginia.

DOT National Transportation Integrated Search

2008-01-01

The Virginia Department of Transportation's (VDOT) Bicycle and Pedestrian Safety (BPS) Program provides funds for implementing short-term, low-cost bicycle and pedestrian safety projects in Virginia. This initiative is administered by evaluating each...

The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.

PubMed

Gillespie, Paddy; O'Neill, Ciaran; Adams, Elisabeth; Turner, Katherine; O'Donovan, Diarmuid; Brugha, Ruairi; Vaughan, Deirdre; O'Connell, Emer; Cormican, Martin; Balfe, Myles; Coleman, Claire; Fitzgerald, Margaret; Fleming, Catherine

2012-04-01

The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves. The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94,717. For cost-effectiveness threshold values of €45,000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%. An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Advanced, High Power, Next Scale, Wave Energy Conversion Device

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

Mekhiche, Mike; Dufera, Hiz; Montagna, Deb

2012-10-29

The project conducted under DOE contract DE‐EE0002649 is defined as the Advanced, High Power, Next Scale, Wave Energy Converter. The overall project is split into a seven‐stage, gated development program. The work conducted under the DOE contract is OPT Stage Gate III work and a portion of Stage Gate IV work of the seven stage product development process. The project effort includes Full Concept Design & Prototype Assembly Testing building on our existing PowerBuoy technology to deliver a device with much increased power delivery. Scaling‐up from 150kW to 500kW power generating capacity required changes in the PowerBuoy design that addressedmore » cost reduction and mass manufacturing by implementing a Design for Manufacturing (DFM) approach. The design changes also focused on reducing PowerBuoy Installation, Operation and Maintenance (IO&M) costs which are essential to reducing the overall cost of energy. In this design, changes to the core PowerBuoy technology were implemented to increase capability and reduce both CAPEX and OPEX costs. OPT conceptually envisaged moving from a floating structure to a seabed structure. The design change from a floating structure to seabed structure would provide the implementation of stroke‐ unlimited Power Take‐Off (PTO) which has a potential to provide significant power delivery improvement and transform the wave energy industry if proven feasible.« less

Contingency management in substance abuse treatment: a structured review of the evidence for its transportability.

PubMed

Hartzler, Bryan; Lash, Steve J; Roll, John M

2012-04-01

Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science. Published by Elsevier Ireland Ltd.

Contingency management in substance abuse treatment: A structured review of the evidence for its transportability

PubMed Central

Hartzler, Bryan; Lash, Steve; Roll, John

2011-01-01

Aims Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. Methods PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. Results Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic’s technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics—like economic policies and inter-agency networking or competition—are salient, often unrecognized influences. Conclusions As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science. PMID:22153943

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

Poncio, S.; Adkison, P.

Coating costs are escalating due to increased awareness of the environment and safety and health issues. Owners can reduce the overall cost of maintenance painting projects through the implementation of a total quality program. This program should encompass project pre-planning, evaluation of safety and quality assurance programs, and analysis of employee absenteeism and turnover. The information presented is a case history of one utility's experience managing a maintenance painting program during a five-year period.

Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD.

PubMed

Hoogendoorn, Martine; Feenstra, Talitha L; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

2010-08-01

The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). A systematic review was performed of randomised controlled trials on smoking cessation interventions in patients with COPD reporting 12-month biochemical validated abstinence rates. The different interventions were grouped into four categories: usual care, minimal counselling, intensive counselling and intensive counselling + pharmacotherapy ('pharmacotherapy'). For each category the average 12-month continuous abstinence rate and intervention costs were estimated. A dynamic population model for COPD was used to project the long-term (cost-) effectiveness (25 years) of 1-year implementation of the interventions for 50% of the patients with COPD who smoked compared with usual care. Uncertainty and one-way sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates. Nine studies were selected. The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care, 2.6% for minimal counselling, 6.0% for intensive counselling and 12.3% for pharmacotherapy. Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were euro 16 900, euro 8200 and euro 2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates. Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.

Save Money and the Planet: Make Your School Energy Efficient.

ERIC Educational Resources Information Center

Lewis, Eleanor J.; Weltman, Eric

1993-01-01

Examines ways in which schools can cut their energy costs. Suggestions are provided for making school lighting more efficient, conducting a life-cycle cost analysis to facilitate energy efficiency, and developing funding for implementing energy-efficient projects. (GLR)

The burden of acute myocardial infarction after a regional cardiovascular center project in Korea.

PubMed

Kim, Arim; Yoon, Seok-Jun; Kim, Young-Ae; Kim, Eun Jung

2015-10-01

The aim of this study was to examine the impact of a government-directed regional cardiovascular center (RCVC) project on the length of stay (LOS) and medical costs due to acute myocardial infarction (AMI). A retrospective claim data review. Forty hospitals including four RCVCs in Korea. A total of 1469 AMI patients who visited a RCVC in two regions between February 2009 and December 2011. RCVC project has been fostering specialized center by region for management of cardiovascular disease. It has built a system that could receive intensive care quickly within 3 h when disease occurred. Changes in the LOS and cost were evaluated using the difference-in-differences (DIDs) method combined with propensity score matching (1:1) and multilevel analysis with adjustment for patient's and institutional factors. The net effect of RCVC project implementation showed decline of LOS (-0.71 days) and total medical costs (-797 US dollars) by DID. After the RCVC project, the LOS for patients with AMI hospitalized in a RCVC was decreased by 8.9% (β = -0.094, P = 0.041) compared with patients hospitalized in a hospital not designed as a RCVC. Compared with costs before the RCVC project, they were decreased by 11.5% (β = -0.122, P = 0.004). We provided evidence regarding the change in the societal burden due to AMI after regionalization. Although there was a reduction of LOS and direct medical costs reported in limited number of regionalized hospitals, in the long term we can anticipate an expanding impact in all regionalized hospitals. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.

PubMed

Shih, Ya-Chen Tina; Chien, Chun-Ru; Moguel, Rocio; Hernandez, Mike; Hajek, Richard A; Jones, Lovell A

2016-04-01

To assess the cost-effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer. Cost-effectiveness analysis. A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LYs), and quality-adjusted life years (QALYs) and addressed uncertainties in one-way and probabilistic sensitivity analyses. Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project. Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was $9,145 and 0.47 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $19,312/QALY. One-way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local-stage patients. CE-acceptability curve showed the probability that the PN program was cost-effective was 0.80 and 0.91 at a societal willingness-to-pay of $50,000 and $100,000/QALY, respectively. Instituting a capitated PN program is cost-effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers. © Health Research and Educational Trust.

Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population.

PubMed

Kim, Bumyang; Lairson, David R; Chung, Tong Han; Kim, Junghyun; Shokar, Navkiran K

2017-06-01

Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

PubMed

Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

2016-01-01

In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

Modular laboratories--cost-effective and sustainable infrastructure for resource-limited settings.

PubMed

Bridges, Daniel J; Colborn, James; Chan, Adeline S T; Winters, Anna M; Dengala, Dereje; Fornadel, Christen M; Kosloff, Barry

2014-12-01

High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. © The American Society of Tropical Medicine and Hygiene.

Notification: Implementation of Executive Order 13771, “Reducing Regulation and Controlling Regulatory Costs”

EPA Pesticide Factsheets

Project #OA&E-FY18-0177, April 10, 2018. The OIG plans to begin preliminary research on the Office of the Administrator's Office of Policy implementation of Executive Order 13771, Reducing Regulation and Controlling Regulatory Costs.

The Salinas Airshower Learning And Discovery Project (SALAD)

NASA Astrophysics Data System (ADS)

Hernandez, Victor; Niduaza, Rommel; Ruiz Castruita, Daniel; Knox, Adrian; Ramos, Daniel; Fan, Sewan; Fatuzzo, Laura

2015-04-01

The SALAD project partners community college and high school STEM students in order to develop and investigate cosmic ray detector telescopes and the physical concepts, using a new light sensor technology based on silicon photomultiplier (SiPM) detectors. Replacing the conventional photomultiplier with the SiPM, offers notable advantages in cost and facilitates more in depth, hands-on learning laboratory activities. The students in the SALAD project design, construct and extensively evaluate the SiPM detector modules. These SiPM modules, can be completed in a short time utilizing cost effective components. We describe our research to implement SiPM as read out light detectors for plastic scintillators in a cosmic ray detector telescope for use in high schools. In particular, we describe our work in the design, evaluation and the assembly of (1) a fast preamplifier, (2) a simple coincidence circuit using fast comparators, to discriminate the SiPM noise signal pulses, and (3) a monovibrator circuit to shape the singles plus the AND logic pulses for subsequent processing. To store the singles and coincidence counts data, an Arduino micro-controller with program sketches can be implemented. Results and findings from our work would be described and presented. US Department of Education Title V Grant Award PO31S090007

Deep space network software cost estimation model

NASA Technical Reports Server (NTRS)

Tausworthe, R. C.

1981-01-01

A parametric software cost estimation model prepared for Deep Space Network (DSN) Data Systems implementation tasks is presented. The resource estimation model incorporates principles and data from a number of existing models. The model calibrates task magnitude and difficulty, development environment, and software technology effects through prompted responses to a set of approximately 50 questions. Parameters in the model are adjusted to fit DSN software life cycle statistics. The estimation model output scales a standard DSN Work Breakdown Structure skeleton, which is then input into a PERT/CPM system, producing a detailed schedule and resource budget for the project being planned.

Identification of cost effective energy conservation measures

NASA Technical Reports Server (NTRS)

Bierenbaum, H. S.; Boggs, W. H.

1978-01-01

In addition to a successful program of readily implemented conservation actions for reducing building energy consumption at Kennedy Space Center, recent detailed analyses have identified further substantial savings for buildings representative of technical facilities designed when energy costs were low. The techniques employed for determination of these energy savings consisted of facility configuration analysis, power and lighting measurements, detailed computer simulations and simulation verifications. Use of these methods resulted in identification of projected energy savings as large as $330,000 a year (approximately two year break-even period) in a single building. Application of these techniques to other commercial buildings is discussed

ICU early physical rehabilitation programs: financial modeling of cost savings.

PubMed

Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

2013-03-01

To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

36 CFR 222.1 - Authority and definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Grasslands, Land Utilization Projects, and other Federal lands for which the Forest Service has...-ground expenditure means payment of direct project costs of implementing an improvement or development...: (i) Non-structural which are practices and treatments undertaken to improve range not involving...

New benchmarks for costs and cost-efficiency of school-based feeding programs in food-insecure areas.

PubMed

Gelli, Aulo; Cavallero, Andrea; Minervini, Licia; Mirabile, Mariana; Molinas, Luca; de la Mothe, Marc Regnault

2011-12-01

School feeding is a popular intervention that has been used to support the education, health and nutrition of school children. Although the benefits of school feeding are well documented, the evidence on the costs of such programs is remarkably thin. Address the need for systematic estimates of the cost of different school feeding modalities, and of the determinants of the considerable cost variation among countries. WFP project data, including expenditures and number of schoolchildren covered, were collected for 78 projects in 62 countries through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The standardized yearly average school feeding cost per child, not including school-level costs, was US$48. The yearly costs per child were lowest at US$23 for biscuit programs reaching school-going children and highest at US$75 for take-home rations programs reaching families of schoolgoing children. The average cost of programs combining on-site meals with extra take-home rations for children from vulnerable households was US$61. Commodity costs were on average 58% of total costs and were highest for biscuit and take-home rations programs (71% and 68%, respectively). Fortified biscuits provided the most cost-efficient option in terms of micronutrient delivery, whereas take-home rations were more cost-efficient in terms of food quantities delivered. Both costs and effects should be considered carefully when designing school feeding interventions. The average costs of school feeding estimated here are higher than those found in earlier studies but fall within the range of costs previously reported. Because this analysis does not include school-level costs, these findings highlight the higher nontransfer costs for programs delivering cooked meals in schools than for other school feeding modalities. The benchmarks presented here reflect the centralized WFP implementation model, which is not always relevant in terms of government school feeding programs, particularly those procuring within national boundaries using "home-grown" approaches.

Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States.

PubMed

Wang, Y Claire; Cheung, Angela M; Bibbins-Domingo, Kirsten; Prosser, Lisa A; Cook, Nancy R; Goldman, Lee; Gillman, Matthew W

2011-02-01

To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution. We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]). Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel. Copyright © 2011 Mosby, Inc. All rights reserved.

Algorithm-guided treatment of depression reduces treatment costs--results from the randomized controlled German Algorithm Project (GAPII).

PubMed

Ricken, Roland; Wiethoff, Katja; Reinhold, Thomas; Schietsch, Kathrin; Stamm, Thomas; Kiermeir, Julia; Neu, Peter; Heinz, Andreas; Bauer, Michael; Adli, Mazda

2011-11-01

The German Algorithm Project, Phase 2 (GAP2) revealed that a standardized stepwise treatment regimen (SSTR) results in better treatment outcomes than treatment as usual (TAU) in depressed inpatients. The objective of this study was a health economic evaluation of SSTR based on a cost effectiveness analysis (CEA). GAP2 was a randomized controlled study with 148 patients. In an intention to treat (ITT) analysis direct treatment costs for study duration (SD) and total time in hospital (TTH; enrolment to discharge) were calculated based on daily hospital charges followed by a CEA to calculate cost expenditure per remitted patient. Treatment costs in SSTR compared to TAU were significantly lower for SD (SSTR: 10 830 € ± 8 632 €, TAU: 15 202 € ± 12 483 €; p = 0.026) and did not differ significantly for TTH (SSTR: 21 561 € ± 16 162 €; TAU: 18 248 € ± 13 454; p = 0.208). CEA revealed that the costs per remission in SSTR were significantly lower for SD (SSTR: 20 035 € ± 15 970 €; SSTR: 38 793 € ± 31 853 €; p<0.0001) and TTH (SSTR: 31 285 € ± 23 451 €; TAU: 38 581 € ± 28 449 €, p = 0.041). Indirect costs were not assessed. Different dropout rates in TAU and SSTR complicated interpretation of data. An SSTR-based algorithm results in a superior cost effectiveness at no significant extra costs. Implementation of treatment algorithms in inpatient-care may help reduce treatment costs. Copyright © 2011 Elsevier B.V. All rights reserved.

34 CFR 606.21 - What are the selection criteria for planning grants?

Code of Federal Regulations, 2010 CFR

2010-07-01

... adequate. (c) Project Management. The Secretary reviews each application to determine the quality of the... which the proposed project costs are necessary and reasonable. (Approved by the Office of Management and... resources to help implement the project; and (4) The planning process is likely to achieve its intended...

Guidelines for estimating the triennial benefits of Kansas transportation research and new developments (K-TRAN) research projects

DOT National Transportation Integrated Search

2004-07-01

Between 1991 and 2003, the K-TRAN program has funded over 200 research projects at a total program cost of $7.3 million. : Since 1991, a total of 76 K-TRAN projects have been implemented. Estimates of monetary triennial benefits have been developed :...

34 CFR 606.21 - What are the selection criteria for planning grants?

Code of Federal Regulations, 2011 CFR

2011-07-01

... adequate. (c) Project Management. The Secretary reviews each application to determine the quality of the... which the proposed project costs are necessary and reasonable. (Approved by the Office of Management and... resources to help implement the project; and (4) The planning process is likely to achieve its intended...

34 CFR 606.21 - What are the selection criteria for planning grants?

Code of Federal Regulations, 2013 CFR

2013-07-01

... adequate. (c) Project Management. The Secretary reviews each application to determine the quality of the... which the proposed project costs are necessary and reasonable. (Approved by the Office of Management and... resources to help implement the project; and (4) The planning process is likely to achieve its intended...

34 CFR 606.21 - What are the selection criteria for planning grants?

Code of Federal Regulations, 2014 CFR

2014-07-01

... adequate. (c) Project Management. The Secretary reviews each application to determine the quality of the... which the proposed project costs are necessary and reasonable. (Approved by the Office of Management and... resources to help implement the project; and (4) The planning process is likely to achieve its intended...

34 CFR 606.21 - What are the selection criteria for planning grants?

Code of Federal Regulations, 2012 CFR

2012-07-01

... adequate. (c) Project Management. The Secretary reviews each application to determine the quality of the... which the proposed project costs are necessary and reasonable. (Approved by the Office of Management and... resources to help implement the project; and (4) The planning process is likely to achieve its intended...

Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies.

PubMed

Pham, Quang Duy; Wilson, David P; Nguyen, Thuong Vu; Do, Nhan Thi; Truong, Lien Xuan; Nguyen, Long Thanh; Zhang, Lei

2016-05-01

The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade. Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario. Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30. Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Projected Impact of Salt Restriction on Prevention of Cardiovascular Disease in China: A Modeling Study

PubMed Central

Liu, Jing; Coxson, Pamela G.; Penko, Joanne; Goldman, Lee; Bibbins-Domingo, Kirsten; Zhao, Dong

2016-01-01

Objectives To estimate the effects of achieving China’s national goals for dietary salt (NaCl) reduction or implementing culturally-tailored dietary salt restriction strategies on cardiovascular disease (CVD) prevention. Methods The CVD Policy Model was used to project blood pressure lowering and subsequent downstream prevented CVD that could be achieved by population-wide salt restriction in China. Outcomes were annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved. Results Reducing mean dietary salt intake to 9.0 g/day gradually over 10 years could prevent approximately 197 000 incident annual CVD events [95% uncertainty interval (UI): 173 000–219 000], reduce annual CVD mortality by approximately 2.5% (2.2–2.8%), gain 303 000 annual QALYs (278 000–329 000), and save approximately 1.4 billion international dollars (Int$) in annual CVD costs (Int$; 1.2–1.6 billion). Reducing mean salt intake to 6.0 g/day could approximately double these benefits. Implementing cooking salt-restriction spoons could prevent 183 000 fewer incident CVD cases (153 000–215 000) and avoid Int$1.4 billion in CVD treatment costs annually (1.2–1.7 billion). Implementing a cooking salt substitute strategy could lead to approximately three times the health benefits of the salt-restriction spoon program. More than three-quarters of benefits from any dietary salt reduction strategy would be realized in hypertensive adults. Conclusion China could derive substantial health gains from implementation of population-wide dietary salt reduction policies. Most health benefits from any dietary salt reduction program would be realized in adults with hypertension. PMID:26840409

IGEA--a chronic disease management project for people with diabetes.

PubMed

Maggini, Marina

2009-01-01

Chronic diseases can be prevented and controlled using available knowledge. Moreover, the solutions are not only effective but can be highly cost-effective. Chronic care model and disease management have emerged, in the last decades, as new models of care delivery. The two models share the objective of improving the quality of care for people with chronic diseases while optimizing health care expenditure. In Italy, within the National Prevention Plan, the Italian Centre for Disease Prevention and Control of the Ministry of Health, and the Istituto Superiore di Sanità (ISS) are developing the IGEA project, which defines a comprehensive strategy for implementing a chronic disease management intervention for people with diabetes.

Effort estimation for enterprise resource planning implementation projects using social choice - a comparative study

NASA Astrophysics Data System (ADS)

Koch, Stefan; Mitlöhner, Johann

2010-08-01

ERP implementation projects have received enormous attention in the last years, due to their importance for organisations, as well as the costs and risks involved. The estimation of effort and costs associated with new projects therefore is an important topic. Unfortunately, there is still a lack of models that can cope with the special characteristics of these projects. As the main focus lies in adapting and customising a complex system, and even changing the organisation, traditional models like COCOMO can not easily be applied. In this article, we will apply effort estimation based on social choice in this context. Social choice deals with aggregating the preferences of a number of voters into a collective preference, and we will apply this idea by substituting the voters by project attributes. Therefore, instead of supplying numeric values for various project attributes, a new project only needs to be placed into rankings per attribute, necessitating only ordinal values, and the resulting aggregate ranking can be used to derive an estimation. We will describe the estimation process using a data set of 39 projects, and compare the results to other approaches proposed in the literature.

Achieving mask order processing automation, interoperability and standardization based on P10

NASA Astrophysics Data System (ADS)

Rodriguez, B.; Filies, O.; Sadran, D.; Tissier, Michel; Albin, D.; Stavroulakis, S.; Voyiatzis, E.

