Immersion frying for the thermal drying of sewage sludge: an economic assessment.

PubMed

Peregrina, Carlos; Rudolph, Victor; Lecomte, Didier; Arlabosse, Patricia

2008-01-01

This paper presents an economic study of a novel thermal fry-drying technology which transforms sewage sludge and recycled cooking oil (RCO) into a solid fuel. The process is shown to have significant potential advantage in terms of capital costs (by factors of several times) and comparable operating costs. Three potential variants of the process have been simulated and costed in terms of both capital and operating requirements for a commercial scale of operation. The differences are in the energy recovery systems, which include a simple condensation of the evaporated water and two different heat pump configurations. Simple condensation provides the simplest process, but the energy efficiency gain of an open heat pump offset this, making it economically somewhat more attractive. In terms of operating costs, current sludge dryers are dominated by maintenance and energy requirements, while for fry-drying these are comparatively small. Fry-drying running costs are dominated by provision of makeup waste oil. Cost reduction could focus on cheaper waste oil, e.g. from grease trap waste.

Cost-effectiveness of simultaneous versus sequential surgery in head and neck reconstruction.

PubMed

Wong, Kevin K; Enepekides, Danny J; Higgins, Kevin M

2011-02-01

To determine whether simultaneous (ablation and reconstruction overlaps by two teams) head and neck reconstruction is cost effective compared to sequentially (ablation followed by reconstruction) performed surgery. Case-controlled study. Tertiary care hospital. Oncology patients undergoing free flap reconstruction of the head and neck. A match paired comparison study was performed with a retrospective chart review examining the total time of surgery for sequential and simultaneous surgery. Nine patients were selected for both the sequential and simultaneous groups. Sequential head and neck reconstruction patients were pair matched with patients who had undergone similar oncologic ablative or reconstructive procedures performed in a simultaneous fashion. A detailed cost analysis using the microcosting method was then undertaken looking at the direct costs of the surgeons, anesthesiologist, operating room, and nursing. On average, simultaneous surgery required 3 hours 15 minutes less operating time, leading to a cost savings of approximately $1200/case when compared to sequential surgery. This represents approximately a 15% reduction in the cost of the entire operation. Simultaneous head and neck reconstruction is more cost effective when compared to sequential surgery.

Hospital financing: calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme.

PubMed

Vogl, Matthias

2014-04-01

The paper analyzes the German inpatient capital costing scheme by assessing its cost module calculation. The costing scheme represents the first separated national calculation of performance-oriented capital cost lump sums per DRG. The three steps in the costing scheme are reviewed and assessed: (1) accrual of capital costs; (2) cost-center and cost category accounting; (3) data processing for capital cost modules. The assessment of each step is based on its level of transparency and efficiency. A comparative view on operating costing and the English costing scheme is given. Advantages of the scheme are low participation hurdles, low calculation effort for G-DRG calculation participants, highly differentiated cost-center/cost category separation, and advanced patient-based resource allocation. The exclusion of relevant capital costs, nontransparent resource allocation, and unclear capital cost modules, limit the managerial relevance and transparency of the capital costing scheme. The scheme generates the technical premises for a change from dual financing by insurances (operating costs) and state (capital costs) to a single financing source. The new capital costing scheme will intensify the discussion on how to solve the current investment backlog in Germany and can assist regulators in other countries with the introduction of accurate capital costing. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Refractory Materials for Flame Deflector Protection System Corrosion Control: Flame Deflector Protection System Life Cycle Cost Analysis Report

NASA Technical Reports Server (NTRS)

Calle, Luz Marina; Hintze, Paul E.; Parlier, Christopher R.; Coffman, Brekke E.; Kolody, Mark R.; Curran, Jerome P.; Trejo, David; Reinschmidt, Ken; Kim, Hyung-Jin

2009-01-01

A 20-year life cycle cost analysis was performed to compare the operational life cycle cost, processing/turnaround timelines, and operations manpower inspection/repair/refurbishment requirements for corrosion protection of the Kennedy Space Center launch pad flame deflector associated with the existing cast-in-place materials and a newer advanced refractory ceramic material. The analysis compared the estimated costs of(1) continuing to use of the current refractory material without any changes; (2) completely reconstructing the flame trench using the current refractory material; and (3) completely reconstructing the flame trench with a new high-performance refractory material. Cost estimates were based on an analysis of the amount of damage that occurs after each launch and an estimate of the average repair cost. Alternative 3 was found to save $32M compared to alternative 1 and $17M compared to alternative 2 over a 20-year life cycle.

24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

Code of Federal Regulations, 2012 CFR

2012-04-01

... bills directly to the utility company, then the development's monthly operating cost per occupied unit... Authority and its affected developments. c. As an example of estimating development operating costs from PHA... divided by 270, the product of 22.5 and 12, to give a cost per unit month of $222. C. Accrual The monthly...

A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

PubMed

Hillel, Alexander T; Ochsner, Matthew C; Johns, Michael M; Klein, Adam M

2016-06-01

To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). Retrospective review of billing records. Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. NA Laryngoscope, 126:1385-1389, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Economics of modern long-haul cargo airships

NASA Technical Reports Server (NTRS)

Ardema, M. D.

1977-01-01

The economic characteristics and historical trends of long-haul air transportation are discussed. Various published estimates of modern airship direct operating costs are presented and comparatively analyzed. The large discrepancies in these estimates are in large measure explained, allowing airship direct operating costs to be estimated with some confidence. Indirect costs are also briefly discussed. Projected airship operating costs are compared with actual costs of competing modes such as airplanes, trucks, rail, and pipelines, and it is concluded that airships cannot economically compete with other long-haul modes. Thus attention is drawn to short-haul applications of the airship; and because short-haul missions lead to vehicle requirements that are considerably different from those for long-haul missions, it is concluded that the civil airship of the future is likely to bear little resemblance to those of the past.

Economic evaluation of DSS 13 unattended operations demonstration

NASA Technical Reports Server (NTRS)

Remer, D. S.; Eisenberger, I.; Lorden, G.

1978-01-01

The goals and data collection requirements to be used for the economic and performance evaluation indexes and life cycle cost parameters for the upcoming operations demonstration of an automated Deep Space Station (DSS) run unattended and controlled remotely from JPL are presented. These evaluation indexes compare the remote operation of telemetry at DSS 13 with the cost and performance of a comparable manned operation at DSS 11. A description is presented of the data that needs to be collected, how the data will be analyzed, and what can and cannot be learned from this operations demonstration.

Direct Cost Analysis of Outpatient Arthroscopic Rotator Cuff Repair in Medicare and Non-Medicare Populations.

PubMed

Narvy, Steven J; Didinger, Tracey C; Lehoang, David; Vangsness, C Thomas; Tibone, James E; Hatch, George F Rick; Omid, Reza; Osorno, Felipe; Gamradt, Seth C

2016-10-01

Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments. The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers. We hypothesized that operative time, implant cost, and overall higher cost would be observed in Medicare patients. Cohort study; Level of evidence, 3. Billing and operative reports from 184 outpatient arthroscopic rotator cuff repairs performed by 5 fellowship-trained arthroscopic surgeons were reviewed. Operative time, number and cost of implants, hospital reimbursement, surgeon reimbursement, and insurance type were determined from billing records and operative reports. Patients were stratified by payer (Medicare vs non-Medicare), and these variables were compared. There were no statistically significant differences in the number of suture anchors used, implant cost, surgical duration, or overall cost of arthroscopic rotator cuff repair between Medicare and other insurers. Reimbursement was significantly higher for other payers when compared with Medicare, resulting in a mean per case deficit of $263.54 between billing and reimbursement for Medicare patients. Operating room time, implant cost, and total procedural cost was the same for Medicare patients as for patients with private payers. Further research needs to be conducted to understand the patient-specific factors that affect the cost of an episode of care for rotator cuff surgery.

Coming Up Short: 35th Annual M&O Cost Study

ERIC Educational Resources Information Center

Agron, Joe

2006-01-01

As the nation's school buildings age and deteriorate, spending on maintenance and operations (M&O) remains paltry, especially when compared with historical figures. This article presents the findings of "American School & University's" 35th annual Maintenance and Operations Cost Study. According to the M&O Cost Study, the median school district…

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

PubMed

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

2012-01-01

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

Cost comparisons for three harvesting systems operating in northern hardwood stands

Treesearch

Chris B. LeDoux; Neil K. Huyler

2000-01-01

Production rates, break-even piece (tree) sizes/costs (BEP), and operating costs were compared for a Koller K-300 cable yarder, a cut-to-length (CTL) harvester, and an A60F Holder tractor operating at three machine utilization rates (MUR) in northern hardwood stands. At an average product price of $0.40/ft3, the BEP size at an MUR of 90 was 7.64 ft3 for the Koller...

Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Cost Analysis of 57 Operations in a 10-year Experience at a Major Deformity Center.

PubMed

Theologis, Alexander A; Miller, Liane; Callahan, Matt; Lau, Darryl; Zygourakis, Corinna; Scheer, Justin K; Burch, Shane; Pekmezci, Murat; Chou, Dean; Tay, Bobby; Mummaneni, Praveen; Berven, Sigurd; Deviren, Vedat; Ames, Christopher P

2016-08-15

Retrospective cohort analysis. To evaluate the economic impact of revision surgery for proximal junctional failures (PJF) after thoracolumbar fusions for adult spinal deformity (ASD). PJF after fusions for ASD is a major cause of disability. Although clinical sequelae are described, PJF-revision operation costs are incompletely defined. Consecutive adults who underwent thoracolumbar fusions for ASD (August, 2003 to January, 2013) were evaluated. Inclusion criteria include construct from pelvis to L2 or above and minimum 6 months follow-up after the index ASD operation. Direct costs (surgical supplies/implants, room/care, pharmacy, services) were identified from medical billing data and calculated for index ASD operations and subsequent surgeries for PJF. Not included in direct cost data were indirect costs, charges, surgeon fees, or revision operations for indications other than PJF (i.e., pseudarthrosis). Patients were compared based on the construct's upper-instrumented vertebra: upper thoracic (UT: T1-6) versus thoracolumbar junction (TLjxn: T9-L2). Of 501 patients, 382 met inclusion criteria. Fifty-one patients [UT:14; TLjxn: 40 at index; average follow-up 32.6 months (6-92 months)] had revisions for PJF, which summed to $3.2 million total direct cost. Average direct cost of index operations for the cohort ($68,294) was significantly greater than PJF-revisions ($55,547). Compared with TLjxn, UT had a significantly higher average cost for index operations ($79,860 vs. $65,868). However, PJF-revision cases were similar in average cost (UT:$60,103; TLjxn:$53,920; P = 0.09). Costs of PJF amounted to an additional 12.1% of the total index surgical cost in 382 patients. Revision operations for PJF after long thoracolumbar fusions for ASD are associated with an average direct cost of $55,547 per case. Revision costs for PJF are similar based on the index procedure's upper-instrumented vertebra level. At a major tertiary center over a 10-year period, PJF came at a very significant economic expense amounting to $3.2 million for 57 cases. 3.

48 CFR 52.248-1 - Value Engineering.

Code of Federal Regulations, 2011 CFR

2011-10-01

... contract requirement and the proposed requirement, the comparative advantages and disadvantages of each, a... not rewardable under performance, design-to-cost (production unit cost, operating and support costs...

48 CFR 52.248-1 - Value Engineering.

Code of Federal Regulations, 2013 CFR

2013-10-01

... contract requirement and the proposed requirement, the comparative advantages and disadvantages of each, a... not rewardable under performance, design-to-cost (production unit cost, operating and support costs...

48 CFR 52.248-1 - Value Engineering.

Code of Federal Regulations, 2012 CFR

2012-10-01

... contract requirement and the proposed requirement, the comparative advantages and disadvantages of each, a... not rewardable under performance, design-to-cost (production unit cost, operating and support costs...

48 CFR 52.248-1 - Value Engineering.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contract requirement and the proposed requirement, the comparative advantages and disadvantages of each, a... not rewardable under performance, design-to-cost (production unit cost, operating and support costs...

48 CFR 52.248-1 - Value Engineering.

Code of Federal Regulations, 2014 CFR

2014-10-01

... contract requirement and the proposed requirement, the comparative advantages and disadvantages of each, a... not rewardable under performance, design-to-cost (production unit cost, operating and support costs...

Comparative Unit Cost and Wage Rate Report on Maintenance and Operation of Physical Plants of Universities and Colleges.

ERIC Educational Resources Information Center

Association of Physical Plant Administrators of Universities and Colleges, Washington, DC.

This report presents the results of a questionnaire from 161 members of the Association of Physical Plant Administrators of Universities and Colleges (APPA). The purpose of this report is to compile and present comparative cost data for the maintenance and operation of physical plants of universities and colleges for the fiscal year 1972-73. The…

Lessons Learned for Planning and Estimating Operations Support Requirements

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn

2011-01-01

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

New generation cut-and-seal devices in oral and oropharyngeal cancer resection: clinical and cost-effectiveness study.

PubMed

Tirelli, G; Del Piero, G C; Valentinuz, G; Monte, A; Gatto, A; Rebelli, A; Quatela, E

2018-04-01

To evaluate the clinical efficacy and cost-effectiveness of ultrasonic shears and the electrothermal bipolar vessel sealing system, in comparison to the traditional cold knife and bipolar forceps, in oral and oropharyngeal cancer surgery. Patients who underwent oral or oropharyngeal cancer resection and neck dissection with either ultrasonic shears (n = 36) or electrothermal bipolar vessel sealing (n = 32) were enrolled. Surgical time, intra-operative bleeding, blood drainage, post-operative pain, neck oedema, complications and hospitalisation duration were compared to those of an historical cohort of 36 patients treated using a cold knife and bipolar forceps. Additionally, a cost-effectiveness evaluation was performed. Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, were advantageous compared to the traditional techniques. The cost of ultrasonic shears and electrothermal bipolar vessel sealing was completely offset by declining time-driven costs for the surgical team and operating theatre. Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, are more advantageous compared to the traditional techniques, from both a clinical and economic point of view.

Considerations on the design and financial feasibility of full-scale membrane bioreactors for municipal applications.

PubMed

Brepols, Ch; Schäfer, H; Engelhardt, N

2010-01-01

Based on the practical experience in design and operation of three full-scale membrane bioreactors (MBR) for municipal wastewater treatment that were commissioned since 1999, an overview on the different design concepts that were applied to the three MBR plants is given. The investment costs and the energy consumption of the MBRs and conventional activated sludge (CAS) plants (with and without tertiary treatment) in the Erft river region are compared. It is found that the specific investment costs of the MBR plants are lower than those of comparable CAS with tertiary treatment. A comparison of the specific energy demand of MBRs and conventional WWTPs is given. The structure of the MBRs actual operational costs is analysed. It can be seen that energy consumption is only responsible for one quarter to one third of all operational expenses. Based on a rough design and empirical cost data, a cost comparison of a full-scale MBR and a CAS is carried out. In this example the CAS employs a sand filtration and a disinfection in order to achieve comparable effluent quality. The influence of membrane lifetime on life cycle cost is assessed.

BRIDGE: A Simulation Model for Comparing the Costs of Expanding a Campus Using Distributed Instruction versus Classroom Instruction. Documentation and Instructions.

ERIC Educational Resources Information Center

Jewett, Frank

These instructions describe the use of BRIDGE, a computer software simulation model that is designed to compare the costs of expanding a college campus using distributed instruction (television or asynchronous network courses) versus the costs of expanding using lecture/lab type instruction. The model compares the projected operating and capital…

SUMMARY OF ELECTRIC SERVICE COSTS FOR TOTALLY AIR CONDITIONED SCHOOLS PREPARED FOR HOUSTON INDEPENDENT SCHOOL DISTRICT, MAY 31, 1967.

ERIC Educational Resources Information Center

WHITESIDES, M.M.

THIS REPORT IS A COMPILATION OF DATA ON ELECTRIC AIR CONDITIONING COSTS, OPERATIONS AND MAINTENANCE. AIR CONDITIONING UNITS ARE COMPARED IN TERMS OF ELECTRIC VERSUS NON-ELECTRIC, AUTOMATIC VERSUS OPERATED, AIR COOLED VERSUS WATER COOLED, RECIPROCATING VERSUS CENTRIFUGAL COMPRESSORS, SPACE AND NOISE, REHEAT, MAINTENANCE AND ORIGINAL COST. DATA ARE…

Development and application of a model for the analysis of trades between space launch system operations and acquisition costs

NASA Astrophysics Data System (ADS)

Nix, Michael B.

2005-12-01

Early design decisions in the development of space launch systems determine the costs to acquire and operate launch systems. Some sources indicate that as much as 90% of life cycle costs are fixed by the end of the critical design review phase. System characteristics determined by these early decisions are major factors in the acquisition cost of flight hardware elements and facilities and influence operations costs through the amount of maintenance and support labor required to sustain system function. Operations costs are also dependent on post-development management decisions regarding how much labor will be deployed to meet requirements of market demand and ownership profit. The ability to perform early trade-offs between these costs is vital to the development of systems that have the necessary capacity to provide service and are profitable to operate. An Excel-based prototype model was developed for making early analyses of trade-offs between the costs to operate a space launch system and to acquire the necessary assets to meet a given set of operational requirements. The model, integrating input from existing models and adding missing capability, allows the user to make such trade-offs across a range of operations concepts (required flight rates, staffing levels, shifts per workday, workdays per week and per year, unreliability, wearout and depot maintenance) and the number, type and capability of assets (flight hardware elements, processing and supporting facilities and infrastructure). The costs and capabilities of hypothetical launch systems can be modeled as a function of interrelated turnaround times and labor resource levels, and asset loss and retirement. The number of flight components and facilities required can be calculated and the operations and acquisition costs compared for a specified scenario. Findings, based on the analysis of a hypothetical two stage to orbit, reusable, unmanned launch system, indicate that the model is suitable for the trade-off analyses desired. The minimum turnaround time/maximum labor allocation for specific hardware configurations and characteristics and corresponding asset requirements can be estimated. Either turnaround time or resources can be varied and the resulting operations and acquisition costs can be compared. Asset reliability, wearout and depot maintenance intervals and durations can be varied as well to analyze the effects on costs. Likewise, the effects on operations and acquisitions costs of the introduction of alternative technologies that affect reliability, maintainability and supportability in various hardware configurations can be evaluated.

Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis.

PubMed

Zakiyah, N; van Asselt, A D I; Postma, M J

2017-03-01

Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012. A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands. In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012. Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on the healthcare budget in The Netherlands.

Spacecraft Autonomy and Automation: A Comparative Analysis of Strategies for Cost Effective Mission Operations

NASA Technical Reports Server (NTRS)

Wright, Nathaniel, Jr.

2000-01-01

The evolution of satellite operations over the last 40 years has drastically changed. October 4, 1957 (during the cold war) the Soviet Union launched the world's first spacecraft into orbit. The Sputnik satellite orbited Earth for three months and catapulted the United States into a race for dominance in space. A year after Sputnik, President Dwight Eisenhower formed the National Space and Aeronautics Administration (NASA). With a team of scientists and engineers, NASA successfully launched Explorer 1, the first US satellite to orbit Earth. During these early years, massive amounts of ground support equipment and operators were required to successfully operate spacecraft vehicles. Today, budget reductions and technological advances have forced new approaches to spacecraft operations. These approaches require increasingly complex, on board spacecraft systems, that enable autonomous operations, resulting in more cost-effective mission operations. NASA's Goddard Space Flight Center, considered world class in satellite development and operations, has developed and operated over 200 satellites during its 40 years of existence. NASA Goddard is adopting several new millennium initiatives that lower operational costs through the spacecraft autonomy and automation. This paper examines NASA's approach to spacecraft autonomy and ground system automation through a comparative analysis of satellite missions for Hubble Space Telescope-HST, Near Earth Asteroid Rendezvous-NEAR, and Solar Heliospheric Observatory-SoHO, with emphasis on cost reduction methods, risk analysis and anomalies and strategies employed for mitigating risk.

Cost-effectiveness analysis of treatments for vertebral compression fractures.

PubMed

Edidin, Avram A; Ong, Kevin L; Lau, Edmund; Schmier, Jordana K; Kemner, Jason E; Kurtz, Steven M

2012-07-01

Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses. After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763. Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.

An Analysis of the Cost Effectiveness of Various Electronic Alternatives for Delivering Distance Education Compared to the Travel Costs for Live Instruction.

ERIC Educational Resources Information Center

Caffarella, Edward; And Others

The feasibility and relative costs of four telecommunication systems for delivering university courses to distant locations in Colorado were compared. The four systems were compressed video, vertical blanking interval video, satellite video, and audiographic systems. Actual costs to install and operate each for a 5-year period were determined,…

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

PubMed

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

49 CFR 1.4 - General responsibilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... safety programs with respect to identification and surveillance of accident locations; highway design... equipment. (3) Informing the public of the comparative characteristics and operational cost of passenger motor vehicles and requiring display of comparative insurance costs by automobile dealers. (4...

49 CFR 1.4 - General responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... safety programs with respect to identification and surveillance of accident locations; highway design... equipment. (3) Informing the public of the comparative characteristics and operational cost of passenger motor vehicles and requiring display of comparative insurance costs by automobile dealers. (4...

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

PubMed

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

2017-09-01

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

Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission.

PubMed

Flamiatos, Jason F; Chen, Yiyi; Lambert, William E; Martinez Acevedo, Ann; Becker, Thomas M; Bash, Jasper C; Amling, Christopher L

2018-06-08

The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien-Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20-0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.

Operating Dedicated Data Centers - Is It Cost-Effective?

NASA Astrophysics Data System (ADS)

Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.

2014-06-01

The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

Hysteroscopic Endometrial Polypectomy: Clinical and Economic Data in Decision Making.

PubMed

Franchini, Mario; Lippi, Giuseppe; Calzolari, Stefano; Giarrè, Giovanna; Gubbini, Giampietro; Catena, Ursula; Di Spiezio Sardo, Attilio; Florio, Pasquale

To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. Retrospective cohort study (Canadian Task Force classification II-2). Tertiary referral hospital and center for gynecologic care. Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016. Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system. The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p = .0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p = .0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p = .0002) CONCLUSION: The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

PubMed

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy.

PubMed

Packiam, Vignesh; Bartlett, David L; Tohme, Samer; Reddy, Srinevas; Marsh, J Wallis; Geller, David A; Tsung, Allan

2012-12-01

The purpose of this study was to compare the clinical and economic outcomes of robotic versus laparoscopic left lateral sectionectomy (LLS). A retrospective analysis was made comparing robotic (n = 11) and laparoscopic (n = 18) LLS performed at the University of Pittsburgh Medical Center between January 2009 and July 2011. Demographic data, operative, and postoperative outcomes were collected. Demographic and tumor characteristics of robotic and laparoscopic LLS were similar. There were also no significant differences in operative outcomes including estimated blood loss and operating room time. Patients undergoing robotic LLS had more admissions to the ICU (46 versus 6 %), increased rate of minor complications (27 versus 0 %), and longer lengths of stay (4 versus 3 days). There were no significant differences in major complication rates or 90-day mortality. The cost of robotic and laparoscopic LLS was not significantly different when only considering direct costs ($5,130 versus $4,408, p = 0.401). However, robotic LLS costs were significantly greater when including indirect costs, which were estimated to be $1,423 per robotic case ($6,553 versus $4,408, p = 0.021). Robotic LLS yields slightly inferior clinical outcomes and increased cost compared to the laparoscopic approach.

Low-Tech High-Tech.

ERIC Educational Resources Information Center

Hart, Tom

1997-01-01

Outlines how Compact Disc-interactive (CD-i)--software that looks like a CD-ROM but operates independently using a television set--can be used in elementary, secondary, and vocational education. Discusses the cost effectiveness of CD-i and compares costs and operational issues with CD-ROM. Describes special features of one CD-i program,…

Heat integrated ethanol dehydration flowsheets

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

Hutahaean, L.S.; Shen, W.H.; Brunt, V. Van

1995-04-01

zA theoretical evaluation of heat-integrated heterogeneous-azeotropic ethanol-water distillation flowsheets is presented. Simulations of two column flowsheets using several different hydrocarbon entrainers reveal a region of potential heat integration and substantial reduction in operating energy. In this paper, methods for comparing hydrocarbon entrainers are shown. Two aspects of entrainers are related to operating and capital costs. The binary azeotropic composition of the entrainer-ethanol mixture is related to the energy requirements of the flowsheet. A temperature difference in the azeotrophic column is related to the size of the column and overall process staging requirements. Although the hydrophobicity of an entrainer is essentialmore » for specification of staging in the dehydration column, no substantial increase in operating energy results from an entrainer that has a higher water content. Likewise, liquid-liquid equilibria between several entrainer-ethanol-water mixtures have no substantial effect on either staging or operation. Rather, increasing the alcohol content of the entrainer-ethanol azeotrope limits its recovery in the dehydration column, and increases the recycle and reflux streams. These effects both contribute to increasing the separation energy requirements and reducing the region of potential heat integration. A cost comparison with a multieffect extractive distillation flowsheet reveals that the costs are comparable; however, the extractive distillation flowsheet is more cost effective as operating costs increase.« less

Post-operative bracing after pedicle screw fixation for thoracolumbar burst fractures: A cost-effectiveness study.

PubMed

Piazza, Matthew; Sinha, Saurabh; Agarwal, Prateek; Mallela, Arka; Nayak, Nikhil; Schuster, James; Stein, Sherman

2017-11-01

While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of reoperation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar burst fractures. Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the authors institution was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values. Of the 225 abstracts reviewed, 48 articles were included in the study, yielding a total of 1957 patients. After including patients from the institutional registry, together a total of 2081 patients were included in the final analysis, 1328 of whom were braced. Non-braced patients were older then braced patients, although this only approached significance (p=0.051). Braced patients had significantly lower rates of re-operation for non-union or clinically significant hardware failure (1.3% vs. 1.8%, p<0.001) although the groups had comparable rates of operative wound dehiscence and infection (p=1.000). These two approaches yielded comparable utility scores (p=0.120). Costs between braced and non-braced patients were comparable excluding the cost of the brace (p=0.256); hence, the added cost of the brace suggests that bracing post-operatively is not a cost effective measure. Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications. Moreover, our data suggests that post-operative bracing may not be a cost-effective measure. Copyright © 2017. Published by Elsevier Ltd.

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

Miller, Benjamin, E-mail: BenjaminMiller@nyc.rr.com; Spertus, Juliette, E-mail: Juliette.Spertus@gmail.com; Kamga, Camille, E-mail: CKamga@UTRC2.org

Highlights: • Pneumatic and truck collection were compared in three New York City locations. • Relative costs, energy use, and greenhouse gas emissions varied significantly. • Variations were due to location-specific factors (e.g., route density, truck type). • Under appropriate conditions, pneumatic collection reduces TMT, BTU, and GHG. • Pneumatic capex may be offset by operating savings and externality benefits. - Abstract: Truck-based collection of municipal solid waste imposes significant negative externalities on cities and constrains the efficiency of separate collection of recyclables and organics and of unit-price-based waste-reduction systems. In recent decades, hundreds of municipal-scale pneumatic collection systems havemore » been installed in Europe and Asia. Relatively few prior studies have compared the economic or environmental impacts of these systems to those of truck collection. A critical factor to consider when making this comparison is the extent to which the findings reflect the specific geographic, demographic, and operational characteristics of the systems considered. This paper is based on three case studies that consider the specific characteristics of three locations, comparing pneumatic systems with conventional collection on the basis of actual waste tonnages, composition, sources, collection routes, truck trips, and facility locations. In one case, alternative upgrades to an existing pneumatic system are compared to a potential truck-collection operation. In the other cases, existing truck operations are compared to proposed pneumatic systems which, to reduce capital costs, would be installed without new trenching or tunneling through the use of existing linear infrastructure. For the two proposed retrofit pneumatic systems, up to 48,000 truck kilometers travelled would be avoided and energy use would be reduced by up to 60% at an incremental cost of up to $400,000 USD per year over the total operating-plus-capital cost of conventional collection. In the location where a greenfield pneumatic system is already in operation, truck collection would be both less expensive and more energy-efficient than pneumatic collection. The results demonstrate that local geographic, demographic, and operational conditions play a decisive role in determining whether pneumatic collection will reduce energy requirements, produce more or fewer greenhouse gas emissions, and cost more or less over the long-term. These findings point to the local factors that will determine the relative economic and environmental costs and benefits in specific situations.« less

Study 2.6 operations analysis mission characterization

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1973-01-01

An analysis of the current operations concepts of NASA and DoD is presented to determine if alternatives exist which may improve the utilization of resources. The final product is intended to show how sensitive these ground rules and design approaches are relative to the total cost of doing business. The results are comparative in nature, and assess one concept against another as opposed to establishing an absolute cost value for program requirements. An assessment of the mission characteristics is explained to clarify the intent, scope, and direction of this effort to improve the understanding of what is to be accomplished. The characterization of missions is oriented toward grouping missions which may offer potential economic benefits by reducing overall program costs. Program costs include design, development, testing, and engineering, recurring unit costs for logistic vehicles, payload costs. and direct operating costs.

Satellite Power Systems (SPS) concept definition study. Volume 2, part 2: System engineering. [cost and programmatics

NASA Technical Reports Server (NTRS)

Hanley, G. M.

1980-01-01

The latest technical and programmatic developments are considered as well as expansions of the Rockwell SPS cost model covering each phase of the program through the year 2030. Comparative cost/economic analyses cover elements of the satellite, construction system, space transportation vehicles and operations, and the ground receiving station. System plans to define time phased costs and planning requirements that support major milestones through the year 2000. A special analysis is included on natural resources required to build the SPS reference configuration. An appendix contains the SPS Work Breakdown Structure and dictionary along with detail cost data sheet on each system and main element of the program. Over 200 line items address DDT&E, theoretical first unit, investment cost per satellite, and operations charges for replacement capital and normal operations and maintenance costs.

Study of the application of advanced technologies to laminar flow control systems for subsonic transports. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Sturgeon, R. F.; Bennett, J. A.; Etchberger, F. R.; Ferrill, R. S.; Meade, L. E.

1976-01-01

A study was conducted to evaluate the technical and economic feasibility of applying laminar flow control to the wings and empennage of long-range subsonic transport aircraft compatible with initial operation in 1985. For a design mission range of 10,186 km (5500 n mi), advanced technology laminar-flow-control (LFC) and turbulent-flow (TF) aircraft were developed for both 200 and 400-passenger payloads, and compared on the basis of production costs, direct operating costs, and fuel efficiency. Parametric analyses were conducted to establish the optimum geometry for LFC and TF aircraft, advanced LFC system concepts and arrangements were evaluated, and configuration variations maximizing the effectiveness of LFC were developed. For the final LFC aircraft, analyses were conducted to define maintenance costs and procedures, manufacturing costs and procedures, and operational considerations peculiar to LFC aircraft. Compared to the corresponding advanced technology TF transports, the 200- and 400-passenger LFC aircraft realized reductions in fuel consumption up to 28.2%, reductions in direct operating costs up to 8.4%, and improvements in fuel efficiency, in ssm/lb of fuel, up to 39.4%. Compared to current commercial transports at the design range, the LFC study aircraft demonstrate improvements in fuel efficiency up to 131%. Research and technology requirements requisite to the development of LFC transport aircraft were identified.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

PubMed

Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

2018-02-01

To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p < 0.001). The mean operating theatre time, surgeon procedure time and length of stay were all significantly lower under local anaesthesia compared to general anaesthesia. Time variables such as operating theatre time and length of stay were the most significant predictors of the total costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

Man Versus Machine: Comparing Double Data Entry and Optical Mark Recognition for Processing CAHPS Survey Data.

PubMed

Fifolt, Matthew; Blackburn, Justin; Rhodes, David J; Gillespie, Shemeka; Bennett, Aleena; Wolff, Paul; Rucks, Andrew

Historically, double data entry (DDE) has been considered the criterion standard for minimizing data entry errors. However, previous studies considered data entry alternatives through the limited lens of data accuracy. This study supplies information regarding data accuracy, operational efficiency, and cost for DDE and Optical Mark Recognition (OMR) for processing the Consumer Assessment of Healthcare Providers and Systems 5.0 survey. To assess data accuracy, we compared error rates for DDE and OMR by dividing the number of surveys that were arbitrated by the total number of surveys processed for each method. To assess operational efficiency, we tallied the cost of data entry for DDE and OMR after survey receipt. Costs were calculated on the basis of personnel, depreciation for capital equipment, and costs of noncapital equipment. The cost savings attributed to this method were negated by the operational efficiency of OMR. There was a statistical significance between rates of arbitration between DDE and OMR; however, this statistical significance did not create a practical significance. The potential benefits of DDE in terms of data accuracy did not outweigh the operational efficiency and thereby financial savings of OMR.

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

PubMed

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

2016-02-05

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

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

PubMed

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

2004-10-01

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

Sludge digestion instead of aerobic stabilisation - a cost benefit analysis based on experiences in Germany.

PubMed

Gretzschel, Oliver; Schmitt, Theo G; Hansen, Joachim; Siekmann, Klaus; Jakob, Jürgen

2014-01-01

As a consequence of a worldwide increase of energy costs, the efficient use of sewage sludge as a renewable energy resource must be considered, even for smaller wastewater treatment plants (WWTPs) with design capacities between 10,000 and 50,000 population equivalent (PE). To find the lower limit for an economical conversion of an aerobic stabilisation plant into an anaerobic stabilisation plant, we derived cost functions for specific capital costs and operating cost savings. With these tools, it is possible to evaluate if it would be promising to further investigate refitting aerobic plants into plants that produce biogas. By comparing capital costs with operation cost savings, a break-even point for process conversion could be determined. The break-even point varies depending on project specific constraints and assumptions related to future energy and operation costs and variable interest rates. A 5% increase of energy and operation costs leads to a cost efficient conversion for plants above 7,500 PE. A conversion of WWTPs results in different positive effects on energy generation and plant operations: increased efficiency, energy savings, and on-site renewable power generation by digester gas which can be used in the plant. Also, the optimisation of energy efficiency results in a reduction of primary energy consumption.

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Code of Federal Regulations, 2014 CFR

2014-04-01

... justified by a newly created property-based needs assessment (a life-cycle physical needs assessments... calculated as the sum of total operating cost, modernization cost, and costs to address accrual needs. Costs... assist PHAs in completing the assessments. The spreadsheet calculator is designed to walk housing...

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Code of Federal Regulations, 2013 CFR

2013-04-01

... justified by a newly created property-based needs assessment (a life-cycle physical needs assessments... calculated as the sum of total operating cost, modernization cost, and costs to address accrual needs. Costs... assist PHAs in completing the assessments. The spreadsheet calculator is designed to walk housing...

[Case control study of fractures-dislocations of ankle joint with conservative and operative treatment].

PubMed

Zhang, Song-Tu; Lin, Yi-Rong; Chen, Lian-Yuan

2010-10-01

To compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment. From September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups. All patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P < 0.05). Conservative treatment and operative treatment can both reach a very good result in treating grade III, IV supination-eversion fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

Effect of facility on the operative costs of distal radius fractures.

PubMed

Mather, Richard C; Wysocki, Robert W; Mack Aldridge, J; Pietrobon, Ricardo; Nunley, James A

2011-07-01

The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. Economic and Decisional Analysis III. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The Launch Systems Operations Cost Model

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

On- and off-grid operation of hybrid renewable power plants: When are the economics favorable?

NASA Astrophysics Data System (ADS)

Petrakopoulou, F.; Santana, D.