2007-02-01

Last year the MUSCLE (Masks through User's Supply Chain: Leadership by Excellence) project was presented. Here is the project advancement. A key process in mask supply chain management is the exchange of technical information for ordering masks. This process is large, complex, company specific and error prone, and leads to longer cycle times and higher costs due to missing or wrong inputs. Its automation and standardization could produce significant benefits. We need to agree on the standard for mandatory and optional parameters, and also a common way to describe parameters when ordering. A system was created to improve the performance in terms of Key Performance Indicators (KPIs) such as cycle time and cost of production. This tool allows us to evaluate and measure the effect of factors, as well as the effect of implementing the improvements of the complete project. Next, a benchmark study and a gap analysis were performed. These studies show the feasibility of standardization, as there is a large overlap in requirements. We see that the SEMI P10 standard needs enhancements. A format supporting the standard is required, and XML offers the ability to describe P10 in a flexible way. Beyond using XML for P10, the semantics of the mask order should also be addressed. A system design and requirements for a reference implementation for a P10 based management system are presented, covering a mechanism for the evolution and for version management and a design for P10 editing and data validation.

Improving Space Project Cost Estimating with Engineering Management Variables

NASA Technical Reports Server (NTRS)

Hamaker, Joseph W.; Roth, Axel (Technical Monitor)

2001-01-01

Current space project cost models attempt to predict space flight project cost via regression equations, which relate the cost of projects to technical performance metrics (e.g. weight, thrust, power, pointing accuracy, etc.). This paper examines the introduction of engineering management parameters to the set of explanatory variables. A number of specific engineering management variables are considered and exploratory regression analysis is performed to determine if there is statistical evidence for cost effects apart from technical aspects of the projects. It is concluded that there are other non-technical effects at work and that further research is warranted to determine if it can be shown that these cost effects are definitely related to engineering management.

Designing, implementing and monitoring social impact mitigation strategies: Lessons from Forest Industry Structural Adjustment Packages

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

Loxton, Edwina A., E-mail: Edwina.Loxton@anu.edu.au; Schirmer, Jacki, E-mail: Jacki.Schirmer@canberra.edu.au; Cooperative Research Centre for Forestry, Hobart, 7001

2013-09-15

Social impact mitigation strategies are implemented by the proponents of policies and projects with the intent of reducing the negative, and increasing the positive social impacts of their activities, and facilitating the achievement of policy/project goals. Evaluation of mitigation strategies is critical to improving their future success and cost-effectiveness. This paper evaluates two Forest Industry Structural Adjustment Packages (FISAP) implemented in Australia in the 1990s to 2000s as part of broader policy changes that reduced access to timber from publicly owned native forests. It assesses the effectiveness of the structure, design, implementation and monitoring of the FISAPs, and highlights themore » interactions between these four elements and their influence on social impacts. The two FISAPs were found to be effective in terms of reducing negative impacts, encouraging positive impacts and contributing towards policy goals, although they did not mitigate negative impacts in all cases, and sometimes interacted with external factors and additional policy changes to contribute to significant short and long term negative impacts. -- Highlights: ► Mitigation strategies aim to reduce negative and enhance positive social impacts ► Mitigation strategy design, implementation, and monitoring are critical to success ► Effective mitigation enhanced the capacity of recipients to respond to change ► Mitigation strategies influenced multiple interacting positive and negative impacts ► Success required good communication, transparency, support, resources and timing.« less

Assessment of indirect losses and costs of emergency for project planning of alpine hazard mitigation

NASA Astrophysics Data System (ADS)

Amenda, Lisa; Pfurtscheller, Clemens

2013-04-01

By virtue of augmented settling in hazardous areas and increased asset values, natural disasters such as floods, landslides and rockfalls cause high economic losses in Alpine lateral valleys. Especially in small municipalities, indirect losses, mainly stemming from a breakdown of transport networks, and costs of emergency can reach critical levels. A quantification of these losses is necessary to estimate the worthiness of mitigation measures, to determine the appropriate level of disaster assistance and to improve risk management strategies. There are comprehensive approaches available for assessing direct losses. However, indirect losses and costs of emergency are widely not assessed and the empirical basis for estimating these costs is weak. To address the resulting uncertainties of project appraisals, a standardized methodology has been developed dealing with issues of local economic effects and emergency efforts needed. In our approach, the cost-benefit-analysis for technical mitigation of the Austrian Torrent and Avalanche Control (TAC) will be optimized and extended using the 2005-debris flow as a design event, which struggled a small town in the upper Inn valley in southwest Tyrol (Austria). Thereby, 84 buildings were affected, 430 people were evacuated and due to this, the TAC implemented protection measures for 3.75 million Euros. Upgrading the method of the TAC and analyzing to what extent the cost-benefit-ratio is about to change, is one of the main objectives of this study. For estimating short-run indirect effects and costs of emergency on the local level, data was collected via questionnaires, field mapping, guided interviews, as well as intense literature research. According to this, up-to-date calculation methods were evolved and the cost-benefit-analysis of TAC was recalculated with these new-implemented results. The cost-benefit-ratio will be more precise and specific and hence, the decision, which mitigation alternative will be carried out. Based on this, the worthiness of the mitigation measures can be determined in more detail and the proper level of emergency assistance can be calculated more adequately. By dint of this study, a better data basis will be created evaluating technical and non-technical mitigation measures, which is useful for government agencies, insurance companies and research.

Designing an activity-based costing model for a non-admitted prisoner healthcare setting.

PubMed

Cai, Xiao; Moore, Elizabeth; McNamara, Martin

2013-09-01

To design and deliver an activity-based costing model within a non-admitted prisoner healthcare setting. Key phases from the NSW Health clinical redesign methodology were utilised: diagnostic, solution design and implementation. The diagnostic phase utilised a range of strategies to identify issues requiring attention in the development of the costing model. The solution design phase conceptualised distinct 'building blocks' of activity and cost based on the speciality of clinicians providing care. These building blocks enabled the classification of activity and comparisons of costs between similar facilities. The implementation phase validated the model. The project generated an activity-based costing model based on actual activity performed, gained acceptability among clinicians and managers, and provided the basis for ongoing efficiency and benchmarking efforts.

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

PubMed

Gu, Dongfeng; He, Jiang; Coxson, Pamela G; Rasmussen, Petra W; Huang, Chen; Thanataveerat, Anusorn; Tzong, Keane Y; Xiong, Juyang; Wang, Miao; Zhao, Dong; Goldman, Lee; Moran, Andrew E

2015-08-01

Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs. The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China. Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version.

PubMed

Vlemmix, Floortje; Rosman, Ageeth N; Fleuren, Margot A H; Rijnders, Marlies E B; Beuckens, Antje; Haak, Monique C; Akerboom, Bettina M C; Bais, Joke M J; Kuppens, Simone M I; Papatsonis, Dimitri N; Opmeer, Brent C; van der Post, Joris A M; Mol, Ben Willem J; Kok, Marjolein

2010-05-10

Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Dutch Trial Register (NTR): 1878.

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

PubMed Central

2010-01-01

Background Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less. We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. Method/design The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV. The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. Discussion This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Trial Registration Dutch Trial Register (NTR): 1878 PMID:20459717

Moving toward implementation : an examination of the organizational and political structures of transit-oriented development.

DOT National Transportation Integrated Search

2009-06-01

The research explores the costs and impacts of Transit Oriented Development (TOD) and : addresses the rationale for designing transit-oriented neighborhoods. It also documents the : outcomes and the impacts of implementing such projects and examines ...

CUDA-based high-performance computing of the S-BPF algorithm with no-waiting pipelining

NASA Astrophysics Data System (ADS)

Deng, Lin; Yan, Bin; Chang, Qingmei; Han, Yu; Zhang, Xiang; Xi, Xiaoqi; Li, Lei

2015-10-01

The backprojection-filtration (BPF) algorithm has become a good solution for local reconstruction in cone-beam computed tomography (CBCT). However, the reconstruction speed of BPF is a severe limitation for clinical applications. The selective-backprojection filtration (S-BPF) algorithm is developed to improve the parallel performance of BPF by selective backprojection. Furthermore, the general-purpose graphics processing unit (GP-GPU) is a popular tool for accelerating the reconstruction. Much work has been performed aiming for the optimization of the cone-beam back-projection. As the cone-beam back-projection process becomes faster, the data transportation holds a much bigger time proportion in the reconstruction than before. This paper focuses on minimizing the total time in the reconstruction with the S-BPF algorithm by hiding the data transportation among hard disk, CPU and GPU. And based on the analysis of the S-BPF algorithm, some strategies are implemented: (1) the asynchronous calls are used to overlap the implemention of CPU and GPU, (2) an innovative strategy is applied to obtain the DBP image to hide the transport time effectively, (3) two streams for data transportation and calculation are synchronized by the cudaEvent in the inverse of finite Hilbert transform on GPU. Our main contribution is a smart reconstruction of the S-BPF algorithm with GPU's continuous calculation and no data transportation time cost. a 5123 volume is reconstructed in less than 0.7 second on a single Tesla-based K20 GPU from 182 views projection with 5122 pixel per projection. The time cost of our implementation is about a half of that without the overlap behavior.

The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia.

PubMed

Crocker, Jonny; Saywell, Darren; Shields, Katherine F; Kolsky, Pete; Bartram, Jamie

2017-12-01

Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34-$81.56 per household targeted in Ghana, and $14.15-$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93-$22.36 per household targeted in Ghana, and $2.35-$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence.

PubMed

Lee, John Tayu; Lawson, Kenny D; Wan, Yizhou; Majeed, Azeem; Morris, Stephen; Soljak, Michael; Millett, Christopher

2017-06-01

The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention. Copyright © 2017. Published by Elsevier Inc.

A Low-Cost Data Acquisition System for Automobile Dynamics Applications

PubMed Central

González, Alejandro; Vinolas, Jordi

2018-01-01

This project addresses the need for the implementation of low-cost acquisition technology in the field of vehicle engineering: the design, development, manufacture, and verification of a low-cost Arduino-based data acquisition platform to be used in <80 Hz data acquisition in vehicle dynamics, using low-cost accelerometers. In addition to this, a comparative study is carried out of professional vibration acquisition technologies and low-cost systems, obtaining optimum results for low- and medium-frequency operations with an error of 2.19% on road tests. It is therefore concluded that these technologies are applicable to the automobile industry, thereby allowing the project costs to be reduced and thus facilitating access to this kind of research that requires limited resources. PMID:29382039

A Low-Cost Data Acquisition System for Automobile Dynamics Applications.

PubMed

González, Alejandro; Olazagoitia, José Luis; Vinolas, Jordi

2018-01-27

This project addresses the need for the implementation of low-cost acquisition technology in the field of vehicle engineering: the design, development, manufacture, and verification of a low-cost Arduino-based data acquisition platform to be used in <80 Hz data acquisition in vehicle dynamics, using low-cost accelerometers. In addition to this, a comparative study is carried out of professional vibration acquisition technologies and low-cost systems, obtaining optimum results for low- and medium-frequency operations with an error of 2.19% on road tests. It is therefore concluded that these technologies are applicable to the automobile industry, thereby allowing the project costs to be reduced and thus facilitating access to this kind of research that requires limited resources.

Implementation of an optical diagnosis strategy saves costs and does not impair clinical outcomes of a fecal immunochemical test-based colorectal cancer screening program.

PubMed

Vleugels, Jasper L A; Greuter, Marjolein J E; Hazewinkel, Yark; Coupé, Veerle M H; Dekker, Evelien

2017-12-01

 In an optical diagnosis strategy, diminutive polyps that are endoscopically characterized with high confidence are removed without histopathological analysis and distal hyperplastic polyps are left in situ. We evaluated the effectiveness and costs of optical diagnosis.  Using the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model, we simulated biennial fecal immunochemical test (FIT) screening in individuals aged 55 - 75 years. In this program, we compared an optical diagnosis strategy with current histopathology assessment of all diminutive polyps. Base-case assumptions included 76 % high-confidence predictions and sensitivities of 88 %, 91 %, and 88 % for endoscopically characterizing adenomas, sessile serrated polyps, and hyperplastic polyps, respectively. Outcomes were colorectal cancer burden, number of colonoscopies, life-years, and costs.  Both the histopathology strategy and the optical diagnosis strategy resulted in 21 life-days gained per simulated individual compared with no screening. For optical diagnosis, €6 per individual was saved compared with the current histopathology strategy. These cost savings were related to a 31 % reduction in colonoscopies in which histopathology was needed for diminutive polyps. Projecting these results onto the Netherlands (17 million inhabitants), assuming a fully implemented FIT-based screening program, resulted in an annual undiscounted cost saving of € 1.7 - 2.2 million for optical diagnosis.  Implementation of optical diagnosis in a FIT-based screening program saves costs without decreasing program effectiveness when compared with current histopathology analysis of all diminutive polyps. Further work is required to evaluate how endoscopists participating in a screening program should be trained, audited, and monitored to achieve adequate competence in optical diagnosis.

Bioresearch module design definition and space shuttle vehicle integration. Volume 3: Management and funding plan

NASA Technical Reports Server (NTRS)

1971-01-01

A description is given of the proposed project organization, documentation and reports, project planning, direction and control, related experience and facilities, and cost estimate data and options for the implementation of the bioresearch module development program.

Environmental Cost Analysis System (ECAS) Status and Compliance Requirements for EM Consolidated Business Center Contracts - 13204

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

Sanford, P.C.; Moe, M.A.; Hombach, W.G.

2013-07-01

The Department of Energy (DOE) Office of Environmental Management (EM) has developed a web-accessible database to collect actual cost data from completed EM projects to support cost estimating and analysis. This Environmental Cost Analysis System (ECAS) database was initially deployed in early 2009 containing the cost and parametric data from 77 decommissioning, restoration, and waste management projects completed under the Rocky Flats Closure Project. In subsequent years we have added many more projects to ECAS and now have a total of 280 projects from 8 major DOE sites. This data is now accessible to DOE users through a web-based reportingmore » tool that allows users to tailor report outputs to meet their specific needs. We are using it as a principal resource supporting the EM Consolidated Business Center (EMCBC) and the EM Applied Cost Engineering (ACE) team cost estimating and analysis efforts across the country. The database has received Government Accountability Office review as supporting its recommended improvements in DOE's cost estimating process, as well as review from the DOE Office of Acquisition and Project Management (APM). Moving forward, the EMCBC has developed a Special Contract Requirement clause or 'H-Clause' to be included in all current and future EMCBC procurements identifying the process that contractors will follow to provide DOE their historical project data in a format compatible with ECAS. Changes to DOE O 413.3B implementation are also in progress to capture historical costs as part of the Critical Decision project closeout process. (authors)« less

75 FR 31383 - Major Capital Investment Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

... identified by the statute, cost effectiveness characterizes the extent to which benefits are in scale with project costs. In its current cost effectiveness measure, FTA includes the direct mobility benefits of the... highway time savings can be included in the mobility benefits that are compared to project costs. FTA has...

A cost-benefit analysis for materials management information systems.

PubMed

Slapak-Iacobelli, L; Wilde, A H

1993-02-01

The cost-benefit analysis provided the system planners with valuable information that served many purposes. It answered the following questions: Why was the CCF undertaking this project? What were the alternatives? How much was it going to cost? And what was the expected outcome? The process of developing cost-benefit the document kept the project team focused. It also motivated them to involve additional individuals from materials management and accounts payable in its development. A byproduct of this involvement was buy-in and commitment to the project by everyone in these areas. Consequently, the project became a team effort championed by many and not just one. We were also able to introduce two new information system processes: 1) a management review process with goals and anticipated results, and 2) a quality assurance process that ensured the CCF had a better product in the end. The cost-benefit analysis provided a planning tool that assisted in successful implementation of an integrated materials management information system.

Silicon material task - Low cost solar array project /JPL/DOE/

NASA Technical Reports Server (NTRS)

Lutwack, R.

1979-01-01

The paper describes the silicon material task of the low-cost solar array project, which has the objective of establishing a silicon production capability equivalent to 500 mW per year at a price less than 10 dollars/kg (1975 dollars) in 1986. The task program is divided into four phases: technical feasibility, scale-up studies (the present phase), experimental process system development units, and implementation of large-scale production plants, and it involves the development of processes for two groups of materials, that is, semiconductor grade and solar cell grade. In addition, the effects of impurities on solar cell performance are being investigated. Attention is given to problem areas of the task program, such as environmental protection, material compatibility between the reacting chemicals and materials of construction of the equipment, and waste disposal.

Telemedicine and the National Information Infrastructure

PubMed Central

Jones, Mary Gardiner

1997-01-01

Abstract Health care is shifting from a focus on hospital-based acute care toward prevention, promotion of wellness, and maintenance of function in community and home-based facilities. Telemedicine can facilitate this shifted focus, but the bulk of the current projects emphasize academic medical center consultations to rural hospitals. Home-based projects encounter barriers of cost and inadequate infrastructure. The 1996 Telecommunications Act as implemented by the Federal Communications commission holds out significant promise to overcome these barriers, although it has serious limitations in its application to health care providers. Health care advocates must work actively on the federal, state, and local public and private sector levels to address these shortcomings and develop cost effective partnerships with other community-based organizations to build network links to facilitate telemedicine-generated services to the home, where the majority of health care decisions are made. PMID:9391928

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

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

Optimising design and cost-effective implementation of future pan-African dietary studies: a review of existing economic integration and nutritional indicators for scenario-based profiling and clustering of countries.

PubMed

Aglago, Elom K; Landais, Edwige; Zotor, Francis; Nicolas, Genevieve; Gunter, Marc J; Amuna, Paul; Slimani, Nadia

2018-02-01

Most of the African countries are undergoing a complex nutrition and epidemiologic transition associated with a rapid increase in the prevalence of diverse non-communicable diseases. Despite this alarming situation, the still limited and fragmented resources available in Africa impede the implementation of effective action plans to tackle the current and projected diet-disease burden. In order to address these common needs and challenges, the African Union is increasingly supporting continental approaches and strategies as reflected in the launching of the Agenda 2063 and the African regional nutrition strategy 2015-2025, among others. To assure the successful implementation of pan-African nutritional and health initiatives, cost-effective approaches considering similarities/disparities in economy, regional integration, development and nutritional aspects between countries are needed. In the absence of pre-existing models, we reviewed regional economic integration and nutritional indicators (n 13) available in international organisations databases or governmental agencies websites, for fifty-two African countries. These indicators were used to map the countries according to common languages (e.g. Arabic, English, French, Portuguese), development status (e.g. human development index), malnutrition status (e.g. obesity) and diet (e.g. staples predominantly based on either cereals or tubers). The review of the indicators showed that there exist similarities between African countries that can be exploited to benefit the continent with cross-national experiences in order to avoid duplication of efforts in the implementation of future pan-African health studies. In addition, including present and future nutrition surveillance programmes in Africa into national statistical systems might be cost-effective and sustainable in the longer term.

Towards low carbon society in Iskandar Malaysia: Implementation and feasibility of community organic waste composting.

PubMed

Bong, Cassendra Phun-Chien; Goh, Rebecca Kar Yee; Lim, Jeng-Shiun; Ho, Wai Shin; Lee, Chew-Tin; Hashim, Haslenda; Abu Mansor, Nur Naha; Ho, Chin Siong; Ramli, Abdul Rahim; Takeshi, Fujiwara

2017-12-01

Rapid population growth and urbanisation have generated large amount of municipal solid waste (MSW) in many cities. Up to 40-60% of Malaysia's MSW is reported to be food waste where such waste is highly putrescible and can cause bad odour and public health issue if its disposal is delayed. In this study, the implementation of community composting in a village within Iskandar Malaysia is presented as a case study to showcase effective MSW management and mitigation of GHG emission. The selected village, Felda Taib Andak (FTA), is located within a palm oil plantation and a crude palm oil processing mill. This project showcases a community-composting prototype to compost food and oil palm wastes into high quality compost. The objective of this article is to highlight the economic and environment impacts of a community-based composting project to the key stakeholders in the community, including residents, oil palm plantation owners and palm oil mill operators by comparing three different scenarios, through a life cycle approach, in terms of the greenhouse gas emission and cost benefit analysis. First scenario is the baseline case, where all the domestic waste is sent to landfill site. In the second scenario, a small-scale centralised composting project was implemented. In the third scenario, the data obtained from Scenario 2 was used to do a projection on the GHG emission and costing analysis for a pilot-scale centralised composting plant. The study showed a reduction potential of 71.64% on GHG emission through the diversion of food waste from landfill, compost utilisation and significant revenue from the compost sale in Scenario 3. This thus provided better insight into the feasibility and desirability in implementing a pilot-scale centralised composting plant for a sub-urban community in Malaysia to achieve a low carbon and self-sustainable society, in terms of environment and economic aspects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Too Late to Vaccinate? The Incremental Benefits and Cost-effectiveness of a Delayed Catch-up Program Using the 4-Valent Human Papillomavirus Vaccine in Norway

PubMed Central

Burger, Emily A.; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S.; Kim, Jane J.