2016-12-01

Hybrid renewable energy conversion systems offer a good alternative to conventional systems in locations where the extension of the electrical grid is difficult or not economical or where the cost of electricity is high. However, stand-alone operation implies net energy output restrictions (limited to exclusively serve the energy demand of a region), capacity oversizing and large storage facilities. In interconnected areas, on the other hand, the operational restrictions of the power stations change significantly and the efficiencies and costs of renewable technologies become more favorable. In this paper, the operation of three main renewable technologies (CSP, PV and wind) is studied assuming both hybrid and individual operation for both autonomous and inter-connected operation. The case study used is a Mediterranean island of ca. 3,000 inhabitants. Each system is optimized to fully cover the energy demand of the community. In addition, in the on-grid operation cases, it is required that the annual energy generated from the renewable sources is net positive (i.e., the island generates at least as much energy as it uses). It is found that when connected to the grid, hybridization of more than one technology is not required to satisfy the energy demand, as expected. Each of the renewable technologies investigated can satisfy the annual energy demand individually, without significant complications. In addition, the cost of electricity generated with the three studied technologies drops significantly for on-grid applications, when compared to off-grid operation. However, when compared to business-as-usual scenarios in both the on- and off-grid cases, both investigated hybrid and single-technology renewable scenarios are found to be economically viable. A sensitivity analysis reveals the limits of the acceptable costs that make the technologies favorable when compared to conventional alternatives.

Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis.

PubMed

Bonouvrié, Kimberley; van den Bosch, Anouk; Roumen, Frans J M E; van Kuijk, Sander M; Nijhuis, Jan G; Evers, Silvia M A A; Wassen, Martine M L H

2016-12-01

To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study.

PubMed

Sarlos, Dimitri; Kots, Lavonne; Stevanovic, Nebojsa; Schaer, Gabriel

2010-05-01

Robotic surgery, with its technical advances, promises to open a new window to minimally invasive surgery in gynaecology. Feasibility and safety of this surgical innovation have been demonstrated in several studies, and now a critical analysis of these new developments regarding outcome and costs is in place. So far only a few studies compare robotic with conventional laparoscopic surgery in gynaecology. Our objective was to evaluate our initial experience performing total robot-assisted hysterectomy with the da Vinci surgical system and compare peri-operative outcome and costs with total laparoscopic hysterectomy. For this prospective matched case-control study at our institution, peri-operative data from our first 40 consecutive total robot-assisted hysterectomies for benign indications were recorded and matched 1:1 with total laparoscopic hysterectomies according to age, BMI and uterus weight. Surgical costs were calculated for both procedures. Surgeons' subjective impressions of robotics were evaluated with a self-developed questionnaire. No conversions to laparotomy or severe peri-operative complications occurred. Mean operating time was 109 (113; 50-170) min for the robotic group and 83 (80; 55-165) min for the conventional laparoscopic group. Mean postoperative hospitalisation for robotic surgery was 3.3 (3; 2-6) days versus 3.9 (4; 2-7) days for the conventional laparoscopic group. Average surgical cost of a robot-assisted laparoscopic hysterectomy was 4067 euros compared to 2151 euros for the conventional laparoscopic procedure at our institution. For the robotic group wider range of motion of the instruments and better ergonomics were considered to be an advantage, and lack of direct access to the patient was stated as a disadvantage. Robot-assited hysterectomy is a feasible and interesting new technique with comparable outcome to total laparoscopic hysterectomy. Operating times of total laparoscopic hysterectomy seem to be achieved quickly especially for experienced laparoscopic surgeons. However, costs of robotic surgery are still higher than for conventional laparoscopy. Randomised clinical trials need to be conducted to further evaluate benefits of this new technology for patients and surgeons and analyse its cost-effectiveness in gynaecology. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Method can improve efficiency of heli-portable seismic operations

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

Kingsbury, O.J.

1995-11-13

There are regions of the world where the only viable means of conducting a seismic survey on land must involve helicopters as a primary means of transport. The high operating cost of helicopters means that such heliportable work is expensive compared with the more common land and marine surveys. This article is addressed to exploration companies contemplating heliportable seismic surveys. Its aim is to show how these operations work and to enable a dramatic reduction in the cost and timescale of future operations compared with numerous operations this writer has witnessed and been involved with in recent years. The coremore » of this article concerns distinct designs of drilling machinery used in these activities and the most efficient ways of configuring this machinery in the field.« less

Parametric study of potential early commercial power plants Task 3-A MHD cost analysis

NASA Technical Reports Server (NTRS)

1983-01-01

The development of costs for an MHD Power Plant and the comparison of these costs to a conventional coal fired power plant are reported. The program is divided into three activities: (1) code of accounts review; (2) MHD pulverized coal power plant cost comparison; (3) operating and maintenance cost estimates. The scope of each NASA code of account item was defined to assure that the recently completed Task 3 capital cost estimates are consistent with the code of account scope. Improvement confidence in MHD plant capital cost estimates by identifying comparability with conventional pulverized coal fired (PCF) power plant systems is undertaken. The basis for estimating the MHD plant operating and maintenance costs of electricity is verified.

Planning and Estimation of Operations Support Requirements

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn E.; Barley, Bryan; Bacskay, Allen; Clardy, Dennon

2010-01-01

Life Cycle Cost (LCC) estimates during the proposal and early design phases, as well as project replans during the development phase, are heavily focused on hardware development schedules and costs. Operations (phase E) costs are typically small compared to the spacecraft development and test costs. This, combined with the long lead time for realizing operations costs, can lead to de-emphasizing estimation of operations support requirements during proposal, early design, and replan cost exercises. The Discovery and New Frontiers (D&NF) programs comprise small, cost-capped missions supporting scientific exploration of the solar system. Any LCC growth can directly impact the programs' ability to fund new missions, and even moderate yearly underestimates of the operations costs can present significant LCC impacts for deep space missions with long operational durations. The National Aeronautics and Space Administration (NASA) D&NF Program Office at Marshall Space Flight Center (MSFC) recently studied cost overruns and schedule delays for 5 missions. The goal was to identify the underlying causes for the overruns and delays, and to develop practical mitigations to assist the D&NF projects in identifying potential risks and controlling the associated impacts to proposed mission costs and schedules. The study found that 4 out of the 5 missions studied had significant overruns at or after launch due to underestimation of the complexity and supporting requirements for operations activities; the fifth mission had not launched at the time of the mission. The drivers behind these overruns include overly optimistic assumptions regarding the savings resulting from the use of heritage technology, late development of operations requirements, inadequate planning for sustaining engineering and the special requirements of long duration missions (e.g., knowledge retention and hardware/software refresh), and delayed completion of ground system development work. This paper updates the D&NF LCC study, looking at the operations (phase E) cost drivers in more detail and extending the study to include 2 additional missions and identifies areas for increased emphasis by project management in order to improve the fidelity of operations estimates.

Estimation of the laser cutting operating cost by support vector regression methodology

NASA Astrophysics Data System (ADS)

Jović, Srđan; Radović, Aleksandar; Šarkoćević, Živče; Petković, Dalibor; Alizamir, Meysam

2016-09-01

Laser cutting is a popular manufacturing process utilized to cut various types of materials economically. The operating cost is affected by laser power, cutting speed, assist gas pressure, nozzle diameter and focus point position as well as the workpiece material. In this article, the process factors investigated were: laser power, cutting speed, air pressure and focal point position. The aim of this work is to relate the operating cost to the process parameters mentioned above. CO2 laser cutting of stainless steel of medical grade AISI316L has been investigated. The main goal was to analyze the operating cost through the laser power, cutting speed, air pressure, focal point position and material thickness. Since the laser operating cost is a complex, non-linear task, soft computing optimization algorithms can be used. Intelligent soft computing scheme support vector regression (SVR) was implemented. The performance of the proposed estimator was confirmed with the simulation results. The SVR results are then compared with artificial neural network and genetic programing. According to the results, a greater improvement in estimation accuracy can be achieved through the SVR compared to other soft computing methodologies. The new optimization methods benefit from the soft computing capabilities of global optimization and multiobjective optimization rather than choosing a starting point by trial and error and combining multiple criteria into a single criterion.

The pharmacoeconomics of peri-operative beta-blocker therapy.

PubMed

Biccard, B M; Sear, J W; Foëx, P

2006-01-01

It is widely recommended that beta-blockade be used peri-operatively as it may reduce the incidence of postoperative cardiovascular complications including death. However, there are few data concerning the cost-effectiveness of such strategies. We have analysed the pharmacoeconomics of acute beta-blockade using data from eight prospective peri-operative studies in which patients underwent elective non-cardiac surgery, and in which the incidence of adverse side-effects of treatment, as well as clinical outcomes, have been reported. The costs of treatment were based on the NHS reference costs for 2004. From these data, the number-needed-to-treat (NNT) to prevent a major cardiovascular complication (including cardiovascular death) in high-risk patients was 18.5. This is comparable to the NNT for peri-operative statin therapy. The incremental cost of peri-operative beta-blockade (costs of drug acquisition and of treating associated adverse drug events) was 67.80 pounds sterling per patient. This results in a total cost of 1254.30 pounds sterling per peri-operative cardiovascular complication prevented. However, there is evidence that in patients at lower cardiovascular risk, beta-blockers may be potentially harmful, since their adverse effects (hypotension, bradycardia) may outweigh their potential cardioprotective effects.

Comparative seed-tree and selection harvesting costs in young-growth mixed-conifer stands

Treesearch

William A. Atkinson; Dale O. Hall

1963-01-01

Little difference was found between yarding and felling costs in seed-tree and selection harvest cuts. The volume per acre logged was 23,800 board feet on the seed-tree compartments and 10,600 board feet on the selection compartments. For a comparable operation with this range of volumes, cutting method decisions should be based on factors other than logging costs....

A Model for the Determination of the Costs of Special Education as Compared with That for General Education. Appendix: Part 2.

ERIC Educational Resources Information Center

Ernst and Ernst, Chicago, IL.

Part 2 of the appendix to "A Model for the Determination of the Costs of Special Education as Compared with That for General Education" contains information on using 10-minute units of service measure in Ernstville, a hypothetical school district conceived to illustrate operation of a proposed cost accounting system. (LH)

A Model for the Determination of the Costs of Special Education as Compared with That for General Education. Appendix: Part 1.

ERIC Educational Resources Information Center

Ernst and Ernst, Chicago, IL.

Part 1 of the appendix to "A Model for the Determination of the Costs of Special Education as Compared with That for General Education" contains comprehensive descriptive and statistical information on Ernstville, a hypothetical school district conceived to illustrate the operation of a proposed cost accounting system. Included are sections on…

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

PubMed

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

2015-01-01

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

Cost Estimates For Selected California Smart Traveler Operational Tests, Volume 1, Technical Report

DOT National Transportation Integrated Search

1993-03-01

THIS REPORT ALSO COMPARES THE COSTS OF USING "SMART-TRAVELER" APPROACHES WITH THE COSTS OF EXPANDING CONVENTIONAL TRANSIT SERVICES TO REDUCE TRAFFIC CONGESTION, AIR POLLUTION AND MOBILITY PROBLEMS IN SUBURBAN AREAS, WHERE MOST PEOPLE IN U.S. METROPOL...

Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis.

PubMed

Cabot, Jennifer C; Lee, Cho Rok; Brunaud, Laurent; Kleiman, David A; Chung, Woong Youn; Fahey, Thomas J; Zarnegar, Rasa

2012-12-01

This study presents a cost analysis of the standard cervical, gasless transaxillary endoscopic, and gasless transaxillary robotic thyroidectomy approaches based on medical costs in the United States. A retrospective review of 140 patients who underwent standard cervical, transaxillary endoscopic, or transaxillary robotic thyroidectomy at 2 tertiary centers was conducted. The cost model included operating room charges, anesthesia fee, consumables cost, equipment depreciation, and maintenance cost. Sensitivity analyses assessed individual cost variables. The mean operative times for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were 121 ± 18.9, 185 ± 26.0, and 166 ± 29.4 minutes, respectively. The total cost for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were $9,028 ± $891, $12,505 ± $1,222, and $13,670 ± $1,384, respectively. Transaxillary approaches were significantly more expensive than the standard cervical technique (standard cervical/transaxillary endoscopic, P < .0001; standard cervical/transaxillary robotic, P < .0001; and transaxillary endoscopic/transaxillary robotic, P = .001). The transaxillary and standard cervical techniques became equivalent in cost when transaxillary endoscopic operative time decreased to 111 minutes and transaxillary robotic operative time decreased to 68 minutes. Increasing the case load did not resolve the cost difference. Transaxillary endoscopic and transaxillary robotic thyroidectomies are significantly more expensive than the standard cervical approach. Decreasing operative times reduces this cost difference. The greater expense may be prohibitive in countries with a flat reimbursement schedule. Copyright © 2012 Mosby, Inc. All rights reserved.

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

ERIC Educational Resources Information Center

Mosley, Isobel

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

Cost Analysis of Endovascular versus Open Repair in the Treatment of Thoracic Aortic Aneurysms

PubMed Central

Gillen, Jacob R.; Schaheen, Basil W.; Yount, Kenan W.; Cherry, Kenneth J.; Kern, John A.; Kron, Irving L.; Upchurch, Gilbert R.; Lau, Christine L.

2014-01-01

Objective For descending thoracic aortic aneurysms (TAAs), it is generally considered that endovascular stents (TEVARs) reduce operative morbidity and mortality compared to open surgical repair. However, long-term differences in patient survival have not been demonstrated, and an increased need for aortic reintervention has been observed. Many assume that TEVAR becomes less cost effective through time due to higher rates of reintervention and surveillance imaging. This study investigated mid-term outcomes and hospital costs of TEVAR compared with open TAA repair. Methods This was a retrospective, single institution review of elective thoracic aortic aneurysm repairs between 2005 and 2012. Patient demographics, operative outcomes, reintervention rates, and hospital costs were assessed. The literature was also reviewed to determine commonly observed complication and reintervention rates for TEVAR and open repair. Monte Carlo simulation was utilized to model and forecast hospital costs for TEVAR and open TAA repair up to 3 years post-intervention. Results Our cohort consisted of 131 TEVARs and 27 open repairs. TEVAR patients were significantly older (67.2 vs. 58.7, p=0.02) and trended towards a more severe comorbidity profile. Operative mortality for TEVAR and open repair was 5.3% and 3.7%, respectively (p=1.0). There was a trend towards more complications in the TEVAR group, although not statistically significant (all p>0.05). In-hospital costs were significantly greater in the TEVAR group ($52,008 vs. $37,172, p=0.001). However, cost modeling utilizing reported complication and reintervention rates from the literature overlaid with our cost data produced a higher cost for the open group in-hospital ($55,109 vs. $48,006) and at 3 years ($58,426 vs. $52,825). Interestingly, TEVAR hospital costs, not reintervention rates, were the most significant driver of cost in the TEVAR group. Conclusions Our institutional data showed a trend toward lower mortality and complication rates with open TAA repair, with significantly lower costs within this cohort compared to TEVAR. These findings were likely at least in part due to the milder comorbidity profile within these patients. In contrast, cost modeling using Monte Carlo simulation demonstrated lower costs with TEVAR compared to open repair at all time points up to 3 years post-intervention. Our institutional data shows that with appropriate patient selection, open repair can be performed safely with low complication rates comparable to TEVAR. The cost model argues that despite the costs associated with more frequent surveillance imaging and reinterventions, TEVAR remains the more cost effective option even years after TAA repair. PMID:25449008

Outcome and cost analysis of bilateral sequential same-day cartilage tympanoplasty compared with bilateral staged tympanoplasty.

PubMed

Olusesi, A D; Oyeniran, O

2017-05-01

Few studies have compared bilateral same-day with staged tympanoplasty using cartilage graft materials. A prospective randomised observational study was performed of 38 chronic suppurative otitis media patients (76 ears) who were assigned to undergo bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential tympanoplasty performed 3 months apart (20 patients, 40 ears). Disease duration, intra-operative findings, combined duration of surgery, post-operative graft appearance at 6 weeks, post-operative complications, re-do rate and relative cost of surgery were recorded. Tympanic membrane perforations were predominantly subtotal (p = 0.36, odds ratio = 0.75). Most grafts were harvested from the conchal cartilage and fewer from the tragus (p = 0.59, odds ratio = 1.016). Types of complication, post-operative hearing gain and revision rates were similar in both patient groups. Surgical outcomes are not significantly different for same-day and bilateral cartilage tympanoplasty, but same-day surgery has the added benefit of a lower cost.

The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: financial outcome of the randomized control Sigma trial.

PubMed

Klarenbeek, Bastiaan R; Coupé, Veerle M H; van der Peet, Donald L; Cuesta, Miguel A

2011-03-01

Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared. Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented. An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection (LSR) to open sigmoid resection (OSR) in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient. To avoid distributional assumptions, the nonparametric bootstrap was applied. For the cost-effectiveness analysis, differences in total cost between LSR and OSR were compared with the differences in VAS pain score, SF-36 values for general health, and complication rate. The difference in total healthcare costs between the group that received LSR (euro 9969) and the group that received OSR (euro 9366) was not statistically significant. The slight increase in total costs was determined mainly by the significantly higher operation costs of LSR (euro 6663 vs. euro 5306). Lower costs for hospitalization (euro 2983 vs. euro 3598), blood products (euro 87 vs. euro 240), paramedical services (euro 157 vs. euro 278), and emergency attendance (euro 72 vs. euro 115) in the LSR group partially compensated these increased operation costs. The incremental cost-effectiveness ratios (ICER) indicate that improvements in pain, quality of life, and complication rate could be achieved at limited costs. Total healthcare costs of laparoscopic and open elective sigmoid resections for symptomatic diverticular disease are similar. As the clinical outcomes are in favor of the LSR group, candidates for an elective sigmoid resection should preferably be approached laparoscopically.

The importance of operations, risk, and cost assessment to space transfer systems design

NASA Technical Reports Server (NTRS)

Ball, J. M.; Komerska, R. J.; Rowell, L. F.

1992-01-01

This paper examines several methodologies which contribute to comprehensive subsystem cost estimation. The example of a space-based lunar space transfer vehicle (STV) design is used to illustrate how including both primary and secondary factors into cost affects the decision of whether to use aerobraking or propulsion for earth orbit capture upon lunar return. The expected dominant cost factor in this decision is earth-to-orbit launch cost driven by STV mass. However, to quantify other significant cost factors, this cost comparison included a risk analysis to identify development and testing costs, a Taguchi design of experiments to determine a minimum mass aerobrake design, and a detailed operations analysis. As a result, the predicted cost advantage of aerobraking, while still positive, was subsequently reduced by about 30 percent compared to the simpler mass-based cost estimates.

Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis.

PubMed

Walcott, Brian P; Khanna, Arjun; Yanamadala, Vijay; Coumans, Jean-Valery; Peterfreund, Robert A

2015-03-01

Lumbar spine surgery is typically performed under general anesthesia, although spinal anesthesia can also be used. Given the prevalence of lumbar spine surgery, small differences in cost between the two anesthetic techniques have the potential to make a large impact on overall healthcare costs. We sought to perform a cost comparison analysis of spinal versus general anesthesia for lumbar spine operations. Following Institutional Review Board approval, a retrospective cohort study was performed from 2009-2012 on consecutive patients undergoing non-instrumented, elective lumbar spine surgery for spondylosis by a single surgeon. Each patient was evaluated for both types of anesthesia, with the decision for anesthetic method being made based on a combination of physical status, anatomical considerations, and ultimately a consensus agreement between patient, surgeon, and anesthesiologist. Patient demographics and clinical characteristics were compared between the two groups. Operating room costs were calculated whilst blinded to clinical outcomes and reported in percentage difference. General anesthesia (n=319) and spinal anesthesia (n=81) patients had significantly different median operative times of 175 ± 39.08 and 158 ± 32.75 minutes, respectively (p<0.001, Mann-Whitney U test). Operating room costs were 10.33% higher for general anesthesia compared to spinal anesthesia (p=0.003, Mann-Whitney U test). Complications of spinal anesthesia included excessive movement (n=1), failed spinal attempt (n=3), intraoperative conversion to general anesthesia (n=2), and a high spinal level (n=1). In conclusion, spinal anesthesia can be performed safely in patients undergoing lumbar spine surgery. It has the potential to reduce operative times, costs, and possibly, complications. Further prospective evaluation will help to validate these findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Performance estimates for space shuttle vehicles using a hydrogen or a methane fueled turboramjet powered first stage

NASA Technical Reports Server (NTRS)

Knip, G., Jr.; Eisenberg, J. D.

1972-01-01

Two- and three-stage (second stage expendable) shuttle vehicles, both having a hydrogen-fueled, turboramjet-powered first stage, are compared with a two-stage, VTOHL, all-rocket shuttle in terms of payload fraction, inert weight, development cost, operating cost, and total cost. All of the vehicles place 22,680 kilograms of payload into a 500-kilometer orbit. The upper stage(s) uses hydrogen-oxygen rockets. The effect on payload fraction and vehicle inert weight of methane and methane-FLOX as a fuel-propellant combination for the three-stage vehicle is indicated. Compared with a rocket first stage for a two-stage shuttle, an airbreathing first stage results in a higher payload fraction and a lower operating cost, but a higher total cost. The effect on cost of program size and first-stage flyback is indicated. The addition of an expendable rocket second stage (three-stage vehicle) improves the payload fraction but is unattractive economically.

Logistics Aloft

DTIC Science & Technology

2011-02-17

inefficient. While the initial purchase cost of the CH-47 and UH-60 can be significantly less than the C-130J or C-27J (the C-27J is in procurement...to replace the C-23), the operating costs of the UH-60 is approximately equal to a small fixed wing aircraft such as the C-23, C-130J, or C-27J...Furthermore, CH-47 operating costs are four to five times that of these fixed wing aircraft.19 In fact, when comparing the increased lift capacity

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

PubMed

Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

2017-01-01

Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. Level III, therapeutic study.

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

PubMed Central

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

2016-01-01

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

Higher cost of single incision laparoscopic cholecystectomy due to longer operating time. A study of opportunity cost based on meta-analysis

PubMed Central

GIRABENT-FARRÉS, M.

2018-01-01

Background We aimed to calculate the opportunity cost of the operating time to demonstrate that single incision laparoscopic cholecystectomy (SILC) is more expensive than classic laparoscopic cholecystectomy (CLC). Methods We identified studies comparing use of both techniques during the period 2008–2016, and to calculate the opportunity cost, we performed another search in the same period of time with an economic evaluation of classic laparoscopy. We performed a meta-analysis of the items selected in the first review considering the cost of surgery and surgical time, and we analyzed their differences. We subsequently calculated the opportunity cost of these time differences based on the design of a cost/time variable using the data from the second literature review. Results Twenty-seven articles were selected from the first review: 26 for operating time (3.138 patients) and 3 for the cost of surgery (831 patients), and 3 articles from the second review. Both techniques have similar operating costs. Single incision laparoscopy surgery takes longer (16.90min) to perform (p <0.00001) and this difference represents an opportunity cost of 755.97 € (cost/time unit factor of 44.73 €/min). Conclusions SILC costs the same as CLC, but the surgery takes longer to perform, and this difference involves an opportunity cost that increases the total cost of SILC. The value of the opportunity cost of the operating time can vary the total cost of a surgical technique and it should be included in the economic evaluation to support the decision to adopt a new surgical technique. PMID:29549678

Cost Benefit and Alternatives Analysis of Distribution Systems with Energy Storage Systems: Preprint

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

Harris, Tom; Nagarajan, Adarsh; Baggu, Murali

This paper explores monetized and non-monetized benefits from storage interconnected to distribution system through use cases illustrating potential applications for energy storage in California's electric utility system. This work supports SDG&E in its efforts to quantify, summarize, and compare the cost and benefit streams related to implementation and operation of energy storage on its distribution feeders. This effort develops the cost benefit and alternatives analysis platform, integrated with QSTS feeder simulation capability, and analyzed use cases to explore the cost-benefit of implementation and operation of energy storage for feeder support and market participation.

Laparoscopic and abdominal hysterectomy: a cost comparison.

PubMed

Tsaltas, J; Magnus, A; Mamers, P M; Lawrence, A S; Lolatgis, N; Healy, D L

1997-02-17

To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.

EVALUATING THE COSTS OF PACKED-TOWER AERATION AND GAC FOR CONTROLLING SELECTED ORGANICS

EPA Science Inventory

This article focuses on a preliminary cost analysis that compares liquid-phase granular activated carbon (GAC) treatment with packed-tower aeration (PTA) treatment, with and without air emissions control. The sensitivity of cost to design and operating variables is also discussed...

Endometrial cancer surgery costs: robot vs laparoscopy.

PubMed

Holtz, David O; Miroshnichenko, Gennady; Finnegan, Mark O; Chernick, Michael; Dunton, Charles J

2010-01-01

To compare surgical costs for endometrial cancer staging between robotic-assisted and traditional laparoscopic methods. Retrospective chart review from November 2005 to July 2006 (Canadian Task Force classification II-3). Non-university-affiliated teaching hospital. Thirty-three women with diagnosed endometrial cancer undergoing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node resection. Patients underwent either robotic or traditional laparoscopic surgery without randomization. Hospital cost data were obtained for operating room time, instrument use, and disposable items from hospital billing records and provided by the finance department. Separate overall hospital stay costs were also obtained. Mean operative costs were higher for robotic procedures ($3323 vs $2029; p<.001), due in part to longer operating room time ($1549 vs $1335; p=.03). The more significant cost difference was due to disposable instrumentation ($1755 vs $672; p<.001). Total hospital costs were also higher for robotic-assisted procedures ($5084 vs $ 3615; p=.002). Robotic surgery costs were significantly higher than traditional laparoscopy costs for staging of endometrial cancer in this small cohort of patients. Copyright (c) 2010 AAGL. Published by Elsevier Inc. All rights reserved.

Assessment of the financial implications for laparoscopic liver surgery: a single-centre UK cost analysis for minor and major hepatectomy.

PubMed

Abu Hilal, Mohammed; Di Fabio, Francesco; Syed, Shareef; Wiltshire, Robert; Dimovska, Eleonora; Turner, David; Primrose, John N; Pearce, Neil W

2013-07-01

Laparoscopic hepatectomy is progressively gaining popularity. However, it is still unclear whether the laparoscopic approach offers cost advantages compared with the open approach, especially when major hepatectomies are required. Data providing useful insights into the costs of the laparoscopic approach for clinicians and hospitals are needed. The aim of this study is to assess the financial implications of the laparoscopic approach for two standardized minor and major hepatectomies: left lateral sectionectomy and right hepatectomy. A cost comparison analysis of patients undergoing laparoscopic right hepatectomy (LRH) and laparoscopic left lateral sectionectomy (LLLS) versus the open counterparts was performed. Data considered for the comparison analysis were operative costs (theatre cost, consumables and surgeon/anaesthetic labour cost), postoperative costs (hospital stay, complication management and readmissions) and overall costs. A total of 149 patients were included: 38 patients underwent LRH and 46 open right hepatectomy (ORH); 46 patients underwent LLLS and 19 open left lateral sectionectomy (OLLS). For LRH the mean operative, postoperative and overall costs were £10,181, £4,037 and £14,218; for ORH the mean operative, postoperative and overall costs were £6,483 (p < 0.0001), £10,304 (p < 0.0001) and £16,787 (p = 0.886). Regarding LLLS, the mean operative, postoperative and overall costs were £5,460, £2,599 and £8,059; for OLLS the mean operative, postoperative and overall costs were £5,841 (p = 0.874), £5,796 (p < 0.0001) and £11,637 (p = 0.0001). Our data support the cost advantage of the laparoscopic approach for left lateral sectionectomy and the cost neutrality for right hepatectomy.

Resource utilization and costs before and after total joint arthroplasty.

PubMed

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

2012-03-23

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

Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot.

PubMed

Gil, Joseph; Schiff, Adam P; Pinzur, Michael S

2013-08-01

The negative impact on health-related quality of life in patients with Charcot foot has prompted operative correction of the acquired deformity. Comparative effectiveness financial models are being introduced to provide valuable information to assist clinical decision making. Seventy-six patients with Charcot foot underwent operative correction with the use of circular external fixation. Thirty-eight (50%) had osteomyelitis. A control group was created from 17 diabetic patients who successfully underwent transtibial amputation and prosthetic fitting during the same period. Cost of care during the 12 months following surgery was derived from inpatient hospitalization, placement in a rehabilitation unit or skilled nursing facility, home health care including parenteral antibiotic therapy, physical therapy, and purchase of prosthetic devices or footwear. Fifty-three of the patients with limb salvage (69.7%) did not require inpatient rehabilitation. Their average cost of care was $56,712. Fourteen of the patients with amputation (82.4%) required inpatient rehabilitation, with an average cost of $49,251. Many surgeons now favor operative correction of Charcot foot deformity. This investigation provides preliminary data on the relative cost of transtibial amputation and prosthetic limb fitting compared with limb salvage. The use of comparative effectiveness models such as this simple attempt may provide valuable information in planning resource allocation for similar complex groups of patients. Level III, economic and decision analysis.

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

For 15 years general hospital managers faced new competition from for-profit specialty hospitals that operate on a "focused factory" model, which threaten to siphon-off the most profitable patients. This paper aims to discuss North American specialty hospitals and to review rising costs impact on general hospital operations. The focus is to discover whether specialty hospitals are more efficient than general hospitals; if so, how significant is the difference and also what can general hospitals do in light of the rising specialty hospitals. The case study involves stochastic frontier regression analysis using Cobb-Douglas and Translog cost functions to compare Minnesota general and specialty hospital efficiency. Analysis is based on data from 117 general and 19 specialty hospitals. The results suggest that specialty hospitals are significantly more efficient than general hospitals. Overall, general hospitals were found to be more than twice as inefficient compared with specialty hospitals in the sample. Some cost-cutting factors highlighted can be implemented to trim rising costs. The case study highlights some managerial levers that general hospital operational managers might use to control rising costs. This also helps them compete with specialty hospitals by reducing overheads and other major costs. The study is based on empirical modeling for an important healthcare operational challenge and provides additional in-depth information that has health policy implications. The analysis and findings enable healthcare managers to guide their institutions in a new direction during a time of change within the industry.

A cost comparison of laparoscopic and open colon surgery in a publicly funded academic institution.

PubMed

Hardy, Krista M; Kwong, Josephine; Pitzul, Kristen B; Vergis, Ashley S; Jackson, Timothy D; Urbach, David R; Okrainec, Allan

2014-04-01

The objective of this study was to compare the total hospital cost of laparoscopic (lap) and open colon surgery at a publicly funded academic institution. Patients undergoing elective laparoscopic or open colon surgery for all indications at the University Health Network, Toronto, Canada, from April 2004 to March 2009 were included. Patient demographic, operative, and outcome data were reviewed retrospectively. Hospital costs were determined from the Ontario Case Costing Initiative, adjusted for inflation, and compared using the Mann-Whitney U test. Linear regression was used to analyze the relationship between length of stay and total hospital cost. There were 391 elective colon resections (223 lap/168 open, 15.4 % conversion). There was no difference in median age, gender, or Charlson score. Body mass index was slightly higher for laparoscopic surgery (27.5/25.9 lap/open; p = 0.008), while the American Society of Anesthesiologists score was slightly higher for open surgery. Median operative time was greater for laparoscopic surgery (224/196 min, lap/open; p = 0.001). There was no difference in complication rates (21.6/22.5 % lap/open; p = 0.900), reoperations (5.8/6.5 % lap/open; p = 0.833) or 30-day readmissions (7.6/12.5 % lap/open; p = 0.122). Number of emergency room visits was greater with open surgery (12.6/20.8 % lap/open; p = 0.037). Operative cost was higher for laparoscopic surgery ($4,171.37/3,489.29 lap/open; p = 0.001), while total hospital cost was significantly reduced ($9,600.22/12,721.41 lap/open; p = 0.001). Median length of stay was shorter for laparoscopic surgery (5/7 days lap/open; p = 0.000), and this correlated directly with hospital cost. Laparoscopic colon surgery is associated with increased operative costs but significantly lower total hospital costs. The cost savings is related, in part, to reduced length of stay with laparoscopic surgery.

Comparison of two cut-to-length harvesting systems operating in eastern hardwoods

Treesearch

Chris B. LeDoux; Niel K. Huyler

2001-01-01

We compared production rates, operating costs, and break-even points (BEP) for small and large cut-to-length (CTL) harvesting systems operating at several machine utilization rates (MUR) in mixed hardwood and softwood stands in Vermont.

Support surfaces for intraoperative prevention of pressure ulcers in patients undergoing surgery: a cost-effectiveness analysis.

PubMed

Pham, Ba'; Teague, Laura; Mahoney, James; Goodman, Laurie; Paulden, Mike; Poss, Jeff; Li, Jianli; Sikich, Nancy Joan; Lourenco, Rosemarie; Ieraci, Luciano; Carcone, Steven; Krahn, Murray

2011-07-01

Patients who undergo prolonged surgical procedures are at risk of developing pressure ulcers. Recent systematic reviews suggest that pressure redistribution overlays on operating tables significantly decrease the associated risk. Little is known about the cost effectiveness of using these overlays in a prevention program for surgical patients. Using a Markov cohort model, we evaluated the cost effectiveness of an intraoperative prevention strategy with operating table overlays made of dry, viscoelastic polymer from the perspective of a health care payer over a 1-year period. We simulated patients undergoing scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position. Compared with the current practice of using standard mattresses on operating tables, the intraoperative prevention strategy decreased the estimated intraoperative incidence of pressure ulcers by 0.51%, corresponding to a number-needed-to-treat of 196 patients. The average cost of using the operating table overlay was $1.66 per patient. Compared with current practice, this intraoperative prevention strategy would increase slightly the quality-adjusted life days of patients and by decreasing the incidence of pressure ulcers, this strategy would decrease both hospital and home care costs for treating fewer pressure ulcers originated intraoperatively. The cost savings was $46 per patient, which ranged from $13 to $116 by different surgical populations. Intraoperative prevention was 99% likely to be more cost effective than the current practice. In patients who undergo scheduled surgical procedures lasting ≥90 min, this intraoperative prevention strategy could improve patients' health and save hospital costs. The clinical and economic evidence support the implementation of this prevention strategy in settings where it has yet to become current practice. Copyright © 2011 Mosby, Inc. All rights reserved.

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

NASA Technical Reports Server (NTRS)

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

1982-01-01

The relationships between field length and cruise speed and aircraft direct operating cost were determined. A gradient optimizing computer program was developed to minimize direct operating cost (DOC) as a function of airplane geometry. In this way, the best airplane operating under one set of constraints can be compared with the best operating under another. A constant 30-passenger fuselage and rubberized engines based on the General Electric CT-7 were used as a baseline. All aircraft had to have a 600 nautical mile maximum range and were designed to FAR part 25 structural integrity and climb gradient regulations. Direct operating cost was minimized for a typical design mission of 150 nautical miles. For purposes of C sub L sub max calculation, all aircraft had double-slotted flaps but with no Fowler action.

Lessons Learned from Outsourcing the Pearl Harbor MK-48 Intermediate Maintenance Activity

DTIC Science & Technology

2008-03-01

transfer of ownership of assets. However, outsourcing is not simply a procurement decision. All organizations procure elements of their operations...systems, commercialization, and franchising (Office of Management and Budget, 2004). Strengths of Outsourcing Outsourcing is more efficient than...operating the IMA with organic resources vs . the cost of a comparable service provided by a contractor. Activity-based costing would also help managers

Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy.

PubMed

Atluri, Pavan; Stetson, Robert L; Hung, George; Gaffey, Ann C; Szeto, Wilson Y; Acker, Michael A; Hargrove, W Clark

2016-02-01

Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

PubMed Central

Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

2011-01-01

Background: Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. Methods: A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Results: Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001). Conclusion: We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity. PMID:22145085

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan.

PubMed

Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

2011-01-01

Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001). We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

Cost of an informatics-based diabetes management program.