2015-01-01

Background Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway. Methods We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural- and vaccine-induced immunity. Results The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50–$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage. Conclusions HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain. PMID:25057044

Healthy city projects in developing countries: the first evaluation.

PubMed

Harpham, T; Burton, S; Blue, I

2001-06-01

The 'healthy city' concept has only recently been adopted in developing countries. From 1995 to 1999, the World Health Organization (WHO), Geneva, supported healthy city projects (HCPs) in Cox's Bazar (Bangladesh), Dar es Salaam (Tanzania), Fayoum (Egypt), Managua (Nicaragua) and Quetta (Pakistan). The authors evaluated four of these projects, representing the first major evaluation of HCPs in developing countries. Methods used were stakeholder analysis, workshops, document analysis and interviews with 102 managers/implementers and 103 intended beneficiaries. Municipal health plan development (one of the main components of the healthy city strategy) in these cities was limited, which is a similar finding to evaluations of HCPs in Europe. The main activities selected by the projects were awareness raising and environmental improvements, particularly solid waste disposal. Two of the cities effectively used the 'settings' approach of the healthy city concept, whereby places such as markets and schools are targeted. The evaluation found that stakeholder involvement varied in relation to: (i) the level of knowledge of the project; (ii) the project office location; (iii) the project management structure; and (iv) type of activities (ranging from low stakeholder involvement in capital-intensive infrastructure projects, to high in some settings-type activities). There was evidence to suggest that understanding of environment-health links was increased across stakeholders. There was limited political commitment to the healthy city projects, perhaps due to the fact that most of the municipalities had not requested the projects. Consequently, the projects had little influence on written/expressed municipal policies. Some of the projects mobilized considerable resources, and most projects achieved effective intersectoral collaboration. WHO support enabled the project coordinators to network at national and international levels, and the capacity of these individuals (although not necessarily their institutions) was increased by the project. The average annual running cost of the projects was approximately 132,000 US dollars per city, which is close to the costs of the only other HCP for which a cost analysis has been undertaken, Bangkok (115,000 US dollars per year) Recommendations for these and other HCPs are provided.

Feasibility of a community health worker strategy for providing near and appropriate treatment of malaria in southeast Nigeria: an analysis of activities, costs and outcomes.

PubMed

Onwujekwe, Obinna; Uzochukwu, Benjamin; Ojukwu, Juliana; Dike, Nkem; Shu, Elvis

2007-02-01

Community health workers (CHWs) could be used to bring appropriate and timely treatment of malaria closer to home and there is the need to increase the body of knowledge about the feasibility of implementing the strategy. To determine the processes, costs and outcomes of design and implementation of a strategy based on use of CHWs for near and appropriate treatment of malaria. The CHW strategy was implemented in two villages (Adu and Ahani) in Enugu state, southeast Nigeria. Adu and Ahani have a population of approximately 3500 and 5000 residents, respectively. The study was conducted in four phases: (1) baseline survey; (2) design; (3) implementation, supervision and monitoring; and (4) evaluation. Interactive meeting with all the stakeholders were used to fine-tune the design of the CHW strategy. Community members that were selected by the project team with the help of community leaders were trained to become CHWs and their remuneration was through commissions on their drug sales. Community and provider's financial and non-financial costs of the startegy were computed. Non-financial costs were the highest contributor to consumer costs, while financial costs constituted more than 90% of provider costs. The total consumer cost in Ahani was US$2548, while the consumer cost in Adu was US$1585. The total provider cost in Ahani was US$4515, while in Adu it was US$4302. The unit cost cost per villager was US$1.40 in Ahani and US$1.70 in Adu, while the unit financial consumer cost per treated patient was $0.05 in both villages, respectively. The CHWs were acceptable to the people and had an increased market share out of existing malaria treatment provision strategies. The cost of starting up the CHW strategy is low and should be affordable to malaria control programs and communities. The CHW strategy is also economically viable and a potential cost-effective source for providing timely, and appropriate treatment of malaria in rural areas. It should be fine-tuned and added to malaria control armamenterium in Nigeria and other parts of sub-Saharan Africa.

Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation

PubMed Central

Menzies, Nicolas A.; Cohen, Ted; Lin, Hsien-Ho; Murray, Megan; Salomon, Joshua A.

2012-01-01

Background The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert. Methods and Findings We evaluated potential health and economic consequences of implementing Xpert in five southern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%–40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert, by US$460 million (294–699 million) over 10 y. Antiretroviral therapy for HIV represents a substantial fraction of these additional costs, because of improved survival in TB/HIV-infected populations through better TB case-finding and treatment. Costs for treating MDR-TB are also expected to rise significantly with Xpert scale-up. Relative to status quo, Xpert has an estimated cost-effectiveness of US$959 (633–1,485) per disability-adjusted life-year averted over 10 y. Across countries, cost-effectiveness ratios ranged from US$792 (482–1,785) in Swaziland to US$1,257 (767–2,276) in Botswana. Assessing outcomes over a 10-y period focuses on the near-term consequences of Xpert adoption, but the cost-effectiveness results are conservative, with cost-effectiveness ratios assessed over a 20-y time horizon approximately 20% lower than the 10-y values. Conclusions Introduction of Xpert could substantially change TB morbidity and mortality through improved case-finding and treatment, with more limited impact on long-term transmission dynamics. Despite extant uncertainty about TB natural history and intervention impact in southern Africa, adoption of Xpert evidently offers reasonable value for its cost, based on conventional benchmarks for cost-effectiveness. However, the additional financial burden would be substantial, including significant increases in costs for treating HIV and MDR-TB. Given the fundamental influence of HIV on TB dynamics and intervention costs, care should be taken when interpreting the results of this analysis outside of settings with high HIV prevalence. Please see later in the article for the Editors' Summary PMID:23185139

DIRECT operational field test evaluation natural use study. Part 4, Recommendations for expanded deployment

DOT National Transportation Integrated Search

1998-08-01

The DIRECT project compared four low-cost driver information systems. Of the four that were : compared, the RDS approach proved superior to the others in toggling reliability and voice quality. The DIRECT project planned to expand the implementation ...

A systems approach to computer-based training

NASA Technical Reports Server (NTRS)

Drape, Gaylen W.

1994-01-01

This paper describes the hardware and software systems approach used in the Automated Recertification Training System (ARTS), a Phase 2 Small Business Innovation Research (SBIR) project for NASA Kennedy Space Center (KSC). The goal of this project is to optimize recertification training of technicians who process the Space Shuttle before launch by providing computer-based training courseware. The objectives of ARTS are to implement more effective CBT applications identified through a need assessment process and to provide an ehanced courseware production system. The system's capabilities are demonstrated by using five different pilot applications to convert existing classroom courses into interactive courseware. When the system is fully implemented at NASA/KSC, trainee job performance will improve and the cost of courseware development will be lower. Commercialization of the technology developed as part of this SBIR project is planned for Phase 3. Anticipated spin-off products include custom courseware for technical skills training and courseware production software for use by corporate training organizations of aerospace and other industrial companies.

A residency clinic chronic condition management quality improvement project.

PubMed

Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon

2007-02-01

Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

A Report On Eight Early-Stage State And Regional Projects Testing Value-Based Payment

PubMed Central

Conrad, Douglas; Grembowski, David; Gibbons, Claire; Marcus-Smith, Miriam; Hernandez, Susan E.; Chang, Judy; Renz, Anne; Lau, Bernard; Cruz, Erin dela

2014-01-01

To help contain health care spending and improve the quality of care, practitioners and policy makers are trying to move away from fee-for-service toward value-based payment, which links providers’ reimbursement to the value, rather than the volume, of services delivered. With funding from the Robert Wood Johnson Foundation, eight grantees across the country are designing and implementing value-based payment reform projects. For example, in Salem, Oregon, the Physicians Choice Foundation is testing “Program Oriented Payments,” which include incentives for providers who follow a condition-specific program of care designed to meet goals set jointly by patient and provider. In this article we describe the funding rationale and the specific objectives, strategies, progress, and early stages of implementation of the eight projects. We also share some early lessons and identify prerequisites for success, such as ensuring that providers have broad and timely access to data so they can meet patients’ needs in cost-effective ways. PMID:23650332

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

PubMed

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

2009-10-09

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

Projected quasiparticle theory for molecular electronic structure

NASA Astrophysics Data System (ADS)

Scuseria, Gustavo E.; Jiménez-Hoyos, Carlos A.; Henderson, Thomas M.; Samanta, Kousik; Ellis, Jason K.

2011-09-01

We derive and implement symmetry-projected Hartree-Fock-Bogoliubov (HFB) equations and apply them to the molecular electronic structure problem. All symmetries (particle number, spin, spatial, and complex conjugation) are deliberately broken and restored in a self-consistent variation-after-projection approach. We show that the resulting method yields a comprehensive black-box treatment of static correlations with effective one-electron (mean-field) computational cost. The ensuing wave function is of multireference character and permeates the entire Hilbert space of the problem. The energy expression is different from regular HFB theory but remains a functional of an independent quasiparticle density matrix. All reduced density matrices are expressible as an integration of transition density matrices over a gauge grid. We present several proof-of-principle examples demonstrating the compelling power of projected quasiparticle theory for quantum chemistry.

Education & Collection Facility GSHP Demonstration Project

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

Joplin, Jeff

The Denver Museum of Nature & Science (DMNS) designed and implemented an innovative ground source heat pump (GSHP) system for heating and cooling its new Education and Collection Facility (ECF) building addition. The project goal was to successfully design and install an open-loop GSHP system that utilized water circulating within an underground municipal recycled (non-potable) water system as the heat sink/source as a demonstration project. The expected results were to significantly reduce traditional GSHP installation costs while increasing system efficiency, reduce building energy consumption, require significantly less area and capital to install, and be economically implemented wherever access to amore » recycled water system is available. The project added to the understanding of GSHP technology by implementing the first GSHP system in the United States utilizing a municipal recycled water system as a heat sink/source. The use of this fluid through a GSHP system has not been previously documented. This use application presents a new opportunity for local municipalities to develop and expand the use of underground municipal recycled (non-potable) water systems. The installation costs for this type of technology in the building structure would be a cost savings over traditional GSHP costs, provided the local municipal infrastructure was developed. Additionally, the GSHP system functions as a viable method of heat sink/source as the thermal characteristics of the fluid are generally consistent throughout the year and are efficiently exchanged through the GSHP system and its components. The use of the recycled water system reduces the area required for bore or loop fields; therefore, presenting an application for building structures that have little to no available land use or access. This GSHP application demonstrates the viability of underground municipal recycled (non-potable) water systems as technically achievable, environmentally supportive, and an efficient system.« less

The cost of routine Aedes aegypti control and of insecticide-treated curtain implementation.

PubMed

Baly, Alberto; Flessa, Steffen; Cote, Marilys; Thiramanus, Thirapong; Vanlerberghe, Veerle; Villegas, Elci; Jirarojwatana, Somchai; Van der Stuyft, Patrick

2011-05-01

Insecticide-treated curtains (ITCs) are promoted for controlling the Dengue vector Aedes aegypti. We assessed the cost of the routine Aedes control program (RACP) and the cost of ITC implementation through the RACP and health committees in Venezuela and through health volunteers in Thailand. The yearly cost of the RACP per household amounted to US$2.14 and $1.89, respectively. The ITC implementation cost over three times more, depending on the channel used. In Venezuela the RACP was the most efficient implementation-channel. It spent US$1.90 (95% confidence interval [CI]: 1.83; 1.97) per curtain distributed, of which 76.9% for the curtain itself. Implementation by health committees cost significantly (P = 0.02) more: US$2.32 (95% CI: 1.93; 2.61) of which 63% for the curtain. For ITC implementation to be at least as cost-effective as the RACP, at equal effectiveness and actual ITC prices, the attained curtain coverage and the adulticiding effect should last for 3 years.

The Cost of Routine Aedes aegypti Control and of Insecticide-Treated Curtain Implementation

PubMed Central

Baly, Alberto; Flessa, Steffen; Cote, Marilys; Thiramanus, Thirapong; Vanlerberghe, Veerle; Villegas, Elci; Jirarojwatana, Somchai; Van der Stuyft, Patrick

2011-01-01

Insecticide-treated curtains (ITCs) are promoted for controlling the Dengue vector Aedes aegypti. We assessed the cost of the routine Aedes control program (RACP) and the cost of ITC implementation through the RACP and health committees in Venezuela and through health volunteers in Thailand. The yearly cost of the RACP per household amounted to US$2.14 and $1.89, respectively. The ITC implementation cost over three times more, depending on the channel used. In Venezuela the RACP was the most efficient implementation-channel. It spent US$1.90 (95% confidence interval [CI]: 1.83; 1.97) per curtain distributed, of which 76.9% for the curtain itself. Implementation by health committees cost significantly (P = 0.02) more: US$2.32 (95% CI: 1.93; 2.61) of which 63% for the curtain. For ITC implementation to be at least as cost-effective as the RACP, at equal effectiveness and actual ITC prices, the attained curtain coverage and the adulticiding effect should last for 3 years. PMID:21540384

Development of the Galaxy Chronic Obstructive Pulmonary Disease (COPD) Model Using Data from ECLIPSE: Internal Validation of a Linked-Equations Cohort Model.

PubMed

Briggs, Andrew H; Baker, Timothy; Risebrough, Nancy A; Chambers, Mike; Gonzalez-McQuire, Sebastian; Ismaila, Afisi S; Exuzides, Alex; Colby, Chris; Tabberer, Maggie; Muellerova, Hana; Locantore, Nicholas; Rutten van Mölken, Maureen P M H; Lomas, David A

2017-05-01

The recent joint International Society for Pharmacoeconomics and Outcomes Research / Society for Medical Decision Making Modeling Good Research Practices Task Force emphasized the importance of conceptualizing and validating models. We report a new model of chronic obstructive pulmonary disease (COPD) (part of the Galaxy project) founded on a conceptual model, implemented using a novel linked-equation approach, and internally validated. An expert panel developed a conceptual model including causal relationships between disease attributes, progression, and final outcomes. Risk equations describing these relationships were estimated using data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study, with costs estimated from the TOwards a Revolution in COPD Health (TORCH) study. Implementation as a linked-equation model enabled direct estimation of health service costs and quality-adjusted life years (QALYs) for COPD patients over their lifetimes. Internal validation compared 3 years of predicted cohort experience with ECLIPSE results. At 3 years, the Galaxy COPD model predictions of annual exacerbation rate and annual decline in forced expiratory volume in 1 second fell within the ECLIPSE data confidence limits, although 3-year overall survival was outside the observed confidence limits. Projections of the risk equations over time permitted extrapolation to patient lifetimes. Averaging the predicted cost/QALY outcomes for the different patients within the ECLIPSE cohort gives an estimated lifetime cost of £25,214 (undiscounted)/£20,318 (discounted) and lifetime QALYs of 6.45 (undiscounted/5.24 [discounted]) per ECLIPSE patient. A new form of model for COPD was conceptualized, implemented, and internally validated, based on a series of linked equations using epidemiological data (ECLIPSE) and cost data (TORCH). This Galaxy model predicts COPD outcomes from treatment effects on disease attributes such as lung function, exacerbations, symptoms, or exercise capacity; further external validation is required.

Light Water Reactor Sustainability Program: Digital Technology Business Case Methodology Guide

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

Thomas, Ken; Lawrie, Sean; Hart, Adam

The Department of Energy’s (DOE’s) Light Water Reactor Sustainability Program aims to develop and deploy technologies that will make the existing U.S. nuclear fleet more efficient and competitive. The program has developed a standard methodology for determining the impact of new technologies in order to assist nuclear power plant (NPP) operators in building sound business cases. The Advanced Instrumentation, Information, and Control (II&C) Systems Technologies Pathway is part of the DOE’s Light Water Reactor Sustainability (LWRS) Program. It conducts targeted research and development (R&D) to address aging and reliability concerns with the legacy instrumentation and control and related information systemsmore » of the U.S. operating light water reactor (LWR) fleet. This work involves two major goals: (1) to ensure that legacy analog II&C systems are not life-limiting issues for the LWR fleet and (2) to implement digital II&C technology in a manner that enables broad innovation and business improvement in the NPP operating model. Resolving long-term operational concerns with the II&C systems contributes to the long-term sustainability of the LWR fleet, which is vital to the nation’s energy and environmental security. The II&C Pathway is conducting a series of pilot projects that enable the development and deployment of new II&C technologies in existing nuclear plants. Through the LWRS program, individual utilities and plants are able to participate in these projects or otherwise leverage the results of projects conducted at demonstration plants. Performance advantages of the new pilot project technologies are widely acknowledged, but it has proven difficult for utilities to derive business cases for justifying investment in these new capabilities. Lack of a business case is often cited by utilities as a barrier to pursuing wide-scale application of digital technologies to nuclear plant work activities. The decision to move forward with funding usually hinges on demonstrating actual cost reductions that can be credited to budgets and thereby truly reduce O&M or capital costs. Technology enhancements, while enhancing work methods and making work more efficient, often fail to eliminate workload such that it changes overall staffing and material cost requirements. It is critical to demonstrate cost reductions or impacts on non-cost performance objectives in order for the business case to justify investment by nuclear operators. The Business Case Methodology (BCM) addresses the “benefit” side of the analysis—as opposed to the cost side—and how the organization evaluates discretionary projects (net present value (NPV), accounting effects of taxes, discount rates, etc.). The cost and analysis side is not particularly difficult for the organization and can usually be determined with a fair amount of precision (not withstanding implementation project cost overruns). It is in determining the "benefits" side of the analysis that utilities have more difficulty in technology projects and that is the focus of this methodology.« less

The seven habits of highly effective project managers

NASA Astrophysics Data System (ADS)

Warner, Mark; Summers, Richard

2016-08-01

Why do some astronomy projects succeed, while others fail? There are obviously many different factors that can and do influence the outcome of any given project, but one of the most prevalent characteristics among successful projects is the combined skills and qualifications of the project manager (PM) at their helms. But this begs an obvious question: what exactly makes a project manager "skilled and qualified?" Asked another way, are there common traits, philosophies, and/or techniques that the most successful PMs share, and if so, what are they? The short answer is yes, the majority successful engineering project managers have significant skills, habits, and character traits in common. The longer answer is there are at least seven of these key traits, or "habits" that many successful PMs share and, more importantly, implement within their respective projects. This paper presents these key factors, including thoughts on scope and quality management, cost and schedule control, project team structures, risk management strategies, stakeholder management, and general project execution.

Health insurance for all long-term care workers: estimated costs and coverage impacts in Minnesota and recommendations for States.

PubMed

Wright, Bernadette; Gruman, Cindy; Alecxih, Lisa; Knatterud, Larhae

2012-01-01

A major barrier to building a strong workforce to meet the growing need for long-care is lack of affordable health benefits. This study projects impacts of funding health coverage for all long-term care workers in Minnesota. Under the most cost effective model plan design, enrollment in employer-sponsored coverage would increase 73% to 100% for individual coverage and 26% to 42% for family coverage. Total monthly costs would be $698/worker in the commercial market or $634/worker through a new dedicated risk pool. Based on our findings and past research, the authors present recommendations for structuring and implementing a long-term care worker health insurance initiative.

NASA Work Breakdown Structure (WBS) Handbook

NASA Technical Reports Server (NTRS)

Fleming, Jon F.; Poole, Kenneth W.

2016-01-01

The purpose of this document is to provide program/project teams necessary instruction and guidance in the best practices for Work Breakdown Structure (WBS) and WBS dictionary development and use for project implementation and management control. This handbook can be used for all types of NASA projects and work activities including research, development, construction, test and evaluation, and operations. The products of these work efforts may be hardware, software, data, or service elements (alone or in combination). The aim of this document is to assist project teams in the development of effective work breakdown structures that provide a framework of common reference for all project elements. The WBS and WBS dictionary are effective management processes for planning, organizing, and administering NASA programs and projects. The guidance contained in this document is applicable to both in-house, NASA-led effort and contracted effort. It assists management teams from both entities in fulfilling necessary responsibilities for successful accomplishment of project cost, schedule, and technical goals. Benefits resulting from the use of an effective WBS include, but are not limited to: providing a basis for assigned project responsibilities, providing a basis for project schedule and budget development, simplifying a project by dividing the total work scope into manageable units, and providing a common reference for all project communication.