PubMed

Blanchfield, Bonnie B; Grant, Richard W; Estey, Greg A; Chueh, Henry C; Gazelle, G Scott; Meigs, James B

2006-01-01

The relatively high cost of information technology systems may be a barrier to hospitals thinking of adopting this technology. The experiences of early adopters may facilitate decision making for hospitals less able to risk their limited resources. This study identifies the costs to design, develop, implement, and operate an innovative informatics-based registry and disease management system (POPMAN) to manage type 2 diabetes in a primary care setting. The various cost components of POPMAN were systematically identified and collected. POPMAN cost 450,000 dollars to develop and operate over 3.5 years (1999-2003). Approximately 250,000 dollars of these costs are one-time expenditures or sunk costs. Annual operating costs are expected to range from 90,000 dollars to 110,000 dollars translating to approximately 90 dollars per patient for a 1,200 patient registry. The cost of POPMAN is comparable to the costs of other quality-improving interventions for patients with diabetes. Modifications to POPMAN for adaptation to other chronic diseases or to interface with new electronic medical record systems will require additional investment but should not be as high as initial development costs. POPMAN provides a means of tracking progress against negotiated quality targets, allowing hospitals to negotiate pay for performance incentives with insurers that may exceed the annual operating cost of POPMAN. As a result, the quality of care of patients with diabetes through use of POPMAN could be improved at a minimal net cost to hospitals.

Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy.

PubMed

Tomaszewski, Jeffrey J; Matchett, Jarred C; Davies, Benjamin J; Jackman, Stephen V; Hrebinko, Ronald L; Nelson, Joel B

2012-07-01

To perform a contemporary comparative cost-analysis of robotic-assisted laparoscopic radical prostatectomy (RARP) and open radical retropubic prostatectomy (RRP). All patients undergoing RARP (n = 115) or RRP (n = 358) by 1 of 4 surgeons at a single institution during a 15-month period were retrospectively reviewed. The hospital length of stay (LOS), operative time, hospital charges, reimbursement, and direct and indirect hospital costs were analyzed and compared. The mean LOS between patients undergoing RARP (1.2 ± 0.6 days) and RRP (1.4 ± 0.8 days) was not significantly different. The operating room supply costs per case were almost 7 times greater for RARP ($2852 ± $528) than for RRP ($417 ± $59; P < .05). The ancillary, cardiology, imaging, administrative, laboratory, and pharmacy costs were not significantly different between the 2 approaches. The mean total costs per case for RARP exceeded the total costs for RRP by 62% ($14 006 ± $1641 vs $8686 ± $1989; P < .05). Payment to the hospital from all sources was nearly equivalent: $10 011 for RRP and $9993 for RARP. Therefore, the average profit for each RRP was $1325 and each RARP lost $4013. In the present single-institution analysis, the total actual costs associated with RARP were significantly greater than those for RRP and were attributable to the robotic equipment and supplies. Copyright © 2012 Elsevier Inc. All rights reserved.

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Code of Federal Regulations, 2010 CFR

2010-04-01

..., supportive services, maintenance, tenant, and PHA-paid utilities) will be reduced as a result of post... and utility allowances) shall be expressed as total operating costs per year. For example, if a... $504 per unit month. By this example, the current costs per occupied unit are at least 10 percent...

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Code of Federal Regulations, 2012 CFR

2012-04-01

..., supportive services, maintenance, tenant, and PHA-paid utilities) will be reduced as a result of post... and utility allowances) shall be expressed as total operating costs per year. For example, if a... $504 per unit month. By this example, the current costs per occupied unit are at least 10 percent...

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Code of Federal Regulations, 2011 CFR

2011-04-01

..., supportive services, maintenance, tenant, and PHA-paid utilities) will be reduced as a result of post... and utility allowances) shall be expressed as total operating costs per year. For example, if a... $504 per unit month. By this example, the current costs per occupied unit are at least 10 percent...

Cost/efficacy evaluation of the technologies applied to video-assisted thoracoscopic surgery lobectomy.

PubMed

Menna, Cecilia; Ibrahim, Mohsen; Rendina, Erino Angelo; Venuta, Federico; Andreetti, Claudio

2017-01-01

Superior outcomes after video-assisted thoracoscopic surgery (VATS) pulmonary lobectomy have been demonstrated, compared with thoracotomy, for patients affected by early-stage non-small cell lung cancer (NSCLC). However, in an era of rising health care costs and controlled resources, the overall medical cost of surgical procedures is measured by the hospitals' marketing offices. Several factors such as surgical technique, conversion rate, length of stay, post-operative complications occurrence and mainly the introduction of new surgical technologies (disposables and devices) could influence the cost-effectiveness of VATS procedures. However, increased operating room costs are counteracted by shorter hospital stay and reduced ward bed stays providing further resources for other patients. Thus, choosing a surgical approach and assessing whether a specific technique is cost-effective is mandatory for a modern thoracic surgeon to justify its expenses. This review tries to reach a conclusion by comparing all recent studies reporting a cost analysis for VATS lobectomy, especially for new technologies used for VATS lobectomy. Nevertheless, no sufficient evidences are published to assess VATS new technologies sustainability and further cost analyses are necessary before VATS lobectomy expense is deemed justified.

Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.

PubMed

Munshi, Saif U; Oyewale, Tajudeen O; Begum, Shahnaz; Uddin, Ziya; Tabassum, Shahina

2016-03-01

Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh. Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing. The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum. Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.

Comparative economics of space resource utilization

NASA Technical Reports Server (NTRS)

Cutler, Andrew Hall

1991-01-01

Physical economic factors such as mass payback ratio, total payback ratio, and capital payback time are discussed and used to compare the economics of using resources from the Moon, Mars and its moons, and near Earth asteroids to serve certain near term markets such as propellant in low Earth orbit or launched mass reduction for lunar and Martian exploration. Methods for accounting for the time cost of money in simple figures of merit such as MPRs are explored and applied to comparisons such as those between lunar, Martian, and asteroidal resources. Methods for trading off capital and operating costs to compare schemes with substantially different capital to operating cost ratio are presented and discussed. Areas where further research or engineering would be extremely useful in reducing economic uncertainty are identified, as are areas where economic merit is highly sensitive to engineering performance - as well as areas where such sensitivity is surprisingly low.

Optimization study on multiple train formation scheme of urban rail transit

NASA Astrophysics Data System (ADS)

Xia, Xiaomei; Ding, Yong; Wen, Xin

2018-05-01

The new organization method, represented by the mixed operation of multi-marshalling trains, can adapt to the characteristics of the uneven distribution of passenger flow, but the research on this aspect is still not perfect enough. This paper introduced the passenger sharing rate and congestion penalty coefficient with different train formations. On this basis, this paper established an optimization model with the minimum passenger cost and operation cost as objective, and operation frequency and passenger demand as constraint. The ideal point method is used to solve this model. Compared with the fixed marshalling operation model, the overall cost of this scheme saves 9.24% and 4.43% respectively. This result not only validates the validity of the model, but also illustrate the advantages of the multiple train formations scheme.

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

PubMed

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

2014-04-01

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

Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy.

PubMed

Çukurova, Ibrahim; Bulğurcu, Suphi; Arslan, Ilker Burak; Dikilitaş, Bünyamin

2018-05-08

In this study, we compared the advantages and disadvantages of piezosurgery and hammer-chisel used in endoscopic dacryocystorhinostomy (EDCR). Between January 2012 and January 2016, 10 women and 8 men in whom piezosurgery was used (group 1) and 11 women and 7 men in whom hammer-chisel was used (group 2) during EDCR operations were compared retrospectively. Recurrence, operation time, postoperative bleeding, and operative cost were evaluated in patients who were followed for an average of 11.8 months. In addition, visual analogue scale (VAS) was used to assess pain at 6 hours postoperatively. No recurrence was observed in group 1, but recurrence was observed in 2 patients in group 2 (P = 0.685). There was no postoperative bleeding in both groups. The mean duration of operation was 30.6 ± 8.2 minutes in group 1 and 46.8 ± 9.5 minutes in group 2 (P = 0.038). The VAS score in group 1 was 2.7 ± 1.4 and the VAS score in group 2 was 5.8 ± 2.2 (P = 0.01). Piezosurgery costs an additional $325 for each patient while the use of the hammer-chisel does not incur additional costs. Piezosurgery causes shorter operation time, less recurrence, and less pain when compared with hammer-chisel.

Is dibotermin alfa a cost-effective substitute for autologous iliac crest bone graft in single level lumbar interbody spine fusion?

PubMed

Svedbom, Axel; Paech, Daniel; Leonard, Catherine; Donnell, David; Song, Fujian; Boszcyk, Bronek; Rothenfluh, Dominique A; Lloyd, Andrew; Borgman, Benny

2015-11-01

To evaluate the cost-effectiveness of dibotermin alfa compared with autologous iliac crest bone graft (ICBG) for patients undergoing single level lumbar interbody spinal fusion in a UK hospital setting. An individual patient data (IPD) meta-analysis of six randomized controlled clinical trials and two single arm trials compared dibotermin alfa on an absorbable collagen implantation matrix (ACIM) (n = 456) and ICBG (n = 244) on resource use, re-operation rates, and SF-6D (Short form 6-dimension) health utility (total N = 700). Failure-related second surgery, operating time, post-operative hospital stay, and quality-adjusted life years (QALYs) derived from the IPD meta-analysis were included as inputs in an economic evaluation undertaken to assess the cost-effectiveness of dibotermin alfa/ACIM versus ICBG for patients undergoing single level lumbar interbody spinal fusion. A four year time horizon and the United Kingdom (UK) National Health Service (NHS) and Personal Social Services (PSS) perspective was adopted in the base case, with sensitivity analyses performed to gauge parameter uncertainty. In the base case analysis, patients treated using dibotermin alfa/ACIM (12 mg pack) accrued 0.055 incremental QALYs at an incremental cost of £ 737, compared with patients treated with ICBG. This resulted in an incremental cost-effectiveness ratio (ICER) of £ 13,523, indicating that at a willingness-to-pay threshold of £ 20,000, dibotermin alfa/ACIM is a cost-effective intervention relative to ICBG from the NHS and PSS perspective. In a UK hospital setting, dibotermin alfa/ACIM is a cost-effective substitute for ICBG for patients who require lumbar interbody arthrodesis.

Efficiency Assessment of Support Mechanisms for Wood-Fired Cogeneration Development in Estonia

NASA Astrophysics Data System (ADS)

Volkova, Anna; Siirde, Andres

2010-01-01

There are various support mechanisms for wood-fired cogeneration plants, which include both support for cogeneration development and stimulation for increasing consumption of renewable energy sources. The efficiency of these mechanisms is analysed in the paper. Overview of cogeneration development in Estonia is given with the focus on wood-fired cogeneration. Legislation acts and amendments, related to cogeneration support schemes, were described. For evaluating the efficiency of support mechanisms an indicator - fuel cost factor was defined. This indicator includes the costs related to the chosen fuel influence on the final electricity generation costs without any support mechanisms. The wood fuel cost factors were compared with the fuel cost factors for peat and oil shale. For calculating the fuel cost factors, various data sources were used. The fuel prices data were based on the average cost of fuels in Estonia for the period from 2000 till 2008. The data about operating and maintenance costs, related to the fuel type in the case of comparing wood fuel and oil shale fuel were taken from the CHP Balti and Eesti reports. The data about operating and maintenance costs used for peat and wood fuel comparison were taken from the Tallinn Elektrijaam reports. As a result, the diagrams were built for comparing wood and its competitive fuels. The decision boundary lines were constructed on the diagram for the situation, when no support was provided for wood fuels and for the situations, when various support mechanisms were provided during the last 12 years.

Computer assisted yarding cost analysis.

Treesearch

Ronald W. Mifflin

1980-01-01

Programs for a programable calculator and a desk-top computer are provided for quickly determining yarding cost and comparing the economics of alternative yarding systems. The programs emphasize the importance of the relationship between production rate and machine rate, which is the hourly cost of owning and operating yarding equipment. In addition to generating the...

7 CFR 1.673 - How will the Forest Service analyze a proposed alternative and formulate its modified condition?

Code of Federal Regulations, 2010 CFR

2010-01-01

... evidence on the implementation costs or operational impacts for electricity production of the proposed... alternative: (1) Will, as compared to the Forest Service's preliminary condition: (i) Cost significantly less... alternative not adopted on: (1) Energy supply, distribution, cost, and use; (2) Flood control; (3) Navigation...

Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?

PubMed

Ho, David M; Huo, Michael H

2007-07-01

Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs. Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups. Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs. Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.

Ship Compliance in Emission Control Areas: Technology Costs and Policy Instruments.

PubMed

Carr, Edward W; Corbett, James J

2015-08-18

This paper explores whether a Panama Canal Authority pollution tax could be an effective economic instrument to achieve Emission Control Area (ECA)-like reductions in emissions from ships transiting the Panama Canal. This tariff-based policy action, whereby vessels in compliance with International Maritime Organisation (IMO) ECA standards pay a lower transit tariff than noncompliant vessels, could be a feasible alternative to petitioning for a Panamanian ECA through the IMO. A $4.06/container fuel tax could incentivize ECA-compliant emissions reductions for nearly two-thirds of Panama Canal container vessels, mainly through fuel switching; if the vessel(s) also operate in IMO-defined ECAs, exhaust-gas treatment technologies may be cost-effective. The RATES model presented here compares current abatement technologies based on hours of operation within an ECA, computing costs for a container vessel to comply with ECA standards in addition to computing the Canal tax that would reduce emissions in Panama. Retrofitted open-loop scrubbers are cost-effective only for vessels operating within an ECA for more than 4500 h annually. Fuel switching is the least-cost option to industry for vessels that operate mostly outside of ECA regions, whereas vessels operating entirely within an ECA region could reduce compliance cost with exhaust-gas treatment technology (scrubbers).

Mass transit : bus rapid transit shows promise

DOT National Transportation Integrated Search

2001-09-17

The U. S. General Accounting Office (GAO) was asked to (1) examine the federal role in supporting Bus Rapid Transit; (2) compare the capital costs, operating costs, and performance characteristics of Bus Rapid Transit and Light Rail systems; and (3) ...

Optimal synthesis and design of the number of cycles in the leaching process for surimi production.

PubMed

Reinheimer, M Agustina; Scenna, Nicolás J; Mussati, Sergio F

2016-12-01

Water consumption required during the leaching stage in the surimi manufacturing process strongly depends on the design and the number and size of stages connected in series for the soluble protein extraction target, and it is considered as the main contributor to the operating costs. Therefore, the optimal synthesis and design of the leaching stage is essential to minimize the total annual cost. In this study, a mathematical optimization model for the optimal design of the leaching operation is presented. Precisely, a detailed Mixed Integer Nonlinear Programming (MINLP) model including operating and geometric constraints was developed based on our previous optimization model (NLP model). Aspects about quality, water consumption and main operating parameters were considered. The minimization of total annual costs, which considered a trade-off between investment and operating costs, led to an optimal solution with lesser number of stages (2 instead of 3 stages) and higher volumes of the leaching tanks comparing with previous results. An analysis was performed in order to investigate how the optimal solution was influenced by the variations of the unitary cost of fresh water, waste treatment and capital investment.

Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

PubMed

Rhee, Peter C; Fischer, Michelle M; Rhee, Laura S; McMillan, Ha; Johnson, Anthony E

2017-03-01

Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. Economic/Decision Analysis IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis.

PubMed

Melfa, G I; Raspanti, C; Attard, M; Cocorullo, G; Attard, A; Mazzola, S; Salamone, G; Gulotta, G; Scerrino, G

2016-01-01

Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70- 95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or "open" under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient's satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student's, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient's satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). MIVAP is more expensive compared to the "open" parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration.

The ALMA CONOPS project: the impact of funding decisions on observatory performance

NASA Astrophysics Data System (ADS)

Ibsen, Jorge; Hibbard, John; Filippi, Giorgio

2014-08-01

In time when every penny counts, many organizations are facing the question of how much scientific impact a budget cut can have or, putting it in more general terms, which is the science impact of alternative (less costly) operational modes. In reply to such question posted by the governing bodies, the ALMA project had to develop a methodology (ALMA Concepts for Operations, CONOPS) that attempts to measure the impact that alternative operational scenarios may have on the overall scientific production of the Observatory. Although the analysis and the results are ALMA specific, the developed approach is rather general and provides a methodology for a cost-performance analysis of alternatives before any radical alterations to the operations model are adopted. This paper describes the key aspects of the methodology: a) the definition of the Figures of Merit (FoMs) for the assessment of quantitative science performance impacts as well as qualitative impacts, and presents a methodology using these FoMs to evaluate the cost and impact of the different operational scenarios; b) the definition of a REFERENCE operational baseline; c) the identification of Alternative Scenarios each replacing one or more concepts in the REFERENCE by a different concept that has a lower cost and some level of scientific and/or operational impact; d) the use of a Cost-Performance plane to graphically combine the effects that the alternative scenarios can have in terms of cost reduction and affected performance. Although is a firstorder assessment, we believe this approach is useful for comparing different operational models and to understand the cost performance impact of these choices. This can be used to take decision to meet budget cuts as well as in evaluating possible new emergent opportunities.

Comparative evaluation of existing expendable upper stages for space shuttle

NASA Technical Reports Server (NTRS)

Weyers, V. J.; Sagerman, G. D.; Borsody, J.; Lubick, R. J.

1974-01-01

The use of existing expendable upper stages in the space shuttle during its early years of operation is evaluated. The Burner 2, Scout, Delta, Agena, Transtage, and Centaur were each studied under contract by their respective manufacturers to determine the extent and cost of the minimum modifications necessary to integrate the stage with the shuttle orbiter. A comparative economic analysis of thirty-five different families of these stages is discussed. Results show that the overall transportation system cost differences between many of the families are quite small. However, by considering several factors in addition to cost, it is possible to select one family as being representative of the capability of the minimum modification existing stage approach. The selected family meets all of the specified mission requirements during the early years of shuttle operation.

Comparative Analysis of Length of Stay and Inpatient Costs for Orthopedic Surgery Patients Treated with IV Acetaminophen and IV Opioids vs. IV Opioids Alone for Post-Operative Pain.

PubMed

Hansen, Ryan N; Pham, An; Strassels, Scott A; Balaban, Stela; Wan, George J

2016-09-01

Recovery from orthopedic surgery is oriented towards restoring functional health outcomes while reducing hospital length of stay (LOS) and medical expenditures. Optimal pain management is a key to reaching these objectives. We sought to compare orthopedic surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia to those who received IV opioids alone and compared the two groups on LOS and hospitalization costs. We performed a retrospective analysis of the Premier Database (Premier, Inc.; between January 2009 and June 2015) comparing orthopedic surgery patients who received post-operative pain management with combination IV acetaminophen and IV opioids to those who received only IV opioids starting on the day of surgery and continuing up to the second post-operative day. The quarterly rate of IV acetaminophen use for all hospitalizations by hospital served as the instrumental variable in two-stage least squares regressions controlling for patient and hospital covariates to compare the LOS and hospitalization costs of IV acetaminophen recipients to opioid monotherapy patients. We identified 4,85,895 orthopedic surgery patients with 1,74,805 (36%) who had received IV acetaminophen. Study subjects averaged 64 years of age and were predominantly non-Hispanic Caucasians (78%) and female (58%). The mean unadjusted LOS for IV acetaminophen patients was 3.2 days [standard deviation (SD) 2.6] compared to 3.9 days (SD 3.9) with only IV opioids (P < 0.0001). Average unadjusted hospitalization costs were $19,024.9 (SD $13,113.7) for IV acetaminophen patients and $19,927.6 (SD $19,578.8) for IV opioid patients (P < 0.0001). These differences remained statistically significant in our instrumental variable models, with IV acetaminophen associated with 0.51 days shorter hospitalization [95% confidence interval (CI) -0.58 to -0.44, P < 0.0001] and $634.8 lower hospitalization costs (95% CI -$1032.5 to -$237.1, P = 0.0018). Compared to opioids alone, managing post-orthopedic surgery pain with the addition of IV acetaminophen is associated with shorter LOS and decreased hospitalization costs. Mallinckrodt Pharmaceuticals.

The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

PubMed

Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

2018-02-21

In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize actual operating margins.

Reducing robotic prostatectomy costs by minimizing instrumentation.

PubMed

Delto, Joan C; Wayne, George; Yanes, Rafael; Nieder, Alan M; Bhandari, Akshay

2015-05-01

Since the introduction of robotic surgery for radical prostatectomy, the cost-benefit of this technology has been under scrutiny. While robotic surgery professes to offer multiple advantages, including reduced blood loss, reduced length of stay, and expedient recovery, the associated costs tend to be significantly higher, secondary to the fixed cost of the robot as well as the variable costs associated with instrumentation. This study provides a simple framework for the careful consideration of costs during the selection of equipment and materials. Two experienced robotic surgeons at our institution as well as several at other institutions were queried about their preferred instrument usage for robot-assisted prostatectomy. Costs of instruments and materials were obtained and clustered by type and price. A minimal set of instruments was identified and compared against alternative instrumentation. A retrospective review of 125 patients who underwent robotically assisted laparoscopic prostatectomy for prostate cancer at our institution was performed to compare estimated blood loss (EBL), operative times, and intraoperative complications for both surgeons. Our surgeons now conceptualize instrument costs as proportional changes to the cost of the baseline minimal combination. Robotic costs at our institution were reduced by eliminating an energy source like the Ligasure or vessel sealer, exploiting instrument versatility, and utilizing inexpensive tools such as Hem-o-lok clips. Such modifications reduced surgeon 1's cost of instrumentation to ∼40% less compared with surgeon 2 and up to 32% less than instrumentation used by surgeons at other institutions. Surgeon 1's combination may not be optimal for all robotic surgeons; however, it establishes a minimally viable toolbox for our institution through a rudimentary cost analysis. A similar analysis may aid others in better conceptualizing long-term costs not as nominal, often unwieldy prices, but as percent changes in spending. With regard to intraoperative outcomes, the use of a minimally viable toolbox did not result in increased EBL, operative time, or intraoperative complications. Simple changes to surgeon preference and creative utilization of instruments can eliminate 40% of costs incurred on robotic instruments alone. Moreover, EBL, operative times, and intraoperative complications are not compromised as a result of cost reduction. Our process of identifying such improvements is straightforward and may be replicated by other robotic surgeons. Further prospective multicenter trials should be initiated to assess other methods of cost reduction.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery--the FOCCUS study.

PubMed

Cuthbertson, Brian H; Campbell, Marion K; Stott, Stephen A; Elders, Andrew; Hernández, Rodolfo; Boyers, Dwayne; Norrie, John; Kinsella, John; Brittenden, Julie; Cook, Jonathan; Rae, Daniela; Cotton, Seonaidh C; Alcorn, David; Addison, Jennifer; Grant, Adrian

2011-01-01

Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Prospective Clinical Trials, ISRCTN32188676.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery - the FOCCUS study

PubMed Central

2011-01-01

Introduction Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. Methods This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. Results A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Conclusions Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Trial registration Prospective Clinical Trials, ISRCTN32188676 PMID:22177541

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

PubMed

Warren, Jeremy A; Ewing, Joseph A; Hale, Allyson L; Blackhurst, Dawn W; Bour, Eric S; Scott, John D

2015-08-01

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients.

PubMed

Vilà, Jordi; Balibrea, José María; Oller, Benjamí; Alastrué, Antonio; Poyatos, Jordi Vilà; Balibrea del Castillo, José María; Sales, Benjamí Oller; Vidal, Antonio Alastrué

2014-09-01

Post-bariatric, body contouring surgery to treat the sequelae of massive weight loss is an undervalued topic by patients and in most of the literature. The objective of this study was to determine the mean cost per patient of this treatment in a public morbid obesity unit, and compare it with the perception by the patients. Costs were estimated using a specific Diagnosis-Related Group-based method and a questionnaire in a sample of 100 patients who had completed body contouring treatment. This study included 23 men and 77 women with a mean age of 48.5 years, a mean reduction of body mass index of 20.77 kg/m, and a median follow-up of 58 months. These patients had undergone surgery, as needed, as follows: on the lower part of the trunk (109 operations; mean cost, &OV0556;6348.6), cruroplasty (43 operations; mean cost, &OV0556;3490), brachioplasty (28 operations; mean cost &OV0556;3150), and the upper part of the trunk (10 operations; mean cost, &OV0556;4290). The rate of complications has been high (up to 50 percent) and, although the more severe complications are rare (10.5 percent Clavien grade IIIb), these represent high costs (mean, &OV0556;24462.6). Forty-five patients answered the questionnaire. Although they think that this surgery improves their quality of life, they have undervalued its total cost (17.58 percent; &OV0556;2034) (p = 0.16). The average cost of post-bariatric surgery body contouring treatment in this unit is &OV0556;8263.95 (1.66 operations per patient). The severe complications increase by 2.96 times the average cost per patient.

A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions.

PubMed

Tapper, Anna-Maija; Hannola, Mikko; Zeitlin, Rainer; Isojärvi, Jaana; Sintonen, Harri; Ikonen, Tuija S

2014-06-01

In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Optimization of power systems with voltage security constraints

NASA Astrophysics Data System (ADS)

Rosehart, William Daniel

As open access market principles are applied to power systems, significant changes in their operation and control are occurring. In the new marketplace, power systems are operating under higher loading conditions as market influences demand greater attention to operating cost versus stability margins. Since stability continues to be a basic requirement in the operation of any power system, new tools are being considered to analyze the effect of stability on the operating cost of the system, so that system stability can be incorporated into the costs of operating the system. In this thesis, new optimal power flow (OPF) formulations are proposed based on multi-objective methodologies to optimize active and reactive power dispatch while maximizing voltage security in power systems. The effects of minimizing operating costs, minimizing reactive power generation and/or maximizing voltage stability margins are analyzed. Results obtained using the proposed Voltage Stability Constrained OPF formulations are compared and analyzed to suggest possible ways of costing voltage security in power systems. When considering voltage stability margins the importance of system modeling becomes critical, since it has been demonstrated, based on bifurcation analysis, that modeling can have a significant effect of the behavior of power systems, especially at high loading levels. Therefore, this thesis also examines the effects of detailed generator models and several exponential load models. Furthermore, because of its influence on voltage stability, a Static Var Compensator model is also incorporated into the optimization problems.

An assessment of nitrogen-based manure application rates on 39 U.S. swine operations.

PubMed

Lory, John A; Massey, Raymond E; Zulovich, Joseph M; Hoehne, John A; Schmidt, Amy M; Carlson, Marcia S; Fulhage, Charles D

2004-01-01

Water quality concerns and revised regulations are changing how confined animal feeding operations manage manure. Devising acceptable and feasible changes in manure practices requires a full understanding of the forces shaping current manure management decisions. Previous theoretical models have shown that a wide range of factors influence the lowest cost solution for manure management. We used a mechanistic model to characterize the manure management practices on 39 swine operations (20 unagitated lagoon and 19 slurry operations) in five states (Iowa, Missouri, North Carolina, Oklahoma, and Pennsylvania). Information was collected from each operation about animal numbers, feed and water use, manure handling and storage characteristics, field locations, crop rotation, fertilizer need, and equipment inventory and usage. Collected data were used as input and to validate results from a mechanistic model that determined acres required for manure application, manure application rate, time required for manure application, value of manure, and costs of manure management. The 39 farms had a mean of 984 animal units (AU) per operation, 18.2 AU ha(-1) (7.4 AU acre(-1)), and manure application costs of dollar 10.49 AU(-1) yr(-1). Significant factors affecting manure management included operation size, manure handling system, state, and ownership structure. Larger operations had lower manure management costs (r2 = 0.32). Manure value potentially exceeded manure application costs on 58% of slurry and 15% of lagoon operations. But 38% of slurry operations needed to apply manure off the farm whereas all lagoon operations had sufficient land for N-based manure management. Manure management was a higher percentage of gross income on contract operations compared with independents (P < 0.01). This research emphasized the importance of site-specific factors affecting manure management decisions and the economics of U.S. swine operations.

The financial implications of endovascular aneurysm repair in the cost containment era.

PubMed

Stone, David H; Horvath, Alexander J; Goodney, Philip P; Rzucidlo, Eva M; Nolan, Brian W; Walsh, Daniel B; Zwolak, Robert M; Powell, Richard J

2014-02-01

Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Surgery scheduling optimization considering real life constraints and comprehensive operation cost of operating room.

PubMed

Xiang, Wei; Li, Chong

2015-01-01

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

The indirect cost of Patient-Specific Instruments.

PubMed

Thienpont, Emmanuel; Paternostre, Frederic; Van Wymeersch, Charles

2015-09-01

To calculate the indirect costs of Patient Specific Instruments (PSI) based on an opportunity cost, cost of efforts and a supply chain cost model to compare PSI for value with conventional total knee arthroplasty (TKA). In 81 patients the total (direct+indirect) cost of PSI-assisted TKA was compared with conventional TKA. Surgical times and coronal mechanical alignment were measured to evaluate the effectiveness of the PSI system. Indirect costs (459 euro) make up 40% of the total cost that can run up to 1142 euro for a patient operated with PSI guides. No difference in surgical times or coronal alignment was observed in between both groups. Considering the total cost of PSI no value was found for the use of PSI in primary TKA as measured by surgical times or for obtaining a neutral mechanical axis in the coronal plane.

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Understanding the cost bases of Space Shuttle pricing policies for commercial and foreign customers

NASA Technical Reports Server (NTRS)

Stone, Barbara A.

1984-01-01

The principles and underlying cost bases of the 1977 and 1982 Space Shuttle Reimbursement Policies are compared and contrasted. Out-of-pocket cost recovery has been chosen as the base of the price for the 1986-1988 time period. With this cost base, it is NASA's intent to recover the total cost of consumables and the launch and flight operations costs added by commercial and foreign customers over the 1986-1988 time period. Beyond 1988, NASA intends to return to its policy of full cost recovery.

Health care expenditures and therapeutic outcomes of a pharmacist-managed anticoagulation service versus usual medical care.

PubMed

Hall, Deanne; Buchanan, Julianne; Helms, Bethany; Eberts, Matthew; Mark, Scott; Manolis, Chronis; Peele, Pamela; Docimo, Anne

2011-07-01

To evaluate the differences in health care expenditures and therapeutic outcomes of patients receiving warfarin therapy management by a pharmacist-managed anticoagulation service compared with those receiving warfarin management by usual medical care. Retrospective, matched-cohort study. University of Pittsburgh Medical Center (UPMC) and UPMC Health Plan. Three hundred fifty adults who received warfarin therapy; 175 were managed by the pharmacist-managed anticoagulation service for at least 2 months between October 1, 2007, and September 30, 2008, (case patients) and 175 received usual care (matched comparison group). Medical claims data compared were direct anticoagulation cost and overall medical care costs, anticoagulation-related adverse events, hospitalizations and emergency department visits, frequency of international normalized ratio (INR) testing, and quantity of warfarin refills. Operational costs of the anticoagulation service were also calculated. The INR values and time within therapeutic range were assessed through anticoagulation service reports and laboratory results. The direct anticoagulation care cost was $35,465 versus $111,586 and the overall medical care cost was $754,191 versus $1,480,661 for the anticoagulation service group versus the usual care group. Accounting for operational and drug expenditure costs, the cost savings was $647,024 for the anticoagulation service group. The anticoagulation service group had significantly fewer anticoagulation-related adverse events (14 vs 41, p<0.0001), hospital admissions (3 vs 14, p<0.00001), and emergency department visits (58 vs 134, p<0.00001). The percentage of INR values in range and the percentage of time the INR values were in range were significantly higher in the anticoagulation service group (67.2% vs 54.6%, p<0.0001, and 73.7% vs 61.3%, p<0.0001, respectively). Compared with the usual care group, the anticoagulation service group had significantly more INR tests performed but demonstrated no significant difference in the quantity of drug refills. After accounting for operational costs, pharmacist-managed anticoagulation leads to reduced health care expenditure while improving therapeutic outcomes compared with usual medical care.

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

PubMed

Maloney, Stephen; Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-07-21

Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

Nerve sparing sutureless total thyroidectomy. Preliminary study.

PubMed

Parmeggiani, Domenico; De Falco, Massimo; Avenia, Nicola; Sanguinetti, Alessandro; Fiore, Andrea; Docimo, Giovanni; Ambrosino, Pasquale; Madonna, Imma; Peltrini, Roberto; Parmeggiani, Umberto

2012-01-01

In the present study the authors assess the advantages of new technologies in thyroid surgery: to prevent nerve injury by using an intra-operative continuous nerve-monitoring techniques and to compare the real advantages of advanced coagulation devices. Among a series of 440 thyroidectomies (jan 2004-feb 2006) the Authors reviewed charts from two groups: (1) 240 total thyroidectomies performed using the traditional monopolar electrocautery, non-absorbable stitches for the principal vascular pedicles. (2) 140 total thyroidectomies performed using dedicated small bipolar electro thermal coagulator (ligasure-precise). (3) Since 2006 in a double blind group selection of 70, we've performed sutureless thyroidectomy with continuous intraoperative nerve monitoring using dedicated endotracheal tube. Mean operative time, post-operative bleeding, post-operative stay, incidence of transient or definitive laryngeal nerve lesions, incidence of permanent or transient hypocalcaemia, costs of the procedures were analyzed. Major complications in the first two groups compared with the data of the literature are absolutely over-imposable, except a reduction of incidence of transient hypocalcaemia in the Precise group, but if we compare data of the 3rd group (NIM), we find a significative reduction of transient and permanent laryngeal nerve palsy incidence. This new technology offers several advantages: (1) atraumatic; (2) easy to use; (3) continuous monitoring and audio feedback to the surgeon (4) works outside the operation field (5) high sensitiveness. Cost-analysis confirm that NIM + ligasure have same or less cost and time and probably less complications than traditional Total Thyroidectomy.

Feasibility and operating costs of an air cycle for CCHP in a fast food restaurant

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

Perez-Blanco, Horacio; Vineyard, Edward

This work considers the possibilities of an air-based Brayton cycle to provide the power, heating and cooling needs of fast-food restaurants. A model of the cycle based on conventional turbomachinery loss coefficients is formulated. The heating, cooling and power capabilities of the cycle are extracted from simulation results. Power and thermal loads for restaurants in Knoxville, TN and in International Falls, MN, are considered. It is found that the cycle can meet the loads by setting speed and mass flow-rate apportionment between the power and cooling functional sections. The associated energy costs appear elevated when compared to the cost ofmore » operating individual components or a more conventional, absorption-based CHP system. Lastly, a first-order estimate of capital investments is provided. Suggestions for future work whereby the operational costs could be reduced are given in the conclusions.« less

Feasibility and operating costs of an air cycle for CCHP in a fast food restaurant

DOE PAGES

Perez-Blanco, Horacio; Vineyard, Edward

2016-05-06

This work considers the possibilities of an air-based Brayton cycle to provide the power, heating and cooling needs of fast-food restaurants. A model of the cycle based on conventional turbomachinery loss coefficients is formulated. The heating, cooling and power capabilities of the cycle are extracted from simulation results. Power and thermal loads for restaurants in Knoxville, TN and in International Falls, MN, are considered. It is found that the cycle can meet the loads by setting speed and mass flow-rate apportionment between the power and cooling functional sections. The associated energy costs appear elevated when compared to the cost ofmore » operating individual components or a more conventional, absorption-based CHP system. Lastly, a first-order estimate of capital investments is provided. Suggestions for future work whereby the operational costs could be reduced are given in the conclusions.« less

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

NASA Technical Reports Server (NTRS)

Greenhill, L. M.

1990-01-01

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

Study of the cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system

NASA Technical Reports Server (NTRS)

Hopkins, J. P.