Work Breakdown Structure (WBS) Handbook

NASA Technical Reports Server (NTRS)

2010-01-01

The purpose of this document is to provide program/project teams necessary instruction and guidance in the best practices for Work Breakdown Structure (WBS) and WBS dictionary development and use for project implementation and management control. This handbook can be used for all types of NASA projects and work activities including research, development, construction, test and evaluation, and operations. The products of these work efforts may be hardware, software, data, or service elements (alone or in combination). The aim of this document is to assist project teams in the development of effective work breakdown structures that provide a framework of common reference for all project elements. The WBS and WBS dictionary are effective management processes for planning, organizing, and administering NASA programs and projects. The guidance contained in this document is applicable to both in-house, NASA-led effort and contracted effort. It assists management teams from both entities in fulfilling necessary responsibilities for successful accomplishment of project cost, schedule, and technical goals. Benefits resulting from the use of an effective WBS include, but are not limited to: providing a basis for assigned project responsibilities, providing a basis for project schedule development, simplifying a project by dividing the total work scope into manageable units, and providing a common reference for all project communication.

Planning and cost analysis of digital radiography services for a network of hospitals (the Veterans Integrated Service Network).

PubMed

Duerinckx, A J; Kenagy, J J; Grant, E G

1998-01-01

This study analysed the design and cost of a picture archiving and communications system (PACS), computerized radiography (CR) and a wide-area network for teleradiology. The Desert Pacific Healthcare Network comprises 10 facilities, including four tertiary medical centres and one small hospital. Data were collected on radiologists' workloads, and patient and image flow within and between these medical centres. These were used to estimate the size and cash flows associated with a system-wide implementation of PACS, CR and teleradiology services. A cost analysis model was used to estimate the potential cost savings in a filmless radiology environment. ATM technology was selected as the communications medium between the medical centres. A strategic plan and business plan were successfully developed. The cost model predicted the cost-effectiveness of the proposed PACS/CR configuration within four to six years, if the base costs were kept low. The experience gained in design and cost analysis of a PACS/teleradiology network will serve as a model for similar projects.

Lessons Learned from Implementation of Information and Communication Technologies in Spain's Healthcare Services

PubMed Central

Carnicero, J.; Rojas, D.

2010-01-01

Background Spain’s health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population's needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type. Objective To better understand the success criteria, the difficulties encountered and certain issues that must be kept in mind to ensure successful implementation of ICT projects in health organizations, based on Spain's experiences in this field. Methods The projects' results are analyzed using the criteria of compliance with the expected scope, cost and time frame. Results The results can be considered satisfactory in primary care facilities, where almost 90% of Spain's general practitioners, pediatricians and primary care nurses are using electronic health record (EHR) systems. In hospitals EHR implementation is more uneven. Over 40% of Spanish primary care centers and 42% of pharmacies are using electronic prescription (the information system that connects the physician to the dispensing pharmacy and the dispensing pharmacy to the payer). Discussion All of Spain’s health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR. PMID:23616846

River enhancement in the Upper Mississippi River basin: Approaches based on river uses, alterations, and management agencies

USGS Publications Warehouse

O'Donnell, T. K.; Galat, D.L.

2007-01-01

The Upper Mississippi River is characterized by a series of locks and dams, shallow impoundments, and thousands of river channelization structures that facilitate commercial navigation between Minneapolis, Minnesota, and Cairo, Illinois. Agriculture and urban development over the past 200 years have degraded water quality and increased the rate of sediment and nutrient delivery to surface waters. River enhancement has become an important management tool employed to address causes and effects of surface water degradation and river modification in the Upper Mississippi River Basin. We report information on individual river enhancement projects and contrast project densities, goals, activities, monitoring, and cost between commercially non-navigated and navigated rivers (Non-navigated and Navigated Rivers, respectively). The total number of river enhancement projects collected during this effort was 62,108. Cost of all projects reporting spending between 1972 and 2006 was about US$1.6 billion. Water quality management was the most cited project goal within the basin. Other important goals in Navigated Rivers included in-stream habitat improvement and flow modification. Most projects collected for Non-navigated Rivers and their watersheds originated from the U.S. Department of Agriculture (USDA). The U.S. Army Corps of Engineers and the USDA were important sources for projects in Navigated Rivers. Collaborative efforts between agencies that implement projects in Non-navigated and Navigated Rivers may be needed to more effectively address river impairment. However, the current state of data sources tracking river enhancement projects deters efficient and broad-scale integration. ?? Journal compilation ?? 2007 Society for Ecological Restoration International.

Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

PubMed Central

Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

2015-01-01

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

Promising New Teacher Support Strategies and Their Costs.

ERIC Educational Resources Information Center

Dianda, Marcella R.; Quartz, Karen Hunter

1995-01-01

Describes several promising new teacher support strategies implemented by California universities and their district partners as part of the California New Teacher Project, noting resources expended to implement each strategy. The strategies are framed according to their programmatic and economic dimensions. Strategies that make the most sense…

Adaptive cover crop implementation and evaluation in the Chesapeake Bay watersheds

USDA-ARS?s Scientific Manuscript database

Four years of applied research, led by the USDA-ARS Choptank River Conservation Reserve Assessment Project (CEAP), have demonstrated that satellite remote sensing, used in combination with cost-share program farm implementation records, can provide a powerful tool for evaluating the nutrient conserv...

Geochemical Monitoring Considerations for the FutureGen 2.0 Project

DOE PAGES

Amonette, James E.; Johnson, Timothy A.; Spencer, Clayton F.; ...

2014-12-31

Geochemical monitoring is an essential component of a suite of monitoring technologies designed to evaluate CO2 mass balance and detect possible loss of containment at the FutureGen 2.0 geologic sequestration site near Jacksonville, IL. This presentation gives an overview of the potential geochemical approaches and tracer technologies that were considered, and describes the evaluation process by which the most cost-effective and robust of these were selected for implementation

Comparison of high-speed rail and maglev system costs

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

Rote, D.M.

1998-07-01

This paper compares the two modes of transportation, and notes important similarities and differences in the technologies and in how they can be implemented to their best advantage. Problems with making fair comparisons of the costs and benefits are discussed and cost breakdowns based on data reported in the literature are presented and discussed in detail. Cost data from proposed and actual construction projects around the world are summarized and discussed. Results from the National Maglev Initiative and the recently-published Commercial Feasibility Study are included in the discussion. Finally, estimates will be given of the expected cost differences between HSRmore » and maglev systems implemented under simple and complex terrain conditions. The extent to which the added benefits of maglev technology offset the added costs is examined.« less

Economic analysis of transmission line engineering based on industrial engineering

NASA Astrophysics Data System (ADS)

Li, Yixuan

2017-05-01

The modern industrial engineering is applied to the technical analysis and cost analysis of power transmission and transformation engineering. It can effectively reduce the cost of investment. First, the power transmission project is economically analyzed. Based on the feasibility study of power transmission and transformation project investment, the proposal on the company system cost management is put forward through the economic analysis of the effect of the system. The cost management system is optimized. Then, through the cost analysis of power transmission and transformation project, the new situation caused by the cost of construction is found. It is of guiding significance to further improve the cost management of power transmission and transformation project. Finally, according to the present situation of current power transmission project cost management, concrete measures to reduce the cost of power transmission project are given from the two aspects of system optimization and technology optimization.

40 CFR 35.2205 - Maximum allowable project cost.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Maximum allowable project cost. 35.2205... project cost. (a) Grants awarded on or after the effective date of this regulation. Except as provided in... regulation, the maximum allowable project cost will be the sum of: (1) The allowable cost of the following...

40 CFR 35.2205 - Maximum allowable project cost.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Maximum allowable project cost. 35.2205... project cost. (a) Grants awarded on or after the effective date of this regulation. Except as provided in... regulation, the maximum allowable project cost will be the sum of: (1) The allowable cost of the following...

40 CFR 35.2205 - Maximum allowable project cost.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Maximum allowable project cost. 35.2205... project cost. (a) Grants awarded on or after the effective date of this regulation. Except as provided in... regulation, the maximum allowable project cost will be the sum of: (1) The allowable cost of the following...

40 CFR 35.2205 - Maximum allowable project cost.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Maximum allowable project cost. 35.2205... project cost. (a) Grants awarded on or after the effective date of this regulation. Except as provided in... regulation, the maximum allowable project cost will be the sum of: (1) The allowable cost of the following...

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

PubMed

Doran, Christopher M; Ling, Rod; Byrnes, Joshua; Crane, Melanie; Shakeshaft, Anthony P; Searles, Andrew; Perez, Donna

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006-2013. This analysis uses Australian dollars (AUD) and 2010-11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006-2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006-2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.

Using Pilots to Assess the Value and Approach of CMMI Implementation

NASA Technical Reports Server (NTRS)

Godfrey, Sara; Andary, James; Rosenberg, Linda

2002-01-01

At Goddard Space Flight Center (GSFC), we have chosen to use Capability Maturity Model Integrated (CMMI) to guide our process improvement program. Projects at GSFC consist of complex systems of software and hardware that control satellites, operate ground systems, run instruments, manage databases and data and support scientific research. It is a challenge to launch a process improvement program that encompasses our diverse systems, yet is manageable in terms of cost effectiveness. In order to establish the best approach for improvement, our process improvement effort was divided into three phases: 1) Pilot projects; 2) Staged implementation; and 3) Sustainment and continual improvement. During Phase 1 the focus of the activities was on a baselining process, using pre-appraisals in order to get a baseline for making a better cost and effort estimate for the improvement effort. Pilot pre-appraisals were conducted from different perspectives so different approaches for process implementation could be evaluated. Phase 1 also concentrated on establishing an improvement infrastructure and training of the improvement teams. At the time of this paper, three pilot appraisals have been completed. Our initial appraisal was performed in a flight software area, considering the flight software organization as the organization. The second appraisal was done from a project perspective, focusing on systems engineering and acquisition, and using the organization as GSFC. The final appraisal was in a ground support software area, again using GSFC as the organization. This paper will present our initial approach, lessons learned from all three pilots and the changes in our approach based on the lessons learned.

A Cost and Performance System (CAPS) in a Federal agency

NASA Technical Reports Server (NTRS)

Huseonia, W. F.; Penton, P. G.

1994-01-01

Cost and Performance System (CAPS) is an automated system used from the planning phase through implementation to analysis and documentation. Data is retrievable or available for analysis of cost versus performance anomalies. CAPS provides a uniform system across intra- and international elements. A common system is recommended throughout an entire cost or profit center. Data can be easily accumulated and aggregated into higher levels of tracking and reporting of cost and performance.The level and quality of performance or productivity is indicated in the CAPS model and its process. The CAPS model provides the necessary decision information and insight to the principal investigator/project engineer for a successful project management experience. CAPS provides all levels of management with the appropriate detailed level of data.

SOCIO-ECONOMIC IMPACT EVALUATION OF LAKE IMPROVEMENT PROJECTS AND LAKE MANAGEMENT GUIDELINES

EPA Science Inventory

Under Public Law 92-500, the U.S. Environmental Protection Agency embarked on a major program of cost sharing grants to implement lake rehabilitation and protection projects. Improvement of water quality impacts the lives of people and organizations; however, the methods used to ...

44 CFR 209.10 - Project implementation requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... to match elevation or acquisition and relocation projects. Increased Cost of Compliance claims can... new structure(s) will be built on the property except as indicated in this paragraph: (A) A public... of FEMA approves in writing before the construction of the structure begins. (D) In general...

44 CFR 209.10 - Project implementation requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to match elevation or acquisition and relocation projects. Increased Cost of Compliance claims can... new structure(s) will be built on the property except as indicated in this paragraph: (A) A public... of FEMA approves in writing before the construction of the structure begins. (D) In general...

44 CFR 209.10 - Project implementation requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... to match elevation or acquisition and relocation projects. Increased Cost of Compliance claims can... new structure(s) will be built on the property except as indicated in this paragraph: (A) A public... of FEMA approves in writing before the construction of the structure begins. (D) In general...

44 CFR 209.10 - Project implementation requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... to match elevation or acquisition and relocation projects. Increased Cost of Compliance claims can... new structure(s) will be built on the property except as indicated in this paragraph: (A) A public... of FEMA approves in writing before the construction of the structure begins. (D) In general...

44 CFR 209.10 - Project implementation requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... to match elevation or acquisition and relocation projects. Increased Cost of Compliance claims can... new structure(s) will be built on the property except as indicated in this paragraph: (A) A public... of FEMA approves in writing before the construction of the structure begins. (D) In general...

Costs and cost-efficiency of a mobile cash transfer to prevent child undernutrition during the lean season in Burkina Faso: a mixed methods analysis from the MAM'Out randomized controlled trial.

PubMed

Puett, Chloe; Salpéteur, Cécile; Houngbe, Freddy; Martínez, Karen; N'Diaye, Dieynaba S; Tonguet-Papucci, Audrey

2018-01-01

This study assessed the costs and cost-efficiency of a mobile cash transfer implemented in Tapoa Province, Burkina Faso in the MAM'Out randomized controlled trial from June 2013 to December 2014, using mixed methods and taking a societal perspective by including costs to implementing partners and beneficiary households. Data were collected via interviews with implementing staff from the humanitarian agency and the private partner delivering the mobile money, focus group discussions with beneficiaries, and review of accounting databases. Costs were analyzed by input category and activity-based cost centers. cost-efficiency was analyzed by cost-transfer ratios (CTR) and cost per beneficiary. Qualitative analysis was conducted to identify themes related to implementing electronic cash transfers, and barriers to efficient implementation. The CTR was 0.82 from a societal perspective, within the same range as other humanitarian transfer programs; however the intervention did not achieve the same degree of cost-efficiency as other mobile transfer programs specifically. Challenges in coordination between humanitarian and private partners resulted in long wait times for beneficiaries, particularly in the first year of implementation. Sensitivity analyses indicated a potential 6% reduction in CTR through reducing beneficiary wait time by one-half. Actors reported that coordination challenges improved during the project, therefore inefficiencies likely would be resolved, and cost-efficiency improved, as the program passed the pilot phase. Despite the time required to establish trusting relationships among actors, and to set up a network of cash points in remote areas, this analysis showed that mobile transfers hold promise as a cost-efficient method of delivering cash in this setting. Implementation by local government would likely reduce costs greatly compared to those found in this study context, and improve cost-efficiency especially by subsidizing expansion of mobile money network coverage and increasing cash distribution points in remote areas which are unprofitable for private partners.

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies.

PubMed

Tilley, Colin; McIntosh, Emma; Bahrami, Maryam; Clarkson, Jan; Deery, Chris; Pitts, Nigel

2005-07-01

To compare the cost-effectiveness of four third molar guideline implementation strategies. Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline. The effectiveness of the guideline depended crucially upon the type of patient treated. In particular, for a minority of patients (14%) with no clinical signals of their 'type', the implementation strategies generate potentially large gains in evidence-based practice. However, the cost per patient of achieving these gains is large given that the costs are incurred for all patients, but benefits accrue only to a minority. The results show that the type of patient presenting for treatment can influence the effectiveness, cost-effectiveness and therefore policy conclusions. Consequently, the design and analysis of studies need to be sufficiently sensitive to detect subtle interaction effects. This may explain the dearth of guideline implementation trials with significant findings. The results also suggest that a more cost-effective implementation method in primary care dentistry may be to subsidize treatment conditional upon patient type.

Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model.

PubMed

Gomez, Jorge Alberto; Lepetic, Alejandro; Demarteau, Nadia

2014-11-26

In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination. The present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile. Projected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively. The findings indicate that the addition of any HPV vaccine to the current cervical screening program of Chile will be advantageous. However, this cost-effectiveness model shows that the HPV-16/18 AS04-adjuvanted vaccine dominated the HPV-6/11/16/18 vaccine. Beyond the context of Chile, the data from this modelling exercise may support healthcare policy and decision-making pertaining to introduction of HPV vaccination in similar resource settings in the region.

Implementing healthcare excellence: the vital role of the CEO in evidence-based design.

PubMed

Zimring, Craig; Augenbroe, Godfried L; Malone, Eileen B; Sadler, Blair L

2008-01-01

This paper explores the role of the chief executive officer (CEO) in evidence-based design (EBD), discussing the internal and external challenges that a CEO faces, such as demands for increased quality, safety, patient-and-family-centeredness, increased revenue, and reduced cost. Based on a series of interviews and case studies and the experience of the authors as researchers, consultants, and CEOs, this paper provides a model for EBD and recommends actions that a CEO can undertake to create an effective project over the life cycle of a building. TOPICAL HEADINGS: Evidence-Based Design: A Performance-Based Approach to Achieving Key Goals; Key Approaches to Executing Evidence-Based Design; Overcoming Barriers to Innovation: The CEO's Vital Role in Implementing Evidence-Based Design The CEO bears special responsibility for successful facility project implementation. Only the CEO possesses the responsibility and authority to articulate the strategy, vision, goals, and resource constraints that frame every project. With the support of their boards, CEOs set the stage for the transformation of an organization's culture and fuel clinical and business process reengineering by encouraging and, if necessary, forcing collaboration between the strong disciplinary and departmental divisions found in healthcare systems.

Effectiveness and Cost-Effectiveness of Blood Pressure Screening in Adolescents in the United States

PubMed Central

Wang, Y. Claire; Cheung, Angela M.; Bibbins-Domingo, Kirsten; Prosser, Lisa A.; Cook, Nancy R.; Goldman, Lee; Gillman, Matthew W.

2014-01-01

Objective To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, “screen-and-treat,” and population-wide strategies to lower the entire BP distribution. Study design We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999–2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). Results Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18 000/QALY [boys] and $47 000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/ QALY [girls]) and increasing physical education ($11 000/QALY [boys] and $35 000/QALY [girls]). Conclusions Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel. PMID:20850759

CHARACTERIZING COSTS, SAVINGS AND BENEFITS OF A SELECTION OF ENERGY EFFICIENT EMERGING TECHNOLOGIES IN THE UNITED STATES

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

Xu, T.; Slaa, J.W.; Sathaye, J.

2010-12-15

Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing CO2 emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing themore » costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world. Successful implementation of emerging technologies not only can help advance productivities and competitiveness but also can play a significant role in mitigation efforts by saving energy. Providing evaluation and estimation of the costs and energy savings potential of emerging technologies is the focus of our work in this project. The overall goal of the project is to identify and select emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. This report contains the results from performing Task 2"Technology evaluation" for the project titled"Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies," which was sponsored by California Energy Commission and managed by CIEE. The project purpose is to analyze market status, market potential, and economic viability of selected technologies applicable to the U.S. In this report, LBNL first performed re-assessments of all of the 33 emerging energy-efficient industrial technologies, including re-evaluation of the 26 technologies that were previously identified by Martin et al. (2000) and their potential significance to energy use in the industries, and new evaluation of additional seven technologies. The re-assessments were essentially updated with recent information that we searched and collected from literature to the extent possible. The progress of selected technologies as they diffused into the marketplace from 2000 to 2010 was then discussed in this report. The report also includes updated detailed characterizations of 15 technologies studied in 2000, with comparisons noted.« less

Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature.

PubMed

Wu, C-H; Kao, I-J; Hung, W-C; Lin, S-C; Liu, H-C; Hsieh, M-H; Bagga, S; Achra, M; Cheng, T-T; Yang, R-S

2018-06-01

Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023-$28,800 US dollars (USD) in Japan to $14,513-$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards.

A cost-effectiveness analysis of three components of a syndromic surveillance system for the early warning of epidemics in rural China.

PubMed

Ding, Yan; Sauerborn, Rainer; Xu, Biao; Shaofa, Nie; Yan, Weirong; Diwan, Vinod K; Dong, Hengjin

2015-11-14

Syndromic surveillance systems (SSSs) collect non-specific syndromes in early stages of disease outbreaks. This makes an SSS a promising tool for the early detection of epidemics. An Integrated Surveillance System in rural China (ISSC project), which added an SSS to the existing Chinese surveillance system for the early warning of epidemics, was implemented from April 2012 to March 2014 in Jiangxi and Hubei Provinces. This study aims to measure the costs and effectiveness of the three components of the SSS in the ISSC project. The central measures of the cost-effectiveness analysis of the three components of the syndromic surveillance system were: 1) the costs per reported event, respectively, at the health facilities, the primary schools and the pharmacies; and 2) the operating costs per surveillance unit per year, respectively, at the health facilities, the primary schools and the pharmacies. Effectiveness was expressed by reporting outputs which were numbers of reported events, numbers of raw signals, and numbers of verified signals. The reported events were tracked through an internal data base. Signal verification forms and epidemiological investigation reports were collected from local country centers for disease control and prevention. We adopted project managers' perspective for the cost analysis. Total costs included set-up costs (system development and training) and operating costs (data collection, quality control and signal verification). We used self-designed questionnaires to collect cost data and received, respectively, 369 and 477 facility and staff questionnaires through a cross-sectional survey with a purposive sampling following the ISSC project. All data were entered into Epidata 3.02 and exported to Stata for descriptive analysis. The number of daily reported events per unit was the highest at pharmacies, followed by health facilities and finally primary schools. Variances existed within the three groups and also between Jiangxi and Hubei. During a 15-month surveillance period, the number of raw signals for early warning in Jiangxi province (n = 36) was nine times of that in Hubei. Health facilities and primary schools had equal numbers of raw signals (n = 19), which was 9.5 times of that from pharmacies. Five signals were confirmed as outbreaks, of which two were influenza, two were chicken pox and one was mumps. The cost per reported event was the highest at primary schools, followed by health facilities and then pharmacies. The annual operating cost per surveillance unit was the highest at pharmacies, followed by health facilities and finally primary schools. Both the cost per reported event and the annual operating cost per surveillance unit in Jiangxi in each of the three groups were higher than their counterparts in Hubei. Health facilities and primary schools are better sources of syndromic surveillance data in the early warning of outbreaks. The annual operating costs of all the three components of the syndromic surveillance system in the ISSC Project were low compared to general government expenditures on health and average individual income in rural China.