1976-01-01

Practical means were assessed for achieving reduced fuel consumption in commercial air transportation. Five areas were investigated: current aircraft types, revised operational procedures, modifications to current aircraft, derivatives of current aircraft and new near-term fuel conservative aircraft. As part of a multiparticipant coordinated effort, detailed performance and operating cost data in each of these areas were supplied to the contractor responsible for the overall analysis of the cost/benefit tradeoffs for reducing the energy consumption of the domestic commercial air transportation system. A follow-on study was performed to assess the potential of an advanced turboprop transport aircraft concept. To provide a valid basis for comparison, an equivalent turbofan transport aircraft concept incorporating equal technology levels was also derived. The aircraft as compared on the basis of weight, size, fuel utilization, operational characteristics and costs.

Influence of System Operation Method on CO2 Emissions of PV/Solar Heat/Cogeneration System

NASA Astrophysics Data System (ADS)

Oke, Shinichiro; Kemmoku, Yoshishige; Takikawa, Hirofumi; Sakakibara, Tateki

A PV/solar heat/cogeneration system is assumed to be installed in a hotel. The system is operated with various operation methods: CO2 minimum operation, fees minimum operation, seasonal operation, daytime operation and heat demand following operation. Of these five operations, the former two are virtual operations that are operated with the dynamic programming method, and the latter three are actual operations. Computer simulation is implemented using hourly data of solar radiation intensity, atmospheric temperature, electric, cooling, heating and hot water supply demands for one year, and the life-cycle CO2 emission and the total cost are calculated for every operations. The calculation results show that the virtual two and the actual three operations reduce the life-cycle CO2 emission by 21% and 13% compared with the conventional system, respectively. In regard to both the CO2 emission and the cost, there is no significant difference between the virtual two operation methods or among actual three operation methods.

Non-Platinum Group Metal OER/ORR Catalysts for Alkaline Membrane Fuel Cells and Electrolyzers

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

Danilovic, Nemanja; Ayers, Katherine

Regenerative fuel cells (RFC) are energy storage devices that capture electrical energy in the form of hydrogen, with potential application for backup power and energy storage in remote locations, unmanned missions, and renewable energy capture. A unitized regenerative fuel cell (URFC) combines two separate electrochemical devices (fuel cell and electrolyzer) into one stack. The stack cost is driven by the platinum group metal (PGM) catalysts and the flow field components designed to withstand high potentials in acidic environments. Since the stack is the most expensive subcomponent of both the fuel cell and electrolyzer system, combining the two devices results inmore » substantial reduction in capital cost. However, in the past, combining the two stacks sacrificed device performance (operating cost) largely because the fuel cell had to operate with the thick electrolysis membranes in a URFC configuration, and due to water management issues in switching modes. Recent work in membrane-based electrolysis has resulted in more mechanically robust designs and materials that allow much thinner membranes, and work in flow cell design such as flow batteries has shown improved water transport through channel design and wet-proofing approaches. Therefore, the URFC concept is worth revisiting. At the same time, alkaline exchange membrane (AEM) devices are gathering attention due to the promise of PGM and valve metal elimination from the stack and a resulting strategic and capital cost benefit as compared with proton exchange membrane (PEM) systems. The result is a lower capital cost system that has half the precious metal group (PGM) catalysts, membrane and other stack component materials compared with discrete RFCs, although at the sacrifice of performance (operating cost). Proton has identified innovative AEM based RFC's to fulfill the role of low capital cost energy storage device owing to the use of non-precious metal containing electrodes, that enables certain markets where higher operating costs can be tolerated.« less

Relative Economic Merits of Storage and Combustion Turbines for Meeting Peak Capacity Requirements under Increased Penetration of Solar Photovoltaics

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

Denholm, Paul; Diakov, Victor; Margolis, Robert

Batteries with several hours of capacity provide an alternative to combustion turbines for meeting peak capacity requirements. Even when compared to state-of-the-art highly flexible combustion turbines, batteries can provide a greater operational value, which is reflected in a lower system-wide production cost. By shifting load and providing operating reserves, batteries can reduce the cost of operating the power system to a traditional electric utility. This added value means that, depending on battery life, batteries can have a higher cost than a combustion turbine of equal capacity and still produce a system with equal or lower overall life-cycle cost. For amore » utility considering investing in new capacity, the cost premium for batteries is highly sensitive to a variety of factors, including lifetime, natural gas costs, PV penetration, and grid generation mix. In addition, as PV penetration increases, the net electricity demand profile changes, which may reduce the amount of battery energy capacity needed to reliably meet peak demand.« less

A Prospective Comparison of Robotic and Laparoscopic Pyeloplasty

PubMed Central

Link, Richard E.; Bhayani, Sam B.; Kavoussi, Louis R.

2006-01-01

Objective: To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. Summary Background Data: LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Methods: Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. Results: The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. Conclusions: For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty. PMID:16552199

A prospective comparison of robotic and laparoscopic pyeloplasty.

PubMed

Link, Richard E; Bhayani, Sam B; Kavoussi, Louis R

2006-04-01

To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.

Practical aspects of photovoltaic technology, applications and cost (revised)

NASA Technical Reports Server (NTRS)

Rosenblum, L.

1985-01-01

The purpose of this text is to provide the reader with the background, understanding, and computational tools needed to master the practical aspects of photovoltaic (PV) technology, application, and cost. The focus is on stand-alone, silicon solar cell, flat-plate systems in the range of 1 to 25 kWh/day output. Technology topics covered include operation and performance of each of the major system components (e.g., modules, array, battery, regulators, controls, and instrumentation), safety, installation, operation and maintenance, and electrical loads. Application experience and trends are presented. Indices of electrical service performance - reliability, availability, and voltage control - are discussed, and the known service performance of central station electric grid, diesel-generator, and PV stand-alone systems are compared. PV system sizing methods are reviewed and compared, and a procedure for rapid sizing is described and illustrated by the use of several sample cases. The rapid sizing procedure yields an array and battery size that corresponds to a minimum cost system for a given load requirement, insulation condition, and desired level of service performance. PV system capital cost and levelized energy cost are derived as functions of service performance and insulation. Estimates of future trends in PV system costs are made.

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

PubMed

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

2017-12-01

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

Does the cost of robotic cholecystectomy translate to a financial burden?

PubMed

Rosemurgy, Alexander; Ryan, Carrie; Klein, Richard; Sukharamwala, Prashant; Wood, Thomas; Ross, Sharona

2015-08-01

Robotic application to cholecystectomy has dramatically increased, though its impact on cost of care and reimbursement has not been elucidated. We undertook this study to evaluate and compare cost of care and reimbursement with robotic versus laparoscopic cholecystectomy. The charges and reimbursement of all robotic and laparoscopic cholecystectomies at one hospital undertaken from June 2012 to June 2013 were determined. Operative duration is defined as time into and time out of the operating room. Data are presented as median data. Comparisons were undertaken using the Mann-Whitney U-test with significance accepted at p ≤ 0.05. Robotic cholecystectomy took longer (47 min longer) and had greater charges ($8,182.57 greater) than laparoscopic cholecystectomy (p < 0.05 for each). However, revenue, earnings before depreciation, interest, and taxes (EBDIT), and Net Income were not impacted by approach. Relative to laparoscopic cholecystectomy, robotic cholecystectomy takes longer and has greater charges. Revenue, EBDIT, and Net Income are similar after either approach; this indicates that costs with either approach are similar. Notably, this is possible because much of hospital-based costs are determined by cost allocation and not cost accounting. Thus, the cost of longer operations and costs inherent to the robotic approach for cholecystectomy do not translate to a perceived financial burden.

Data on cost analysis of drilling mud displacement during drilling operation.

PubMed

Okoro, Emeka Emmanuel; Dosunmu, Adewale; Iyuke, Sunny E

2018-08-01

The focus of this research was to present a data article for analyzing the cost of displacing a drilling fluid during the drilling operation. The cost of conventional Spud, KCl and Pseudo Oil base (POBM) muds used in drilling oil and gas wells are compared with that of a Reversible Invert Emulsion Mud. The cost analysis is limited to three sections for optimum and effective Comparison. To optimize drilling operations, it is important that we specify the yardstick by which drilling performance is measured. The most relevant yardstick is the cost per foot drilled. The data have shown that the prices for drilling mud systems are a function of the mud system formulation cost for that particular mud weight and maintenance per day. These costs for different mud systems and depend on the base fluid. The Reversible invert emulsion drilling fluid, eliminates the cost acquired in displacing Pseudo Oil Based mud (POBM) from the well, possible formation damage (permeability impairment) resulting from the use of viscous pill in displacing the POBM from the wellbore, and also eliminates the risk of taking a kick during mud change-over. With this reversible mud system, the costs of special fluids that are rarely applied for the well-completion purpose (cleaning of thick mud filter cake) may be reduced to the barest minimum.

Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures.

PubMed

Shields, Edward; Kates, Stephen L

2014-12-01

This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws. Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment. There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group. Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone, and after accounting for re-operations.

Cost characteristics of tilt-rotor, conventional air and high speed rail short-haul intercity passenger service

NASA Technical Reports Server (NTRS)

Schoendorfer, David L.; Morlok, Edward K.

1985-01-01

The cost analysis done to support an assessment of the potential for a small tilt-rotor aircraft to operate in short-haul intercity passenger service is described in detail. Anticipated costs of tilt-rotor air service were compared to the costs of two alternatives: conventional air and high speed rail (HSR). Costs were developed for corridor service, varying key market characteristics including distance, passenger volumes, and minimum frequency standards. The resulting cost vs output information can then be used to compare modal costs for essentially identical service quality and passenger volume or for different service levels and volumes for each mode, as appropriate. Extensive sensitivity analyses are performed. The cost-output features of these technologies are compared. Tilt-rotor is very attractive compared to HSR in terms of costs over the entire range of volume. It also has costs not dramatically different from conventional air, but tilt-rotor costs are generally higher. Thus some of its other advantages, such as the VTOL capability, must offset the cost disadvantage for it to be a preferred or competitive mode in any given market. These issues are addressed in the companion report which considers strategies for tilt-rotor development in commercial air service.

Alternative Models of Service, Centralized Machine Operations. Phase II Report. Volume II.

ERIC Educational Resources Information Center

Technology Management Corp., Alexandria, VA.

A study was conducted to determine if the centralization of playback machine operations for the national free library program would be feasible, economical, and desirable. An alternative model of playback machine services was constructed and compared with existing network operations considering both cost and service. The alternative model was…

Example of cost calculations for an operating room and a post-anaesthesia care unit.

PubMed

Raft, J; Millet, F; Meistelman, C

2015-08-01

The aim of this study was to evaluate the cost of an operating room using data from our hospital. Using an accounting-based method helped us. Over the year 2012, the sum of direct and indirect expenses with cost sharing expenses allowed us to calculate the cost of the operating room (OR) and of the post-anaesthesia care unit (PACU). The cost of the OR and PACU was €10.8 per minute of time offered. Two thirds of the direct expenses were allocated to surgery and one third to anaesthesia. Indirect expenses were 25% of the direct expenses. The cost of medications and single use medical devises was €111.45 per anaesthesia. The total cost of anaesthesia (taking into account wages and indirect expenses) was €753.14 per anaesthesia as compared to the total cost of the anaesthesia. The part of medications and single use devices for anaesthesia was 14.8% of the total cost. Despite the difficulties facing cost evaluation, this model of calculation, assisted by the cost accounting controller, helped us to have a concrete financial vision. It also shows that a global reflexion is necessary during financial decision-making. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

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

PubMed Central

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

2016-01-01

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

A comparison of operational performance : Washington state ferries to ferry operators worldwide.

DOT National Transportation Integrated Search

2010-06-01

This project compares eight measures of performance related to transit service quality (e.g. trip reliability, on-time departures) and cost-efficiency (e.g. farebox recovery, subsidy per passenger) between Washington State Ferries (WSF) and 23 ferry ...

Prostate Vaporization Techniques in Canadian Hospital

ClinicalTrials.gov

2018-04-11

Direct Costs Excluding Capital Equipment Purchase; Operator (Surgeon) Completed Questionnaire; Operative Parameters (Time, Bleeding Etc); Complications (Post-op Retention, Bleeding, Re-admission to Hospital, Infection Etc); 3 Month Efficacy Evaluation (Compared to Baseline) Using Validated Symptom Assessment Tools (See Outcome Metrics for Details)

[Cost analysis for navigation in knee endoprosthetics].

PubMed

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

2009-12-01

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

In search of the economic sustainability of Hadron therapy: the real cost of setting up and operating a Hadron facility.

PubMed

Vanderstraeten, Barbara; Verstraete, Jan; De Croock, Roger; De Neve, Wilfried; Lievens, Yolande

2014-05-01

To determine the treatment cost and required reimbursement for a new hadron therapy facility, considering different technical solutions and financing methods. The 3 technical solutions analyzed are a carbon only (COC), proton only (POC), and combined (CC) center, each operating 2 treatment rooms and assumed to function at full capacity. A business model defines the required reimbursement and analyzes the financial implications of setting up a facility over time; activity-based costing (ABC) calculates the treatment costs per type of patient for a center in a steady state of operation. Both models compare a private, full-cost approach with public sponsoring, only taking into account operational costs. Yearly operational costs range between €10.0M (M = million) for a publicly sponsored POC to €24.8M for a CC with private financing. Disregarding inflation, the average treatment cost calculated with ABC (COC: €29,450; POC: €46,342; CC: €46,443 for private financing; respectively €16,059, €28,296, and €23,956 for public sponsoring) is slightly lower than the required reimbursement based on the business model (between €51,200 in a privately funded POC and €18,400 in COC with public sponsoring). Reimbursement for privately financed centers is very sensitive to a delay in commissioning and to the interest rate. Higher throughput and hypofractionation have a positive impact on the treatment costs. Both calculation methods are valid and complementary. The financially most attractive option of a publicly sponsored COC should be balanced to the clinical necessities and the sociopolitical context. Copyright © 2014 Elsevier Inc. All rights reserved.

Association Between Surgeon Scorecard Use and Operating Room Costs.

PubMed

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

2017-03-01

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

Assessment of the treatment costs of extracorporeal shock wave therapy versus surgical treatment for shoulder diseases.

PubMed

Haake, M; Rautmann, M; Wirth, T

2001-01-01

To determine the actual costs of extracorporeal shock wave therapy (ESWT) in patients with tendinitis of the supraspinatus muscle. A comparison of the costs of surgical treatment versus the costs for ESWT was made. The total accrued costs were determined 12 weeks after intervention, using a sample group of 60 patients with calcifying or noncalcifying tendinitis of the supraspinatus muscle. The costs per case ranged from EUR 2,700 to EUR 4,300 per patient for ESWT and from EUR 13,400 to EUR 23,450 for surgical treatment, dependent on the method of calculation. Approximately 65% of the per-patient cost is attributable to productivity losses in the workplace. In comparable short-term results, costs for operative treatment are 5-7 times higher than for ESWT. The greater trauma caused by an operative procedure leads to patients being off work for a longer period and thus a correspondingly higher social economic burden.

Cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system

NASA Technical Reports Server (NTRS)

Kraus, E. F.; Vanabkoude, J. C.

1976-01-01

The fuel saving potential and cost effectiveness of numerous operational and technical options proposed for reducing the fuel consumption of the U.S. commercial airline fleet was examined and compared. The impact of the most promising fuel conserving options on fuel consumption, passenger demand, operating costs and airline profits when implemented in the U.S. domestic and international airline fleets was determined. A forecast estimate was made of the potential fuel savings achievable in the U.S. scheduled air transportation system. Specifically, the means for reducing the jet fuel consumption of the U.S. scheduled airlines in domestic and international passenger operations were investigated. A design analysis was made of two turboprop aircraft as possible fuel conserving derivatives of the DC-9-30.

Flight plan optimization

NASA Astrophysics Data System (ADS)

Dharmaseelan, Anoop; Adistambha, Keyne D.

2015-05-01

Fuel cost accounts for 40 percent of the operating cost of an airline. Fuel cost can be minimized by planning a flight on optimized routes. The routes can be optimized by searching best connections based on the cost function defined by the airline. The most common algorithm that used to optimize route search is Dijkstra's. Dijkstra's algorithm produces a static result and the time taken for the search is relatively long. This paper experiments a new algorithm to optimize route search which combines the principle of simulated annealing and genetic algorithm. The experimental results of route search, presented are shown to be computationally fast and accurate compared with timings from generic algorithm. The new algorithm is optimal for random routing feature that is highly sought by many regional operators.

Doing Pre-operative Investigations in Emergency Department; a Clinical Audit.

PubMed

Rafiq, Muhammad Salman; Rafiq, Maria; Rafiq, Muhammad Imran; Salman, Seema Gul; Hafeez, Sania

2017-01-01

Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria. A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines. A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay. Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay.

Evaluating Trade-offs of a Large, Infrequent Diversion for Restoration of a Forested Wetland and Associated Ecosystem Services in the Mississippi delta

NASA Astrophysics Data System (ADS)

Day, J.; Rutherford, J.; Weigman, A.; D'Elia, C.

2017-12-01

Flood control levees have eliminated the supply of sediment to Mississippi delta coastal wetlands, putting the delta on a trajectory for submergence in the 21st century. River diversions have been proposed as a method to provide a sustainable supply of sediment to the delta. Operating river diversions based on the size and frequency of natural crevasse events that were large (>5000 m3/s) and infrequent (active < once a year). This study assesses tradeoffs for a large, infrequent diversion into the forested wetlands of the Maurepas Swamp using a 2-dimensional model, that predicts land building is simulated for several diversion sizes and intermittencies. A cost-benefit analysis (CBA) was conducted by combining model results with an ecosystem service valuation (ESV) and estimated costs. Land building is proportional to diversion size and inversely proportional to years inactive. Because benefits are assumed to scale linearly with land gain, and costs increase with diversion size, there are disadvantages to operating large diversions less often, compared to smaller diversions more often. However, infrequent operation would provide additional ES benefits to the broader Lake Pontchartrain ecosystem by minimizing long-term changes to water quality and salinity, reducing inundation time, and allowing for greater consolidation of soils between diversion pulses. Compared to diversions, marsh creation costs increase over time due to sea level rise and energy costs.

Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis.

PubMed

Olson, Jacob K; Deming, Lisa A; King, Denis R; Rager, Terrence M; Gartner, Sarah; Huibregtse, Natalie; Moss, R Lawrence; Besner, Gail E

2017-10-10

Single visit surgery (SVS) consists of same-day pre-operative assessment and operation with telephone post-operative follow-up. This reduces family time commitment to 1 hospital trip rather than 2-3. We began SVS for ambulatory patients with clear surgical indications in 2013. We sought to determine family satisfaction, cost savings to families, and institutional financial feasibility of SVS. SVS patients were compared to age/case matched conventional surgery (CS) patients. Satisfaction was assessed by post-operative telephone survey. Family costs were calculated as the sum of lost revenue (based on median income) and transportation costs ($0.50/mile). Satisfaction was high in both groups (98% for SVS vs. 93% for CS; p=0.27). 40% of CS families indicated that they would have preferred SVS, whereas no SVS families indicated preference for the CS option (p<0.001). Distance from the hospital did not correlate with satisfaction. Estimated cost savings for an SVS family was $188. Reimbursement, hospital and physician charges, and day-of-surgery cancellation rates were similar. SVS provides substantial cost savings to families while maintaining patient satisfaction and equivalent institutional reimbursement. SVS is an effective approach to low-risk ambulatory surgical procedures that is less disruptive to families, facilitates access to pediatric surgical care, and reduces resource utilization. Cost Effectiveness Study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost-Effectiveness of Alternative Approaches to Computer-Assisted Instruction.

ERIC Educational Resources Information Center

Levin, Henry M.; And Others

Operating on the premise that different approaches to computer-assisted instruction (CAI) may use different configurations of hardware and software, different curricula, and different organizational and personnel arrangements, this study explored the feasibility of collecting evaluations of CAI to evaluate the comparative cost-effectiveness of…

Spinal Surgeon Variation in Single-Level Cervical Fusion Procedures: A Cost and Hospital Resource Utilization Analysis.

PubMed

Hijji, Fady Y; Massel, Dustin H; Mayo, Benjamin C; Narain, Ankur S; Long, William W; Modi, Krishna D; Burke, Rory M; Canar, Jeff; Singh, Kern

2017-07-01

Retrospective analysis. To compare perioperative costs and outcomes of patients undergoing single-level anterior cervical discectomy and fusions (ACDF) at both a service (orthopedic vs. neurosurgical) and individual surgeon level. Hospital systems are experiencing significant pressure to increase value of care by reducing costs while maintaining or improving patient-centered outcomes. Few studies have examined the cost-effectiveness cervical arthrodesis at a service level. A retrospective review of patients who underwent a primary 1-level ACDF by eight surgeons (four orthopedic and four neurosurgical) at a single academic institution between 2013 and 2015 was performed. Patients were identified by Diagnosis-Related Group and procedural codes. Patients with the ninth revision of the International Classification of Diseases coding for degenerative cervical pathology were included. Patients were excluded if they exhibited preoperative diagnoses or postoperative social work issues affecting their length of stay. Comparisons of preoperative demographics were performed using Student t tests and chi-squared analysis. Perioperative outcomes and costs for hospital services were compared using multivariate regression adjusted for preoperative characteristics. A total of 137 patients diagnosed with cervical degeneration underwent single-level ACDF; 44 and 93 were performed by orthopedic surgeons and neurosurgeons, respectively. There was no difference in patient demographics. ACDF procedures performed by orthopedic surgeons demonstrated shorter operative times (89.1 ± 25.5 vs. 96.0 ± 25.5 min; P = 0.002) and higher laboratory costs (Δ+$6.53 ± $5.52 USD; P = 0.041). There were significant differences in operative time (P = 0.014) and labor costs (P = 0.034) between individual surgeons. There was no difference in total costs between specialties or individual surgeons. Surgical subspecialty training does not significantly affect total costs of ACDF procedures. Costs can, however, vary between individual surgeons based on operative times. Variation between individual surgeons highlights potential areas for improvement of the cost effectiveness of spinal procedures. 4.

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

PubMed

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

2012-07-01

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

Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC.

PubMed

Lee, Richard; Chughtai, Bilal; Herman, Michael; Shariat, Shahrokh F; Scherr, Douglas S

2011-09-01

• To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion. • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms 'laparoscopic', 'robotic', or 'robotic-assisted'.In all, three articles were identified. • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates. • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups. • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered. • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered. • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON. • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs. • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery. • Complications materially affected cost performance. • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered. • This effect is most pronounced for patients undergoing IC. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

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

PubMed

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

2014-05-01

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

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

PubMed

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

2016-12-01

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

The ATA-67 Formula for Direct Operating Cost

NASA Technical Reports Server (NTRS)

Faulkner, H. B.

1972-01-01

The ATA formulas for direct operating cost were developed for the purpose of comparing different aircraft, existing or not, on the same route or the same aircraft on different routes. Such characteristics of the airline as crew pay, maintenance procedures, and depreciation schedules are kept constant. In air transportation systems analysis the 1967 ATA formula is usually used with appropriate exceptions or modifications, such as: different maintenance labor rate, total maintenance multiplied by a factor, maintenance burden deleted, different depreciation schedule, or different spares percentages.

Information prioritization for control and automation of space operations

NASA Technical Reports Server (NTRS)

Ray, Asock; Joshi, Suresh M.; Whitney, Cynthia K.; Jow, Hong N.

1987-01-01

The applicability of a real-time information prioritization technique to the development of a decision support system for control and automation of Space Station operations is considered. The steps involved in the technique are described, including the definition of abnormal scenarios and of attributes, measures of individual attributes, formulation and optimization of a cost function, simulation of test cases on the basis of the cost function, and examination of the simulation scenerios. A list is given comparing the intrinsic importances of various Space Station information data.

Two-Year Operational Evaluation Of A Consumer Electronics-Based Data Acquisition System For Equipment Monitoring

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

Van Hoy, Blake W.; Phillips, Larry D.; Wetherington Jr, G Randall

Oak Ridge National Laboratory (ORNL) has performed a two-year evaluation of the performance of an in-house developed consumer electronics-based data acquisition system (DAS). The main advantage of this approach compared to conventional instrumentation grade systems is cost; instrument grade data acquisition systems average costs range from $800 to $2,000 per channel compared to a range of $200 - $400 per channel for a consumer electronics-based system. The DAS is operated as a full-time in-situ vibration monitor. The resulting data stream is streamed over the ORNL network, at an aggregate rate of approximately 2 megabytes/s, to a Linux server. The servermore » includes the capability to implement event-triggered data stores, as well as real-time files for the implementation of continuous display monitoring of the spectra. Detailed spectral analysis is performed post event. The DAS is installed on a large industrial chiller and cooling water pump associated with ORNL’s Titan supercomputer. These mechanical systems include rotating components that operate at fundamental frequencies within the range of 30 Hz to over 3 KHz. Evaluation of the DAS data over a two-year operating period leads to the conclusion that for many industrial processes this system could form the basis for a cost effective means of obtaining operating health data in real time from rotating machinery. The deployment has also shown that the DAS technology is reliable. Furthermore, because the cost of the DAS is low, the other significant advantage of this approach is that the DAS can be deployed in a dedicated manner and operated on a full-time basis.« less

The contribution of Raman spectroscopy to the analytical quality control of cytotoxic drugs in a hospital environment: eliminating the exposure risks for staff members and their work environment.

PubMed

Bourget, Philippe; Amin, Alexandre; Vidal, Fabrice; Merlette, Christophe; Troude, Pénélope; Baillet-Guffroy, Arlette

2014-08-15

The purpose of the study was to perform a comparative analysis of the technical performance, respective costs and environmental effect of two invasive analytical methods (HPLC and UV/visible-FTIR) as compared to a new non-invasive analytical technique (Raman spectroscopy). Three pharmacotherapeutic models were used to compare the analytical performances of the three analytical techniques. Statistical inter-method correlation analysis was performed using non-parametric correlation rank tests. The study's economic component combined calculations relative to the depreciation of the equipment and the estimated cost of an AQC unit of work. In any case, analytical validation parameters of the three techniques were satisfactory, and strong correlations between the two spectroscopic techniques vs. HPLC were found. In addition, Raman spectroscopy was found to be superior as compared to the other techniques for numerous key criteria including a complete safety for operators and their occupational environment, a non-invasive procedure, no need for consumables, and a low operating cost. Finally, Raman spectroscopy appears superior for technical, economic and environmental objectives, as compared with the other invasive analytical methods. Copyright © 2014 Elsevier B.V. All rights reserved.

Operative Cost Comparison: Plating Versus Intramedullary Fixation for Clavicle Fractures.

PubMed

Hanselman, Andrew E; Murphy, Timothy R; Bal, George K; McDonough, E Barry

2016-09-01

Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (P<.001); average cost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (P<.001). Average cost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.]. Copyright 2016, SLACK Incorporated.

Cost-effectiveness of lumbar artificial intervertebral disc replacement: driven by the choice of comparator.

PubMed

Parkinson, Bonny; Goodall, Stephen; Thavaneswaran, Prema

2013-09-01

Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement (AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Supporting Air and Space Expeditionary Forces: Analysis of CONUS Centralized Intermediate Repair Facilities

DTIC Science & Technology

2008-01-01

designing cost -effective CIRF networks or readily comparing alterna- tive potential network designs. The RAND Corporation was asked to develop such an...optimization model that allows users to select the best mix of land- and sea-based FSLs for a given set of operational scenarios, thereby reducing costs while...27 Overview of Post-BRAC Bed-Downs and CIRF Assignments . . . . . . . . . . . . . 27 JEIM Cost

Child Care: How Do Military and Civilian Center Costs Compare? United States General Accounting Office Report to Congressional Requesters.

ERIC Educational Resources Information Center

Fagnoni, Cynthia M.

The Department of Defense's (DOD) child development program has been identified as a model for the rest of the nation. To provide a benchmark cost estimate for Congress as it addresses child care issues, this report identifies the objectives of the military child development program, describes its operation, determines the full costs of DOD…

Budget impact model of Mydrane®, a new intracameral injectable used for intra-operative mydriasis, from a UK hospital perspective.

PubMed

Davey, Keith; Chang, Bernard; Purslow, Christine; Clay, Emilie; Vataire, Anne-Lise

2018-04-19

During cataract surgery, maintaining an adequate degree of mydriasis throughout the entire operation is critical to allow for visualisation of the capsulorhexis and the crystalline lens. Good anaesthesia is also essential for safe intraocular surgery. Mydrane® is a new injectable intracameral solution containing two mydriatics (tropicamide 0.02% and phenylephrine 0.31%) and one anaesthetic (lidocaine 1%) that was developed as an alternative to the conventional topical pre-operative mydriatics used in cataract surgery. This study aimed to estimate the budget impact across a one year time frame using Mydrane® instead of topical dilating eye drops, for a UK hospital performing 3,000 cataract operations a year. A budget impact model (BIM) was developed to compare the economic outcomes associated with the use of Mydrane® versus topical drops (tropicamide 0.5% and phenylephrine 10%) in patients undergoing cataract surgery in a UK hospital. The outcomes of interest included costs and resource use (e.g. clinician time, mydriasis failures, operating room time, number of patients per vial of therapy etc.) associated with management of mydriasis in patients undergoing cataract surgery. All model inputs considered the UK hospital perspective without social or geographical variables. Deterministic sensitivity analyses were also performed to assess the model uncertainty. Introduction of Mydrane® is associated with a cost saving of £6,251 over 3,000 cataract surgeries in one year. The acquisition costs of the Mydrane® (£18,000 by year vs. £3,330 for eye drops) were balanced by substantial reductions in mainly nurses' costs and time, plus a smaller contribution from savings in surgeons' costs (£20,511) and lower costs associated with auxiliary dilation (£410 due to avoidance of additional dilation methods). Results of the sensitivity analyses confirmed the robustness of the model to the variation of inputs. Except for the duration of one session of eye drop instillation and the cost of Mydrane®, Mydrane® achieved an incremental cost gain compared to tropicamide/phenylephrine eye drops. Despite a higher acquisition cost of Mydrane®, the budget impact of Mydrane® on hospital budgets is neutral. Mydrane® offers a promising alternative to traditional regimes using eye drops, allowing for a better patient flow and optimisation of the surgery schedule with neutral budget impact.

Ablative material testing for low-pressure, low-cost rocket engines

NASA Technical Reports Server (NTRS)

Richter, G. Paul; Smith, Timothy D.

1995-01-01

The results of an experimental evaluation of ablative materials suitable for the production of light weight, low cost rocket engine combustion chambers and nozzles are presented. Ten individual specimens of four different compositions of silica cloth-reinforced phenolic resin materials were evaluated for comparative erosion in a subscale rocket engine combustion chamber. Gaseous hydrogen and gaseous oxygen were used as propellants, operating at a nominal chamber pressure of 1138 kPa (165 psi) and a nominal mixture ratio (O/F) of 3.3. These conditions were used to thermally simulate operation with RP-1 and liquid oxygen, and achieved a specimen throat gas temperature of approximately 2456 K (4420 R). Two high-density composition materials exhibited high erosion resistance, while two low-density compositions exhibited approximately 6-75 times lower average erosion resistance. The results compare favorably with previous testing by NASA and provide adequate data for selection of ablatives for low pressure, low cost rocket engines.

Hospital costs of colorectal cancer surgery for the oldest old: A Dutch population-based study.

PubMed

Govaert, Johannes A; Govaert, Marc J P M; Fiocco, Marta; van Dijk, Wouter A; Tollenaar, Rob A E M; Wouters, Michel W J M

2016-12-01

Background Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if oldest-old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts. All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed. Oldest-old patients (≥85 years) were compared to patients <85 years. Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costs. Compared to <85-year-old patients (n = 9130), the oldest old (n = 783) had longer hospital stays (LOS) (11.3 vs. 13.2, P < 0.001), more severe complications (21.8% vs. 29.0%, P < 0.001), more failure to rescue (13.9% vs. 37.0%, P < 0.001) and higher mortality (3.0% vs. 10.7%, P < 0.001). Deceased oldest-old patients had significantly less LOS and less LOS ICU. Total hospital costs were 3% lower for oldest-old patients (€13,168) than for <85-year-old patients (€13,644, P < 0.001). In cases of severe complications or death, hospital costs for the oldest old were 25% and 31% lower than those of <85-year-old patients (both P < 0.001). Although frequently assumed to be more expensive, operating on oldest-old patients with colorectal cancer does not increase hospital costs compared to younger patients. This was most likely due to faster deterioration or less aggressive treatment of oldest-old patients when (severe) complications occurred. J. Surg. Oncol. 2016;114:1009-1015. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Comparative evaluation of distributed-collector solar thermal electric power plants

NASA Technical Reports Server (NTRS)

Fujita, T.; El Gabalawi, N.; Herrera, G. G.; Caputo, R. S.

1978-01-01

Distributed-collector solar thermal-electric power plants are compared by projecting power plant economics of selected systems to the 1990-2000 timeframe. The approach taken is to evaluate the performance of the selected systems under the same weather conditions. Capital and operational costs are estimated for each system. Energy costs are calculated for different plant sizes based on the plant performance and the corresponding capital and maintenance costs. Optimum systems are then determined as the systems with the minimum energy costs for a given load factor. The optimum system is comprised of the best combination of subsystems which give the minimum energy cost for every plant size. Sensitivity analysis is done around the optimum point for various plant parameters.

Which Refrigeration System is Best for Your School?

ERIC Educational Resources Information Center

Little, Philip F.

1963-01-01

Several types of refrigeration systems available to the consulting engineer are discussed. The engineer should analyze all energy sources and base his recommendations on comparative costs and availability of sources, keeping in mind that operating costs are of primary importance to schools. The analysis begins with a careful appraisal of the…

Benchmarking of municipal waste water treatment plants (an Austrian project).

PubMed

Lindtner, S; Kroiss, H; Nowak, O

2004-01-01

An Austrian research project focused on the development of process indicators for treatment plants with different process and operation modes. The whole treatment scheme was subdivided into four processes, i.e. mechanical pretreatment (Process 1), mechanical-biological waste water treatment (Process 2), sludge thickening and stabilisation (Process 3) and further sludge treatment and disposal (Process 4). In order to get comparable process indicators it was necessary to subdivide the sample of 76 individual treatment plants all over Austria into five groups according to their mean organic load (COD) in the influent. The specific total yearly costs, the yearly operating costs and the yearly capital costs of the four processes have been related to the yearly average of the measured organic load expressed in COD (110 g COD/pe/d). The specific investment costs for the whole treatment plant and for Process 2 have been related to a calculated standard design capacity of the mechanical-biological part of the treatment plant expressed in COD. The capital costs of processes 1, 3 and 4 have been related to the design capacity of the treatment plant. For each group (related to the size of the plant) a benchmark band has been defined for the total yearly costs, the total yearly operational costs and the total yearly capital costs. For the operational costs of the Processes 1 to 4 one benchmark ([see symbol in text] per pe/year) has been defined for each group. In addition a theoretical cost reduction potential has been calculated. The cost efficiency in regard to water protection and some special sub-processes such as aeration and sludge dewatering has been analysed.

Defense Weather Satellites: DOD Faces Acquisition Challenges for Addressing Capability Needs

DTIC Science & Technology

2016-07-07

stakeholders in conducting the AOA, it did not effectively collaborate with the National Oceanic and Atmospheric Administration (NOAA), which, on a...and compare the operational effectiveness and life cycle costs of potential solutions. This testimony is based on a report GAO issued in March...and its Space- Based Environmental Monitoring (SBEM) Analysis of Alternatives (AOA) to identify and compare the operational effectiveness and life

Hand-assisted laparoscopic versus robot-assisted laparoscopic partial nephrectomy: comparison of short-term outcomes and cost.

PubMed

Elsamra, Sammy E; Leone, Andrew R; Lasser, Michael S; Thavaseelan, Simone; Golijanin, Dragan; Haleblian, George E; Pareek, Gyan

2013-02-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion. A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient. Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot. While early in our experience, RALPN offered no significant advantage in short-term outcomes over HALPN and was associated with an increased cost of over $1150.