Validation of Cost-Effectiveness Criterion for Evaluating Noise Abatement Measures

DOT National Transportation Integrated Search

1999-04-01

This project will provide the Texas Department of Transportation (TxDOT)with information about the effects of the current cost-effectiveness criterion. The project has reviewed (1) the cost-effectiveness criteria used by other states, (2) the noise b...

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.

The NASA Deep Space Network (DSN) Array

NASA Technical Reports Server (NTRS)

Gatti, Mark

2006-01-01

The DSN Array Project is currently working with Senior Management at both JPL and NASA to develop strategies towards starting a major implementation project. Several studies within NASA are concluding, all of which recommend that any future DSN capability include arraying of antennas to increase performance. Support of Deep Space, Lunar, and CEV (crewed exploration vehicle) missions is possible. High data rate and TDRSS formatting is being investigated. Any future DSN capacity must include Uplink. Current studies ongoing to investigate and develop technologies for uplink arraying; provides advantages in three ways: 1) N2 effect. EIRP grows as N2(-vs-N for a downlink array); 2) Improved architectural options (can separate uplink and downlink); and 3) Potential for more cost effective transmitters for fixed EIRP.

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Guidelines for appropriate care: the importance of empirical normative analysis.

PubMed

Berg, M; Meulen, R T; van den Burg, M

2001-01-01

The Royal Dutch Medical Association recently completed a research project aimed at investigating how guidelines for 'appropriate medical care' should be construed. The project took as a starting point that explicit attention should be given to ethical and political considerations in addition to data about costs and effectiveness. In the project, two research groups set out to design guidelines and cost-effectiveness analyses (CEAs) for two circumscribed medical areas (angina pectoris and major depression). Our third group was responsible for the normative analysis. We undertook an explorative, qualitative pilot study of the normative considerations that played a role in constructing the guidelines and CEAs, and simultaneously interviewed specialists about the normative considerations that guided their diagnostic and treatment decisions. Explicating normative considerations, we argue, is important democratically: the issues at stake should not be left to decision analysts and guideline developers to decide. Moreover, it is a necessary condition for a successful implementation of such tools: those who draw upon these tools will only accept them when they can recognize themselves in the considerations implied. Empirical normative analysis, we argue, is a crucial tool in developing guidelines for appropriate medical care.

Implementing Patient Safety Initiatives in Rural Hospitals

ERIC Educational Resources Information Center

Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

2009-01-01

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

PubMed

Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

2016-03-01

Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Implementation of unmanned aircraft systems by the U.S. Geological Survey

USGS Publications Warehouse

Cress, J.J.; Sloan, J.L.; Hutt, M.E.

2011-01-01

The U.S. Geological Survey (USGS) Unmanned Aircraft Systems (UAS) Project Office is leading the implementation of UAS technology in anticipation of transforming the research methods and management techniques employed across the Department of the Interior. UAS technology is being made available to monitor environmental conditions, analyse the impacts of climate change, respond to natural hazards, understand landscape change rates and consequences, conduct wildlife inventories and support related land management missions. USGS is teaming with the Department of the Interior Aviation Management Directorate (AMD) to lead the safe and cost-effective adoption of UAS technology by the Department of the Interior Agencies and USGS scientists.

Hanford business structure for HANDI 2000 business management system

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

Wilson, D.

The Hanford Business Structure integrates the project`s technical, schedule, and cost baselines; implements the use of a standard code of accounts; and streamlines performance reporting and cost collection. Technical requirements drive the technical functions and come from the RDD 100 database. The functions will be identified in the P3 scheduling system and also in the PeopleSoft system. Projects will break their work down from the technical requirements in the P3 schedules. When the level at which they want to track cost via the code of accounts is reached, a Project ID will be generated in the PeopleSoft system. P3 maymore » carry more detailed schedules below the Project ID level. The standard code of accounts will identify discrete work activities done across the site and various projects. They will include direct and overhead type work scopes. Activities in P3 will roll up to this standard code of accounts. The field that will be used to record this in PeopleSoft is ``Activity``. In Passport it is a user-defined field. It will have to be added to other feeder systems. Project ID and code of accounts are required fields on all cost records.« less

The healthy workplace project: Reduced viral exposure in an office setting.

PubMed

Reynolds, Kelly A; Beamer, Paloma I; Plotkin, Kevin R; Sifuentes, Laura Y; Koenig, David W; Gerba, Charles P

2016-05-03

Viral illnesses such as gastroenteritis and the common cold create a substantial burden in the workplace due to reduced productivity, increased absenteeism, and increased health care costs. Behaviors in the workplace contribute to the spread of human viruses via direct contact between hands, contaminated surfaces, and the mouth, eyes, and/or nose. This study assessed whether implementation of the Healthy Workplace Project (HWP) (providing hand sanitizers, disinfecting wipes, facial tissues, and use instructions) would reduce viral loads in an office setting of approximately 80 employees after seeding fomites and the hands of volunteer participants with an MS-2 phage tracer. The HWP significantly reduced viable phage detected on participants' hands, communal fomites, and personal fomites (p ≤ .010) in office environments and presents a cost-effective method for reducing the health and economic burden associated with viral illnesses in the workplace.

30 CFR 880.13 - Project implementation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... will design, plan, and engineer a method of operation for control or extinguishment of the outcrop or... in phases, a series of project contracts. (2) If OSM assistance is required, OSM will be reimbursed by the State or Indian tribe for all costs incurred, including OSM employees' time. (b) In States and...

30 CFR 880.13 - Project implementation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... will design, plan, and engineer a method of operation for control or extinguishment of the outcrop or... in phases, a series of project contracts. (2) If OSM assistance is required, OSM will be reimbursed by the State or Indian tribe for all costs incurred, including OSM employees' time. (b) In States and...

30 CFR 880.13 - Project implementation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... will design, plan, and engineer a method of operation for control or extinguishment of the outcrop or... in phases, a series of project contracts. (2) If OSM assistance is required, OSM will be reimbursed by the State or Indian tribe for all costs incurred, including OSM employees' time. (b) In States and...

30 CFR 880.13 - Project implementation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... will design, plan, and engineer a method of operation for control or extinguishment of the outcrop or... in phases, a series of project contracts. (2) If OSM assistance is required, OSM will be reimbursed by the State or Indian tribe for all costs incurred, including OSM employees' time. (b) In States and...

30 CFR 880.13 - Project implementation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... will design, plan, and engineer a method of operation for control or extinguishment of the outcrop or... in phases, a series of project contracts. (2) If OSM assistance is required, OSM will be reimbursed by the State or Indian tribe for all costs incurred, including OSM employees' time. (b) In States and...

Community outreach: rural mobile health unit.

PubMed

Alexy, B B; Elnitsky, C A

1996-12-01

With the increased emphasis on cost containment, hospital administrators are investigating community outreach projects to remain economically viable. The authors describe the planning and implementation of a mobile health unit for rural elderly residents. This project represents an alternative model of healthcare delivery in a rural area with limited resources and healthcare providers.

Ice Storage System for School Complex.

ERIC Educational Resources Information Center

Montgomery, Ross D.

1998-01-01

Describes a project at the Manatee Education Center in Naples, Florida, which won an ASHRAE award. Project involved the implementation of ice-storage technology in 19 schools. Compares the performance of ice-storage systems with traditional chiller designs in two other schools. Tables illustrate costs for the campuses. Addresses the maintenance…

Current Developments in Cost Accounting/Performance Measuring Systems for Implementing Advanced Manufacturing Technology

DTIC Science & Technology

1989-11-01

incomplete accounting of benefits, few strategic projects will * be adopted. Nanni , et al [21], provide similar discussion regarding a benefit analysis in...management tends to ignore the fact that minimizing costs within departments does not guarantee minimization of overall costs ( Nanni (21]). Sullivan, et...changes in the manufacturing environment. The author also remarks that these cost systems need to be modified or replaced by entirely new systems

Materials experiment carrier concepts definition study. Volume 3: Programmatics, part 2

NASA Technical Reports Server (NTRS)

1981-01-01

Project logic, schedule and funding information was derived to enable decisions to be made regarding implementation of MEC system development. A master schedule and cost and price estimates (ROM) were developed for a project that consists of development of an all-up MEC, its integration with payloads and its flight on one 90 day mission. In Part 2 of the study a simple initial MEC was defined to accommodate three MPS baseline payloads. The design of this initial MEC is illustrated. The project logic, detailed schedules, and ROM cost estimate relate to a project in which this initial MEC is developed, integrated with payloads and flown once for 180 days.

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

PubMed

van der Meer, Esther W C; van Dongen, Johanna M; Boot, Cécile R L; van der Gulden, Joost W J; Bosmans, Judith E; Anema, Johannes R

2016-05-01

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results.

Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective.

PubMed

Zhang, Lei; Regan, David G; Ong, Jason J; Gambhir, Manoj; Chow, Eric P F; Zou, Huachun; Law, Matthew; Hocking, Jane; Fairley, Christopher K

2017-09-05

We investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15-26) men who have sex with men (MSM). We developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017-2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM. A targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253-71,500) cases of anogenital warts, 191 (88-319) person-years living with anal cancer through 2017-2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100-117,164) cases of anogenital warts, 447 (204-725) person-years living with anal cancers through 2017-2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479-21,803) anogenital wart and 91 (42-152) person-years living with anal cancer. In combination with a boys' program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628-11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness. A boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparing estimates of child mortality reduction modelled in LiST with pregnancy history survey data for a community-based NGO project in Mozambique

PubMed Central

2011-01-01

Background There is a growing body of evidence that integrated packages of community-based interventions, a form of programming often implemented by NGOs, can have substantial child mortality impact. More countries may be able to meet Millennium Development Goal (MDG) 4 targets by leveraging such programming. Analysis of the mortality effect of this type of programming is hampered by the cost and complexity of direct mortality measurement. The Lives Saved Tool (LiST) produces an estimate of mortality reduction by modelling the mortality effect of changes in population coverage of individual child health interventions. However, few studies to date have compared the LiST estimates of mortality reduction with those produced by direct measurement. Methods Using results of a recent review of evidence for community-based child health programming, a search was conducted for NGO child health projects implementing community-based interventions that had independently verified child mortality reduction estimates, as well as population coverage data for modelling in LiST. One child survival project fit inclusion criteria. Subsequent searches of the USAID Development Experience Clearinghouse and Child Survival Grants databases and interviews of staff from NGOs identified no additional projects. Eight coverage indicators, covering all the project’s technical interventions were modelled in LiST, along with indicator values for most other non-project interventions in LiST, mainly from DHS data from 1997 and 2003. Results The project studied was implemented by World Relief from 1999 to 2003 in Gaza Province, Mozambique. An independent evaluation collecting pregnancy history data estimated that under-five mortality declined 37% and infant mortality 48%. Using project-collected coverage data, LiST produced estimates of 39% and 34% decline, respectively. Conclusions LiST gives reasonably accurate estimates of infant and child mortality decline in an area where a package of community-based interventions was implemented. This and other validation exercises support use of LiST as an aid for program planning to tailor packages of community-based interventions to the epidemiological context and for project evaluation. Such targeted planning and assessments will be useful to accelerate progress in reaching MDG4 targets. PMID:21501454

Project Risk Management

NASA Technical Reports Server (NTRS)

Jr., R. F. Miles

1995-01-01

Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.

The Torres Indigenous Hip Hop Project: evaluating the use of performing arts as a medium for sexual health promotion.

PubMed

McEwan, Alexandra; Crouch, Alan; Robertson, Heather; Fagan, Patricia

2013-08-01

The Torres Indigenous Hip Hop Project (the Project) was conducted in the Torres and Northern Peninsula Area of Queensland during early 2010. This paper provides a critical analysis of project outcomes and identifies criteria that may form a suitable framework for the assessment of proposals for sexual health promotion using performing arts-based approaches in Aboriginal and Torres Strait Islander settings. A case study method was used. The first phase of analysis assessed whether project objectives were met using data collected during project planning and implementation. The second phase used these findings, augmented by interviews with key personnel, to respond to the question 'How could this be done better?'. The Project required significant human and organisational implementation support. The project was successful in facilitating event-specific community mobilisation. It raised awareness of sexual health disadvantage and engaged effectively with the target group. It laid important groundwork to progress school-based and community mechanisms to address regional youth disadvantage. Against these benefits are issues of opportunity cost and the need for ongoing resources to capitalise on the opportunities created. With substantial support and planning, such approaches can play an important role in engaging young people and bridging the gap between clinical interventions and improvements in health deriving from community-driven strategies. SO WHAT? This paper contributes to existing literature by identifying key elements of an effective approach to using performing arts in sexual health promotion in Aboriginal and Torres Strait Islander settings. It also provides guidance when consideration is being given to investment in resource-intensive health promotion initiatives.

Work plan for the Isotopes Facilities Deactivation Project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

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

NONE

1995-08-01

The purpose of the Isotopes Facilities Deactivation Project (IFDP) is to place former isotopes production facilities at the Oak Ridge National Laboratory in a safe, stable, and environmentally sound condition; suitable for an extended period of minimum surveillance and maintenance (S and M) and as quickly and economical as possible. Implementation and completion of the deactivation project will further reduce the risks to the environment and to public safety and health. Furthermore, completion of the project will result in significant S and M cost savings in future years. The IFDP work plan defines the project schedule, the cost estimate, andmore » the technical approach for the project. A companion document, the EFDP management plan, has been prepared to document the project objectives, define organizational relationships and responsibilities, and outline the management control systems to be employed in the management of the project. The project has adopted the strategy of deactivating the simple facilities first, to reduce the scope of the project and to gain experience before addressing more difficult facilities. A decision support system is being developed to identify the activities that best promote the project mission and result in the largest cost savings. This work plan will be reviewed and revised annually. Deactivation of EFDP Facilities was initiated in FY 1994 and will be completed in FY 2000. The schedule for deactivation of facilities is shown. The total cost of the project is estimated to be $51M. The costs are summarized. Upon completion of deactivation, annual S and M costs of these facilities will be reduced from the current level of $5M per year to less than $1M per year.« less

Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness.

PubMed

Pantoja, A; Lönnroth, K; Lal, S S; Chauhan, L S; Uplekar, M; Padma, M R; Unnikrishnan, K P; Rajesh, J; Kumar, P; Sahu, S; Wares, F; Floyd, K

2009-06-01

Bangalore City, India. To assess the cost and cost-effectiveness of public-private mix (PPM) for tuberculosis (TB) care and control when implemented on a large scale. DOTS implementation under the Revised National TB Control Programme (RNTCP) began in 1999, PPM was introduced in mid-2001 and a second phase of intensified PPM began in 2003. Data on the costs and effects of TB treatment from 1999 to 2005 were collected and used to compare the two distinct phases of PPM with a scenario of no PPM. Costs were assessed in 2005 $US for public and private providers, patients and patient attendants. Sources of data included expenditure records, medical records, interviews with staff and patient surveys. Effectiveness was measured as the number of cases successfully treated. When PPM was implemented, total provider costs increased in proportion to the number of successfully treated TB cases. The average cost per patient treated from the provider perspective when PPM was implemented was stable, at US$69, in the intensified phase compared with US$71 pre-PPM. PPM resulted in the shift of an estimated 7200 patients from non-DOTS to DOTS treatment over 5 years. PPM implementation substantially reduced costs to patients, such that the average societal cost per patient successfully treated fell from US$154 to US$132 in the 4 years following the initiation of PPM. Implementation of PPM on a large scale in an urban setting can be cost-effective, and considerably reduces the financial burden of TB for patients.

ACTS for distance education in developing countries

NASA Technical Reports Server (NTRS)

Kalu, A; Ventre, G.

1995-01-01

The need for electrical energy supply in the rural communities of developing countries has been well documented. Equally well known is the potential for photovoltaic in cost effectively meeting this need. A major impediment to fulfilling the need is the lack of indigenous personnel with a knowledgeof photovoltaic systems, and the associated infrastructure required to implement project. Various delivery schemes for providing the needed training to developing countries personnel have been investigated. Various train methods and programs that have been employed to remedy the problem have had significant drawbacks in terms of cost, consistency, impact, reach, and sustainability. The hypothesis to be tested in this project posits that satellite-based distance education using ACTS technologies can overcome these impediments. The purpose of the project is to investigate the applicability of the ACTS satellite in providing distance education in photovoltaic systems to developing countries and rural communities. An evaluation of the cost effectiveness of using ACTS unique technologies to overcome identified problems shall be done. The limitations of ACTS in surmounting distance education problems in developing countries shall be investigated. This project will, furthermore, provide training to Savannah State College faculty in photovoltaic (PV) systems and in distance education configurations and models. It will also produce training materials adequate for use in PV training programs via distance education. Savannah State College will, as a consequence become well equipped to play a leading role in the training of minority populations in photovoltaic systems and other renewables through its Center for Advanced Water Technology and Energy Systems. This communication provides the project outline including the specific issues that will be investigated during the project. Also presented i the project design which covers the participations of the various components of a network of institutions that is formed for optimal project execution. The expected results and project output, including plans for potential leverages and linkages to be derived, are also discussed. Finally, we point out possible extensions from this project and other related projects that could be initiated based on the experiences gained from the project.

Too late to vaccinate? The incremental benefits and cost-effectiveness of a delayed catch-up program using the 4-valent human papillomavirus vaccine in Norway.

PubMed

Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

2015-01-15

Human papillomavirus (HPV) vaccines are ideally administered before HPV exposure; therefore, catch-up programs for girls past adolescence have not been readily funded. We evaluated the benefits and cost-effectiveness of a delayed, 1-year female catch-up vaccination program in Norway. We calibrated a dynamic HPV transmission model to Norwegian data and projected the costs and benefits associated with 8 HPV-related conditions while varying the upper vaccination age limit to 20, 22, 24, or 26 years. We explored the impact of vaccine protection in women with prior vaccine-targeted HPV infections, vaccine cost, coverage, and natural- and vaccine-induced immunity. The incremental benefits and cost-effectiveness decreased as the upper age limit for catch-up increased. Assuming a vaccine cost of $150/dose, vaccination up to age 20 years remained below Norway's willingness-to-pay threshold (approximately $83 000/quality-adjusted life year gained); extension to age 22 years was cost-effective at a lower cost per dose ($50-$75). At high levels of vaccine protection in women with prior HPV exposure, vaccinating up to age 26 years was cost-effective. Results were stable with lower coverage. HPV vaccination catch-up programs, 5 years after routine implementation, may be warranted; however, even at low vaccine cost per dose, the cost-effectiveness of vaccinating beyond age 22 years remains uncertain. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Dallas area rapid transit LRT starter line assessment study design. Final research report

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

Shunk, G.A.; Turnbull, K.F.; Lindquist, N.F.

1995-03-01

Light rail transit (LRT) systems have recently been implemented in a number of urban areas throughout the United States and additional projects are in various stages of planning and development. Questions have been raised concerning the impact of these systems on ridership levels, transit operating costs, regional mobility, land use, economic development, energy, air quality, congestion levels, and other factors. The implementation of the Dallas Area Rapid Transit (DART) LRT starter line provides the opportunity to assess the impact of an LRT system in a Southwestern city in the United States. This research project was undertaken to assist with themore » development of a comprehensive study design for assessing the effects of the DART LRT starter line. To accomplish this objective, a review was conducted of before-and-after studies of recent LRT, heavy rail, and high-occupancy vehicle (HOV) projects. The goals and objectives of the DART system were also reviewed and existing transportation-related data collection activities in the Dallas area were examined. This information was used to develop a preliminary study design for assessing the effects of the DART LRT starter line. This report documents the review of recent before-and-after studies and presents the preliminary study design for assessing the effects of the DART LRT starter line.« less

Introduction of a breast cancer care programme including ultra short hospital stay in 4 early adopter centres: framework for an implementation study.