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

PubMed Central

MELFA, G.I.; RASPANTI, C.; ATTARD, M.; COCORULLO, G.; ATTARD, A.; MAZZOLA, S.; SALAMONE, G.; GULOTTA, G.; SCERRINO, G.

2016-01-01

Background Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70–95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. Patients and methods 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or “open” under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient’s satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student’s, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. Results 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient’s satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). Conclusions MIVAP is more expensive compared to the “open” parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration. PMID:27381690

Production cost structure in US outpatient physical therapy health care.

PubMed

Lubiani, Gregory G; Okunade, Albert A

2013-02-01

This paper investigates the technology cost structure in US physical therapy care. We exploit formal economic theories and a rich national data of providers to tease out implications for operational cost efficiencies. The 2008-2009 dataset comprising over 19 000 bi-weekly, site-specific physical therapy center observations across 28 US states and Occupational Employment Statistics data (Bureau of Labor Statistics) includes measures of output, three labor types (clinical, support, and administrative), and facilities (capital). We discuss findings from the iterative seemingly unrelated regression estimation system model. The generalized translog cost estimates indicate a well-behaved underlying technology structure. We also find the following: (i) factor demands are downwardly sloped; (ii) pair-wise factor relationships largely reflect substitutions; (iii) factor demand for physical therapists is more inelastic compared with that for administrative staff; and (iv) diminishing scale economies exist at the 25%, 50%, and 75% output (patient visits) levels. Our findings advance the timely economic understanding of operations in an increasingly important segment of the medical care sector that has, up-to-now (because of data paucity), been missing from healthcare efficiency analysis. Our work further provides baseline estimates for comparing operational efficiencies in physical therapy care after implementations of the 2010 US healthcare reforms. Copyright © 2012 John Wiley & Sons, Ltd.

Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management.

PubMed

Gupta, Deepak; Haber, Halim

2014-06-01

Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had undergone LERP or MERP at our Same Day Surgery Center.

Advances in dust cyclone research

USDA-ARS?s Scientific Manuscript database

Dust cyclones reduce particulate emissions but their operation consumes electrical energy. Response surface methodology was used to compare two strategies to reduce energy costs without increasing emissions. Cyclones of a standard design (1D3D) were operated singly and in series, as was an ‘Experi...

Space station: Cost and benefits

NASA Technical Reports Server (NTRS)

1983-01-01

Costs for developing, producing, operating, and supporting the initial space station, a 4 to 8 man space station, and a 4 to 24 man space station are estimated and compared. These costs include contractor hardware; space station assembly and logistics flight costs; and payload support elements. Transportation system options examined include orbiter modules; standard and extended duration STS fights; reusable spacebased perigee kick motor OTV; and upper stages. Space station service charges assessed include crew hours; energy requirements; payload support module storage; pressurized port usage; and OTV service facility. Graphs show costs for science missions, space processing research, small communication satellites; large GEO transportation; OVT launch costs; DOD payload costs, and user costs.

Optimization of wastewater treatment plant operation for greenhouse gas mitigation.

PubMed

Kim, Dongwook; Bowen, James D; Ozelkan, Ertunga C

2015-11-01

This study deals with the determination of optimal operation of a wastewater treatment system for minimizing greenhouse gas emissions, operating costs, and pollution loads in the effluent. To do this, an integrated performance index that includes three objectives was established to assess system performance. The ASMN_G model was used to perform system optimization aimed at determining a set of operational parameters that can satisfy three different objectives. The complex nonlinear optimization problem was simulated using the Nelder-Mead Simplex optimization algorithm. A sensitivity analysis was performed to identify influential operational parameters on system performance. The results obtained from the optimization simulations for six scenarios demonstrated that there are apparent trade-offs among the three conflicting objectives. The best optimized system simultaneously reduced greenhouse gas emissions by 31%, reduced operating cost by 11%, and improved effluent quality by 2% compared to the base case operation. Copyright © 2015 Elsevier Ltd. All rights reserved.

A market, operation, and mission assessment of large rural for-profit hospitals with positive cash flow.

PubMed

McCue, Michael J

2007-01-01

National benchmark data for 2002 indicate that large rural for-profit hospitals have a median cash flow margin of 19.5% compared to 9.2% for their nonprofit counterparts. This study aims to gain insight regarding the driving factors behind the high cash flow performance of large rural for-profit hospitals. Using 3 annual periods of Centers for Medicare and Medicaid cost report data with the last fiscal year ending between September 30, 2002, and August 30, 2003, the study found a cash flow margin of 21.5% for the large rural for-profit hospitals. All these facilities were owned by hospital management companies. To assess their underlying market, operational, and mission factors, these hospitals were compared to a similar comparison group of large rural nonprofit hospitals that are system owned and have positive cash flows. Using logistic regression analysis, the study found lower operating expense per adjusted discharge and salary expense as a percentage of total operating expense among large rural for-profit, system-owned hospitals with positive cash flows relative to nonprofits with similar traits. Overall, the findings of this study reflect how these for-profit hospitals, which are owned by hospital management companies, focus on controlling their labor costs as well as operating costs per discharge in order to achieve a greater positive cash flow position.

Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of acute appendicitis: 4-years experience in a district hospital

PubMed Central

2014-01-01

Background Laparoscopic appendectomy is not yet unanimously considered the “gold standard” in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. This study aimed to compare outcomes and cost of laparoscopic and open appendectomy in a district hospital. Methods A retrospective analysis of 230 patients who underwent appendectomy at the Division of General Surgery of the Civil Hospital of Ragusa, Italy, from May 2008 to May 2012 was performed. The variables analyzed included patients data (age, gender, previous abdominal surgery, preoperative WBC count, duration of symptoms, ASA risk score), rate of uncomplicated or complicated appendicitis, operative time, postoperative complications, length of hospital stay, and total costs. The patients were divided in two groups according to the surgical approach and compared for each variable. The results were analyzed using the t Student test for quantitative variables, and the Chi-square test with Yates correction and Fisher exact test for categorical. Results Laparoscopic appendectomy was performed in 139 patients, open appendectomy in 91. Two cases (1.4%) were converted to open procedure and included in the laparoscopic group data. Patient data and rate of complicated appendicitis were similar in the two study groups. There was no statistical difference (p = 0.476) in the mean operative time between the laparoscopic (52.2 min; range, 20–155) and open appendectomy (49.3 min; range, 20–110) groups. The overall incidence of minor and major complications was significantly lower (p = 0.006) after laparoscopic appendectomy (2.9%, 4 cases) than after open appendectomy (13.2%, 12 cases); rate of intra-abdominal abscess were similar. The length of hospital stay was significantly shorter (p = 0.001) in laparoscopic group (2.75 days; range, 1–8) than in open group (3.87 days; range, 1–19). The mean total cost was 2282 Euro in laparoscopic group and 2337 Euro in open group, with a no significant difference of 55 Euro (p = 0.812). Conclusion Laparoscopic appendectomy is associated with fewer complications, shorter hospital stay, and similar operative time, intra-abdominal abscess rate, and total costs, compared with open appendectomy. Therefore, laparoscopic appendectomy can be recommended as preferred approach in acute appendicitis. PMID:24646120

Comparing post-combustion CO2 capture operation at retrofitted coal-fired power plants in the Texas and Great Britain electric grids

NASA Astrophysics Data System (ADS)

Cohen, Stuart M.; Chalmers, Hannah L.; Webber, Michael E.; King, Carey W.

2011-04-01

This work analyses the carbon dioxide (CO2) capture system operation within the Electric Reliability Council of Texas (ERCOT) and Great Britain (GB) electric grids using a previously developed first-order hourly electricity dispatch and pricing model. The grids are compared in their 2006 configuration with the addition of coal-based CO2 capture retrofits and emissions penalties from 0 to 100 US dollars per metric ton of CO2 (USD/tCO2). CO2 capture flexibility is investigated by comparing inflexible CO2 capture systems to flexible ones that can choose between full- and zero-load CO2 capture depending on which operating mode has lower costs or higher profits. Comparing these two grids is interesting because they have similar installed capacity and peak demand, and both are isolated electricity systems with competitive wholesale electricity markets. However, differences in capacity mix, demand patterns, and fuel markets produce diverging behaviours of CO2 capture at coal-fired power plants. Coal-fired facilities are primarily base load in ERCOT for a large range of CO2 prices but are comparably later in the dispatch order in GB and consequently often supply intermediate load. As a result, the ability to capture CO2 is more important for ensuring dispatch of coal-fired facilities in GB than in ERCOT when CO2 prices are high. In GB, higher overall coal prices mean that CO2 prices must be slightly higher than in ERCOT before the emissions savings of CO2 capture offset capture energy costs. However, once CO2 capture is economical, operating CO2 capture on half the coal fleet in each grid achieves greater emissions reductions in GB because the total coal-based capacity is 6 GW greater than in ERCOT. The market characteristics studied suggest greater opportunity for flexible CO2 capture to improve operating profits in ERCOT, but profit improvements can be offset by a flexibility cost penalty.

The cost benefit and efficiency of waste water treatment using domestic ponds—the ultimate solution in Southern Africa

NASA Astrophysics Data System (ADS)

Ntengwe, F. W.

Wastewater treatment has become a challenge to most countries in Southern Africa because of the fluctuating economies that have been hit by high levels of debts. The treatment of domestic wastewater using ponds, if carefully utilized, as has been observed in most countries in the world, is the most cost effective means of handling wastewaters. When compared to the conventional use of treatment plants, the ponds have been observed to be the ultimate solution for the countries in Southern Africa especially those that are classified as Highly Indebted Poor Countries (HIPC) because of little or no operating costs associated with the treatment. The study conducted on Kitwe Waste Water Treatment Ponds to evaluate the cost benefit and efficiencies has revealed low levels of operating cost and high removal efficiencies of oxygen demanding wastes (BOD removal of 86% and TSS removal of 75%), pH values ranged from 7 to 8 indicating an increasing alkalinity from facultative to maturation ponds while other parameters such as nitrates, phosphates and temperature were found to be within acceptable levels thereby releasing effluent that makes the environment sustainable. The overall social benefit was found to be much higher than the operating costs.

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

PubMed

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

2018-05-18

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

A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

PubMed Central

Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

2015-01-01

Background Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. Objective This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. Methods The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. Results The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions. Conclusions Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context. PMID:26197801

Loop ileostomy closure: comparison of cost effectiveness between suture and stapler.

PubMed

Horisberger, Karoline; Beldi, Guido; Candinas, Daniel

2010-12-01

Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques. A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost. Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005). Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.

Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis.

PubMed

Richardson, John; Di Fabio, Francesco; Clarke, Hannah; Bajalan, Mohammed; Davids, Joe; Abu Hilal, Mohammed

2015-01-01

The adoption of laparoscopy for distal pancreatectomy has proven to substantially improve short-term outcomes. Stress response after major surgery can be further minimized within an enhanced recovery programme (ERP). However, data on the potential benefit of an ERP for laparoscopic distal pancreatectomy are still lacking. The aim was to assess the feasibility, safety and cost of ERP for patients undergoing laparoscopic distal pancreatectomy. This is a case-control study from a Tertiary University Hospital. Sixty-six consecutive patients who underwent laparoscopic distal pancreatectomy were analyzed. Twenty-two patients were enrolled for the ERP and compared with previous consecutive 44 patients managed traditionally (1:2 ratio). Operative details, post-operative outcome and cost analysis were compared in the two groups. Patients enrolled in the ERP had similar intraoperative blood loss (median 165 ml vs. 200 ml; p = 0.176), operation time (225 min vs. 210 min; p = 0.633), time to remove naso-gastric tube (1 vs. 1 day; p = 0.081) but significantly shorter time to mobilization (median 1 vs. 2 days; p = 0.0001), start solid diet (2 vs. 3 days; p = 0004), and pass stools (3 vs. 5 days; p = 0.002) compared to the control group. Median length of stay was significantly shorter in the ERP group (3 vs. 6 days; p < 0.0001). No significant difference in readmission or complication rate was observed. Cost analysis was significantly in favor of the ERP group (p = 0.0004). Implementation of ERP optimizes outcomes for laparoscopic distal pancreatectomy with significant earlier return to normal gut function, reduced length of stay and cost saving. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Environmental performance review and cost analysis of MSW landfilling by baling-wrapping technology versus conventional system

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

Baldasano, J.M.; Gasso, S.; Perez, C

2003-07-01

This paper first reviews the chemical, physical and biological processes, and the environmental performance of MSW compacted and plastic-wrapped into air-tight bales with low-density polyethylene (LDPE). The baling-wrapping process halts the short and half-term biological activity and consequently the emission of gases and leachates. It also facilitates the handling of the refuse, and considerably reduces the main environmental impacts of a landfill. The main technologies available for baling-wrapping MSW are also presented. Furthermore, a cost analysis comparing a conventional landfill (CL) without baling system versus two landfills using different baling-wrapping technologies (rectangular and cylindrical bales) is carried out. The resultsmore » are presented comparatively under the conditions of construction, operation and maintenance and postclosure, as required by European Directive 1999/31. A landfill using rectangular plastic-wrapped bales (LRPB) represents an economically competitive option compared to a CL. The increased capacity of the waste disposal zone when using rectangular bales due to the high density of the bales compensates for the increased operating and maintenance (O and M) costs of the method. Landfills using cylindrical plastic-wrapped bales (LCPB's) do not fare so well, mainly because the density within the bales is lower, the cylindrical geometry of the bales does not allow such an efficient use of the space within the landfill, and the processing capacity of the machinery is lower. From the cost model, the resulting unit costs per tonne in a LRPB, a LCPB and a CL for 100,000 t/year of waste, an operation time of 15 years and a landfill depth (H) of 20 m, are 31.52, 43.36 and 31.83 Euro/t, respectively.« less

Data analytics and optimization of an ice-based energy storage system for commercial buildings

DOE PAGES

Luo, Na; Hong, Tianzhen; Li, Hui; ...

2017-07-25

Ice-based thermal energy storage (TES) systems can shift peak cooling demand and reduce operational energy costs (with time-of-use rates) in commercial buildings. The accurate prediction of the cooling load, and the optimal control strategy for managing the charging and discharging of a TES system, are two critical elements to improving system performance and achieving energy cost savings. This study utilizes data-driven analytics and modeling to holistically understand the operation of an ice–based TES system in a shopping mall, calculating the system’s performance using actual measured data from installed meters and sensors. Results show that there is significant savings potential whenmore » the current operating strategy is improved by appropriately scheduling the operation of each piece of equipment of the TES system, as well as by determining the amount of charging and discharging for each day. A novel optimal control strategy, determined by an optimization algorithm of Sequential Quadratic Programming, was developed to minimize the TES system’s operating costs. Three heuristic strategies were also investigated for comparison with our proposed strategy, and the results demonstrate the superiority of our method to the heuristic strategies in terms of total energy cost savings. Specifically, the optimal strategy yields energy costs of up to 11.3% per day and 9.3% per month compared with current operational strategies. A one-day-ahead hourly load prediction was also developed using machine learning algorithms, which facilitates the adoption of the developed data analytics and optimization of the control strategy in a real TES system operation.« less

Data analytics and optimization of an ice-based energy storage system for commercial buildings

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

Luo, Na; Hong, Tianzhen; Li, Hui

Ice-based thermal energy storage (TES) systems can shift peak cooling demand and reduce operational energy costs (with time-of-use rates) in commercial buildings. The accurate prediction of the cooling load, and the optimal control strategy for managing the charging and discharging of a TES system, are two critical elements to improving system performance and achieving energy cost savings. This study utilizes data-driven analytics and modeling to holistically understand the operation of an ice–based TES system in a shopping mall, calculating the system’s performance using actual measured data from installed meters and sensors. Results show that there is significant savings potential whenmore » the current operating strategy is improved by appropriately scheduling the operation of each piece of equipment of the TES system, as well as by determining the amount of charging and discharging for each day. A novel optimal control strategy, determined by an optimization algorithm of Sequential Quadratic Programming, was developed to minimize the TES system’s operating costs. Three heuristic strategies were also investigated for comparison with our proposed strategy, and the results demonstrate the superiority of our method to the heuristic strategies in terms of total energy cost savings. Specifically, the optimal strategy yields energy costs of up to 11.3% per day and 9.3% per month compared with current operational strategies. A one-day-ahead hourly load prediction was also developed using machine learning algorithms, which facilitates the adoption of the developed data analytics and optimization of the control strategy in a real TES system operation.« less

State of the art of metalclad airships

NASA Technical Reports Server (NTRS)

Pavlecka, V. H.; Roda, J.

1975-01-01

Metalclad airship development of the past history are considered along with the immediate prospects for continuation of the development of these airships. The metalclad airships promise high safety even in highly inclement weather, are capable of high speeds, while lifting high useful loads. Metalclad airships which in first cost would compare favorably with the costs of sea-going ships and in operating costs promise to be lower than airplanes.

Cost analysis of carbon dioxide concentrators

NASA Technical Reports Server (NTRS)

Yakut, M. M.

1972-01-01

A methodology is developed to predict the relevant contributions of the more intangible cost elements encountered in the development of flight-qualified hardware and is used to predict the costs of three carbon dioxide concentration systems. The cost and performance data from Gemini, Skylab, and other programs are utilized as a basis for establishing the cost estimating relationships. The concentration systems analyzed are the molecular sieves C02 concentrator, the hydrogen-depolarized concentrator, and the regenerable solid desiccant concentrator. Besides the cost estimates for each system, their comparative criteria including relative characteristics, operational differences, and development status are considered.

Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid.

PubMed

Sucher, Mark G; Giordani, Mauro; Figoni, Andrew; Nedopil, Alexander J

2016-10-01

To evaluate the peri-operative blood loss with the use of epsilon-aminocaproic acid (ε-ACA) in total hip arthroplasty (THA). One hundred sixty patients treated with THA were followed; 5 g ε-ACA diluted in 100 ml normal saline was applied intra-operatively. Eighty patients not receiving ε-ACA (non ε-ACA group) and eighty patients receiving ε-ACA (ε-ACA group) were compared regarding blood loss, need of transfusion, and thrombo-embolic complications. Blood loss (mean ± SD) for the non ε-ACA group was 1678 ± 515 ml and for the ε-ACA group 1403 ± 417 ml (p < 0.05). In the non ε-ACA group 23 patients needed blood transfusions compared to ten patients in the ε-ACA group (p < 0.05). Cost savings were $284.39 per patient. No patient in either group developed a thrombo-embolic complication. This study demonstrates a significant reduction in peri-operative blood loss after THA with topically applied ε-ACA. The application of ε-ACA reduced costs by lowering transfusion rates and did not increase thrombo-embolic events. ε-ACA is safe and effective in reducing blood loss and cost-efficient in THA.

Analyzing costs of space debris mitigation methods

NASA Astrophysics Data System (ADS)

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

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

Hard permanent magnet development trends and their application to A.C. machines

NASA Technical Reports Server (NTRS)

Mildrum, H. F.

1981-01-01

The physical and magnetic properties of Mn-Al-C, Fe-Cr-Co, and RE-TM (rare earth-transition metal intermetallics) in polymer and soft metal bonded or sintered form are considered for ac circuit machine usage. The manufacturing processes for the magnetic materials are reviewed, and the mechanical and electrical properties of the magnetic materials are compared, with consideration given to the reference Alnico magnet. The Mn-Al-C magnets have the same magnetic properties and costs as Alnico units, operate well at low temperatures, but have poor high temperature performance. Fe-Cr-Co magnets also have comparable cost to Alnico magnets, and operate at high or low temperature, but are brittle, expensive, and contain Co. RE-Co magnets possess a high energy density, operate well in a wide temperature range, and are expensive. Recommendation for exploring the rare-earth alternatives are offered.

Cost-effectiveness analysis of the treatment of large leiomyomas: laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy.

PubMed

Mittapalli, Raja; Fanning, James; Flora, Robert; Fenton, Bradford W

2007-05-01

The purpose of this study was to perform a cost-effectiveness analysis comparing the treatment of large leiomyomas by laparoscopic assisted vaginal hysterectomy (LAVH) versus abdominal hysterectomy (AH). Twenty consecutive LAVH were compared to 20 consecutive AH for leiomyoma > or = 250 g. Hospital costs were obtained through Healthcare cost accounting system. The 6 principles of cost-effectiveness analysis were used. The groups were similar in respect to age, weight, race, medical comorbidities, blood loss, and operative time. Median uterine weight (513 g) was approximately 20% > for LAVH. Length of stay and pain was significantly less for LAVH. Total hospital cost for AH was approximately 12% less expensive ($4394 vs $5023, P = .18). Because of multiple benefits of LAVH versus AH and no significant difference in cost, we believe LAVH is an acceptable treatment for large leiomyoma.

Theory and implementation of summarization: Improving sensor interpretation for spacecraft operations

NASA Astrophysics Data System (ADS)

Swartwout, Michael Alden

New paradigms in space missions require radical changes in spacecraft operations. In the past, operations were insulated from competitive pressures of cost, quality and time by system infrastructures, technological limitations and historical precedent. However, modern demands now require that operations meet competitive performance goals. One target for improvement is the telemetry downlink, where significant resources are invested to acquire thousands of measurements for human interpretation. This cost-intensive method is used because conventional operations are not based on formal methodologies but on experiential reasoning and incrementally adapted procedures. Therefore, to improve the telemetry downlink it is first necessary to invent a rational framework for discussing operations. This research explores operations as a feedback control problem, develops the conceptual basis for the use of spacecraft telemetry, and presents a method to improve performance. The method is called summarization, a process to make vehicle data more useful to operators. Summarization enables rational trades for telemetry downlink by defining and quantitatively ranking these elements: all operational decisions, the knowledge needed to inform each decision, and all possible sensor mappings to acquire that knowledge. Summarization methods were implemented for the Sapphire microsatellite; conceptual health management and system models were developed and a degree-of-observability metric was defined. An automated tool was created to generate summarization methods from these models. Methods generated using a Sapphire model were compared against the conventional operations plan. Summarization was shown to identify the key decisions and isolate the most appropriate sensors. Secondly, a form of summarization called beacon monitoring was experimentally verified. Beacon monitoring automates the anomaly detection and notification tasks and migrates these responsibilities to the space segment. A set of experiments using Sapphire demonstrated significant cost and time savings compared to conventional operations. Summarization is based on rational concepts for defining and understanding operations. Therefore, it enables additional trade studies that were formerly not possible and also can form the basis for future detailed research into spacecraft operations.

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

PubMed

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

2009-01-01

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

Production cost analysis of Euphorbia lathyris. Final report

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

Mendel, D.A.; Schooley, F.A.; Dickenson, R.L.

1979-08-01

The purpose of SRI's study was to estimate the costs of producing Euphorbia in commercial quantities in five regions of the United States, which include both irrigated and nonirrigated areas. The study assumed that a uniform crop yield could be achieved in the five regions by varying the quantities of production inputs. Therefore, the production costs estimates, which are based on fourth quarter 1978 dollars, include both fixed and variable costs for each region. Doane's Machinery Custom Rates for 1978 were used to estimate all variable costs except materials, which were estimated separately. Custom rates are determined by members ofmore » the Doane Countywide Farm Panel, a group of farmers specifically selected to represent the various sizes and types of commercial farms found throughout the country. The rates reported are the most recent rates the panel members had either paid, charged, or known for certain a second party had paid or charged. Custom rates for any particular operation include equipment operating costs (fuel, lubrication, and repairs), equipment ownership costs (depreciation, taxes, interest), as well as a labor charge for the operator. Custom rates are regionally specific and thereby assist the accuracy of this analysis. Fixed costs include land, management, and transportation of the plant material to a conversion facility. When appropriate, fixed costs were regionally specific. Changes in total production costs over future time periods were not addressed. The total estimated production costs of Euphorbia in each region were compared with production costs for corn and alfalfa in the same regions. Finally, the effects on yield and costs of changes in the production inputs were estimated.« less

Costing transurethral resection of the prostate and diagnosis related group in Australia compared with United States costs.

PubMed

Gordon, N S

1994-02-01

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases. The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital. The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co-morbidity; mean length of stay 7.0; relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co-morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels. The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.

Carbon dioxide capture from atmospheric air using sodium hydroxide spray.

PubMed

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

2008-04-15

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

Costs to Automate Demand Response - Taxonomy and Results from Field Studies and Programs

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

Piette, Mary A.; Schetrit, Oren; Kiliccote, Sila

During the past decade, the technology to automate demand response (DR) in buildings and industrial facilities has advanced significantly. Automation allows rapid, repeatable, reliable operation. This study focuses on costs for DR automation in commercial buildings with some discussion on residential buildings and industrial facilities. DR automation technology relies on numerous components, including communication systems, hardware and software gateways, standards-based messaging protocols, controls and integration platforms, and measurement and telemetry systems. This report compares cost data from several DR automation programs and pilot projects, evaluates trends in the cost per unit of DR and kilowatts (kW) available from automated systems,more » and applies a standard naming convention and classification or taxonomy for system elements. Median costs for the 56 installed automated DR systems studied here are about $200/kW. The deviation around this median is large with costs in some cases being an order of magnitude great or less than the median. This wide range is a result of variations in system age, size of load reduction, sophistication, and type of equipment included in cost analysis. The costs to automate fast DR systems for ancillary services are not fully analyzed in this report because additional research is needed to determine the total cost to install, operate, and maintain these systems. However, recent research suggests that they could be developed at costs similar to those of existing hot-summer DR automation systems. This report considers installation and configuration costs and does include the costs of owning and operating DR automation systems. Future analysis of the latter costs should include the costs to the building or facility manager costs as well as utility or third party program manager cost.« less

A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff.

PubMed

Vanhegan, I S; Malik, A K; Jayakumar, P; Ul Islam, S; Haddad, F S

2012-05-01

Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.

The difference between energy consumption and energy cost: Modelling energy tariff structures for water resource recovery facilities.

PubMed

Aymerich, I; Rieger, L; Sobhani, R; Rosso, D; Corominas, Ll

2015-09-15

The objective of this paper is to demonstrate the importance of incorporating more realistic energy cost models (based on current energy tariff structures) into existing water resource recovery facilities (WRRFs) process models when evaluating technologies and cost-saving control strategies. In this paper, we first introduce a systematic framework to model energy usage at WRRFs and a generalized structure to describe energy tariffs including the most common billing terms. Secondly, this paper introduces a detailed energy cost model based on a Spanish energy tariff structure coupled with a WRRF process model to evaluate several control strategies and provide insights into the selection of the contracted power structure. The results for a 1-year evaluation on a 115,000 population-equivalent WRRF showed monthly cost differences ranging from 7 to 30% when comparing the detailed energy cost model to an average energy price. The evaluation of different aeration control strategies also showed that using average energy prices and neglecting energy tariff structures may lead to biased conclusions when selecting operating strategies or comparing technologies or equipment. The proposed framework demonstrated that for cost minimization, control strategies should be paired with a specific optimal contracted power. Hence, the design of operational and control strategies must take into account the local energy tariff. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery: A Multicenter Randomized Controlled Trial

PubMed Central

van Bakelen, N. B.; Vermeulen, K. M.; Buijs, G. J.; Jansma, J.; de Visscher, J. G. A. M.; Hoppenreijs, Th. J. M.; Bergsma, J. E.; Stegenga, B.; Bos, R. R. M.

2015-01-01

Background Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. Materials and Methods This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years). Results In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group. Conclusion and Discussion The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO’s, Le Fort-I osteotomies and bimaxillary osteotomies. Trial Registration Controlled-Trials.com ISRCTN 44212338 PMID:26192813

Treatment of cervical radiculopathy: A review of the evolution and economics.

PubMed

Ament, Jared D; Karnati, Tejas; Kulubya, Edwin; Kim, Kee D; Johnson, J Patrick

2018-01-01

The surgical treatment of cervical radiculopathy has centered around anterior cervical discectomy and fusion (ACDF). Alternatively, the posterior cervical laminoforaminotomy/microdiscectomy (PCF/PCM), which results in comparable outcomes and is more cost-effective, has been underutilized. Here, we compared the direct/indirect costs, reoperation rates, and outcome for ACDF and PCF vs. PCM using PubMed, Medline, and Embase databases. There were no significant differences between the re-operative rates of PCF/PCM (2% to 9.8%) versus ACDF (2% to 8%). Direct costs of ACDF were also significantly higher; the 1-year cost-utility analysis demonstrated that ACDF had $131,951/QALY while PCM had $79,856/QALY. PCF/PCM for radiculopathy are safe and more cost-effective vs. ACDF, and have similar clinical outcomes.

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

Not Available

The purpose of this analysis is to provide information necessary for the Department of Energy (DOE) to evaluate the practical utility of the Nitrate to Ammonia and Ceramic or Glass (NAC/NAG/NAX) process, which is under development in the Oak Ridge National Laboratory. The NAC/NACx/NAX process can convert aqueous radioactive nitrate-laden waste to a glass, ceramic, or grout solid waste form. The tasks include, but are not limited to, the following: Identify current commercial technologies to meet hazardous and radiological waste disposal requirements. The technologies may be thermal or non-thermal but must be all inclusive (i.e., must convert a radionuclide-containing nitratemore » waste with a pH around 12 to a stable form that can be disposed at permitted facilities); evaluate and compare DOE-sponsored vitrification, grouting, and minimum additive waste stabilization projects for life-cycle costs; compare the technologies above with respect to material costs, capital equipment costs, operating costs, and operating efficiencies. For the NAC/NAG/NAX process, assume aluminum reactant is government furnished and ammonia gas may be marketed; compare the identified technologies with respect to frequency of use within DOE for environmental management applications with appropriate rationale for use; Assess the potential size of the DOE market for the NAC/NAG/NAX process; assess and off-gas issues; and compare with international technologies, including life-cycle estimates.« less

The small community solar thermal power experiment. Parabolic dish technology for industrial process heat application

NASA Technical Reports Server (NTRS)

Polzien, R. E.; Rodriguez, D.

1981-01-01

Aspects of incorporating a thermal energy transport system (ETS) into a field of parabolic dish collectors for industrial process heat (IPH) applications were investigated. Specific objectives are to: (1) verify the mathematical optimization of pipe diameters and insulation thicknesses calculated by a computer code; (2) verify the cost model for pipe network costs using conventional pipe network construction; (3) develop a design and the associated production costs for incorporating risers and downcomers on a low cost concentrator (LCC); (4) investigate the cost reduction of using unconventional pipe construction technology. The pipe network design and costs for a particular IPH application, specifically solar thermally enhanced oil recovery (STEOR) are analyzed. The application involves the hybrid operation of a solar powered steam generator in conjunction with a steam generator using fossil fuels to generate STEOR steam for wells. It is concluded that the STEOR application provides a baseline pipe network geometry used for optimization studies of pipe diameter and insulation thickness, and for development of comparative cost data, and operating parameters for the design of riser/downcomer modifications to the low cost concentrator.

Re-Assessing Green Building Performance: A Post Occupancy Evaluation of 22 GSA Buildings

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

Fowler, Kimberly M.; Rauch, Emily M.; Henderson, Jordan W.

2010-06-01

2nd report on the performance of GSA's sustainably designed buildings. The purpose of this study was to provide an overview of measured whole building performance as it compares to GSA and industry baselines. The PNNL research team found the data analysis illuminated strengths and weaknesses of individual buildings as well as the portfolio of buildings. This section includes summary data, observations that cross multiple performance metrics, discussion of lessons learned from this research, and opportunities for future research. The summary of annual data for each of the performance metrics is provided in Table 25. The data represent 1 year ofmore » measurements and are not associated with any specific design features or strategies. Where available, multiple years of data were examined and there were minimal significant differences between the years. Individually focused post occupancy evaluation (POEs) would allow for more detailed analysis of the buildings. Examining building performance over multiple years could potentially offer a useful diagnostic tool for identifying building operations that are in need of operational changes. Investigating what the connection is between the building performance and the design intent would offer potential design guidance and possible insight into building operation strategies. The 'aggregate operating cost' metric used in this study represents the costs that were available for developing a comparative industry baseline for office buildings. The costs include water utilities, energy utilities, general maintenance, grounds maintenance, waste and recycling, and janitorial costs. Three of the buildings that cost more than the baseline in Figure 45 have higher maintenance costs than the baseline, and one has higher energy costs. Given the volume of data collected and analyzed for this study, the inevitable request is for a simple answer with respect to sustainably designed building performance. As previously stated, compiling the individual building values into single metrics is not statistically valid given the small number of buildings, but it has been done to provide a cursory view of this portfolio of sustainably designed buildings. For all metrics except recycling cost per rentable square foot and CBE survey response rate, the averaged building performance was better than the baseline for the GSA buildings in this study.« less

Cargo Logistics Airlift Systems Study (CLASS). Volume 3: Cross impact between the 1990 market and the air physical distribution systems, book 2

NASA Technical Reports Server (NTRS)

Burby, R. J.; Kuhlman, W. H.

1978-01-01

Book 2 of this volume is divided into the following sections: (1) commodities and system networks; (2) future mode choice decisions and commodity air eligibility; (3) comparative cargo transportation costs - air, truck, rail and water; (4) elasticities of demand; (5) operating cost; (6) operating profit, rate making, and returns; (7) importance of rate and service on future aircraft; (8) potential market demand for new aircraft; (9) scenario of events affecting system/market growth; and (10) future study and technology requirements.

Hospital costs associated with smoking in veterans undergoing general surgery.

PubMed

Kamath, Aparna S; Vaughan Sarrazin, Mary; Vander Weg, Mark W; Cai, Xueya; Cullen, Joseph; Katz, David A

2012-06-01

Approximately 30% of patients undergoing elective general surgery smoke cigarettes. The association between smoking status and hospital costs in general surgery patients is unknown. The objectives of this study were to compare total inpatient costs in current smokers, former smokers, and never smokers undergoing general surgical procedures in Veterans Affairs (VA) hospitals; and to determine whether the relationship between smoking and cost is mediated by postoperative complications. Patients undergoing general surgery during the period of October 1, 2005 to September 30, 2006 were identified in the VA Surgical Quality Improvement Program (VASQIP) data set. Inpatient costs were extracted from the VA Decision Support System (DSS). Relative surgical costs (incurred during index hospitalization and within 30 days of operation) for current and former smokers relative to never smokers, and possible mediators of the association between smoking status and cost were estimated using generalized linear regression models. Models were adjusted for preoperative and operative variables, accounting for clustering of costs at the hospital level. Of the 14,853 general surgical patients, 34% were current smokers, 39% were former smokers, and 27% were never smokers. After controlling for patient covariates, current smokers had significantly higher costs compared with never smokers: relative cost was 1.04 (95% Cl 1.00 to 1.07; p = 0.04); relative costs for former smokers did not differ significantly from those of never smokers: 1.02 (95% Cl 0.99 to 1.06; p = 0.14). The relationship between smoking and hospital costs for current smokers was partially mediated by postoperative respiratory complications. These findings complement emerging evidence recommending effective smoking cessation programs in general surgical patients and provide an estimate of the potential savings that could be accrued during the preoperative period. Published by Elsevier Inc.

Cost analysis of objective resident cataract surgery assessments.