PubMed

de Kok, Mascha; Frotscher, Caroline N A; van der Weijden, Trudy; Kessels, Alfons G H; Dirksen, Carmen D; van de Velde, Cornelis J H; Roukema, Jan A; Bell, Antoine V R J; van der Ent, Fred W; von Meyenfeldt, Maarten F

2007-07-02

Whereas ultra-short stay (day care or 24 hour hospitalisation) following breast cancer surgery was introduced in the US and Canada in the 1990s, it is not yet common practice in Europe. This paper describes the design of the MaDO study, which involves the implementation of ultra short stay admission for patients after breast cancer surgery, and evaluates whether the targets of the implementation strategy are reached. The ultra short stay programme and the applied implementation strategy will be evaluated from the economic perspective. The MaDO study is a pre-post-controlled multi-centre study, that is performed in four hospitals in the Netherlands. It includes a pre and post measuring period of six months each with six months of implementation in between in at least 40 patients per hospital per measurement period. Primary outcome measure is the percentage of patients treated in ultra short stay. Secondary endpoints are the percentage of patients treated according to protocol, degree of involvement of home care nursing, quality of care from the patient's perspective, cost-effectiveness of the ultra short stay programme and cost-effectiveness of the implementation strategy. Quality of care will be measured by the QUOTE-breast cancer instrument, cost-effectiveness of the ultra short stay programme will be measured by means of the EuroQol (administered at four time-points) and a cost book for patients. Cost-effectiveness analysis will be performed from a societal perspective. Cost-effectiveness of the implementation strategy will be measured by determination of the costs of implementation activities. This study will reveal barriers and facilitators for implementation of the ultra short stay programme. Moreover, the results of the study will provide information about the cost-effectiveness of the ultra short stay programme and the implementation strategy. Current Controlled Trials ISRCTN77253391.

Costs and benefits of health information technology.

PubMed

Shekelle, Paul G; Morton, Sally C; Keeler, Emmett B

2006-04-01

An evidence report was prepared to assess the evidence base regarding benefits and costs of health information technology (HIT) systems, that is, the value of discrete HIT functions and systems in various healthcare settings, particularly those providing pediatric care. PubMed, the Cochrane Controlled Clinical Trials Register, and the Cochrane Database of Reviews of Effectiveness (DARE) were electronically searched for articles published since 1995. Several reports prepared by private industry were also reviewed. Of 855 studies screened, 256 were included in the final analyses. These included systematic reviews, meta-analyses, studies that tested a hypothesis, and predictive analyses. Each article was reviewed independently by two reviewers; disagreement was resolved by consensus. Of the 256 studies, 156 concerned decision support, 84 assessed the electronic medical record, and 30 were about computerized physician order entry (categories are not mutually exclusive). One hundred twenty four of the studies assessed the effect of the HIT system in the outpatient or ambulatory setting; 82 assessed its use in the hospital or inpatient setting. Ninety-seven studies used a randomized design. There were 11 other controlled clinical trials, 33 studies using a pre-post design, and 20 studies using a time series. Another 17 were case studies with a concurrent control. Of the 211 hypothesis-testing studies, 82 contained at least some cost data. We identified no study or collection of studies, outside of those from a handful of HIT leaders, that would allow a reader to make a determination about the generalizable knowledge of the study's reported benefit. Beside these studies from HIT leaders, no other research assessed HIT systems that had comprehensive functionality and included data on costs, relevant information on organizational context and process change, and data on implementation. A small body of literature supports a role for HIT in improving the quality of pediatric care. Insufficient data were available on the costs or cost-effectiveness of implementing such systems. The ability of Electronic Health Records (EHRs) to improve the quality of care in ambulatory care settings was demonstrated in a small series of studies conducted at four sites (three U.S. medical centers and one in the Netherlands). The studies demonstrated improvements in provider performance when clinical information management and decision support tools were made available within an EHR system, particularly when the EHRs had the capacity to store data with high fidelity, to make those data readily accessible, and to help translate them into context-specific information that can empower providers in their work. Despite the heterogeneity in the analytic methods used, all cost-benefit analyses predicted substantial savings from EHR (and health care information exchange and interoperability) implementation: The quantifiable benefits are projected to outweigh the investment costs. However, the predicted time needed to break even varied from three to as many as 13 years. HIT has the potential to enable a dramatic transformation in the delivery of health care, making it safer, more effective, and more efficient. Some organizations have already realized major gains through the implementation of multifunctional, interoperable HIT systems built around an EHR. However, widespread implementation of HIT has been limited by a lack of generalizable knowledge about what types of HIT and implementation methods will improve care and manage costs for specific health organizations. The reporting of HIT development and implementation requires fuller descriptions of both the intervention and the organizational/economic environment in which it is implemented.

Implementing a Cost Effectiveness Analyzer for Web-Supported Academic Instruction: A Campus Wide Analysis

ERIC Educational Resources Information Center

Cohen, Anat; Nachmias, Rafi

2009-01-01

This paper describes the implementation of a quantitative cost effectiveness analyzer for Web-supported academic instruction that was developed in Tel Aviv University during a long term study. The paper presents the cost effectiveness analysis of Tel Aviv University campus. Cost and benefit of 3,453 courses were analyzed, exemplifying campus-wide…

Impact assessment and cost-effectiveness of m-health application used by community health workers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol.

PubMed

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Thakur, Jarnail Singh; Gupta, Madhu; Singh, Tarundeep

2016-01-01

An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project. A pre-post quasi-experimental design with a control group will be used to undertake difference in differences analysis for assessing the impact of intervention. The Annual Health Survey (2011) will provide pre-intervention data, and a household survey will be carried out to provide post-intervention data.Two community development blocks where the intervention was introduced will be treated as intervention blocks while two controls blocks are selected after matching with intervention blocks on three indicators: average number of antenatal care checkups, percentage of women receiving three or more antenatal checkups, and percentage of institutional deliveries. Two categories of beneficiaries will be interviewed in both areas: women with a child between 29 days and 6 months and women with a child between 12 and 23 months. Propensity score matched samples from intervention and control areas in pre-post periods will be analyzed using the difference in differences method to estimate the impact of intervention in utilization of key services.Bottom-up costing methods will be used to assess the cost of implementing intervention. A decision model will estimate long-term effects of improved health services utilization on mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per disability-adjusted life year averted and cost per unit increase in composite service coverage in intervention versus control groups. The study will generate significant evidence on impact of the m-health intervention for maternal, neonatal, and child services and on the cost of scaling up m-health technology for accredited social health activists in India.

The MERMAID project

NASA Technical Reports Server (NTRS)

Cowderoy, A. J. C.; Jenkins, John O.; Poulymenakou, A

1992-01-01

The tendency for software development projects to be completed over schedule and over budget was documented extensively. Additionally many projects are completed within budgetary and schedule target only as a result of the customer agreeing to accept reduced functionality. In his classic book, The Mythical Man Month, Fred Brooks exposes the fallacy that effort and schedule are freely interchangeable. All current cost models are produced on the assumption that there is very limited scope for schedule compression unless there is a corresponding reduction in delivered functionality. The Metrication and Resources Modeling Aid (MERMAID) project, partially financed by the Commission of the European Communities (CEC) as Project 2046 began in Oct. 1988 and its goal were as follows: (1) improvement of understanding of the relationships between software development productivity and product and process metrics; (2) to facilitate the widespread technology transfer from the Consortium to the European Software Industry; and (3) to facilitate the widespread uptake of cost estimation techniques by the provision of prototype cost estimation tools. MERMAID developed a family of methods for cost estimation, many of which have had tools implemented in prototypes. These prototypes are best considered as toolkits or workbenches.

Civil Service Workforce Market Supply and the Effect on Cost Estimating Relationship (CERS) that May Effect the Productivity Factors for Future NASA Missions

NASA Technical Reports Server (NTRS)

Sterk, Steve; Chesley, Stephan

2008-01-01

The upcoming retirement of the Baby Boomers will leave a workforce age gap between the younger generation (the future NASA decision makers) and the gray beards. This paper will reflect on the average age of the workforce across NASA Centers, the Aerospace Industry and other Government Agencies, like DoD. This paper will dig into Productivity and Realization Factors and how they get applied to bi-monthly (payroll) data for true full-time equivalent (FTE) calculations that could be used at each of the NASA Centers and other business systems that are on the forefront in being implemented. This paper offers some comparative costs analysis/solutions, from simple FTE cost-estimating relationships (CERs) versus CERs for monthly time-phasing activities for small research projects that start and get completed within a government fiscal year. This paper will present the results of a parametric study investigating the cost-effectiveness of alternative performance-based CERs and how they get applied into the Center's forward pricing rate proposals (FPRP). True CERs based on the relationship of a younger aged workforce will have some effects on labor rates used in both commercial cost models and other internal home-grown cost models which may impact the productivity factors for future NASA missions.

Prioritization Methodology for Chemical Replacement

NASA Technical Reports Server (NTRS)

Cruit, W.; Schutzenhofer, S.; Goldberg, B.; Everhart, K.

1993-01-01

This project serves to define an appropriate methodology for effective prioritization of efforts required to develop replacement technologies mandated by imposed and forecast legislation. The methodology used is a semiquantitative approach derived from quality function deployment techniques (QFD Matrix). This methodology aims to weigh the full environmental, cost, safety, reliability, and programmatic implications of replacement technology development to allow appropriate identification of viable candidates and programmatic alternatives. The results are being implemented as a guideline for consideration for current NASA propulsion systems.

Cost-effectiveness of diabetes case management for low-income populations.

PubMed

Gilmer, Todd P; Roze, Stéphane; Valentine, William J; Emy-Albrecht, Katrina; Ray, Joshua A; Cobden, David; Nicklasson, Lars; Philis-Tsimikas, Athena; Palmer, Andrew J

2007-10-01

To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status. Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model. The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40-year time horizon) from a third-party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long-term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed. Incremental cost-effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi-Cal, and commercial insurance cohorts, respectively. The Project Dulce diabetes case management program was associated with cost-effective improvements in quality-adjusted life expectancy and decreased incidence of diabetes-related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low-income populations.

Development of a module for Cost-Benefit analysis of risk reduction measures for natural hazards for the CHANGES-SDSS platform

NASA Astrophysics Data System (ADS)

Berlin, Julian; Bogaard, Thom; Van Westen, Cees; Bakker, Wim; Mostert, Eric; Dopheide, Emile

2014-05-01

Cost benefit analysis (CBA) is a well know method used widely for the assessment of investments either in the private and public sector. In the context of risk mitigation and the evaluation of risk reduction alternatives for natural hazards its use is very important to evaluate the effectiveness of such efforts in terms of avoided monetary losses. However the current method has some disadvantages related to the spatial distribution of the costs and benefits, the geographical distribution of the avoided damage and losses, the variation in areas that are benefited in terms of invested money and avoided monetary risk. Decision-makers are often interested in how the costs and benefits are distributed among different administrative units of a large area or region, so they will be able to compare and analyse the cost and benefits per administrative unit as a result of the implementation of the risk reduction projects. In this work we first examined the Cost benefit procedure for natural hazards, how the costs are assessed for several structural and non-structural risk reduction alternatives, we also examined the current problems of the method such as the inclusion of cultural and social considerations that are complex to monetize , the problem of discounting future values using a defined interest rate and the spatial distribution of cost and benefits. We also examined the additional benefits and the indirect costs associated with the implementation of the risk reduction alternatives such as the cost of having a ugly landscape (also called negative benefits). In the last part we examined the current tools and software used in natural hazards assessment with support to conduct CBA and we propose design considerations for the implementation of the CBA module for the CHANGES-SDSS Platform an initiative of the ongoing 7th Framework Programme "CHANGES of the European commission. Keywords: Risk management, Economics of risk mitigation, EU Flood Directive, resilience, prevention, cost benefit analysis, spatial distribution of costs and benefits

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

PubMed Central

Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-01

Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. PMID:28057607

Modelling the implications of reducing smoking prevalence: the benefits of increasing the UK tobacco duty escalator to public health and economic outcomes.

PubMed

Knuchel-Takano, Andre; Hunt, Daniel; Jaccard, Abbygail; Bhimjiyani, Arti; Brown, Martin; Retat, Lise; Brown, Katrina; Hinde, Sebastian; Selvarajah, Chit; Bauld, Linda; Webber, Laura

2017-12-06

Taxing tobacco is one of the most effective ways to reduce smoking prevalence, mitigate its devastating consequential health harms and progress towards a tobacco-free society. This study modelled the health and economic impacts of increasing the existing cigarette tobacco duty escalator (TDE) in the UK from the current 2% above consumer price inflation to 5%. A two-stage modelling process was used. First, a non-linear multivariate regression model was fitted to cross-sectional smoking data, creating longitudinal projections from 2015 to 2035. Second, these projections were used to predict the future incidence, prevalence and cost of 17 smoking-related diseases using a Monte Carlo microsimulation approach. A sustained increase in the duty escalator was evaluated against a baseline of continuing historical smoking trends and the existing duty escalator. A sustained increase in the TDE is projected to reduce adult smoking prevalence to 6% in 2035, from 10% in a baseline scenario. After increasing the TDE, only 65% of female and 60% of male would-be smokers would actually be smoking in 2035. The intervention is projected to avoid around 75 200 new cases of smoking-related diseases between 2015 and 2035. In 2035 alone, £49 m in National Health Service and social care costs and £192 m in societal premature mortality and morbidity costs are projected to be avoided. Increasing the UK TDE to 5% above inflation could effectively reduce smoking prevalence, prevent diseases and avoid healthcare costs. It would deliver substantial progress towards a tobacco-free society and should be implemented by the UK Government with urgency. © 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.

Managing a big ground-based astronomy project: the Thirty Meter Telescope (TMT) project

NASA Astrophysics Data System (ADS)

Sanders, Gary H.

2008-07-01

TMT is a big science project and its scale is greater than previous ground-based optical/infrared telescope projects. This paper will describe the ideal "linear" project and how the TMT project departs from that ideal. The paper will describe the needed adaptations to successfully manage real world complexities. The progression from science requirements to a reference design, the development of a product-oriented Work Breakdown Structure (WBS) and an organization that parallels the WBS, the implementation of system engineering, requirements definition and the progression through Conceptual Design to Preliminary Design will be summarized. The development of a detailed cost estimate structured by the WBS, and the methodology of risk analysis to estimate contingency fund requirements will be summarized. Designing the project schedule defines the construction plan and, together with the cost model, provides the basis for executing the project guided by an earned value performance measurement system.

Implementing a trustworthy cost-accounting model.

PubMed

Spence, Jay; Seargeant, Dan

2015-03-01

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

Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes.

PubMed

Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

2015-01-01

To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Software cost/resource modeling: Deep space network software cost estimation model

NASA Technical Reports Server (NTRS)

Tausworthe, R. J.

1980-01-01

A parametric software cost estimation model prepared for JPL deep space network (DSN) data systems implementation tasks is presented. The resource estimation model incorporates principles and data from a number of existing models, such as those of the General Research Corporation, Doty Associates, IBM (Walston-Felix), Rome Air Force Development Center, University of Maryland, and Rayleigh-Norden-Putnam. The model calibrates task magnitude and difficulty, development environment, and software technology effects through prompted responses to a set of approximately 50 questions. Parameters in the model are adjusted to fit JPL software lifecycle statistics. The estimation model output scales a standard DSN work breakdown structure skeleton, which is then input to a PERT/CPM system, producing a detailed schedule and resource budget for the project being planned.

Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).

PubMed

Sabin, Lora L; Knapp, Anna B; MacLeod, William B; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H; Gill, Christopher J

2012-01-01

The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

Implementation of Advanced Warehouses in a Hospital Environment - Case study

NASA Astrophysics Data System (ADS)

Costa, J.; Sameiro Carvalho, M.; Nobre, A.

2015-05-01

In Portugal, there is an increase of costs in the healthcare sector due to several factors such as the aging of the population, the increased demand for health care services and the increasing investment in new technologies. Thus, there is a need to reduce costs, by presenting the effective and efficient management of logistics supply systems with enormous potential to achieve savings in health care organizations without compromising the quality of the provided service, which is a critical factor, in this type of sector. In this research project the implementation of Advanced Warehouses has been studied, in the Hospital de Braga patient care units, based in a mix of replenishment systems approaches: the par level system, the two bin system and the consignment model. The logistics supply process is supported by information technology (IT), allowing a proactive replacement of products, based on the hospital services consumption records. The case study was developed in two patient care units, in order to study the impact of the operation of the three replenishment systems. Results showed that an important inventory holding costs reduction can be achieved in the patient care unit warehouses while increasing the service level and increasing control of incoming and stored materials with less human resources. The main conclusion of this work illustrates the possibility of operating multiple replenishment models, according to the types of materials that healthcare organizations deal with, so that they are able to provide quality health care services at a reduced cost and economically sustainable. The adoption of adequate IT has been shown critical for the success of the project.

Good practices on cost - effective road infrastructure safety investments.

PubMed

Yannis, George; Papadimitriou, Eleonora; Evgenikos, Petros; Dragomanovits, Anastasios

2016-12-01

The paper presents the findings of a research project aiming to quantify and subsequently classify several infrastructure-related road safety measures, based on the international experience attained through extensive and selected literature review and additionally on a full consultation process including questionnaire surveys addressed to experts and relevant workshops. Initially, a review of selected research reports was carried out and an exhaustive list of road safety infrastructure investments covering all types of infrastructure was compiled. Individual investments were classified according to the infrastructure investment area and the type of investment and were thereafter analysed on the basis of key safety components. These investments were subsequently ranked in relation to their safety effects and implementation costs and on the basis of this ranking, a set of five most promising investments was selected for an in-depth analysis. The results suggest that the overall cost effectiveness of a road safety infrastructure investment is not always in direct correlation with the safety effect and is recommended that cost-benefit ratios and safety effects are always examined in conjunction with each other in order to identify the optimum solution for a specific road safety problem in specific conditions and with specific objectives.

Micro-Grids for Colonias (TX)

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

Dean Schneider; Michael Martin; Renee Berry

2012-07-31

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

Cost-benefit calculation of phytoremediation technology for heavy-metal-contaminated soil.

PubMed

Wan, Xiaoming; Lei, Mei; Chen, Tongbin

2016-09-01

Heavy-metal pollution of soil is a serious issue worldwide, particularly in China. Soil remediation is one of the most difficult management issues for municipal and state agencies because of its high cost. A two-year phytoremediation project for soil contaminated with arsenic, cadmium, and lead was implemented to determine the essential parameters for soil remediation. Results showed highly efficient heavy metal removal. Costs and benefits of this project were calculated. The total cost of phytoremediation was US$75,375.2/hm(2) or US$37.7/m(3), with initial capital and operational costs accounting for 46.02% and 53.98%, respectively. The costs of infrastructures (i.e., roads, bridges, and culverts) and fertilizer were the highest, mainly because of slow economic development and serious contamination. The cost of phytoremediation was lower than the reported values of other remediation technologies. Improving the mechanization level of phytoremediation and accurately predicting or preventing unforeseen situations were suggested for further cost reduction. Considering the loss caused by environmental pollution, the benefits of phytoremediation will offset the project costs in less than seven years. Copyright © 2015 Elsevier B.V. All rights reserved.

42 CFR 495.340 - As-needed HIT PAPD update and as-needed HIT IAPD update requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.340 As... document or the HIT implementation advance planning document. (d) A change in implementation concept or a change to the scope of the project. (e) A change to the approved cost allocation methodology. ...

42 CFR 495.340 - As-needed HIT PAPD update and as-needed HIT IAPD update requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.340 As... document or the HIT implementation advance planning document. (d) A change in implementation concept or a change to the scope of the project. (e) A change to the approved cost allocation methodology. ...

Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

PubMed

Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

2013-07-01

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

Final Report. Solar Assist for Administration Building and Community Gym/Pool

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

Synder, Randy; Bresette, Joseph

2015-06-23

Tonto Apache Tribe applied to the Department of Energy’s “Tribal Energy Program” for the “Community Scale Clean Energy Projects” in Indian Country in 2013 to implement a solar project to reduce energy use in two tribal buildings. Total estimated project cost was $804,140, with the Department and Tribe each providing 50% of the project costs. Photovoltaic systems totaling 75 kW on the Administration Building and 192 kW on the Gymnasium were installed. We used roof tops and installed canopies in adjacent parking areas for mounting the systems. The installed systems were designed to offset 65% of the facilities electric load.