PubMed

Nandigam, Kiran; Soh, Jonathan; Gensheimer, William G; Ghazi, Ahmed; Khalifa, Yousuf M

2015-05-01

To compare 8 ophthalmology resident surgical training tools to determine which is most cost effective. University of Rochester Medical Center, Rochester, New York, USA. Retrospective evaluation of technology. A cost-analysis model was created to compile all relevant costs in running each tool in a medium-sized ophthalmology program. Quantitative cost estimates were obtained based on cost of tools, cost of time in evaluations, and supply and maintenance costs. For wet laboratory simulation, Eyesi was the least expensive cataract surgery simulation method; however, it is only capable of evaluating simulated cataract surgery rehearsal and requires supplementation with other evaluative methods for operating room performance and for noncataract wet lab training and evaluation. The most expensive training tool was the Eye Surgical Skills Assessment Test (ESSAT). The 2 most affordable methods for resident evaluation in operating room performance were the Objective Assessment of Skills in Intraocular Surgery (OASIS) and Global Rating Assessment of Skills in Intraocular Surgery (GRASIS). Cost-based analysis of ophthalmology resident surgical training tools are needed so residency programs can implement tools that are valid, reliable, objective, and cost effective. There is no perfect training system at this time. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-01-01

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

Systematic Evaluation of Stochastic Methods in Power System Scheduling and Dispatch with Renewable Energy

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

Wang, Yishen; Zhou, Zhi; Liu, Cong

2016-08-01

As more wind power and other renewable resources are being integrated into the electric power grid, the forecast uncertainty brings operational challenges for the power system operators. In this report, different operational strategies for uncertainty management are presented and evaluated. A comprehensive and consistent simulation framework is developed to analyze the performance of different reserve policies and scheduling techniques under uncertainty in wind power. Numerical simulations are conducted on a modified version of the IEEE 118-bus system with a 20% wind penetration level, comparing deterministic, interval, and stochastic unit commitment strategies. The results show that stochastic unit commitment provides amore » reliable schedule without large increases in operational costs. Moreover, decomposition techniques, such as load shift factor and Benders decomposition, can help in overcoming the computational obstacles to stochastic unit commitment and enable the use of a larger scenario set to represent forecast uncertainty. In contrast, deterministic and interval unit commitment tend to give higher system costs as more reserves are being scheduled to address forecast uncertainty. However, these approaches require a much lower computational effort Choosing a proper lower bound for the forecast uncertainty is important for balancing reliability and system operational cost in deterministic and interval unit commitment. Finally, we find that the introduction of zonal reserve requirements improves reliability, but at the expense of higher operational costs.« less

Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma.

PubMed

Crowson, Matthew G; Ramprasad, Vaibhav H; Chapurin, Nikita; Cunningham, Calhoun D; Kaylie, David M

2016-11-01

To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies. Retrospective review and cost analysis. Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits. One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001). The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed. 4. Laryngoscope, 126:2574-2579, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis.

PubMed

Strosberg, David S; Nguyen, Michelle C; Muscarella, Peter; Narula, Vimal K

2017-03-01

Robotic-assisted surgery is gaining popularity in general surgery. Our objective was to evaluate and compare operative outcomes and total costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC). A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 by a single surgeon at a large academic medical center. Demographics, diagnosis, perioperative variables, postoperative complications, 30-day readmissions, and operative and hospital costs were collected and analyzed between those patient groups. A total of 237 patients underwent RC or LC, and comprised the study population. Ninety-seven patients (40.9 %) underwent LC, and 140 patients (50.1 %) underwent RC. Patients who underwent RC had a higher body mass index (p = 0.03), lower rates of coronary artery disease (p < 0.01), and higher rates of chronic cholecystitis (p < 0.01). There were lower rates of intraoperative cholangiography (p < 0.01) and conversion to an open procedure (p < 0.01), however longer operative times (p < 0.01) for patients in the RC group. There were no bile duct injuries in either group, no difference in bile leak rates (p = 0.65), or need for reoperation (p = 1.000). Cost analysis of outpatient-only procedures, excluding cases with conversion to open or use of intraoperative cholangiography, demonstrated higher total charges (p < 0.01) and cost (p < 0.01) and lower revenue (p < 0.01) for RC compared to LC, with no difference in total payments (p = 0.34). Robotic cholecystectomy appears to be safe although costlier in comparison with laparoscopic cholecystectomy. Further studies are needed to understand the long-term implications of robotic technology, the cost to the health care system, and its role in minimally invasive surgery.

Development of advanced high temperature in-cylinder components and tribological systems for low heat rejection diesel engines, phase 1

NASA Astrophysics Data System (ADS)

Kroeger, C. A.; Larson, H. J.

1992-03-01

Analysis and concept design work completed in Phase 1 have identified a low heat rejection engine configuration with the potential to meet the Heavy Duty Transport Technology program specific fuel consumption goal of 152 g/kW-hr. The proposed engine configuration incorporates low heat rejection, in-cylinder components designed for operation at 24 MPa peak cylinder pressure. Water cooling is eliminated by selective oil cooling of the components. A high temperature lubricant will be required due to increased in-cylinder operating temperatures. A two-stage turbocharger air system with intercooling and aftercooling was selected to meet engine boost and BMEP requirements. A turbocompound turbine stage is incorporated for exhaust energy recovery. The concept engine cost was estimated to be 43 percent higher compared to a Caterpillar 3176 engine. The higher initial engine cost is predicted to be offset by reduced operating costs due the lower fuel consumption.

Development of advanced high temperature in-cylinder components and tribological systems for low heat rejection diesel engines, phase 1

NASA Technical Reports Server (NTRS)

Kroeger, C. A.; Larson, H. J.

1992-01-01

Analysis and concept design work completed in Phase 1 have identified a low heat rejection engine configuration with the potential to meet the Heavy Duty Transport Technology program specific fuel consumption goal of 152 g/kW-hr. The proposed engine configuration incorporates low heat rejection, in-cylinder components designed for operation at 24 MPa peak cylinder pressure. Water cooling is eliminated by selective oil cooling of the components. A high temperature lubricant will be required due to increased in-cylinder operating temperatures. A two-stage turbocharger air system with intercooling and aftercooling was selected to meet engine boost and BMEP requirements. A turbocompound turbine stage is incorporated for exhaust energy recovery. The concept engine cost was estimated to be 43 percent higher compared to a Caterpillar 3176 engine. The higher initial engine cost is predicted to be offset by reduced operating costs due the lower fuel consumption.

Study to evaluate the effect of EVA on payload systems. Volume 1: Executive summary. [project planning of space missions employing extravehicular activity as a means of cost reduction

NASA Technical Reports Server (NTRS)

Patrick, J. W.; Kraly, E. F.

1975-01-01

Programmatic benefits to payloads are examined which can result from the routine use of extravehicular activity (EVA) during space missions. Design and operations costs were compared for 13 representative baseline payloads to the costs of those payloads adapted for EVA operations. The EVA-oriented concepts developed in the study were derived from these baseline concepts and maintained mission and program objectives as well as basic configurations. This permitted isolation of cost saving factors associated specifically with incorporation of EVA in a variety of payload designs and operations. The study results were extrapolated to a total of 74 payload programs. Using appropriate complexity and learning factors, net EVA savings were extrapolated to over $551M for NASA and U.S. civil payloads for routine operations. Adding DOD and ESRO payloads increases the net estimated savings of $776M. Planned maintenance by EVA indicated an estimated $168M savings due to elimination of automated service equipment. Contingency problems of payloads were also analyzed to establish expected failure rates for shuttle payloads. The failure information resulted in an estimated potential for EVA savings of $1.9 B.

Rotational Thromboelastometry or Conventional Coagulation Tests in Liver Transplantation: Comparing Blood Loss, Transfusions, and Cost.

PubMed

Smart, Laura; Mumtaz, Khalid; Scharpf, Danielle; Gray, Nicole O'Bleness; Traetow, Daniel; Black, Sylvester; Michaels, Anthony J; Elkhammas, Elmahdi; Kirkpatrick, Robert; Hanje, A James

Orthotopic liver transplantation (OLT) can be associated with significant bleeding requiring multiple blood product transfusions. Rotational thromboelastometry (ROTEM) is a point-of-care device that has been used to monitor coagulation during OLT. Whether it reduces blood loss/transfusions during OLT remains controversial. We aim to compare ROTEM with conventional coagulation tests (aPTT, PT, INR, platelet count, fibrinogen) to guide transfusion of platelets, cryoprecipitate, and fresh frozen plasma (FFP) during OLT over 3 years. Thirty-four patients who had transfusions guided by ROTEM were compared to 34 controls who received transfusions guided by conventional coagulation tests (CCT). Intraoperative blood loss, type/ amount of blood products transfused, and direct costs were compared between the two groups. The ROTEM group had significantly less intra-operative blood loss (2.0 vs. 3.0 L, p = 0.04) and fresh frozen plasma (FFP) transfusion (4 units vs. 6.5 units, p = 0.015) compared to the CCT group (2.0L vs. 3.0L, p = 0.04). However, total number of patients transfused cryoprecipitate was increased in ROTEM (n = 25;73%) as compared to CCT (n = 19; 56%), p = 0.033. The direct cost of blood products plus testing was reduced in the ROTEM group ($113,142.89 vs. $127,814.77). In conclusion implementation of a ROTEM-guided transfusion algorithm resulted in a reduction in intra-operative blood loss, FFP transfusion and a decrease in direct cost during OLT. ROTEM is a useful and safe point of care device in OLT setting.

Lower cost offshore field development utilizing autonomous vehicles

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

Frisbie, F.R.; Vie, K.J.; Welch, D.W.

1996-12-31

The offshore oil and gas industry has the requirement to inspect offshore oil and gas pipelines for scour, corrosion and damage as well as inspect and intervene on satellite production facilities. This task is currently performed with Remotely Operated Vehicles (ROV) operated from dynamically positioned (DP) offshore supply or diving support boats. Currently, these tasks are expensive due to the high day rates for DP ships and the slow, umbilical impeded, 1 knot inspection rates of the tethered ROVs, Emerging Autonomous Undersea Vehicle (AUV) technologies offer opportunities to perform these same inspection tasks for 50--75% lower cost, with comparable ormore » improved quality. The new generation LAPV (Linked Autonomous Power Vehicles) will operate from fixed facilities such as TLPs or FPFs and cover an operating field 10 kms in diameter.« less

Barwood CNG Cab Fleet Study: Final Results

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

Whalen, P.; Kelly, K.; John, M.

1999-05-03

This report describes a fleet study conducted over a 12-month period to evaluate the operation of dedicated compress natural gas (CNG) Ford Crown Victoria sedans in a taxicab fleet. In the study, we assess the performance and reliability of the vehicles and the cost of operating the CNG vehicles compared to gasoline vehicles. The study results reveal that the CNG vehicles operated by this fleet offer both economic and environmental advantages. The total operating costs of the CNG vehicles were about 25% lower than those of the gasoline vehicles. The CNG vehicles performed as well as the gasoline vehicles, andmore » were just as reliable. Barwood representatives and drivers have come to consider the CNG vehicles an asset to their business and to the air quality of the local community.« less

Can re-regulation reservoirs and batteries cost-effectively mitigate sub-daily hydropeaking?

NASA Astrophysics Data System (ADS)

Haas, J.; Nowak, W.; Anindito, Y.; Olivares, M. A.

2017-12-01

To compensate for mismatches between generation and load, hydropower plants frequently operate in strong hydropeaking schemes, which is harmful to the downstream ecosystem. Furthermore, new power market structures and variable renewable systems may exacerbate this behavior. Ecological constraints (minimum flows, maximum ramps) are frequently used to mitigate hydropeaking, but these stand in direct tradeoff with the operational flexibility required for integrating renewable technologies. Fortunately, there are also physical methods (i.e. re-regulation reservoirs and batteries) but to date, there are no studies about their cost-effectiveness for hydropeaking mitigation. This study aims to fill that gap. For this, we formulate an hourly mixed-integer linear optimization model to plan the weekly operation of a hydro-thermal-renewable power system from southern Chile. The opportunity cost of water (needed for this weekly scheduling) is obtained from a mid-term programming solved with dynamic programming. We compare the current (unconstrained) hydropower operation with an ecologically constrained operation. The resulting cost increase is then contrasted with the annual payments necessary for the physical hydropeaking mitigation options. For highly constrained operations, both re-regulation reservoirs and batteries show to be economically attractive for hydropeaking mitigation. For intermediate constrained scenarios, re-regulation reservoirs are still economic, whereas batteries can be a viable solution only if they become cheaper in future. Given current cost projections, their break-even point (for hydropeaking mitigation) is expected within the next ten years. Finally, less stringent hydropeaking constraints do not justify physical mitigation measures, as the necessary flexibility can be provided by other power plants of the system.

Survey points to practices that reduce refinery maintenance spending

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

Ricketts, R.

During the past decade, Solomon Associates Inc., Dallas, has conducted several comparative analyses of maintenance costs in the refining industry. These investigations have brought to light maintenance practices and reliability improvement activities that are responsible for the wide range of maintenance costs recorded by refineries. Some of the practices are of an organizational nature and thus are of interest to managers reviewing their operations. The paper discusses maintenance costs; profitability; cost trends; equipment availability; funds application; two basic organizational approached to maintenance (repair-focused organization and reliability-focused organization); low-cost practices; and organizational style.

Life cycle cost of a hybrid forward osmosis - low pressure reverse osmosis system for seawater desalination and wastewater recovery.

PubMed

Valladares Linares, R; Li, Z; Yangali-Quintanilla, V; Ghaffour, N; Amy, G; Leiknes, T; Vrouwenvelder, J S

2016-01-01

In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis - low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor - reverse osmosis - advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m(3) d(-1) of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m(3) produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and water permeability, the total water cost could be further reduced. Copyright © 2015 Elsevier Ltd. All rights reserved.

Age-Dependent Cost-Utility of Pediatric Cochlear Implantation

PubMed Central

Semenov, Yevgeniy R.; Yeh, Susan T.; Seshamani, Meena; Wang, Nae-Yuh; Tobey, Emily A.; Eisenberg, Laurie S.; Quittner, Alexandra L.; Frick, Kevin D.; Niparko, John K.

2013-01-01

Objective Cochlear implantation has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence on the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation--a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the current study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost-utility of pediatric cochlear implantation by age at intervention will be analyzed. Design Prospective, longitudinal assessment of health-utility and educational placement outcomes in 175 children recruited from 6 US centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent cochlear implantation before 5 years of age, and had up to 6 years of post-implant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by pre-operative, operative, and post-operative expenditures. Incremental costs and benefits of implantation were compared between the three age groups and relative to a non-implantation baseline. Results Children implanted at <18 months of age gained an average of 10.7 QALYs over their projected lifetime as compared to 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different between the 3 age groups. Additionally, mean lifetime costs of implantation were similar between the 3 groups, at approximately $2,000/child/year (77.5 year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared to 57% and 63% for the middle and oldest groups, respectively (p<0.05) after six years of follow-up. After incorporating lifetime educational cost savings, cochlear implantation led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child’s projected lifetime. Conclusions Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with cochlear implantation was associated with greater and longer quality of life improvements, similar direct costs of implantation, and economically-valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to cochlear implantation at older ages. PMID:23558665

Ion propulsion cost effectivity

NASA Technical Reports Server (NTRS)

Zafran, S.; Biess, J. J.

1978-01-01

Ion propulsion modules employing 8-cm thrusters and 30-cm thrusters were studied for Multimission Modular Spacecraft (MMS) applications. Recurring and nonrecurring cost elements were generated for these modules. As a result, ion propulsion cost drivers were identified to be Shuttle charges, solar array, power processing, and thruster costs. Cost effective design approaches included short length module configurations, array power sharing, operation at reduced thruster input power, simplified power processing units, and power processor output switching. The MMS mission model employed indicated that nonrecurring costs have to be shared with other programs unless the mission model grows. Extended performance missions exhibited the greatest benefits when compared with monopropellant hydrazine propulsion.

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

PubMed

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

2005-07-01

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

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

NASA Astrophysics Data System (ADS)

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

2015-10-01

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

Comparison of efficacy, safety, and cost-effectiveness of in-office cup forcep biopsies versus operating room biopsies for laryngopharyngeal tumors.

PubMed

Naidu, Harini; Noordzij, J Pieter; Samim, Arang; Jalisi, Scharukh; Grillone, Gregory A

2012-09-01

To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia. This was a retrospective review of patients' records at Boston Medical Center from 2006 to 2008. In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group. Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures. In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Handbook of estimating data, factors, and procedures. [for manufacturing cost studies

NASA Technical Reports Server (NTRS)

Freeman, L. M.

1977-01-01

Elements to be considered in estimating production costs are discussed in this manual. Guidelines, objectives, and methods for analyzing requirements and work structure are given. Time standards for specific specfic operations are listed for machining, sheet metal working, electroplating and metal treating; painting; silk screening, etching and encapsulating; coil winding; wire preparation and wiring; soldering; and the fabrication of etched circuits and terminal boards. The relation of the various elements of cost to the total cost as proposed for various programs by various contractors is compared with government estimates.

Financial performance of health plans in Medicaid managed care.

PubMed

McCue, Mike

2012-01-01

This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization.

Cost optimisation and minimisation of the environmental impact through life cycle analysis of the waste water treatment plant of Bree (Belgium).

PubMed

De Gussem, K; Wambecq, T; Roels, J; Fenu, A; De Gueldre, G; Van De Steene, B

2011-01-01

An ASM2da model of the full-scale waste water plant of Bree (Belgium) has been made. It showed very good correlation with reference operational data. This basic model has been extended to include an accurate calculation of environmental footprint and operational costs (energy consumption, dosing of chemicals and sludge treatment). Two optimisation strategies were compared: lowest cost meeting the effluent consent versus lowest environmental footprint. Six optimisation scenarios have been studied, namely (i) implementation of an online control system based on ammonium and nitrate sensors, (ii) implementation of a control on MLSS concentration, (iii) evaluation of internal recirculation flow, (iv) oxygen set point, (v) installation of mixing in the aeration tank, and (vi) evaluation of nitrate setpoint for post denitrification. Both an environmental impact or Life Cycle Assessment (LCA) based approach for optimisation are able to significantly lower the cost and environmental footprint. However, the LCA approach has some advantages over cost minimisation of an existing full-scale plant. LCA tends to chose control settings that are more logic: it results in a safer operation of the plant with less risks regarding the consents. It results in a better effluent at a slightly increased cost.

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

DOE PAGES

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

2015-06-11

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

Warranty optimisation based on the prediction of costs to the manufacturer using neural network model and Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Stamenkovic, Dragan D.; Popovic, Vladimir M.

2015-02-01

Warranty is a powerful marketing tool, but it always involves additional costs to the manufacturer. In order to reduce these costs and make use of warranty's marketing potential, the manufacturer needs to master the techniques for warranty cost prediction according to the reliability characteristics of the product. In this paper a combination free replacement and pro rata warranty policy is analysed as warranty model for one type of light bulbs. Since operating conditions have a great impact on product reliability, they need to be considered in such analysis. A neural network model is used to predict light bulb reliability characteristics based on the data from the tests of light bulbs in various operating conditions. Compared with a linear regression model used in the literature for similar tasks, the neural network model proved to be a more accurate method for such prediction. Reliability parameters obtained in this way are later used in Monte Carlo simulation for the prediction of times to failure needed for warranty cost calculation. The results of the analysis make possible for the manufacturer to choose the optimal warranty policy based on expected product operating conditions. In such a way, the manufacturer can lower the costs and increase the profit.

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

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

Ren, Lantian; Cafferty, Kara; Roni, Mohammad

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

Economic analysis of linking operating room scheduling and hospital material management information systems for just-in-time inventory control.

PubMed

Epstein, R H; Dexter, F

2000-08-01

Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.

Discovery and New Frontiers Project Budget Analysis Tool

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn E.

2011-01-01

The Discovery and New Frontiers (D&NF) programs are multi-project, uncoupled programs that currently comprise 13 missions in phases A through F. The ability to fly frequent science missions to explore the solar system is the primary measure of program success. The program office uses a Budget Analysis Tool to perform "what-if" analyses and compare mission scenarios to the current program budget, and rapidly forecast the programs ability to meet their launch rate requirements. The tool allows the user to specify the total mission cost (fixed year), mission development and operations profile by phase (percent total mission cost and duration), launch vehicle, and launch date for multiple missions. The tool automatically applies inflation and rolls up the total program costs (in real year dollars) for comparison against available program budget. Thus, the tool allows the user to rapidly and easily explore a variety of launch rates and analyze the effect of changes in future mission or launch vehicle costs, the differing development profiles or operational durations of a future mission, or a replan of a current mission on the overall program budget. Because the tool also reports average monthly costs for the specified mission profile, the development or operations cost profile can easily be validate against program experience for similar missions. While specifically designed for predicting overall program budgets for programs that develop and operate multiple missions concurrently, the basic concept of the tool (rolling up multiple, independently-budget lines) could easily be adapted to other applications.

Launch Vehicle Production and Operations Cost Metrics

NASA Technical Reports Server (NTRS)

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

2014-01-01

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

Economic Evaluation of Telemedicine for Patients in ICUs.

PubMed

Yoo, Byung-Kwang; Kim, Minchul; Sasaki, Tomoko; Melnikow, Joy; Marcin, James P

2016-02-01

Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. Simulation analyses performed by standard decision models. Hypothetical ICU defined by the U.S. literature. Hypothetical adult patients in ICU defined by the U.S. literature. The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on break-even analyses. Our analyses suggest that telemedicine in the ICU is cost-effective in most cases and cost saving in some cases. The thresholds of cost and effectiveness, estimated by break-even analyses, help hospitals determine the impact of telemedicine in the ICU and potential cost saving.

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 ...

Profitability of Cropping Systems Featuring Tillage and Compost

USDA-ARS?s Scientific Manuscript database

Productivity rather than profitability is often used to compare agronomic systems. Increasing energy prices will force producers to scrutinize machinery operation and input costs, which will shift emphasis to profitability. The objective of this study was to compare returns to land and management fo...

Performance comparison and economics analysis of waste stabilization ponds and horizontal subsurface flow constructed wetlands treating domestic wastewater: a case study of the Juja sewage treatment works.

PubMed

Mburu, Njenga; Tebitendwa, Sylvie M; van Bruggen, Johan J A; Rousseau, Diederik P L; Lens, Piet N L

2013-10-15

The performance, effluent quality, land area requirement, investment and operation costs of a full-scale waste stabilization pond (WSP) and a pilot scale horizontal subsurface flow constructed wetland (HSSF-CW) at Jomo Kenyatta University of Agriculture and Technology (JKUAT) were investigated between November 2010 to January 2011. Both systems gave comparable medium to high levels of organic matter and suspended solids removal. However, the WSP showed a better removal for Total Phosphorus (TP) and Ammonium (NH4(+)-N). Based on the population equivalent calculations, the land area requirement per person equivalent of the WSP system was 3 times the area that would be required for the HSSF-CW to treat the same amount of wastewater. The total annual cost estimates consisting of capital, operation and maintenance (O&M) costs were comparable for both systems. However, the evaluation of the capital cost of either system showed that it is largely influenced by the size of the population served, local cost of land and the construction materials involved. Hence, one can select either system in terms of treatment efficiency. When land is available other factor including the volume of wastewater or the investment, and O&M costs determine the technology selection. Copyright © 2013 Elsevier Ltd. All rights reserved.

Electric and hybrid electric vehicles: A technology assessment based on a two-stage Delphi study

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

Vyas, A.D.; Ng, H.K.; Santini, D.J.

1997-12-01

To address the uncertainty regarding future costs and operating attributes of electric and hybrid electric vehicles, a two stage, worldwide Delphi study was conducted. Expert opinions on vehicle attributes, current state of the technology, possible advancements, costs, and market penetration potential were sought for the years 2000, 2010, and 2020. Opinions related to such critical components as batteries, electric drive systems, and hybrid vehicle engines, as well as their respective technical and economic viabilities, were also obtained. This report contains descriptions of the survey methodology, analytical approach, and results of the analysis of survey data, together with a summary ofmore » other factors that will influence the degree of market success of electric and hybrid electric vehicle technologies. Responses by industry participants, the largest fraction among all the participating groups, are compared with the overall responses. An evaluation of changes between the two Delphi stages is also summarized. An analysis of battery replacement costs for various types is summarized, and variable operating costs for electric and hybrid vehicles are compared with those of conventional vehicles. A market penetration analysis is summarized, in which projected market shares from the survey are compared with predictions of shares on the basis of two market share projection models that use the cost and physical attributes provided by the survey. Finally, projections of market shares beyond the year 2020 are developed by use of constrained logit models of market shares, statistically fitted to the survey data.« less

Comparative study of FDMA, TDMA and hybrid 30/20 GHz satellite communications systems for small users

NASA Technical Reports Server (NTRS)

Berk, G.; Jean, P. N.; Rotholz, E.

1982-01-01

This study compares several satellite uplink and downlink accessing schemes for a Customer Premises Service. Four conceptual system designs are presented: Satellite-Routed FDMA, Frequency-Routed TDMA, Satellite-Switched TDMA, and Processor-Routed TDMA, operating in the 30/20 GHz band. The designs are compared on the basis of estimated satellite weight, power consumption, and cost. The system capacities are analyzed for a fixed multibeam coverage of CONUS. Analysis shows that the system capacity is limited by the available satellite resources and by the terminal size and cost.

Application service provider (ASP) financial models for off-site PACS archiving

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Liu, Brent J.; McCoy, J. Michael; Enzmann, Dieter R.

2003-05-01

For the replacement of its legacy Picture Archiving and Communication Systems (approx. annual workload of 300,000 procedures), UCLA Medical Center has evaluated and adopted an off-site data-warehousing solution based on an ASP financial with a one-time single payment per study archived. Different financial models for long-term data archive services were compared to the traditional capital/operational costs of on-site digital archives. Total cost of ownership (TCO), including direct and indirect expenses and savings, were compared for each model. Financial parameters were considered: logistic/operational advantages and disadvantages of ASP models versus traditional archiving systems. Our initial analysis demonstrated that the traditional linear ASP business model for data storage was unsuitable for large institutions. The overall cost markedly exceeds the TCO of an in-house archive infrastructure (when support and maintenance costs are included.) We demonstrated, however, that non-linear ASP pricing models can be cost-effective alternatives for large-scale data storage, particularly if they are based on a scalable off-site data-warehousing service and the prices are adapted to the specific size of a given institution. The added value of ASP is that it does not require iterative data migrations from legacy media to new storage media at regular intervals.

The choice: Welding with CO2 or Nd:YAG lasers

NASA Astrophysics Data System (ADS)

Leong, Keng H.

The recent commercial availability of multi-kilowatt Nd:YAG lasers has opened new avenues for rapid laser processing as well as intensified the competition (cost effectiveness) between CO2 and Nd:YAG laser systems. Vendors offering Nd:YAG laser systems may claim lower operating costs (than CO2) and fiberoptic beam delivery flexibility while CO2 systems vendors may emphasize lower capital cost and well established processing requirements and experience. The capital and operating costs of a laser system are impacted by demand and supply economics and technological advances. Frequently the total cost of a workcell using a laser for processing has to be considered rather than the laser system alone. Consequently it is not very practical to approach the selection of a laser system based on its capital cost and estimated operating cost only. This presentation describes a more pragmatic approach to aid the user in the selection of the optimal multi-kilowatt laser system for a particular processing requirement with emphasis on welding. CO2 laser systems are well established on the factory floor. Consequently, emphasis is given to the comparative application of Nd:YAG lasers, process requirements and performance. Requirements for the laser welding of different metals are examined in the context of hardware (laser system and beam delivery) selection and examples of welding speeds that can be achieved using CO2 and Nd:YAG lasers are examined.

Predictors of micro-costing components in liver transplantation

PubMed Central

de Paiva Haddad, Luciana Bertocco; Ducatti, Liliana; Mendes, Luana Regina Baratelli Carelli; Andraus, Wellington; D’Albuquerque, Luiz Augusto Carneiro

2017-01-01

OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards. PMID:28658432

Teen Smoking

MedlinePlus

... compare the cost of smoking with that of electronic devices, clothes or other teen essentials. Give your ... risks. Don't let your teen be fooled. Electronic cigarettes are battery-operated devices designed to look ...

[Influence of the space layout of a surgical department on use efficiency].

PubMed

Weiss, G; von Baer, R; Riedl, S

2002-02-01

There is a growing gap between the rapidly increasing diagnostic and therapeutic opportunities and the patient demands on one side and the continuously declining hospital budgets on the other side. This gap forces hospitals to search for rationalization potentials and ways to increase their efficiency. It is well known that the operating theatre unit is one of the most important internal cost factors. Many reorganization projects therefore focus on operating theatres. In Germany, several alternative operating room layouts have been developed in order to reduce running und building costs and to reach a high degree of flexibility in their everyday use by means of an improved design. This article analyses and compares the classic operating room and four alternative layouts intended to make them suitable for reaching the promised objectives and, especially, achieving an economically run business management. Furthermore, preferred layouts for certain types of operations are recommended.

Energy Storage Applications in Power Systems with Renewable Energy Generation

NASA Astrophysics Data System (ADS)

Ghofrani, Mahmoud

In this dissertation, we propose new operational and planning methodologies for power systems with renewable energy sources. A probabilistic optimal power flow (POPF) is developed to model wind power variations and evaluate the power system operation with intermittent renewable energy generation. The methodology is used to calculate the operating and ramping reserves that are required to compensate for power system uncertainties. Distributed wind generation is introduced as an operational scheme to take advantage of the spatial diversity of renewable energy resources and reduce wind power fluctuations using low or uncorrelated wind farms. The POPF is demonstrated using the IEEE 24-bus system where the proposed operational scheme reduces the operating and ramping reserve requirements and operation and congestion cost of the system as compared to operational practices available in the literature. A stochastic operational-planning framework is also proposed to adequately size, optimally place and schedule storage units within power systems with high wind penetrations. The method is used for different applications of energy storage systems for renewable energy integration. These applications include market-based opportunities such as renewable energy time-shift, renewable capacity firming, and transmission and distribution upgrade deferral in the form of revenue or reduced cost and storage-related societal benefits such as integration of more renewables, reduced emissions and improved utilization of grid assets. A power-pool model which incorporates the one-sided auction market into POPF is developed. The model considers storage units as market participants submitting hourly price bids in the form of marginal costs. This provides an accurate market-clearing process as compared to the 'price-taker' analysis available in the literature where the effects of large-scale storage units on the market-clearing prices are neglected. Different case studies are provided to demonstrate our operational-planning framework and economic justification for different storage applications. A new reliability model is proposed for security and adequacy assessment of power networks containing renewable resources and energy storage systems. The proposed model is used in combination with the operational-planning framework to enhance the reliability and operability of wind integration. The proposed framework optimally utilizes the storage capacity for reliability applications of wind integration. This is essential for justification of storage deployment within regulated utilities where the absence of market opportunities limits the economic advantage of storage technologies over gas-fired generators. A control strategy is also proposed to achieve the maximum reliability using energy storage systems. A cost-benefit analysis compares storage technologies and conventional alternatives to reliably and efficiently integrate different wind penetrations and determines the most economical design. Our simulation results demonstrate the necessity of optimal storage placement for different wind applications. This dissertation also proposes a new stochastic framework to optimally charge and discharge electric vehicles (EVs) to mitigate the effects of wind power uncertainties. Vehicle-to-grid (V2G) service for hedging against wind power imbalances is introduced as a novel application for EVs. This application enhances the predictability of wind power and reduces the power imbalances between the scheduled output and actual power. An Auto Regressive Moving Average (ARMA) wind speed model is developed to forecast the wind power output. Driving patterns of EVs are stochastically modeled and the EVs are clustered in the fleets of similar daily driving patterns. Monte Carlo Simulation (MCS) simulates the system behavior by generating samples of system states using the wind ARMA model and EVs driving patterns. A Genetic Algorithm (GA) is used in combination with MCS to optimally coordinate the EV fleets for their V2G services and minimize the penalty cost associated with wind power imbalances. The economic characteristics of automotive battery technologies and costs of V2G service are incorporated into a cost-benefit analysis which evaluates the economic justification of the proposed V2G application. Simulation results demonstrate that the developed algorithm enhances wind power utilization and reduces the penalty cost for wind power under-/over-production. This offers potential revenues for the wind producer. Our cost-benefit analysis also demonstrates that the proposed algorithm will provide the EV owners with economic incentives to participate in V2G services. The proposed smart scheduling strategy develops a sustainable integrated electricity and transportation infrastructure.

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

PubMed

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

2015-12-01

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

Perioperative blood ordering optimization process using information from an anesthesia information management system.

PubMed

Rinehart, Joseph B; Lee, Tiffany C; Kaneshiro, Kayleigh; Tran, Minh-Ha; Sun, Coral; Kain, Zeev N

2016-04-01

As part of ongoing perioperative surgical home implantation process, we applied a previously published algorithm for creation of a maximum surgical blood order schedule (MSBOS) to our operating rooms. We hypothesized that using the MSBOS we could show a reduction in unnecessary preoperative blood testing and associated costs. Data regarding all surgical cases done at UC Irvine Health's operating rooms from January 1, 2011, to January 1, 2014 were extracted from the anesthesia information management systems (AIMS). After the data were organized into surgical specialties and operative sites, blood order recommendations were generated based on five specific case characteristics of the group. Next, we assessed current ordering practices in comparison to actual blood utilization to identify potential areas of wastage and performed a cost analysis comparing the annual hospital costs from preoperative blood orders if the blood order schedule were to be followed to historical practices. Of the 19,138 patients who were categorized by the MSBOS as needing no blood sample, 2694 (14.0%) had a type and screen (T/S) ordered and 1116 (5.8%) had a type and crossmatch ordered. Of the 6073 procedures where MSBOS recommended only a T/S, 2355 (38.8%) had blood crossmatched. The cost analysis demonstrated an annual reduction in actual hospital costs of $57,335 with the MSBOS compared to historical blood ordering practices. We showed that the algorithm for development of a multispecialty blood order schedule is transferable and yielded reductions in preoperative blood product screening at our institution. © 2016 AABB.

Intelligent electric vehicle charging: Rethinking the valley-fill

NASA Astrophysics Data System (ADS)

Valentine, Keenan; Temple, William G.; Zhang, K. Max

This study proposes an intelligent PEV charging scheme that significantly reduces power system cost while maintaining reliability compared to the widely discussed valley-fill method of aggregated charging in the early morning. This study considers optimal PEV integration into the New York Independent System Operator's (NYISO) day-ahead and real-time wholesale energy markets for 21 days in June, July, and August of 2006, a record-setting summer for peak load. NYISO market and load data is used to develop a statistical Locational Marginal Price (LMP) and wholesale energy cost model. This model considers the high cost of ramping generators at peak-load and the traditional cost of steady-state operation, resulting in a framework with two competing cost objectives. Results show that intelligent charging assigns roughly 80% of PEV load to valley hours to take advantage of low steady-state cost, while placing the remaining 20% equally at shoulder and peak hours to reduce ramping cost. Compared to unregulated PEV charging, intelligent charging reduces system cost by 5-16%; a 4-9% improvement over the flat valley-fill approach. Moreover, a Charge Flexibility Constraint (CFC), independent of market modeling, is constructed from a vehicle-at-home profile and the mixture of Level 1 and Level 2 charging infrastructure. The CFC is found to severely restrict the ability to charge vehicles during the morning load valley. This study further shows that adding more Level 2 chargers without regulating PEV charging will significantly increase wholesale energy cost. Utilizing the proposed intelligent PEV charging method, there is a noticeable reduction in system cost if the penetration of Level 2 chargers is increased from 70/30 to 50/50 (Level 1/Level 2). However, the system benefit is drastically diminished for higher penetrations of Level 2 chargers.

Cost accounting, management control, and planning in health care.

PubMed

Siegrist, R B; Blish, C S

1988-02-01

Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

The latest developments and outlook for hydrogen liquefaction technology

NASA Astrophysics Data System (ADS)

Ohlig, K.; Decker, L.