Population-Level Cost-Effectiveness of Implementing Evidence-Based Practices into Routine Care

PubMed Central

Fortney, John C; Pyne, Jeffrey M; Burgess, James F

2014-01-01

Objective The objective of this research was to apply a new methodology (population-level cost-effectiveness analysis) to determine the value of implementing an evidence-based practice in routine care. Data Sources/Study Setting Data are from sequentially conducted studies: a randomized controlled trial and an implementation trial of collaborative care for depression. Both trials were conducted in the same practice setting and population (primary care patients prescribed antidepressants). Study Design The study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. Data Collection/Extraction Methods The randomized controlled trial collected quality-adjusted life years (QALYs) from survey and medication possession ratios (MPRs) from administrative data. The implementation trial collected MPRs and intervention costs from administrative data and implementation costs from survey. Principal Findings In the randomized controlled trial, MPRs were significantly correlated with QALYs (p = .03). In the implementation trial, patients at implementation sites had significantly higher MPRs (p = .01) than patients at control sites, and by extrapolation higher QALYs (0.00188). Total costs (implementation, intervention) were nonsignificantly higher ($63.76) at implementation sites. The incremental population-level cost-effectiveness ratio was $33,905.92/QALY (bootstrap interquartile range −$45,343.10/QALY to $99,260.90/QALY). Conclusions The methodology was feasible to operationalize and gave reasonable estimates of implementation value. PMID:25328029

Evolution of environmental impact assessment as applied to watershed modification projects in Canada

NASA Astrophysics Data System (ADS)

Dirschl, Herman J.; Novakowski, Nicholas S.; Sadar, M. Husain

1993-07-01

This article reviews the application of environmental impact assessment (EIA) procedures and practices to three watershed modification projects situaled in western Canada. These ventures were justified for accelerating regional economic development, and cover the period during which public concerns for protecting the environment rapidly made their way into the national political agenda. An historical account and analysis of the situation, therefore, seems desirable in order to understand the development of EIA processes, practices, and methodologies since the start of construction of the first project in 1961. This study concludes that there has been good progress in predicting and evaluating environmental and related social impacts of watershed modification proposals. However, a number of obstacles need to be overcome before EIA can firmly establish itself as an effective planning tool. These difficulties include jurisdictional confusions and conflicts, division of authority and responsibility in designing and implementing appropriate mitigative and monitoring measures, lack of tested EIA methodologies, and limited availability of qualified human resources. A number of conclusions and suggestions are offered so that future watershed modification proposals may be planned and implemented in a more environmentally sustainable fashion. These include: (1) EIA processes must be completed before irrevocable decisions are made. (2) Any major intrusion into a watershed is likely to impact on some major components of the ecosystem(s). (3) Mitigation costs must form part of the benefit-cost analysis of any project proposal. (4) Interjurisdictional cooperation is imperative where watersheds cross political boundaries. (5) The EIA process is a public process, hence public concerns must be dealt with fairly. (6) The role of science in the EIA process must be at arms length from project proponents and regulators, and allowed to function in the interest of the protection of the environment and public health and safety.

Public Health Service--health maintenance organizations: final regulations.

PubMed

1980-01-24

These rules amend the Public Health Service (PHS) regulations by implementing certain changes made by the HMO Amendments of 1978 with respect to grants and loan guarantees for planning and initial development costs (Subpart D) and to loans and loan guarantees for initial costs of operation (Subpart E). These regulations change Subpart D by including projects for the "expansion of services" of an HMO among the projects eligible for initial development assistance. In addition, they change the limits on the amount of assistance permitted for initial development projects. These regulations also change Subpart E by substituting the words "costs of operation" for the words "operating costs," thereby expanding the scope of assistance for initial operations (1) to include costs of certain small capital expenditures for equipment and alterations and renovations of facilities and (2) to incorporate into the regulations a longstanding policy which specifies the amount of preaward balance sheet liabilities which may be paid for with funds under operating loans (whether made directly or guaranteed by the Secretary).

Computational Models Used to Assess US Tobacco Control Policies.

PubMed

Feirman, Shari P; Glasser, Allison M; Rose, Shyanika; Niaura, Ray; Abrams, David B; Teplitskaya, Lyubov; Villanti, Andrea C

2017-11-01

Simulation models can be used to evaluate existing and potential tobacco control interventions, including policies. The purpose of this systematic review was to synthesize evidence from computational models used to project population-level effects of tobacco control interventions. We provide recommendations to strengthen simulation models that evaluate tobacco control interventions. Studies were eligible for review if they employed a computational model to predict the expected effects of a non-clinical US-based tobacco control intervention. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Six primary non-clinical intervention types were examined across the 40 studies: taxation, youth prevention, smoke-free policies, mass media campaigns, marketing/advertising restrictions, and product regulation. Simulation models demonstrated the independent and combined effects of these interventions on decreasing projected future smoking prevalence. Taxation effects were the most robust, as studies examining other interventions exhibited substantial heterogeneity with regard to the outcomes and specific policies examined across models. Models should project the impact of interventions on overall tobacco use, including nicotine delivery product use, to estimate preventable health and cost-saving outcomes. Model validation, transparency, more sophisticated models, and modeling policy interactions are also needed to inform policymakers to make decisions that will minimize harm and maximize health. In this systematic review, evidence from multiple studies demonstrated the independent effect of taxation on decreasing future smoking prevalence, and models for other tobacco control interventions showed that these strategies are expected to decrease smoking, benefit population health, and are reasonable to implement from a cost perspective. Our recommendations aim to help policymakers and researchers minimize harm and maximize overall population-level health benefits by considering the real-world context in which tobacco control interventions are implemented. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Recruitment strategies and costs for a community-based physical activity program.

PubMed

Peck, Lara E; Sharpe, Patricia A; Burroughs, Ericka L; Granner, Michelle L

2008-04-01

A community-based participatory research project using social marketing strategies was implemented to promote physical activity among women aged 35 to 54 who were insufficiently active or completely inactive. A variety of media were used to disseminate messages about how to enroll in Step Up. Step Out! This article describes the effectiveness and cost of the recruitment strategies and lessons learned in recruiting the women. Of the total inquiries (n = 691), 430 women were eligible and enrolled in the program. Based on data from questionnaires, the most effective method of recruiting women into Step Up. Step Out! was word of mouth (36%). Newspaper ads accounted for 29% of the women's responses. The least effective method was billboards. Mass media was not as effective in recruiting women for the program as interpersonal efforts such as word of mouth. Interpersonal efforts are a valuable and possibly underrated recruitment and promotion tool.

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia

PubMed Central

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer. PMID:26824695

Implementation of computer-based patient records in primary care: the societal health economic effects.

PubMed Central

Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.

1996-01-01

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland county, Sweden. MAIN OUTCOME MEASURES: Central implementation issues. First-year societal direct normal costs, direct unexpected costs, and indirect costs. Societal benefits. RESULTS: The total societal effect of the CPR implementation was a cost of nearly 250,000 SEK (USD 37,000) per GP team. About 20% of the effect consisted of direct unexpected costs, accured from the reduction of practitioners' leisure time. The main issues in the implementation process were medical informatics knowledge and computer skills, adaptation of the human-computer interaction design to practice routines, and information access through the CPR. CONCLUSIONS: The societal costs exceed the benefits during the first year after CPR implementation at the observed PHC centres. Early investments in requirements engineering and staff training may increase the efficiency. Exploitation of the CPR for disease prevention and clinical quality improvement is necessary to defend the investment in societal terms. The exact calculation of societal costs requires further analysis of the affected groups' willingness to pay. PMID:8947717

Costs and cost-effectiveness of a mobile phone text-message reminder programmes to improve health workers' adherence to malaria guidelines in Kenya.

PubMed

Zurovac, Dejan; Larson, Bruce A; Sudoi, Raymond K; Snow, Robert W

2012-01-01

Simple interventions for improving health workers' adherence to malaria case-management guidelines are urgently required across Africa. A recent trial in Kenya showed that text-message reminders sent to health workers' mobile phones improved management of pediatric outpatients by 25 percentage points. In this paper we examine costs and cost-effectiveness of this intervention. We evaluate costs and cost-effectiveness in 2010 USD under three implementation scenarios: (1) as implemented under study conditions in study areas; (2) if the intervention was routinely implemented by the Ministry of Health (MoH) in the same areas; and (3) if the intervention was scaled up nationally. Under study conditions, intervention costs were 19,342 USD, of which 45% were for developing and pretesting text-messages, 12% for developing text-message distribution system, 29% for collecting health workers' phone numbers, and 13% were costs of sending text-messages and monitoring of the system. If the intervention was implemented in the same areas by the MoH, the costs would be 28% lower (13,920 USD) due to lower costs of collecting health workers' numbers. The cost of national scale-up would be 97,350 USD, and the majority of these costs (66%) would be for sending text-messages. The cost per additional child correctly managed was 0.50 USD under study conditions, 0.36 USD if implemented by the MoH in the same area, and estimated at only 0.03 USD if implemented nationally. Even if the effect size was only 5% or the cost on the national scale was 400% higher than estimated, the cost per additional child correctly managed would be only 0.16 USD. A simple text-messaging intervention improving health worker adherence to malaria guidelines is effective and inexpensive. Further research is justified to optimize delivery of the intervention and expand targets beyond children and malaria disease.

Synthetic building materials for transport buildings and structures

NASA Astrophysics Data System (ADS)

Gerasimova, Vera

2017-10-01

The most effective building materials account for the highest growth not only in construction of residential and public buildings, but also other capital projects including roadways, bridges, drainage, communications and other engineering projects. Advancement in the technology of more efficient and ecologically responsible insulation materials have been a priority for safety, minimal maintenance and longevity of finished construction projects. The practical use of modern building materials such as insulation, sound reduction and low energy consumption are a benefit in cost and application compared to the use of outdated heavier and labor-intensive materials. The most efficient way for maximizing insolation and sound proofing should be done during the design stages of the project according to existing codes and regulations that are required by Western Government. All methods and materials that are used need to be optimized in order to reach a high durability and low operational and maintenance cost exceeding more than 50 years of the life of the building, whether it is for public, industrial or residential use. Western construction techniques and technologies need to be applied and adapted by the Russian Federation to insure the most productive successful methods are being implemented. The issues of efficient insulation materials are outlined in this article.

Family Health Services project: the way forward.

PubMed

Dabiri, O M

1993-01-01

Nigerians did not readily accept family planning when Family Health Services (FHS) began in 1988. FHS has made much headway in training, IEC (information, education, and communication), and constituency building and advocacy. Its staff have identified obstacles to implementation, especially program sustainability and management structure. Key limits to sustainability of IEC efforts were inadequately trained personnel and inability of trained personnel to apply what they learned at work stations. The Federal Ministry and Social Services' role in the FHS project was not clearly defined. Some private sector factors contributing to a confused management structure were inadequate method mix, high contraceptive cost, poor monitoring of quality of care, and no coordination of family planning training with the public factor. FHS has since decided to focus its efforts on increasing the demand for and availability of modern contraceptives and improving the quality of family planning services of both the public and private sectors. FHS hopes that accomplishing these activities will reduce fertility, morbidity, and mortality. Strategic plans include a regional focus, quality of care, a variety of methods offered, intensification, hospital and clinics, a management information system, contraceptive logistics, distribution regulations, and addressing social, cultural, and behavioral factors. To effectively implement the strategy, USAID and the Federal Ministry held a workshop in 1993 to effect full integration of Nigerian experience in the 2nd phase of the project (FHS II). Participants reviewed the strengths and weaknesses of the first phase and agreed on implementation. For example, nongovernmental organizations should implement FHS II. FHS II includes training, IEC, and commodities/logistics.

Recommendations for an Executive Information System (EIS) for the NASA Accounting and Financial Information System (NAFIS)

NASA Technical Reports Server (NTRS)

Goss, Ernest Preston

1991-01-01

The objectives were to: (1) survey state-of-the-art computing architectures, tools, and technologies for implementing an Executive Information System (EIS); (2) review MSFC capabilities and efforts in developing an EIS for Shuttle Projects Office and the Payloads Project Office; (3) review management reporting requirements for the NASA Accounting and Financial Information System (NAFIS) Project in the areas of cost, schedule, and technical performance, and insure that the EIS fully supports these requirements; and (4) develop and implement a pilot concept for a NAFIS EIS. A summary of the findings of this work is presented.

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

PubMed

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

2011-02-21

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

The Effectiveness, Costs and Coastal Protection Benefits of Natural and Nature-Based Defences.

PubMed

Narayan, Siddharth; Beck, Michael W; Reguero, Borja G; Losada, Iñigo J; van Wesenbeeck, Bregje; Pontee, Nigel; Sanchirico, James N; Ingram, Jane Carter; Lange, Glenn-Marie; Burks-Copes, Kelly A

2016-01-01

There is great interest in the restoration and conservation of coastal habitats for protection from flooding and erosion. This is evidenced by the growing number of analyses and reviews of the effectiveness of habitats as natural defences and increasing funding world-wide for nature-based defences-i.e. restoration projects aimed at coastal protection; yet, there is no synthetic information on what kinds of projects are effective and cost effective for this purpose. This paper addresses two issues critical for designing restoration projects for coastal protection: (i) a synthesis of the costs and benefits of projects designed for coastal protection (nature-based defences) and (ii) analyses of the effectiveness of coastal habitats (natural defences) in reducing wave heights and the biophysical parameters that influence this effectiveness. We (i) analyse data from sixty-nine field measurements in coastal habitats globally and examine measures of effectiveness of mangroves, salt-marshes, coral reefs and seagrass/kelp beds for wave height reduction; (ii) synthesise the costs and coastal protection benefits of fifty-two nature-based defence projects and; (iii) estimate the benefits of each restoration project by combining information on restoration costs with data from nearby field measurements. The analyses of field measurements show that coastal habitats have significant potential for reducing wave heights that varies by habitat and site. In general, coral reefs and salt-marshes have the highest overall potential. Habitat effectiveness is influenced by: a) the ratios of wave height-to-water depth and habitat width-to-wavelength in coral reefs; and b) the ratio of vegetation height-to-water depth in salt-marshes. The comparison of costs of nature-based defence projects and engineering structures show that salt-marshes and mangroves can be two to five times cheaper than a submerged breakwater for wave heights up to half a metre and, within their limits, become more cost effective at greater depths. Nature-based defence projects also report benefits ranging from reductions in storm damage to reductions in coastal structure costs.

The MobiSan approach: informal settlements of Cape Town, South Africa.

PubMed

Naranjo, A; Castellano, D; Kraaijvanger, H; Meulman, B; Mels, A; Zeeman, G

2010-01-01

Pook se Bos informal settlement and the Cape Town Water & Sanitation Services Department are partnering on an urban sanitation project with a Dutch Consortium consisting of Lettinga Associates Foundation (LeAF), Landustrie Sneek and Vitens-Evides International. The aim of the project is to improve the basic sanitation services provided in informal settlements through the implementation of the MobiSan approach. The approach consists of a communal Urine-Diversion and Dehydration Toilet (UDDT) built in a former sea shipping container. The system is independent of water, electricity or sewerage connection and it is maintained by full-time community caretakers who also act as hygiene promoters. The project seeks to link sanitation services with hygiene promotion in informal settlements while enhancing user satisfaction and reducing costs in providing basic sanitation services. This paper describes the preliminary experiences and lessons learnt during the implementation and evaluation of the MobiSan prototype and discusses its potential for replication. The MobiSan has proved to be an appropriate option by means of dealing successfully with shallow groundwater table, land availability and high settlement densities. In addition it has been demonstrated to be cost-competitive in terms of operating cost compared to chemical toilets.

Community Action Against Asthma

PubMed Central

Parker, Edith A; Israel, Barbara A; Williams, Melina; Brakefield-Caldwell, Wilma; Lewis, Toby C; Robins, Thomas; Ramirez, Erminia; Rowe, Zachary; Keeler, Gerald

2003-01-01

BACKGROUND Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. OBJECTIVE To conduct a process evaluation of the CAAA community–academic partnership. DESIGN In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING Community setting in Detroit, Michigan. PARTICIPANTS Twenty-three members of the CAAA SC. MEASUREMENTS Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to “a different way of doing things” in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved. PMID:12848839

Fort Irwin integrated resource assessment. Volume 3: Sitewide Energy Project identification for buildings and facilities

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

Keller, J.M.; Dittmer, A.L.; Elliott, D.B.

1995-02-01

The U.S. Army Forces Command (FORSCOM) has tasked the U.S. Department of Energy (DOE) Federal Energy Management Program (FEMP), supported by the Pacific Northwest Laboratory, to identify, evaluate, and assist in acquiring all cost-effective energy projects at Fort Irwin. This is part of a model program that PNL is designing to support energy-use decisions in the federal sector. This report provides the results of the fossil fuel and electric energy resource opportunity (ERO) assessments performed by PNL at the FORSCOM Fort Irwin facility located near Barstow, California. It is a companion report to Volume 1, Executive Summary, and Volume 2,more » Baseline Detail. The results of the analyses of EROs are presented in 16 common energy end-use categories (e.g., boilers and furnaces, service hot water, and building lighting). A narrative description of each ERO is provided, along with a table detailing information on the installed cost, energy and dollar savings; impacts on operations and maintenance (O&M); and, when applicable, a discussion of energy supply and demand, energy security, and environmental issues. A description of the evaluation methodologies and technical and cost assumptions is also provided for each ERO. Summary tables present the cost-effectiveness of energy end-use equipment before and after the implementation of each ERO and present the results of the life-cycle cost (LCC) analysis indicating the net present valve (NPV) and savings-to-investment ratio (SIR) of each ERO.« less

Forest Protection and Reforestation in Costa Rica: Evaluation of a Clean Development Mechanism Prototype.

PubMed

Subak

2000-09-01

/ Costa Rica has recently established a program that provides funds for reforestation and forest protection on private lands, partly through the sale of carbon certificates to industrialized countries. Countries purchasing these carbon offsets hope one day to receive credit against their own commitments to limit emissions of greenhouse gases. Costa Rica has used the proceeds of the sale of carbon offsets to Norway to help finance this forest incentive program, called the Private Forestry Project, which pays thousands of participants to reforest or protect forest on their lands. The Private Forestry Project is accompanied by a monitoring program conducted by Costa Rican forest engineers that seeks to determine net carbon storage accomplished on these lands each year. The Private Forestry Project, which is officially registered as an Activity Implemented Jointly, is a possible model for bundled projects funded by the Clean Development Mechanism (CDM) established by the 1997 Kyoto Protocol to the UN Framework Convention on Climate Change. It also serves as an interesting example for the CDM because it was designed by a developing country host-not by an industrialized country investor. Accordingly, it reflects the particular "sustainable development" objectives of the host country or at least the host planners. Early experience in implementing the Private Forestry Project is evaluated in light of the main objectives of the CDM and its precursor-Activities Implemented Jointly. It is concluded that the project appears to meet the criteria of global cost-effectiveness and financing from non-ODA sources. The sustainable development implications of the project are specific to the region and would not necessarily match the ideals of all investing and developing countries. The project may be seen to achieve additional greenhouse gas abatement when compared against some (although not all) baselines.

Engaging stakeholder communities as body image intervention partners: The Body Project as a case example.

PubMed

Becker, Carolyn Black; Perez, Marisol; Kilpela, Lisa Smith; Diedrichs, Phillippa C; Trujillo, Eva; Stice, Eric

2017-04-01

Despite recent advances in developing evidence-based psychological interventions, substantial changes are needed in the current system of intervention delivery to impact mental health on a global scale (Kazdin & Blase, 2011). Prevention offers one avenue for reaching large populations because prevention interventions often are amenable to scaling-up strategies, such as task-shifting to lay providers, which further facilitate community stakeholder partnerships. This paper discusses the dissemination and implementation of the Body Project, an evidence-based body image prevention program, across 6 diverse stakeholder partnerships that span academic, non-profit and business sectors at national and international levels. The paper details key elements of the Body Project that facilitated partnership development, dissemination and implementation, including use of community-based participatory research methods and a blended train-the-trainer and task-shifting approach. We observed consistent themes across partnerships, including: sharing decision making with community partners, engaging of community leaders as gatekeepers, emphasizing strengths of community partners, working within the community's structure, optimizing non-traditional and/or private financial resources, placing value on cost-effectiveness and sustainability, marketing the program, and supporting flexibility and creativity in developing strategies for evolution within the community and in research. Ideally, lessons learned with the Body Project can be generalized to implementation of other body image and eating disorder prevention programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Report on the Loss of the Mars Polar Lander and Deep Space 2 Missions

NASA Technical Reports Server (NTRS)

Albee, Arden; Battel, Steven; Brace, Richard; Burdick, Garry; Casani, John; Lavell, Jeffrey; Leising, Charles; MacPherson, Duncan; Burr, Peter; Dipprey, Duane

2000-01-01

NASA's Mars Surveyor Program (MSP) began in 1994 with plans to send spacecraft to Mars every 26 months. Mars Global Surveyor (MGS), a global mapping mission, was launched in 1996 and is currently orbiting Mars. Mars Surveyor '98 consisted of Mars Climate Orbiter (MCO) and Mars Polar Lander (MPL). Lockheed Martin Astronautics (LMA) was the prime contractor for Mars Surveyor '98. The Jet Propulsion Laboratory (JPL), California Institute of Technology, manages the Mars Surveyor Program for NASA's Office of Space Science. MPL was developed under very tight funding constraints. The combined development cost of MPL and MCO, including the cost of the two launch vehicles, was approximately the same as the development cost of the Mars Pathfinder mission, including the cost of its single launch vehicle. The MPL project accepted the challenge to develop effective implementation methodologies consistent with programmatic requirements.

Implementation and utilization of a comprehensive information network in an integrated private not-for-profit regional health care system

NASA Astrophysics Data System (ADS)

Long, James M., III

1995-10-01

The capacity to access, integrate, and analyze demographic, financial, and clinical data within a regional health care system represents an opportunity to ensure and enhance clinical quality and to reduce costs in a carefully planned and controlled manner. Properly used, such capability should improve health care delivery for local populations and provide the institution with a level of integration of services achieved by few health care organizations. The Baptist Health System (BHS), based in Birmingham, Alabama, is currently standardizing operating procedures among its various components and implementing a comprehensive, enterprise-wide information network. Clinical quality improvement and case management are being promulgated throughout the enterprise using a continuum-of-care model developed internally. Having successfully completed a pilot project using teleconferences for core lectures in internal medicine between two large teaching hospitals, BHS is taking advantage of enterprise- wide teleconference capability using a combination of fiberoptic (T3) and standard digital telephone (T1) transmission to speed installation and reduce the cost of implementation into two office buildings and eleven hospitals. The information system will serve to prepare BHS for the advent of managed care and other anticipated changes in health care, while ensuring continued ability to deliver high quality, cost-effective medical and health-related services.

Spacelab dedicated discipline laboratory (DDL) utilization concept

NASA Technical Reports Server (NTRS)

Wunsch, P.; De Sanctis, C.

1984-01-01

The dedicated discipline laboratory (DDL) concept is a new approach for implementing Spacelab missions that involves the grouping of science instruments into mission complements of single or compatible disciplines. These complements are evolved in such a way that the DDL payloads can be left intact between flights. This requires the dedication of flight hardware to specific payloads on a long-term basis and raises the concern that the purchase of additional flight hardware will be required to implement the DDL program. However, the payoff is expected to result in significant savings in mission engineering and assembly effort. A study has been conducted recently to quantify both the requirements for new hardware and the projected mission cost savings. It was found that some incremental additions to the current inventory will be needed to fly the mission model assumed. Cost savings of $2M to 6.5M per mission were projected in areas analyzed in depth, and additional savings may occur in areas for which detailed cost data were not available.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

PubMed

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

A review of BIM (Building Information Modeling) implementation in Indonesia construction industry

NASA Astrophysics Data System (ADS)

Suryadinata Telaga, Abdi

2018-05-01

Construction projects in Indonesia have been growing rapidly in the last three years. Therefore, construction management is very important to ensure completion of construction projects are within schedule and budget. Utilization of building information modeling (BIM) can increase the efficiency of a construction project. However, the implementation of BIM in Indonesia is still not known. This paper is intended to review the implementation of BIM in Indonesia through literature analysis. To find BIM articles in Indonesia, Firstly, searching was limited to English articles published in reputed journals or conferences. However the results were limited, then the search was expanded to the article using Indonesian languages that published in journal and conference. Based on the number of articles, the results showed that BIM research in Indonesia is still in a dearth. Furthermore, BIM study cases were conducted in a limited location and within a small population. Nevertheless, the literature shared the conclusion that BIM can increase project efficiency, but the implementation was hindered by high initial investment cost, inadequate human resources, small demand, and technology resistant. The research contributes to providing a current reported level of BIM implementation in Indonesia. In the future research to study of BIM implementation comprehensively in Indonesia is eminent.

Improvement of General Electric’s Chilled Ammonia Process with the use of Membrane Technology

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

Muraskin, Dave; Dube, Sanjay; Baburao, Barath

General Electric Environmental Control Solutions (formerly Alstom Power Environmental Control Systems) set out to complete the Phase 1 award requirements for a Phase II renewal application for their project selected under DOE-FOA-0001190 “Small and Large Scale Pilots for Reducing the Cost of CO 2 Capture and Compression”. The project focus was to implement several improvement concepts utilizing membrane technology at the recipient’s Chilled Ammonia Process (CAP) CO 2 capture large-scale pilot plant. The goal was to lower the overall cost of technology. During the development of costs for the preliminary techno-economic assessment (TEA), it became clear that the capital andmore » operating costs of this concept were not economically attractive. All work related to a Phase II renewal application at that point was halted as GE made the decision not to submit a Phase II renewal application. Discussions with DOE resulted in a path towards useful information produced from the design and cost work already completed on the project. With the reverse osmosis (RO) unit providing most of the cost issues, GE would provide a sensitivity analysis of the RO unit with respect to project cost. This information would be included with the Techno-Economic Analysis along with the Technology Gap Analysis.« less

Civil Service Workforce Market Supply and the Effect on the Cost Estimating Relationships (CERs) that may effect the Productivity Factors for Future NASA Missions

NASA Technical Reports Server (NTRS)

Sterk, Steve; Chesley, Stephen

2008-01-01

The upcoming retirement of the Baby Boomers on the horizon will leave a performance gap between younger generation (the future NASA decision makers) and the gray beards. This paper will reflect on the average age of workforce across NASA Centers, the Aerospace Industry and other Government Agencies, like DoD. This papers will dig into Productivity and Realization Factors and how they get applied to bimonthly (payroll data) for true FTE calculations that could be used at each of the NASA Centers and other business systems that are on the forefront in being implemented. This paper offers some comparative costs solutions, from simple - full time equivalent (FTE) cost estimating relationships CERs, to complex - CERs for monthly time-phasing activities for small research projects that start and get completed within a government fiscal year. This paper will present the results of a parametric study investigating the cost-effectiveness of different alternatives performance based cost estimating relationships (CERs) and how they get applied into the Center s forward pricing rate proposals (FPRP). True CERs based on the relationship of a younger aged workforce will have some effects on labor rates used in both commercial cost models and internal home-grown cost models which may impact the productivity factors for future NASA missions.

The new concept of hospital--the strategic plan of the "Policlinico A. Gemelli" and positioning of the reengineering project.

PubMed

Cicchetti, A

1998-01-01

The innovations introduced in the Italian Health Care System by the legislative decrees No. 502/92 and 517/93 are remarkable, drawing on managerial methods and organizational structure of hospitals. To face this kind of change, in 1995 the "Policlinico A. Gemelli" prepared a five-year Strategic Plan that gave strategical lines and targets to be pursued. This plan has isolated 3 main strategical projects to be implemented with the participation of all medical and managerial professionals operating in the "Policlinico". The most complex project is that of the reengineering of management processes, we expect to end during 1998. The main target is to check the fundamental factors involved with the aim of achieving patient satisfaction as well as a cost-effective management.

End-of-Life Care in the Intensive Care Unit

PubMed Central

Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

2012-01-01

The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

Analysis of renewable energy projects' implementation in Russia

NASA Astrophysics Data System (ADS)

Ratner, S. V.; Nizhegorodtsev, R. M.

2017-06-01

With the enactment in 2013 of a renewable energy scheme by contracting qualified power generation facilities working on renewable energy sources (RES), the process of construction and connection of such facilities to the Federal Grid Company has intensified in Russia. In 2013-2015, 93 projects of solar, wind, and small hydropower energy were selected on the basis of competitive bidding in the country with the purpose of subsequent support. Despite some technical and organizational problems and a time delay of some RES projects, in 2014-2015 five solar generating facilities with total capacity of 50 MW were commissioned, including 30 MW in Orenburg oblast. However, the proportion of successful projects is low and amounts to approximately 30% of the total number of announced projects. The purpose of this paper is to analyze the experience of implementation of renewable energy projects that passed through a competitive selection and gained the right to get a partial compensation for the construction and commissioning costs of RES generating facilities in the electric power wholesale market zone. The informational background for the study is corporate reports of project promoters, analytical and information materials of the Association NP Market Council, and legal documents for the development of renewable energy. The methodological base of the study is a theory of learning curves that assumes that cost savings in the production of high-tech products depends on the production growth rate (economy of scale) and gaining manufacturing experience (learning by doing). The study has identified factors that have a positive and a negative impact on the implementation of RES projects. Improvement of promotion measures in the renewable energy development in Russia corresponding to the current socio-economic situation is proposed.

Technical and Economic Assessment of the Implementation of Measures for Reducing Energy Losses in Distribution Systems

NASA Astrophysics Data System (ADS)

Aguila, Alexander; Wilson, Jorge

2017-07-01

This paper develops a methodology to assess a group of measures of electrical improvements in distribution systems, starting from the complementation of technical and economic criteria. In order to solve the problem of energy losses in distribution systems, technical and economic analysis was performed based on a mathematical model to establish a direct relationship between the energy saved by way of minimized losses and the costs of implementing the proposed measures. This paper aims at analysing the feasibility of reducing energy losses in distribution systems, by changing existing network conductors by larger crosssection conductors and distribution voltage change at higher levels. The impact of this methodology provides a highly efficient mathematical tool for analysing the feasibility of implementing improvement projects based on their costs which is a very useful tool for the distribution companies that will serve as a starting point to the analysis for this type of projects in distribution systems.

Avoidable cost of alcohol abuse in Canada.

PubMed

Rehm, Jürgen; Patra, Jayadeep; Gnam, William H; Sarnocinska-Hart, Anna; Popova, Svetlana

2011-01-01

To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree. Copyright © 2010 S. Karger AG, Basel.

Assessing the feasibility, cost, and utility of developing models of human performance in aviation

NASA Technical Reports Server (NTRS)

Stillwell, William

1990-01-01

The purpose of the effort outlined in this briefing was to determine whether models exist or can be developed that can be used to address aviation automation issues. A multidisciplinary team has been assembled to undertake this effort, including experts in human performance, team/crew, and aviation system modeling, and aviation data used as input to such models. The project consists of two phases, a requirements assessment phase that is designed to determine the feasibility and utility of alternative modeling efforts, and a model development and evaluation phase that will seek to implement the plan (if a feasible cost effective development effort is found) that results from the first phase. Viewgraphs are given.

A Nurse-Directed Model for Nitrous Oxide Use During Labor.

PubMed

Pinyan, Toni; Curlee, Kelly; Keever, Mellanie; Baldwin, Kathleen M

Nitrous oxide has a long history of use and has been well documented in the literature as a safe, effective, and inexpensive option for pain management in labor in other countries, but it is underused in the United States. Pain relief options for laboring women in rural community hospitals with a small perinatal service are limited due to lack of availability of in-house anesthesia coverage. This quality improvement project involved development and implementation of a nurse-driven, self-administered, demand-flow nitrous oxide program as an option for pain relief for laboring women in a rural community hospital. Women's Services registered nurses developed the project using an interdisciplinary team approach based on an extensive literature review and consultation with experts across the country. The hospital is part of a large healthcare system; approval was sought and obtained by the system as part of the project. Cost analysis and patient satisfaction data were evaluated. Outcomes were monitored. Approximately one half of the patients who have given birth at the hospital since initiation of the project have used nitrous oxide during labor. The majority of women who participated in a survey after birth found it helpful during mild-to-moderate labor pain. No adverse effects have noted in either the mother or the baby following nitrous oxide use. Initiation and management of nitrous oxide by registered nurses is a safe and cost-effective option for labor pain. It may be especially beneficial in hospitals that do not have 24/7 in-house anesthesia coverage.

Management experiences and trends for water reuse implementation in Northern California.

PubMed

Bischel, Heather N; Simon, Gregory L; Frisby, Tammy M; Luthy, Richard G

2012-01-03

In 2010, California fell nearly 300,000 acre-ft per year (AFY) short of its goal to recycle 1,000,000 AFY of municipal wastewater. Growth of recycled water in the 48 Northern California counties represented only 20% of the statewide increase in reuse between 2001 and 2009. To evaluate these trends and experiences, major drivers and challenges that influenced the implementation of recycled water programs in Northern California are presented based on a survey of 71 program managers conducted in 2010. Regulatory requirements limiting discharge, cited by 65% of respondents as a driver for program implementation, historically played an important role in motivating many water reuse programs in the region. More recently, pressures from limited water supplies and needs for system reliability are prevalent drivers. Almost half of respondents (49%) cited ecological protection or enhancement goals as drivers for implementation. However, water reuse for direct benefit of natural systems and wildlife habitat represents just 6-7% of total recycling in Northern California and few financial incentives exist for such projects. Economic challenges are the greatest barrier to successful project implementation. In particular, high costs of distribution systems (pipelines) are especially challenging, with $1 to 3 million/mile costs experienced. Negative perceptions of water reuse were cited by only 26% of respondents as major hindrances to implementation of surveyed programs.

Decision support for the management of water resources at Sub-middle of the São Francisco river basin in Brazil using integrated hydro-economic modeling and scenarios for land use changes

NASA Astrophysics Data System (ADS)

Moraes, M. G. A.; Souza da Silva, G.

2016-12-01

Hydro-economic models can measure the economic effects of different operating rules, environmental restrictions, ecosystems services, technical constraints and institutional constraints. Furthermore, water allocation can be improved by considering economical criteria's. Likewise, climate and land use change can be analyzed to provide resilience. We developed and applied a hydro-economic optimization model to determine the optimal water allocation of main users in the Lower-middle São Francisco River Basin in Northeast (NE) Brazil. The model uses demand curves for the irrigation projects, small farmers and human supply, rather than fixed requirements for water resources. This study analyzed various constraints and operating alternatives for the installed hydropower dams in economic terms. A seven-year period (2000-2006) with water scarcity in the past has been selected to analyze the water availability and the associated optimal economic water allocation. The used constraints are technical, socioeconomic and environmental. The economically impacts of scenarios like prioritizing human consumption, impacts of the implementation of the São Francisco river transposition, human supply without high distribution losses, environmental hydrographs, forced reservoir level control, forced reduced reservoir capacity, alteration of lower flow restriction were analyzed. The results in this period show that scarcity costs related ecosystem service and environmental constraints are significant, and have major impacts (increase of scarcity cost) for consumptive users like irrigation projects. In addition, institutional constraints such as prioritizing human supply, minimum release limits downstream of the reservoirs and the implementation of the transposition project impact the costs and benefits of the two main economic sectors (irrigation and power generation) in the region of the Lower-middle of the São Francisco river basin. Scarcity costs for irrigation users generally increase more (in percentage terms) than the other users associated to environmental and institutional constraints.

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

PubMed

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Impact of Early Design Phase Risk Identification Biases on Space System Project Performance

NASA Technical Reports Server (NTRS)

Reeves, John D., Jr.; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar

2012-01-01

Risk identification during the early design phases of complex systems is commonly implemented but often fails to result in the identification of events and circumstances that truly challenge project performance. Inefficiencies in cost and schedule estimation are usually held accountable for cost and schedule overruns, but the true root cause is often the realization of programmatic risks. A deeper understanding of frequent risk identification trends and biases pervasive during space system design and development is needed, for it would lead to improved execution of existing identification processes and methods.

Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines.

PubMed

Newall, A T; Jit, M; Hutubessy, R

2014-06-01

The World Health Organization's CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the 'WHO-CHOICE thresholds' reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices.

Geocoding and social marketing in Alabama's cancer prevention programs.

PubMed

Miner, Julianna W; White, Arica; Lubenow, Anne E; Palmer, Sally

2005-11-01

The Alabama Department of Public Health (ADPH) is collaborating with the National Cancer Institute to develop detailed profiles of underserved Alabama communities most at risk for cancer. These profiles will be combined with geocoded data to create a pilot project, Cancer Prevention for Alabama's Underserved Populations: A Focused Approach. The project's objectives are to provide the ADPH's cancer prevention programs with a more accurate and cost-effective means of planning, implementing, and evaluating its prevention activities in an outcomes-oriented and population-appropriate manner. The project links geocoded data from the Alabama Statewide Cancer Registry with profiles generated by the National Cancer Institute's cancer profiling system, Consumer Health Profiles. These profiles have been successfully applied to market-focused cancer prevention messages across the United States. The ADPH and the National Cancer Institute will evaluate the efficacy of using geocoded data and lifestyle segmentation information in strategy development and program implementation. Alabama is the first state in the nation not only to link geocoded cancer registry data with lifestyle segmentation data but also to use the National Cancer Institute's profiles and methodology in combination with actual state data.

Liquid lens: advances in adaptive optics

NASA Astrophysics Data System (ADS)

Casey, Shawn Patrick

2010-12-01

'Liquid lens' technologies promise significant advancements in machine vision and optical communications systems. Adaptations for machine vision, human vision correction, and optical communications are used to exemplify the versatile nature of this technology. Utilization of liquid lens elements allows the cost effective implementation of optical velocity measurement. The project consists of a custom image processor, camera, and interface. The images are passed into customized pattern recognition and optical character recognition algorithms. A single camera would be used for both speed detection and object recognition.

Analysis of the effectiveness of industrial R and D. [costs and impact on economic growth

NASA Technical Reports Server (NTRS)

Fisher, W. H.; Kleiman, H. S.; Moore, J. L.; Triplett, M. B.

1976-01-01

The criteria used by private industry in evaluating and selecting proposed research and development projects for implementation, and also in determining which R and D facilities are to be acquired were investigated. Conceptual and practical issues inherent in any quantitative analysis of the contribution of R and D to economic growth were identified in order to assist NASA in developing approaches for analzying the economic implication of its own R and D efforts.

'Emerging technologies for the changing global market' - Prioritization methodology for chemical replacement

NASA Technical Reports Server (NTRS)

Cruit, Wendy; Schutzenhofer, Scott; Goldberg, Ben; Everhart, Kurt

1993-01-01

This project served to define an appropriate methodology for effective prioritization of technology efforts required to develop replacement technologies mandated by imposed and forecast legislation. The methodology used is a semiquantitative approach derived from quality function deployment techniques (QFD Matrix). This methodology aims to weight the full environmental, cost, safety, reliability, and programmatic implications of replacement technology development to allow appropriate identification of viable candidates and programmatic alternatives. The results will be implemented as a guideline for consideration for current NASA propulsion systems.

Emerging technologies for the changing global market

NASA Technical Reports Server (NTRS)

Cruit, Wendy; Schutzenhofer, Scott; Goldberg, Ben; Everhart, Kurt

1993-01-01

This project served to define an appropriate methodology for effective prioritization of technology efforts required to develop replacement technologies mandated by imposed and forecast legislation. The methodology used is a semi-quantative approach derived from quality function deployment techniques (QFD Matrix). This methodology aims to weight the full environmental, cost, safety, reliability, and programmatic implications of replacement technology development to allow appropriate identification of viable candidates and programmatic alternatives. The results will be implemented as a guideline for consideration for current NASA propulsion systems.

Implementing genetic education in primary care: the Gen-Equip programme.

PubMed

Paneque, Milena; Cornel, Martina C; Curtisova, Vaclava; Houwink, Elisa; Jackson, Leigh; Kent, Alastair; Lunt, Peter; Macek, Milan; Stefansdottir, Vigdis; Turchetti, Daniela; Skirton, Heather

2017-04-01

Genetics and genomics are increasingly relevant to primary healthcare but training is unavailable to many practitioners. Education that can be accessed by practitioners without cost or travel is essential. The Gen-Equip project was formed to provide effective education in genetics for primary healthcare in Europe and so improve patient care. Partners include patient representatives and specialists in genetics and primary care from six countries. Here, we report the progress and challenges involved in creating a European online educational program in genetics.