2014-01-01

Liquefied hydrogen is presently mainly used for space applications and the semiconductor industry. While clean energy applications, for e.g. the automotive sector, currently contribute to this demand with a small share only, their demand may see a significant boost in the next years with the need for large scale liquefaction plants exceeding the current plant sizes by far. Hydrogen liquefaction for small scale plants with a maximum capacity of 3 tons per day (tpd) is accomplished with a Brayton refrigeration cycle using helium as refrigerant. This technology is characterized by low investment costs but lower process efficiency and hence higher operating costs. For larger plants, a hydrogen Claude cycle is used, characterized by higher investment but lower operating costs. However, liquefaction plants meeting the potentially high demand in the clean energy sector will need further optimization with regard to energy efficiency and hence operating costs. The present paper gives an overview of the currently applied technologies, including their thermodynamic and technical background. Areas of improvement are identified to derive process concepts for future large scale hydrogen liquefaction plants meeting the needs of clean energy applications with optimized energy efficiency and hence minimized operating costs. Compared to studies in this field, this paper focuses on application of new technology and innovative concepts which are either readily available or will require short qualification procedures. They will hence allow implementation in plants in the close future.

An Evaluation of Food Service Systems at Fort Myer, Bolling Air Force Base and Fort Benjamin Harrison

DTIC Science & Technology

1974-09-01

A comparative evaluation of the food service operations at Fort Myer, Virginia; Bolling Air Force Base, Maryland; and Fort Benjamin Harrison, Indiana...was conducted. These three bases each represent different types of food service systems, which are respectively: contract provided food and labor...Operations Research and Systems Analysis Office had the responsibility for comparing the costs, nutritional aspects and consumer attitudes involved in these three different systems of food service .

Resident versus no resident: a single institutional study on operative complications, mortality, and cost.

PubMed

Hwang, Christine S; Pagano, Christina R; Wichterman, Keith A; Dunnington, Gary L; Alfrey, Edward J

2008-08-01

Previous studies have demonstrated an increase in surgical morbidity, mortality, duration of stay, and costs in teaching hospitals. These studies are confounded by many variables. Controlling for these variables, we studied the effect of surgical residents on these outcomes during rotations with non-academic-based teaching faculty at a teaching hospital. Patients received care at a single teaching hospital from a group of 8 surgeons. Four surgeons did not have resident coverage (group 1) and the other 4 had coverage (group 2). Continuous severity adjusted complications, mortality, length of stay, cost, and hospital margin data were collected and compared. Five common procedures were examined: bowel resection, laparoscopic cholecystectomy, hernia, mastectomy, and appendectomy. Comparing all procedures together, there were no differences in complications between the groups, although there was greater mortality, a greater duration of stay, and higher costs in group 2. When comparing the 5 most common procedures individually, there was no difference in complications or mortality, although a greater length of stay and higher costs in group 2. Comparing the most common procedures performed individually, patients cared for by surgeons with surgical residents at a teaching hospital have an increase in duration of stay and cost, although no difference in complications or mortality compared to surgeons without residents.

Cost-effectiveness of New Surgical Treatments for Hemorrhoidal Disease: A Multicentre Randomized Controlled Trial Comparing Transanal Doppler-guided Hemorrhoidal Artery Ligation With Mucopexy and Circular Stapled Hemorrhoidopexy.

PubMed

Lehur, Paul A; Didnée, Anne S; Faucheron, Jean-Luc; Meurette, Guillaume; Zerbib, Philippe; Siproudhis, Laurent; Vinson-Bonnet, Béatrice; Dubois, Anne; Casa, Christine; Hardouin, Jean-Benoit; Durand-Zaleski, Isabelle

2016-11-01

To compare Doppler-guided hemorrhoidal artery ligation (DGHAL) with circular stapled hemorrhoidopexy (SH) in the treatment of grade II/III hemorrhoidal disease (HD). DGHAL is a treatment option for symptomatic HD; existing studies report limited risk and satisfactory outcomes. DGHAL has never before been compared with SH in a large-scale multi-institutional randomized clinical trial. Three hundred ninety-three grade II/III HD patients recruited in 22 centers from 2010 to 2013 were randomized to DGHAL (n = 197) or SH (n = 196). The primary endpoint was operative-related morbidity at 3 months (D.90) based on the Clavien-Dindo surgical complications grading. Total cost, cost-effectiveness, and clinical outcome were assessed at 1 year. At D.90, operative-related adverse events occurred after DGHAL and SH, respectively, in 47 (24%) and 50 (26%) patients (P = 0.70). DGHAL resulted in longer mean operating time (44±16 vs 30±14 min; P < 0.001), less pain (postoperative and at 2 wks visual analogic scale: 2.2 vs 2.8; 1.3 vs 1.9; P = 0.03; P = 0.013) and shorter sick leave (12.3 vs 14.8 d; P = 0.045). At 1 year, DGHAL led to more residual grade III HD (15% vs 5%) and a higher reoperation rate (8% vs 4%). Patient satisfaction was >90% for both procedures. Total cost at 1 year was greater for DGHAL [&OV0556;2806 (&OV0556;2670; 2967) vs &OV0556;2538 (&OV0556;2386; 2737)]. The D.90, incremental cost-effectiveness ratio (ICER) was &OV0556;7192 per averted complication. At 1 year DGHAL strategy was dominated. DGHAL and SH are viable options in grade II/III HD with no significant difference in operative-related risk. Although resulting in less postoperative pain and shorter sick leave, DGHAL was more expensive, took longer, and provided a possible inferior anatomical correction suggesting an increased risk of recurrence.

Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery.

PubMed

Lau, Susie; Vaknin, Zvi; Ramana-Kumar, Agnihotram V; Halliday, Darron; Franco, Eduardo L; Gotlieb, Walter H

2012-04-01

To evaluate the effect of introducing a robotic program on cost and patient outcome. This was a prospective evaluation of clinical outcome and cost after introducing a robotics program for the treatment of endometrial cancer and a retrospective comparison to the entire historical cohort. Consecutive patients with endometrial cancer who underwent robotic surgery (n=143) were compared with all consecutive patients who underwent surgery (n=160) before robotics. The rate of minimally invasive surgery increased from 17% performed by laparoscopy to 98% performed by robotics in 2 years. The patient characteristics were comparable in both eras, except for a higher body mass index in the robotics era (median 29.8 compared with 27.6; P<.005). Patients undergoing robotics had longer operating times (233 compared with 206 minutes), but fewer adverse events (13% compared with 42%; P<.001), lower estimated median blood loss (50 compared with 200 mL; P<.001), and shorter median hospital stay (1 compared with 5 days; P<.001). The overall hospital costs were significantly lower for robotics compared with the historical group (Can$7,644 compared with Can$10,368 [Canadian dollars]; P<.001) even when acquisition and maintenance cost were included (Can$8,370 compared with Can$10,368; P=.001). Within 2 years after surgery, the short-term recurrence rate appeared lower in the robotics group compared with the historic cohort (11 recurrences compared with 19 recurrences; P<.001). Introduction of robotics for endometrial cancer surgery increased the proportion of patients benefitting from minimally invasive surgery, improved short-term outcomes, and resulted in lower hospital costs. II.

Is robotic surgery cost-effective: yes.

PubMed

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

2012-01-01

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

Hypersonic transports - Economics and environmental effects.

NASA Technical Reports Server (NTRS)

Petersen, R. H.; Waters, M. H.

1973-01-01

An economic analysis of hypersonic transports is presented to show projected operating costs (direct and indirect) and return on investment. Important assumptions are varied to determine the probable range of values for operating costs and return on investment. The environmental effects of hypersonic transports are discussed and compared to current supersonic transports. Estimates of sideline and flyover noise are made for a typical hypersonic transport, and the sonic boom problem is analyzed and discussed. Since the exhaust products from liquid hydrogen-fueled engines differ from those of kerosene-fueled aircraft, a qualitative assessment of air pollution effects is made.

Hypersonic transports - Economics and environmental effects.

NASA Technical Reports Server (NTRS)

Petersen, R. H.; Waters, M. H.

1972-01-01

An economic analysis of hypersonic transports is presented to show projected operating costs (direct and indirect) and return on investment. Important assumptions are varied to determine the probable range of values for operating costs and return on investment. The environmental effects of hypersonic transports are discussed and compared to current supersonic transports. Estimates of sideline and flyover noise are made for a typical hypersonic transport, and the sonic boom problem is analyzed and discussed. Since the exhaust products from liquid hydrogen-fueled engines differ from those of kerosene-fueled aircraft, a qualitative assessment of air pollution effects is made.

Hypersonic transports: Economics and environmental effects

NASA Technical Reports Server (NTRS)

Petersen, R. H.; Waters, M. H.

1972-01-01

An economic analysis of hypersonic transports is presented to show projected operating costs (direct and indirect) and return on investment. Important assumptions are varied to determine the probable range of values for operating costs and return on investment. The environmental effects of hypersonic transports are discussed and compared to current supersonic transports. Estimates of sideline and fly-over noise are made for a typical hypersonic transport, and the sonic boom problem is analyzed and discussed. Since the exhaust products from liquid hydrogen-fueled engines differ from those of kerosene-fueled aircraft, a qualitative assessment of air pollution effects is made.

Turboprop cargo aircraft systems study

NASA Technical Reports Server (NTRS)

Muehlbauer, J. C.; Hewell, J. G., Jr.; Lindenbaum, S. P.; Randall, C. C.; Searle, N.; Stone, R. G., Jr.

1981-01-01

The effects of using advanced turboprop propulsion systems to reduce the fuel consumption and direct operating costs of cargo aircraft were studied, and the impact of these systems on aircraft noise and noise prints around a terminal area was determined. Parametric variations of aircraft and propeller characteristics were investigated to determine their effects on noiseprint areas, fuel consumption, and direct operating costs. From these results, three aircraft designs were selected and subjected to design refinements and sensitivity analyses. Three competitive turbofan aircraft were also defined from parametric studies to provide a basis for comparing the two types of propulsion.

Comparing Costs of Telephone versus Face-to-Face Extended Care Programs for the Management of Obesity in Rural Settings

PubMed Central

Radcliff, Tiffany A.; Bobroff, Linda B.; Lutes, Lesley D.; Durning, Patricia E.; Daniels, Michael J.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Perri, Michael G.

2012-01-01

Background A major challenge following successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge may be exacerbated in rural areas with limited local support resources. Objective This study describes and compares program costs and cost-effectiveness for 12-month extended care lifestyle maintenance programs following an initial 6-month weight loss program. Design A 1-year prospective controlled randomized clinical trial. Participants/Setting The study included 215 female participants age 50 or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003, to May 31, 2007. Intervention The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly-assigned to a 12-month extended care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main Outcome Measures Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical Analyses Performed Non-parametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared to individual telephone counseling ($268 per participant) and control ($226 per participant) programs. While the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared to the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared to the other two programs (approximately $33/kg for telephone and control). Conclusions Both the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost, but similar outcomes compared to the face-to-face format. PMID:22818246

Manned Mars mission cost estimate

NASA Technical Reports Server (NTRS)

Hamaker, Joseph; Smith, Keith

1986-01-01

The potential costs of several options of a manned Mars mission are examined. A cost estimating methodology based primarily on existing Marshall Space Flight Center (MSFC) parametric cost models is summarized. These models include the MSFC Space Station Cost Model and the MSFC Launch Vehicle Cost Model as well as other modes and techniques. The ground rules and assumptions of the cost estimating methodology are discussed and cost estimates presented for six potential mission options which were studied. The estimated manned Mars mission costs are compared to the cost of the somewhat analogous Apollo Program cost after normalizing the Apollo cost to the environment and ground rules of the manned Mars missions. It is concluded that a manned Mars mission, as currently defined, could be accomplished for under $30 billion in 1985 dollars excluding launch vehicle development and mission operations.

Strapdown cost trend study and forecast

NASA Technical Reports Server (NTRS)

Eberlein, A. J.; Savage, P. G.

1975-01-01

The potential cost advantages offered by advanced strapdown inertial technology in future commercial short-haul aircraft are summarized. The initial procurement cost and six year cost-of-ownership, which includes spares and direct maintenance cost were calculated for kinematic and inertial navigation systems such that traditional and strapdown mechanization costs could be compared. Cost results for the inertial navigation systems showed that initial costs and the cost of ownership for traditional triple redundant gimbaled inertial navigators are three times the cost of the equivalent skewed redundant strapdown inertial navigator. The net cost advantage for the strapdown kinematic system is directly attributable to the reduction in sensor count for strapdown. The strapdown kinematic system has the added advantage of providing a fail-operational inertial navigation capability for no additional cost due to the use of inertial grade sensors and attitude reference computers.

Air/molten salt direct-contact heat-transfer experiment and economic analysis

NASA Astrophysics Data System (ADS)

Bohn, M. S.

1983-11-01

Direct-contact heat-transfer coefficients have been measured in a pilot-scale packed column heat exchanger for molten salt/air duty. Two types of commercial tower packings were tested: metal Raschig rings and initial Pall rings. Volumetric heat-transfer coefficients were measured and appeared to depend upon air flow but not on salt flow rate. An economic analysis was used to compare the cost-effectiveness of direct-contact heat exchange with finned-tube heat exchanger in this application. Incorporating the measured volumetric heat-transfer coefficients, a direct-contact system appeared to be from two to five times as cost-effective as a finned-tube heat exchanger, depending upon operating temperature. The large cost advantage occurs for higher operating temperatures (2700(0)C), where high rates of heat transfer and flexibility in materials choice give the cost advantage to the direct-contact heat exchanger.

Low-cost and no-cost practice to achieve energy efficiency of government office buildings: A case study in federal territory of Malaysia

NASA Astrophysics Data System (ADS)

Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Ibrahim, Amlus

2016-08-01

This paper presents the findings of a case study to achieve energy-efficient performance of conventional office buildings in Malaysia. Two multi-storey office buildings in Federal Territory of Malaysia have been selected. The aim is to study building energy saving potential then to highlight the appropriate measures that can be implemented. Data was collected using benchmarking method by comparing the measured consumption to other similar office buildings and a series of preliminary audit which involves interviews, a brief review of utility and operating data as well as a walkthrough in the buildings. Additionally, in order to get a better understanding of major energy consumption in the selected buildings, general audit have been conducted to collect more detailed information about building operation. In the end, this study emphasized low-cost and no-cost practice to achieve energy efficiency with significant results in some cases.

A Framework for Automating Cost Estimates in Assembly Processes

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

Calton, T.L.; Peters, R.R.

1998-12-09

When a product concept emerges, the manufacturing engineer is asked to sketch out a production strategy and estimate its cost. The engineer is given an initial product design, along with a schedule of expected production volumes. The engineer then determines the best approach to manufacturing the product, comparing a variey of alternative production strategies. The engineer must consider capital cost, operating cost, lead-time, and other issues in an attempt to maximize pro$ts. After making these basic choices and sketching the design of overall production, the engineer produces estimates of the required capital, operating costs, and production capacity. 177is process maymore » iterate as the product design is refined in order to improve its pe~ormance or manufacturability. The focus of this paper is on the development of computer tools to aid manufacturing engineers in their decision-making processes. This computer sof~are tool provides aj?amework in which accurate cost estimates can be seamlessly derivedfiom design requirements at the start of any engineering project. Z+e result is faster cycle times through first-pass success; lower ll~e cycie cost due to requirements-driven design and accurate cost estimates derived early in the process.« less

[Economic impact of strategies using ephedrine prefilled syringes].

PubMed

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

2013-11-01

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

A life cycle cost economics model for projects with uniformly varying operating costs. [management planning

NASA Technical Reports Server (NTRS)

Remer, D. S.

1977-01-01

A mathematical model is developed for calculating the life cycle costs for a project where the operating costs increase or decrease in a linear manner with time. The life cycle cost is shown to be a function of the investment costs, initial operating costs, operating cost gradient, project life time, interest rate for capital and salvage value. The results show that the life cycle cost for a project can be grossly underestimated (or overestimated) if the operating costs increase (or decrease) uniformly over time rather than being constant as is often assumed in project economic evaluations. The following range of variables is examined: (1) project life from 2 to 30 years; (2) interest rate from 0 to 15 percent per year; and (3) operating cost gradient from 5 to 90 percent of the initial operating costs. A numerical example plus tables and graphs is given to help calculate project life cycle costs over a wide range of variables.

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

PubMed

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

2015-12-01

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

Comparing cost of indwelling pleural catheter vs talc pleurodesis for malignant pleural effusion.

PubMed

Penz, Erika D; Mishra, Eleanor K; Davies, Helen E; Manns, Braden J; Miller, Robert F; Rahman, Najib M

2014-10-01

Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. Using data from the clinical trial, we compared costs associated with use of IPCs and with talc pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing, and doctor time were obtained from the UK National Health Service reference costs and University of Kent's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using nonparametric bootstrapping. All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index. Overall mean cost (SD) for managing patients with IPCs and talc pleurodesis was $4,993 ($5,529) and $4,581 ($4,359), respectively. The incremental mean cost difference was $401, with 95% CI of -$1,387 to $2,261. The mean cost related to ongoing drainage in the IPC group was $1,011 ($732) vs $57 ($213) in the talc pleurodesis group (P = .001). This included the cost of drainage bottles, dressing changes in the first month, and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival < 14 weeks, IPC is significantly less costly than talc pleurodesis, with mean cost difference of -$1,719 (95% CI, -$3,376 to -$85). There is no significant difference in the mean cost of managing patients with IPCs compared with talc pleurodesis. For patients with limited survival, IPC appears less costly. isrctn.org; No.: ISRCTN87514420; URL: www.isrctn.org.

Chipping whole trees for fuel chips: a production study

Treesearch

Dana Mitchell; Tom Gallagher

2007-01-01

A time and motion study was conducted to determine the productivity and cost of an in-woods chipping operation when processing whole mall-diameter trees for biomass. The study removed biomass from two overstocked stands and compared the cost of this treatment to existing alternatives. The treatment stands consisted of a 30-year-old longleaf pine stand and a 37-year-old...

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

DTIC Science & Technology

1994-09-01

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

A low-cost touchscreen operant chamber using a Raspberry Pi™.

PubMed

O'Leary, James D; O'Leary, Olivia F; Cryan, John F; Nolan, Yvonne M

2018-03-08

The development of a touchscreen platform for rodent testing has allowed new methods for cognitive testing that have been back-translated from clinical assessment tools to preclinical animal models. This platform for cognitive assessment in animals is comparable to human neuropsychological tests such as those employed by the Cambridge Neuropsychological Test Automated Battery, and thus has several advantages compared to the standard maze apparatuses typically employed in rodent behavioral testing, such as the Morris water maze. These include improved translation of preclinical models, as well as high throughput and the automation of animal testing. However, these systems are relatively expensive, which can impede progress for researchers with limited resources. Here we describe a low-cost touchscreen operant chamber based on the single-board computer, Raspberry Pi TM , which is capable of performing tasks similar to those supported by current state-of-the-art systems. This system provides an affordable alternative for cognitive testing in a touchscreen operant paradigm for researchers with limited funding.

LIQHYSMES—size, loss and cost considerations for the SMES—a conceptual analysis

NASA Astrophysics Data System (ADS)

Sander, Michael; Neumann, Holger

2011-10-01

A new energy storage concept for variable renewable energy, LIQHYSMES, has been proposed which combines the use of liquid hydrogen (LH2) with superconducting magnetic energy storage (SMES). LH2 with its high volumetric energy density and, compared with compressed hydrogen, increased operational safety is the prime energy carrier for large scale stationary energy storage. But balancing load or supply fluctuations with hydrogen alone is unrealistic due to the response times of the flow control. To operate the hydrogen part more steadily, additional short-term electrical energy storage is needed. For this purpose a SMES based on coated conductors or magnesium diboride MgB2 operated in the LH2 bath, is proposed. Different solenoidal and toroidal SMES designs for the 10 GJ range are compared in terms of size and ramping losses. Cost targets for different power levels and supply periods are addressed, taking into account current developments in competing short-term storage devices like super-capacitors, batteries and flywheels.

Analyzing costs of space debris mitigation methods

NASA Astrophysics Data System (ADS)

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

2004-01-01

The steadily increasing number of space objects poses a considerable hazard to all kinds of spacecraft. To reduce the risks to future space missions different debris mitigation measures and spacecraft protection techniques have been investigated during the last years. However, the economic efficiency has not been considered yet in this context. Current studies have the objective to evaluate the mission costs due to space debris in a business as usual (no mitigation) scenario compared to the missions costs considering debris mitigation. The aim is an estimation of the time until the investment in debris mitigation will lead to an effective reduction of mission costs. This paper presents the results of investigations on the key issues of cost estimation for spacecraft and the influence of debris mitigation and shielding on cost. Mitigation strategies like the reduction of orbital lifetime and de- or re-orbit of non-operational satellites are methods to control the space debris environment. These methods result in an increase of costs. In a first step the overall costs of different types of unmanned satellites are analyzed. A selected cost model is simplified and generalized for an application on all operational satellites. In a next step the influence of space debris on cost is treated, if the implementation of mitigation strategies is considered.

Performance Evaluation of an Expanded Range XIPS Ion Thruster System for NASA Science Missions

NASA Technical Reports Server (NTRS)

Oh, David Y.; Goebel, Dan M.

2006-01-01

This paper examines the benefit that a solar electric propulsion (SEP) system based on the 5 kW Xenon Ion Propulsion System (XIPS) could have for NASA's Discovery class deep space missions. The relative cost and performance of the commercial heritage XIPS system is compared to NSTAR ion thruster based systems on three Discovery class reference missions: 1) a Near Earth Asteroid Sample Return, 2) a Comet Rendezvous and 3) a Main Belt Asteroid Rendezvous. It is found that systems utilizing a single operating XIPS thruster provides significant performance advantages over a single operating NSTAR thruster. In fact, XIPS performs as well as systems utilizing two operating NSTAR thrusters, and still costs less than the NSTAR system with a single operating thruster. This makes XIPS based SEP a competitive and attractive candidate for Discovery class science missions.

Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

PubMed

Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

2013-03-01

We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Space Station Freedom operations costs

NASA Technical Reports Server (NTRS)

Accola, Anne L.; Williams, Gregory J.

1988-01-01

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

What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments.

PubMed

Orr, R Douglas; Sodhi, Nipun; Dalton, Sarah E; Khlopas, Anton; Sultan, Assem A; Chughtai, Morad; Newman, Jared M; Savage, Jason; Mroz, Thomas E; Mont, Michael A

2018-02-02

Relative value units (RVUs) are a compensation model based on the effort required to provide a procedure or service to a patient. Thus, procedures that are more complex and require greater technical skill and aftercare, such as multilevel spine surgery, should provide greater physician compensation. However, there are limited data comparing RVUs with operative time. Therefore, this study aims to compare mean (1) operative times; (2) RVUs; and (3) RVU/min between posterior segmental instrumentation of 3-6, 7-12, and ≥13 vertebral segments, and to perform annual cost difference analysis. A total of 437 patients who underwent instrumentation of 3-6 segments (Cohort 1, current procedural terminology [CPT] code: 22842), 67 patients who had instrumentation of 7-12 segments (Cohort 2, CPT code: 22843), and 16 patients who had instrumentation of ≥13 segments (Cohort 3, CPT code: 22844) were identified from the National Surgical Quality Improvement Program (NSQIP) database. Mean operative times, RVUs, and RVU/min, as well as an annualized cost difference analysis, were calculated and compared using Student t test. This study received no funding from any party or entity. Cohort 1 had shorter mean operative times than Cohorts 2 and 3 (217 minutes vs. 325 minutes vs. 426 minutes, p<.05). Cohort 1 had a lower mean RVU than Cohorts 2 and 3 (12.6 vs. 13.4 vs. 16.4). Cohort 1 had a greater RVU/min than Cohorts 2 and 3 (0.08 vs. 0.05, p<.05; vs. 0.08 vs. 0.05, p>.05). A $112,432.12 annualized cost difference between Cohorts 1 and 2, a $176,744.76 difference between Cohorts 1 and 3, and a $64,312.55 difference between Cohorts 2 and 3 were calculated. The RVU/min takes into account not just the value provided but also the operative times required for highly complex cases. The RVU/min for fewer vertebral level instrumentation being greater (0.08 vs. 0.05), as well as the $177,000 annualized cost difference, indicates that compensation is not proportional to the added time, effort, and skill for more complex cases. Copyright © 2018 Elsevier Inc. All rights reserved.

A life cycle cost economics model for automation projects with uniformly varying operating costs. [applied to Deep Space Network and Air Force Systems Command

NASA Technical Reports Server (NTRS)

Remer, D. S.

1977-01-01

The described mathematical model calculates life-cycle costs for projects with operating costs increasing or decreasing linearly with time. The cost factors involved in the life-cycle cost are considered, and the errors resulting from the assumption of constant rather than uniformly varying operating costs are examined. Parameters in the study range from 2 to 30 years, for project life; 0 to 15% per year, for interest rate; and 5 to 90% of the initial operating cost, for the operating cost gradient. A numerical example is presented.

Tension cost correlates with mechanical and biochemical parameters in different myocardial contractility conditions

PubMed Central

Moreira, Cleci M.; Meira, Eduardo F.; Vestena, Luis; Stefanon, Ivanita; Vassallo, Dalton V.; Padilha, Alessandra S.

2012-01-01

OBJECTIVES: Tension cost, the ratio of myosin ATPase activity to tension, reflects the economy of tension development in the myocardium. To evaluate the mechanical advantage represented by the tension cost, we studied papillary muscle contractility and the activity of myosin ATPase in the left ventricles in normal and pathophysiological conditions. METHODS: Experimental protocols were performed using rat left ventricles from: (1) streptozotocin-induced diabetic and control Wistar rats; (2) N-nitro-L-arginine methyl ester (L-NAME) hypertensive and untreated Wistar rats; (3) deoxycorticosterone acetate (DOCA) salt-treated, nephrectomized and salt- and DOCA-treated rats; (4) spontaneous hypertensive rats (SHR) and Wistar Kyoto (WKY) rats; (5) rats with myocardial infarction and sham-operated rats. The isometric force, tetanic tension, and the activity of myosin ATPase were measured. RESULTS: The results obtained from infarcted, diabetic, and deoxycorticosterone acetate-salt-treated rats showed reductions in twitch and tetanic tension compared to the control and sham-operated groups. Twitch and tetanic tension increased in the N-nitro-L-arginine methyl ester-treated rats compared with the Wistar rats. Myosin ATPase activity was depressed in the infarcted, diabetic, and deoxycorticosterone acetate salt-treated rats compared with control and sham-operated rats and was increased in N-nitro-L-arginine methyl ester-treated rats. These parameters did not differ between SHR and WKY rats. In the studied conditions (e.g., post-myocardial infarction, deoxycorticosterone acetate salt-induced hypertension, chronic N-nitro-L-arginine methyl ester treatment, and streptozotocin-induced diabetes), a positive correlation between force or plateau tetanic tension and myosin ATPase activity was observed. CONCLUSION: Our results suggest that the myocardium adapts to force generation by increasing or reducing the tension cost to maintain myocardial contractility with a better mechanical advantage. PMID:22666794

Resource utilization for non-operative cervical radiculopathy: Management by surgeons versus non-surgeons.

PubMed

Chung, Sophie H; Bohl, Daniel D; Paul, Jonathan T; Rihn, Jeffrey A; Harrop, James S; Ghogawala, Zoher; Hilibrand, Alan S; Grauer, Jonathan N

2017-07-01

To compare the estimated resource utilization for non-operative treatment of cervical radiculopathy if managed by surgeons versus non-surgeons. A Cervical Spine Research Society-sponsored survey was administered at a national spine surgery conference to surgeons and non-surgeons, as classified above. The survey asked questions regarding resource utilization and perceived costs for the "average patient" with cervical radiculopathy managed non-operatively. Resource utilization and perceived costs were compared between surgeon and non-surgeon participants, and between private practice and academic and/or hybrid groups that combine academic and private practices. In total, 101 of the 125 conference attendees participated in the survey (return rate 80.8%, of which 60% were surgeons). Surgeon and non-surgeon estimates for duration of non-operative care did not differ (3.3 versus 4.2 months, p=0.071). Estimates also did not differ for estimated number of physical therapy visits (10.5 versus 10.5, p=0.983), cervical injections (1.4 versus 1.7, p=0.272), chiropractic visits (3.1 versus 3.7, p=0.583), or perceived days off from work (14.9 versus 16.3, p=0.816). The only difference identified was that surgeon estimates of the number of physician visits while providing non-operative care were lower than non-surgeon estimates (3.2 versus 4.0, p=0.018). In terms of estimated costs, surgeon and non-surgeon were mostly similar (only difference being that surgeon estimates for the total cost of physician visits per patient were lower than non-surgeon estimates ($382 versus $579, p=0.007). Surgeon estimates for the percent of their patients that go on to receive surgery within 6 months were higher than non-surgeon estimates (28.6% versus 18.8%, p=0.018). Similarly, surgeon estimates for the percent of their patients to go on to receive surgery within 2 years were higher than non-surgeon estimates (37.8% versus 24.8%, p=0.013). Academic/hybrid and private practice group resource utilization estimates and costs were also compared, and no significant differences were found in any comparisons. Additionally, no significant differences were found in these groups for duration of non-operative care, or the estimates of the percent of patients who go on to receive surgery within 6 months or two years. These data suggest that patients with cervical radiculopathy managed by surgeons and those by non-surgeons have overall similar resource utilization during a non-operative trial. This suggests that relatively similar care is provided regardless of whom initiates the non-operative trial (surgeon or non-surgeon). Although surgeons thought their patients more likely to undergo surgery following a non-operative trial, this may be a bias due to patient referral-specifically, surgeons may be more likely than non-surgeons to manage patients with more severe or longer-standing radiculopathy. Copyright © 2017 Elsevier B.V. All rights reserved.

The Effects of Pre-Operative Enteral Nutrition from Nasal Feeding Tubes on Gastric Outlet Obstruction.

PubMed

Chen, Zhi-Hua; Lin, Su-Yong; Dai, Qi-Bao; Hua, Jin; Chen, Shao-Qin

2017-04-10

We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal-jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and t -test; statistical significance was defined as p < 0.05. The success rate of the placement was 91.18% (three out of 31 cases). After pre-EN, the levels of weight, albumin (ALB), prealbumin (PA), and transferrin (TNF) in the EN group were significantly increased by pre-operation day compared to admission day, but were not significantly increased in the PN group; the weights in the EN group were significantly increased compared to the PN group by pre-operation day and day of discharge; total protein (TP), ALB, PA, and TNF of the EN group were significantly increased compared to the PN group on pre-operation and post-operative days one and three. The levels of CD3+, CD4+/CD8+, IgA, and IgM in the EN group were higher than those of the PN group at pre-operation and post-operation; the EN group had a significantly lower incidence of poor wound healing, peritoneal cavity infection, pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal-jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function, and gastrointestinal function, and sped up recovery, while not increasing the cost of hospitalization.

Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes.

PubMed

Richardson, Michael T; Backhus, Leah M; Berry, Mark F; Vail, Daniel G; Ayers, Kelsey C; Benson, Jalen A; Bhandari, Prasha; Teymourtash, Mehran; Shrager, Joseph B

2018-03-01

To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs. In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL). A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P < .0001). The use of nonstapler supplies, including energy devices, sealants, and disposables, drove intraoperative costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P < .0001), but this accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons. The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies. Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

PubMed Central

Zhang, Sheldon; Salem, Benissa E.; Farabee, David; Hall, Betsy; Marlow, Elizabeth; Faucette, Mark; Bond, Doug; Yadav, Kartik

2015-01-01

Objectives This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. Methods The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. Results When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. Conclusions In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system. PMID:27217822

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis.

PubMed

Nyamathi, Adeline M; Zhang, Sheldon; Salem, Benissa E; Farabee, David; Hall, Betsy; Marlow, Elizabeth; Faucette, Mark; Bond, Doug; Yadav, Kartik

2016-03-01

This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

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

DTIC Science & Technology

1994-09-01

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

National Fuel Cell Bus Program: Accelerated Testing Evaluation Report and Appendices, Alameda-Contra Costa Transit District (AC Transit)

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

Chandler, K.; Eudy, L.

2009-01-01

This is an evaluation of hydrogen fuel cell transit buses operating at AC Transit in revenue service since March 20, 2006 compared to similar diesel buses operating from the same depot. This evaluation report includes results from November 2007 through October 2008. Evaluation results include implementation experience, fueling station operation, fuel cell bus operations at Golden Gate Transit, and evaluation results at AC Transit (bus usage, availability, fuel economy, maintenance costs, and roadcalls).

49 CFR 575.401 - Vehicle labeling of fuel economy, greenhouse gas, and other pollutant emissions information.

Code of Federal Regulations, 2014 CFR

2014-10-01

... vehicles designed to operate on a single fuel, identify the appropriate fuel. For example, identify the... information, include the expression “The best vehicle rates 99 MPGe.” (6) Comparative five-year fuel costs... appropriate for vehicles designed to operate on different fuels. (vii) Below the combined fuel economy value...

49 CFR 575.401 - Vehicle labeling of fuel economy, greenhouse gas, and other pollutant emissions information.

Code of Federal Regulations, 2012 CFR

2012-10-01

... vehicles designed to operate on a single fuel, identify the appropriate fuel. For example, identify the... information, include the expression “The best vehicle rates 99 MPGe.” (6) Comparative five-year fuel costs... appropriate for vehicles designed to operate on different fuels. (vii) Below the combined fuel economy value...

49 CFR 575.401 - Vehicle labeling of fuel economy, greenhouse gas, and other pollutant emissions information.

Code of Federal Regulations, 2013 CFR

2013-10-01

... vehicles designed to operate on a single fuel, identify the appropriate fuel. For example, identify the... information, include the expression “The best vehicle rates 99 MPGe.” (6) Comparative five-year fuel costs... appropriate for vehicles designed to operate on different fuels. (vii) Below the combined fuel economy value...

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

PubMed

Varacallo, Matthew; Mattern, Patrick; Acosta, Jonathan; Toossi, Nader; Denehy, Kevin; Harding, Susan

2018-05-03

To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. Retrospective cohort study SETTING:: Level I Trauma Center PATIENTS:: Two hundred ninety-nine patients undergoing open reduction internal fixation (ORIF) for the treatment of an acute, isolated ankle fracture between 2010 and 2015. none MAIN OUTCOME MEASUREMENTS:: Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates. Orthopedic (64.9%) and podiatry (35.1%) patients were included. The mean index admission cost was $14,048.65 ± $5,797.48. Outpatient cases were significantly cheaper compared to inpatient cases ($10,164.22 ± $3,899.61 versus $15,942.55 ± $5,630.85, respectively, p < 0.001).Unplanned readmission rates were 5.4% (16/299) and 6.7% (20/299) at 30- and 90-days, respectively, and were often (13/20, 65.0%) due to surgical site infections. Independent risk factors for unplanned hospital readmissions included treatment by the podiatry service (p = 0.024), and an American Society of Anesthesiologists (ASA) score of ≥ 3 (p = 0.017). Risk factors for increasing total post discharge costs included treatment by the podiatry service (p = 0.011), and male gender (p = 0.046). Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an ASA score ≥ 3, with the former also independently increasing total post-discharge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

Efficiency assessment of wastewater treatment plants: A data envelopment analysis approach integrating technical, economic, and environmental issues.

PubMed

Castellet, Lledó; Molinos-Senante, María

2016-02-01

The assessment of the efficiency of wastewater treatment plants (WWTPs) is essential to compare their performance and consequently to identify the best operational practices that can contribute to the reduction of operational costs. Previous studies have evaluated the efficiency of WWTPs using conventional data envelopment analysis (DEA) models. Most of these studies have considered the operational costs of the WWTPs as inputs, while the pollutants removed from wastewater are treated as outputs. However, they have ignored the fact that each pollutant removed by a WWTP involves a different environmental impact. To overcome this limitation, this paper evaluates for the first time the efficiency of a sample of WWTPs by applying the weighted slacks-based measure model. It is a non-radial DEA model which allows assigning weights to the inputs and outputs according their importance. Thus, the assessment carried out integrates environmental issues with the traditional "techno-economic" efficiency assessment of WWTPs. Moreover, the potential economic savings for each cost item have been quantified at a plant level. It is illustrated that the WWTPs analyzed have significant room to save staff and energy costs. Several managerial implications to help WWTPs' operators make informed decisions were drawn from the methodology and empirical application carried out. Copyright © 2015 Elsevier Ltd. All rights reserved.

Conceptual design study of potential early commercial MHD powerplant. Report of task 2 results

NASA Astrophysics Data System (ADS)

Hals, F. A.

1981-03-01

The conceptual design of one of the potential early commercial MHD power plants was studied. The plant employs oxygen enrichment of the combustion air and preheating of this oxygen enriched air to an intermediate temperature of 1200 F attainable with a tubular type recuperative heat exchanger. Conceptual designs of plant componets and equipment with performance, operational characteristics, and costs are reported. Plant economics and overall performance including full and part load operation are reviewed. The projected performance and estimated cost of this early MHD plant are compared to conventional power plants, although it does not offer the same high efficiency and low costs as the mature MHD power plant. Environmental aspects and the methods incorporated in plant design for emission control of sulfur and nitrogen are reviewed.

[Possible cost reduction and better surgical results using EEA stapler in tumors of the upper rectum].

PubMed

Coda, A; Ferri, F

1990-01-01

The aim of this work was to compare the relative costs and outcome of the anterior resection of the rectum for upper rectal cancer mechanically or manually performed. Therefore, the last two manual sutures and the first two cases operated using mechanical sutures were taken into account. Patients were homogenous for age, general conditions and cancer stage. Upper rectal location was choosen for the comparison considering the use of stapler not essential in this site. Analysis of the course showed no complications, shorter hospitalization, reduced drug therapy, and fewer diagnostic procedures needed in patients operated on with staplers. Although these data have no statistical rank, better surgical results and remarkable saving in social costs were observed with the use of stapling devices.

Conceptual design study of potential early commercial MHD powerplant. Report of task 2 results

NASA Technical Reports Server (NTRS)

Hals, F. A.

1981-01-01

The conceptual design of one of the potential early commercial MHD power plants was studied. The plant employs oxygen enrichment of the combustion air and preheating of this oxygen enriched air to an intermediate temperature of 1200 F attainable with a tubular type recuperative heat exchanger. Conceptual designs of plant componets and equipment with performance, operational characteristics, and costs are reported. Plant economics and overall performance including full and part load operation are reviewed. The projected performance and estimated cost of this early MHD plant are compared to conventional power plants, although it does not offer the same high efficiency and low costs as the mature MHD power plant. Environmental aspects and the methods incorporated in plant design for emission control of sulfur and nitrogen are reviewed.

Investigation of remote sensing techniques as inputs to operational resource management models. [South Dakota

NASA Technical Reports Server (NTRS)

Schmer, F. A. (Principal Investigator); Isakson, R. E.; Eidenshink, J. C.

1977-01-01

The author has identified the following significant results. Successful operational applications of LANDSAT data were found for level 1 land use mapping, drainage network delineation, and aspen mapping. Visual LANDSAT interpretation using 1:125,000 color composite imagery was the least expensive method of obtaining timely level 1 land use data. With an average agricultural/rangeland interpretation accuracy in excess of 80%, such a data source was considered the most cost effective of those sources available to state agencies. Costs do not compare favorably with those incurred using the present method of extracting land use data from historical tabular summaries. The cost increase in advancing from the present procedure to a satellite-based data source was justified in terms of expanded data content.

Private equity ownership and nursing home financial performance.

PubMed

Pradhan, Rohit; Weech-Maldonado, Robert; Harman, Jeffrey S; Laberge, Alex; Hyer, Kathryn

2013-01-01

Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.

Cost analysis of minimally invasive hysterectomy vs open approach performed by a single surgeon in an Italian center.

PubMed

Pellegrino, Antonio; Damiani, Gianluca Raffaello; Fachechi, Giorgio; Corso, Silvia; Pirovano, Cecilia; Trio, Claudia; Villa, Mario; Turoli, Daniela; Youssef, Aly

2017-06-01

Despite the rapid uptake of robotic surgery, the effectiveness of robotically assisted hysterectomy (RAH) remains uncertain, due to the costs widely variable. Observed the different related costs of robotic procedures, in different countries, we performed a detailed economic analysis of the cost of RAH compared with total laparoscopic (TLH) and open hysterectomy (OH). The three surgical routes were matched according to age, BMI, and comorbidities. Hysterectomy costs were collected prospectively from September 2014 to September 2015. Direct costs were determined by examining the overall medical pathway for each type of intervention. Surgical procedure cost for RAH was €3598 compared with €912 for TLH and €1094 for OH. The cost of the robot-specific supplies was €2705 per intervention. When considering overall medical surgical care, the patient treatment average cost of a RAH was €4695 with a hospital stay (HS) of 2 days (range 2-4) compared with €2053 for TLH and €2846 for OH. The main driver of additional costs is disposable instruments of the robot, which is not compensated by the hospital room costs and by an experienced team staff. Implementation of strategies to reduce the cost of robotic instrumentation is due. No significant cost difference among the three procedures was observed; however, despite the optimal operative time, the experienced, surgeon and the lower HS, RAH resulted 2, 3 times and 1, 6 times more expensive in our institution than TLH and OH, respectively.

Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients.

PubMed

Soliani, G; De Troia, A; Portinari, M; Targa, S; Carcoforo, P; Vasquez, G; Fisichella, P M; Feo, C V

2017-08-01

To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

The school bus routing and scheduling problem with transfers

PubMed Central

Doerner, Karl F.; Parragh, Sophie N.

2015-01-01

In this article, we study the school bus routing and scheduling problem with transfers arising in the field of nonperiodic public transportation systems. It deals with the transportation of pupils from home to their school in the morning taking the possibility that pupils may change buses into account. Allowing transfers has several consequences. On the one hand, it allows more flexibility in the bus network structure and can, therefore, help to reduce operating costs. On the other hand, transfers have an impact on the service level: the perceived service quality is lower due to the existence of transfers; however, at the same time, user ride times may be reduced and, thus, transfers may also have a positive impact on service quality. The main objective is the minimization of the total operating costs. We develop a heuristic solution framework to solve this problem and compare it with two solution concepts that do not consider transfers. The impact of transfers on the service level in terms of time loss (or user ride time) and the number of transfers is analyzed. Our results show that allowing transfers reduces total operating costs significantly while average and maximum user ride times are comparable to solutions without transfers. © 2015 Wiley Periodicals, Inc. NETWORKS, Vol. 65(2), 180–203 2015 PMID:28163329

[Comparison of two cesarean techniques: classic versus Misgav Ladach cesarean].

PubMed

Moreira, P; Moreau, J C; Faye, M E; Ka, S; Kane Guèye, S M; Faye, E O; Dieng, T; Diadhiou, F

2002-10-01

The aim of the study was to compare two cesarean section techniques Methodology. A prospective study was conducted UB 400 cesareans performed at the Gynecological and Obstetric Clinic of the Dakar Teaching Hospital between March 2000 and August 2000. Two hundred patients underwent the classical procedure (CL group) and the other 200 the Misgav Ladach procedure (ML group). Per- and post-operative data were compared between the two groups with Student's test and the Chi(2) test. A p-value less than 0.05 was considered statistically significant. The two groups were similar for socio-demographic and clinical data. The delay between the skin incision and infant delivery was significantly shorter in the ML group (5 minutes 26 seconds versus 6 minutes 20 seconds). The same trend was found for the length of operation (36 minutes 36 seconds versus 54 minutes 38 seconds). Fewer sutures were used in the ML group (2.92 versus 4.14). There is no significant difference for dose of analgesia, post-operative complications and hospital discharge. Cost analysis demonstrated that the Misgav Ladach procedure was 10000 FCFA (15 euros) less costly. Misgav Ladach method is simple, rapid, cost-effective cesarean procedure which appears to be an attractive alternative to traditional cesarean section.

Comparative cost-benefit analysis of tele-homecare for community-dwelling elderly in Japan: Non-Government versus Government Supported Funding Models.

PubMed

Akiyama, Miki; Abraham, Chon

2017-08-01

Tele-homecare is gaining prominence as a viable care alternative, as evidenced by the increase in financial support from international governments to fund initiatives in their respective countries. The primary reason for the funding is to support efforts to reduce lags and increase capacity in access to care as well as to promote preventive measures that can avert costly emergent issues from arising. These efforts are especially important to super-aged and aging societies such as in Japan, many European countries, and the United States (US). However, to date and to our knowledge, a direct comparison of non-government vs. government-supported funding models for tele-homecare is particularly lacking in Japan. The aim of this study is to compare these operational models (i.e., non-government vs. government-supported funding) from a cost-benefit perspective. This simulation study applies to a Japanese hypothetical cohort with implications for other super-aged and aging societies abroad. We performed a cost-benefit analysis (CBA) on two operational models for enabling tele-homecare for elderly community-dwelling cohorts based on a decision tree model, which we created with parameters from published literature. The two models examined are (a) Model 1-non-government-supported funding that includes monthly fixed charges paid by users for a portion of the operating costs, and (b) Model 2-government-supported funding that includes startup and installation costs only (i.e., no operating costs) and no monthly user charges. We performed base case cost-benefit analysis and probabilistic cost-benefit analysis with a Monte Carlo simulation. We calculated net benefit and benefit-to-cost ratios (BCRs) from the societal perspective with a five-year time horizon applying a 3% discount rate for both cost and benefit values. The cost of tele-homecare included (a) the startup system expense, averaged over a five-year depreciation period, and (b) operation expenses (i.e., labor and non-labor) per user per year. The benefit of tele-homecare was measured by annual willingness to pay (WTP) for tele-homecare by a user and medical expenditures avoided. Both costs and benefits were inflated using the relevant Japanese consumer price index (CPI) and converted into 2015 US dollars with purchasing power parity (PPP) adjusted. Base case net benefits of Model 1 and Model 2 were $417.00 and $97.30, respectively. Base case BCR of Model 1 tele-homecare was 1.63, while Model 2 was 1.03. The probabilistic analysis estimated mean (95%CI) for BCRs of Model 1 and Model 2 was 1.84 (1.89, 1.88) and 1.46 (1.43, 1.49), respectively. Sensitivity analysis showed robustness of Model 1 in 7 parameters but Model 2 was sensitive in all key parameters such as initial system cost, device cost, number of users, and medical expenditure saved. Break-even analysis showed that the system cost of Model 2 had to be under $187,500. Our results for each model collectively showed that tele-homecare in Japan is cost-saving to some extent. However, the government-funded model (i.e., Model 2), which typically requires use of all startup funding to be spent within the first year on system costs, was inferior to the monthly fee model (i.e., Model 1) that did not use the government funding for installation or continued operations, but rather incorporated a monthly fee from users to support the receipt of services via tele-homecare. While the benefits of Model 1 outweighed the benefits of Model 2, the government-subsidized method employed in Model 2 could be more beneficial in general if some explicit prequalifying estimated metrics are instituted prior to funding. Thus, governments need to require applicants requesting funding to note, at a minimum, (a) estimated costs, (b) the expected number of tele-homecare users, and expected benefits such as (c) WTP by the user, or (d) medical expenditure saved by tele-homecare as a means of financing some of the operational costs. Copyright © 2017 Elsevier B.V. All rights reserved.

Economic comparison of fabric filters and electrostatic precipitators for particulate control on coal-fired utility boilers

NASA Technical Reports Server (NTRS)

Cukor, P. M.; Chapman, R. A.

1978-01-01

The uncertainties and associated costs involved in selecting and designing a particulate control device to meet California's air emission regulations are considered. The basic operating principles of electrostatic precipitators and fabric filters are discussed, and design parameters are identified. The size and resulting cost of the control device as a function of design parameters is illustrated by a case study for an 800 MW coal-fired fired utility boiler burning a typical southwestern subbituminous coal. The cost of selecting an undersized particulate control device is compared with the cost of selecting an oversized device.

Analysis of Advanced Modular Power Systems (AMPS) for Deep Space Exploration

NASA Technical Reports Server (NTRS)

Oeftering, Richard; Soeder, James F.; Beach, Ray

2014-01-01

The Advanced Modular Power Systems (AMPS) project is developing a modular approach to spacecraft power systems for exploration beyond Earth orbit. AMPS is intended to meet the need of reducing the cost of design development, test and integration and also reducing the operational logistics cost of supporting exploration missions. AMPS seeks to establish modular power building blocks with standardized electrical, mechanical, thermal and data interfaces that can be applied across multiple exploration vehicles. The presentation discusses the results of a cost analysis that compares the cost of the modular approach against a traditional non-modular approach.

Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures.

PubMed

Passi, Monica; Inamdar, Sumant; Hersch, David; Dowling, Oonagh; Sejpal, Divyesh V; Trindade, Arvind J

2018-03-01

Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups. A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group). Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007). The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.

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

Chevallier, J.; Turner, L.

This article describes the design and operation of Trident IX a successfully applied jack up system. A summary of Trident IX's two years of operation in the Arabian Gulf and offshore West Africa is presented. The system is compared to conventional jacking systems in terms of design, operation, costs and safety. Dynamic forces at 400 ft. water depths are summarized, and design of the legs to withstand these dynamic forces and accomodate the new system are explained. Features are listed.

Integrating black liquor gasification with pulping - Process simulation, economics and potential benefits

NASA Astrophysics Data System (ADS)

Lindstrom, Erik Vilhelm Mathias

Gasification of black liquor could drastically increase the flexibility and improve the profit potential of a mature industry. The completed work was focused on research around the economics and benefits of its implementation, utilizing laboratory pulping experiments and process simulation. The separation of sodium and sulfur achieved through gasification of recovered black liquor, can be utilized in processes like modified continuous cooking, split sulfidity and green liquor pretreatment pulping, and polysulfide-anthraquinone pulping, to improve pulp yield and properties. Laboratory pulping protocols have been developed for these modified pulping technologies and different process options evaluated. The process simulation work around BLG has led to the development of a WinGEMS module for the low temperature MTCI steam reforming process, and case studies comparing a simulated conventional kraft process to different process options built around the implementation of a BLG unit operation into the kraft recovery cycle. Pulp yield increases of 1-3% points with improved product quality, and the potential for capital and operating cost savings relative to the conventional kraft process have been demonstrated. Process simulation work has shown that the net variable operating cost for a pulping process using BLGCC is highly dependent on the cost of lime kiln fuel and the selling price of green power to the grid. Under the assumptions taken in the performed case study, the BLGCC process combined with split sulfidity or PSAQ pulping operations had net variable operating cost 2-4% greater than the kraft reference. The influence of the sales price of power to the grid is the most significant cost factor. If a sales price increase to 6 ¢/KWh for green power could be achieved, cost savings of about $40/ODtP could be realized in all investigated BLG processes. Other alternatives to improve the process economics around BLG would be to modify or eliminate the lime kiln unit operations, utilizing high sulfidity green liquor pretreatment, PSAQ with auto-causticization, or converting the process to mini-sulfide sulfite-AQ.

Strategic supply system design - a holistic evaluation of operational and production cost for a biorefinery supply chain

DOE PAGES

Lamers, Patrick; Tan, Eric C. D.; Searcy, Erin M.; ...

2015-08-20

Here, pioneer cellulosic biorefineries across the United States rely on a conventional feedstock supply system based on one-year contracts with local growers, who harvest, locally store, and deliver feed-stock in low-density format to the conversion facility. While the conventional system is designed for high biomass yield areas, pilot scale operations have experienced feedstock supply shortages and price volatilities due to reduced harvests and competition from other industries. Regional supply dependency and the inability to actively manage feedstock stability and quality, provide operational risks to the biorefinery, which translate into higher investment risk. The advanced feedstock supply system based on amore » network of depots can mitigate many of these risks and enable wider supply system benefits. This paper compares the two concepts from a system-level perspective beyond mere logistic costs. It shows that while processing operations at the depot increase feedstock supply costs initially, they enable wider system benefits including supply risk reduction (leading to lower interest rates on loans), industry scale-up, conversion yield improvements, and reduced handling equipment and storage costs at the biorefinery. When translating these benefits into cost reductions per liter of gasoline equivalent (LGE), we find that total cost reductions between -0.46 to -0.21 per LGE for biochemical and -0.32 to -0.12 per LGE for thermochemical conversion pathways are possible. Naturally, these system level benefits will differ between individual actors along the feedstock supply chain. Further research is required with respect to depot sizing, location, and ownership structures.« less

A sensitivity analysis of process design parameters, commodity prices and robustness on the economics of odour abatement technologies.

PubMed

Estrada, José M; Kraakman, N J R Bart; Lebrero, Raquel; Muñoz, Raúl

2012-01-01

The sensitivity of the economics of the five most commonly applied odour abatement technologies (biofiltration, biotrickling filtration, activated carbon adsorption, chemical scrubbing and a hybrid technology consisting of a biotrickling filter coupled with carbon adsorption) towards design parameters and commodity prices was evaluated. Besides, the influence of the geographical location on the Net Present Value calculated for a 20 years lifespan (NPV20) of each technology and its robustness towards typical process fluctuations and operational upsets were also assessed. This comparative analysis showed that biological techniques present lower operating costs (up to 6 times) and lower sensitivity than their physical/chemical counterparts, with the packing material being the key parameter affecting their operating costs (40-50% of the total operating costs). The use of recycled or partially treated water (e.g. secondary effluent in wastewater treatment plants) offers an opportunity to significantly reduce costs in biological techniques. Physical/chemical technologies present a high sensitivity towards H2S concentration, which is an important drawback due to the fluctuating nature of malodorous emissions. The geographical analysis evidenced high NPV20 variations around the world for all the technologies evaluated, but despite the differences in wage and price levels, biofiltration and biotrickling filtration are always the most cost-efficient alternatives (NPV20). When, in an economical evaluation, the robustness is as relevant as the overall costs (NPV20), the hybrid technology would move up next to BTF as the most preferred technologies. Copyright © 2012 Elsevier Inc. All rights reserved.

Strategic supply system design - a holistic evaluation of operational and production cost for a biorefinery supply chain

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

Lamers, Patrick; Tan, Eric C. D.; Searcy, Erin M.

Here, pioneer cellulosic biorefineries across the United States rely on a conventional feedstock supply system based on one-year contracts with local growers, who harvest, locally store, and deliver feed-stock in low-density format to the conversion facility. While the conventional system is designed for high biomass yield areas, pilot scale operations have experienced feedstock supply shortages and price volatilities due to reduced harvests and competition from other industries. Regional supply dependency and the inability to actively manage feedstock stability and quality, provide operational risks to the biorefinery, which translate into higher investment risk. The advanced feedstock supply system based on amore » network of depots can mitigate many of these risks and enable wider supply system benefits. This paper compares the two concepts from a system-level perspective beyond mere logistic costs. It shows that while processing operations at the depot increase feedstock supply costs initially, they enable wider system benefits including supply risk reduction (leading to lower interest rates on loans), industry scale-up, conversion yield improvements, and reduced handling equipment and storage costs at the biorefinery. When translating these benefits into cost reductions per liter of gasoline equivalent (LGE), we find that total cost reductions between -0.46 to -0.21 per LGE for biochemical and -0.32 to -0.12 per LGE for thermochemical conversion pathways are possible. Naturally, these system level benefits will differ between individual actors along the feedstock supply chain. Further research is required with respect to depot sizing, location, and ownership structures.« less

Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer.

PubMed

Coronado, Pluvio J; Herraiz, Miguel A; Magrina, Javier F; Fasero, María; Vidart, Jose A

2012-12-01

To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy. We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features. Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p=0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p=0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3g/dl, -2.3g/dl and -2.5 g/dl respectively, p=0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p=0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p=0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p=0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p=0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p=0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p=0.566). Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Stapled hemorrhoidopexy, an innovative surgical procedure for hemorrhoidal prolapse: cost-utility analysis.

PubMed

Ribarić, Goran; Kofler, Justus; Jayne, David G

2011-08-15

To undertake full economic evaluation of stapled hemorrhoidopexy (PPH) to establish its cost-effectiveness and investigate whether PPH can become cost-saving compared to conventional excisional hemorrhoidectomy (CH). A cost-utility analysis in hospital and health care system (UK) was undertaken using a probabilistic, cohort-based decision tree to compare the use of PPH with CH. Sensitivity analyses allowed showing outcomes in regard to the variations in clinical practice of PPH procedure. The participants were patients undergoing initial surgical treatment of third and fourth degree hemorrhoids within a 1-year time-horizon. Data on clinical effectiveness were obtained from a systematic review of the literature. Main outcome measures were the cost per procedure at the hospital level, total direct costs from the health care system perspective, quality adjusted life years (QALY) gained and incremental cost per QALY gained. A decrease in operating theater time and hospital stay associated with PPH led to a cost saving compared to CH of GBP 27 (US $43.11, €30.50) per procedure at the hospital level and to an incremental cost of GBP 33 (US $52.68, €37.29) after one year from the societal perspective. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an incremental cost-effective ratio (ICER) of GBP 4316 (US $6890.47, €4878.37). Taking into consideration recent literature on clinical outcomes, PPH becomes cost saving compared to CH for the health care system. PPH is a cost-effective procedure with an ICER of GBP 4136 and it seems that an innovative surgical procedure could be cost saving in routine clinical practice.

On the Path to SunShot. Advancing Concentrating Solar Power Technology, Performance, and Dispatchability

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

Mehos, Mark; Turchi, Craig; Jorgenson, Jennie

2016-05-01

This report examines the remaining challenges to achieving the competitive concentrating solar power (CSP) costs and large-scale deployment envisioned under the U.S. Department of Energy's SunShot Initiative. Although CSP costs continue to decline toward SunShot targets, CSP acceptance and deployment have been hindered by inexpensive photovoltaics (PV). However, a recent analysis found that thermal energy storage (TES) could increase CSP's value--based on combined operational and capacity benefits--by up to 6 cents/kWh compared to variable-generation PV, under a 40% renewable portfolio standard in California. Thus, the high grid value of CSP-TES must be considered when evaluating renewable energy options. An assessmentmore » of net system cost accounts for the difference between the costs of adding new generation and the avoided cost from displacing other resources providing the same level of energy and reliability. The net system costs of several CSP configurations are compared with the net system costs of conventional natural-gas-fired combustion-turbine (CT) and combined-cycle plants. At today's low natural gas prices and carbon emission costs, the economics suggest a peaking configuration for CSP. However, with high natural gas prices and emission costs, each of the CSP configurations compares favorably against the conventional alternatives, and systems with intermediate to high capacity factors become the preferred alternatives. Another analysis compares net system costs for three configurations of CSP versus PV with batteries and PV with CTs. Under current technology costs, the least-expensive option is a combination of PV and CTs. However, under future cost assumptions, the optimal configuration of CSP becomes the most cost-effective option.« less

Two-tier tube-trailer pressure consolidation operation method for hydrogen refueling station cost reduction

DOE PAGES

Reddi, Krishna; Elgowainy, Amgad; Rustagi, Neha; ...

2018-01-10

An operation strategy known as two-tier “pressure consolidation” of delivered tube-trailers (or equivalent supply storage) has been developed to maximize the throughput at gaseous hydrogen refueling stations (HRSs) for fuel cell electric vehicles (FCEVs). The high capital costs of HRSs and the consequent high investment risk are deterring growth of the infrastructure needed to promote the deployment of FCEVs. Stations supplied by gaseous hydrogen will be necessary for FCEV deployment in both the near and long term. Here, the two-tier pressure consolidation method enhances gaseous HRSs in the following ways: (1) reduces the capital cost compared with conventional stations, asmore » well as those operating according to the original pressure consolidation approach described by Elgowainy et al. (2014) [1], (2) minimizes pressure cycling of HRS supply storage relative to the original pressure consolidation approach; and (3) increases use of the station’s supply storage (or delivered tube-trailers) while maintaining higher state-of-charge vehicle fills.« less

A series on optimizing satellite systems. I - Restoring interruptions of communications sattelite service: Logistical and cost comparisons of mature and newly operational systems

NASA Astrophysics Data System (ADS)

Snow, Marcellus S.

1989-09-01

A mathematical model is presented of costs and operational factors involved in provision for service interruptions of both a mature and typically large incumbent satellite system and of a smaller, more recently operational system. The equation expresses the required launch frequency for the new system as a function of the launch spacing of the mature system; the time disparity between the inauguration of the two systems; and the rate of capacity depreciation. In addition, a technique is presented to compare the relative extent to which the discounted costs of the new system exceed those of the mature system in furnishing the same effective capacity in orbit, and thus the same service liability, at a given point in time. It is determined that a mature incumbent communications satellite system, having more capacity in orbit, will on balance have a lower probability of service interruption than a newer, smaller system.

Two-tier tube-trailer pressure consolidation operation method for hydrogen refueling station cost reduction

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

Reddi, Krishna; Elgowainy, Amgad; Rustagi, Neha

An operation strategy known as two-tier “pressure consolidation” of delivered tube-trailers (or equivalent supply storage) has been developed to maximize the throughput at gaseous hydrogen refueling stations (HRSs) for fuel cell electric vehicles (FCEVs). The high capital costs of HRSs and the consequent high investment risk are deterring growth of the infrastructure needed to promote the deployment of FCEVs. Stations supplied by gaseous hydrogen will be necessary for FCEV deployment in both the near and long term. Here, the two-tier pressure consolidation method enhances gaseous HRSs in the following ways: (1) reduces the capital cost compared with conventional stations, asmore » well as those operating according to the original pressure consolidation approach described by Elgowainy et al. (2014) [1], (2) minimizes pressure cycling of HRS supply storage relative to the original pressure consolidation approach; and (3) increases use of the station’s supply storage (or delivered tube-trailers) while maintaining higher state-of-charge vehicle fills.« less

ATAD control goals through the analysis of process variables and evaluation of quality, production and cost.

PubMed

Nájera, S; Gil-Martínez, M; Zambrano, J A

2015-01-01

The aim of this paper is to establish and quantify different operational goals and control strategies in autothermal thermophilic aerobic digestion (ATAD). This technology appears as an alternative to conventional sludge digestion systems. During the batch-mode reaction, high temperatures promote sludge stabilization and pasteurization. The digester temperature is usually the only online, robust, measurable variable. The average temperature can be regulated by manipulating both the air injection and the sludge retention time. An improved performance of diverse biochemical variables can be achieved through proper manipulation of these inputs. However, a better quality of treated sludge usually implies major operating costs or a lower production rate. Thus, quality, production and cost indices are defined to quantify the outcomes of the treatment. Based on these, tradeoff control strategies are proposed and illustrated through some examples. This paper's results are relevant to guide plant operators, to design automatic control systems and to compare or evaluate the control performance on ATAD systems.

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

NASA Astrophysics Data System (ADS)

Saleh, Dalia El Sayed Abbas Mohamed

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

Development of termination and utilization concepts for flat conductor cables. Volume 3: Cost study comparison, flat versus round conductor cable

NASA Technical Reports Server (NTRS)

1972-01-01

A cost study comparing flat conductor cable (FCC) with small-gage wire (SGW) and conventional round conductor cable (RCC) is presented. This study was based on a vehicle wiring system consisting of 110,000 ft of conventional RCC equally divided between AWG sizes 20,22, and 24 using MIL-W-81044-type wire and MIL-C-26500 circular connectors. Basic cost data were developed on a similar-sized commercial jet airplane wiring system on a previous company R&D program in which advanced wiring techniques were carried through equivalent installations on an airplane mockup; and on data developed on typical average bundles during this program. Various cost elements included were engineering labor, operations (manufacturing) labor, material costs, and cost impact on payload. Engineering labor includes design, wiring system integration, wiring diagrams and cable assembly drawings, wire installations, and other related supporting functions such as the electronic data processing for the wiring. Operations labor includes mockup, tooling and production planning, fabrication, assembly, installation, and quality control cost impact on payload is the conversion of wiring system weight variations through use of different wiring concepts to program payload benefits in terms of dollars.

Evaluating the Impacts of Real-Time Pricing on the Cost and Value of Wind Generation

DOE PAGES

Siohansi, Ramteen

2010-05-01

One of the costs associated with integrating wind generation into a power system is the cost of redispatching the system in real-time due to day-ahead wind resource forecast errors. One possible way of reducing these redispatch costs is to introduce demand response in the form of real-time pricing (RTP), which could allow electricity demand to respond to actual real-time wind resource availability using price signals. A day-ahead unit commitment model with day-ahead wind forecasts and a real-time dispatch model with actual wind resource availability is used to estimate system operations in a high wind penetration scenario. System operations are comparedmore » to a perfect foresight benchmark, in which actual wind resource availability is known day-ahead. The results show that wind integration costs with fixed demands can be high, both due to real-time redispatch costs and lost load. It is demonstrated that introducing RTP can reduce redispatch costs and eliminate loss of load events. Finally, social surplus with wind generation and RTP is compared to a system with neither and the results demonstrate that introducing wind and RTP into a market can result in superadditive surplus gains.« less

Ceramic automotive Stirling engine program

NASA Technical Reports Server (NTRS)

1986-01-01

The Ceramic Automotive Stirling Engine Program evaluated the application of advanced ceramic materials to an automotive Stirling engine. The objective of the program was to evaluate the technical feasibility of utilizing advanced ceramics to increase peak engine operating temperature, and to evaluate the performance benefits of such an increase. Manufacturing cost estimates were also developed for various ceramic engine components and compared with conventional metallic engine component costs.

Harvesting costs and production rates for seed-tree removal in young-growth, mixed-conifer stands

Treesearch

Philip M. McDonald

1969-01-01

Ponderosa pine seed trees left from a previous cutting on the Challenge Experimental Forest, California, were removed in October 1963. Logging costs and production rates were compared with those for a seed-tree cutting on an area nearby. Production rates for seed-tree removal greatly exceeded those for the operation as a whole. Skidding production increased by 38...

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

NASA Technical Reports Server (NTRS)

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

1980-01-01

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

Cost analysis in the toxicology laboratory.

PubMed

Travers, E M

1990-09-01

The process of determining laboratory sectional and departmental costs and test costs for instrument-generated and manually generated reportable results for toxicology laboratories has been outlined in this article. It is hoped that the basic principles outlined in the preceding text will clarify and elucidate one of the most important areas needed for laboratory fiscal integrity and its survival in these difficult times for health care providers. The following general principles derived from this article are helpful aids for managers of toxicology laboratories. 1. To manage a cost-effective, efficient toxicology laboratory, several factors must be considered: the laboratory's instrument configuration, test turnaround time needs, the test menu offered, the analytic methods used, the cost of labor based on time expended and the experience and educational level of the staff, and logistics that determine specimen delivery time and costs. 2. There is a wide variation in costs for toxicologic methods, which requires that an analysis of capital (equipment) purchase and operational (test performance) costs be performed to avoid waste, purchase wisely, and determine which tests consume the majority of the laboratory's resources. 3. Toxicologic analysis is composed of many complex steps. Each step must be individually cost-accounted. Screening test results must be confirmed, and the cost for both steps must be included in the cost per reportable result. 4. Total costs will vary in the same laboratory and between laboratories based on differences in salaries paid to technical staff, differences in reagent/supply costs, the number of technical staff needed to operate the analyzer or perform the method, and the inefficient use of highly paid staff to operate the analyzer or perform the method. 5. Since direct test costs vary directly with the type and number of analyzers or methods and are dependent on the operational mode designed by the manufacturer, laboratory managers should construct an actual test-cost data base for instrument or method in use to accurately compare costs using the "bottom-up" approach. 6. Laboratory expenses can be examined from three perspectives: total laboratory, laboratory section, and subsection workstation. The objective is to track all laboratory expenses through each of these levels. 7. In the final analysis, a portion of total laboratory expenses must be allocated to each unit of laboratory output--the billable procedure or, in laboratories where tests are not billed, the tests produced.(ABSTRACT TRUNCATED AT 400 WORDS)

Distributed Generation Energy Technology Operations and Maintenance Costs |

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

Modelling energy costs for different operational strategies of a large water resource recovery facility.

PubMed

Póvoa, P; Oehmen, A; Inocêncio, P; Matos, J S; Frazão, A

2017-05-01

The main objective of this paper is to demonstrate the importance of applying dynamic modelling and real energy prices on a full scale water resource recovery facility (WRRF) for the evaluation of control strategies in terms of energy costs with aeration. The Activated Sludge Model No. 1 (ASM1) was coupled with real energy pricing and a power consumption model and applied as a dynamic simulation case study. The model calibration is based on the STOWA protocol. The case study investigates the importance of providing real energy pricing comparing (i) real energy pricing, (ii) weighted arithmetic mean energy pricing and (iii) arithmetic mean energy pricing. The operational strategies evaluated were (i) old versus new air diffusers, (ii) different DO set-points and (iii) implementation of a carbon removal controller based on nitrate sensor readings. The application in a full scale WRRF of the ASM1 model coupled with real energy costs was successful. Dynamic modelling with real energy pricing instead of constant energy pricing enables the wastewater utility to optimize energy consumption according to the real energy price structure. Specific energy cost allows the identification of time periods with potential for linking WRRF with the electric grid to optimize the treatment costs, satisfying operational goals.

Advisory Algorithm for Scheduling Open Sectors, Operating Positions, and Workstations

NASA Technical Reports Server (NTRS)

Bloem, Michael; Drew, Michael; Lai, Chok Fung; Bilimoria, Karl D.

2012-01-01

Air traffic controller supervisors configure available sector, operating position, and work-station resources to safely and efficiently control air traffic in a region of airspace. In this paper, an algorithm for assisting supervisors with this task is described and demonstrated on two sample problem instances. The algorithm produces configuration schedule advisories that minimize a cost. The cost is a weighted sum of two competing costs: one penalizing mismatches between configurations and predicted air traffic demand and another penalizing the effort associated with changing configurations. The problem considered by the algorithm is a shortest path problem that is solved with a dynamic programming value iteration algorithm. The cost function contains numerous parameters. Default values for most of these are suggested based on descriptions of air traffic control procedures and subject-matter expert feedback. The parameter determining the relative importance of the two competing costs is tuned by comparing historical configurations with corresponding algorithm advisories. Two sample problem instances for which appropriate configuration advisories are obvious were designed to illustrate characteristics of the algorithm. Results demonstrate how the algorithm suggests advisories that appropriately utilize changes in airspace configurations and changes in the number of operating positions allocated to each open sector. The results also demonstrate how the advisories suggest appropriate times for configuration changes.

Benchmarking the expected stack manufacturing cost of next generation, intermediate-temperature protonic ceramic fuel cells with solid oxide fuel cell technology

NASA Astrophysics Data System (ADS)

Dubois, Alexis; Ricote, Sandrine; Braun, Robert J.

2017-11-01

Recent progress in the performance of intermediate temperature (500-600 °C) protonic ceramic fuel cells (PCFCs) has demonstrated both fuel flexibility and increasing power density that approach commercial application requirements. These developments may eventually position the technology as a viable alternative to solid oxide fuel cells (SOFCs) and molten carbonate fuel cells (MCFCs). The PCFCs investigated in this work are based on a BaZr0.8Y0.2O3-δ (BZY20) thin electrolyte supported by BZY20/Ni porous anodes, and a triple conducting cathode material comprised of BaCo0.4Fe0.4Zr0.1Y0.1O3-δ (BCFZY0.1). These cells are prepared using a low-cost solid-state reactive sintering (SSRS) process, and are capable of power densities of 0.156 W cm-2 at 500 °C operating directly from methane fuel. We develop a manufacturing cost model to estimate the Nth generation production costs of PCFC stack technology using high volume manufacturing processes and compare them to the state-of-the-art in SOFC technology. The low-cost cell manufacturing enabled by the SSRS technique compensates for the lower PCFC power density and the trade-off between operating temperature and efficiency enables the use of lower-cost stainless steel materials. PCFC stack production cost estimates are found to be as much as 27-37% lower at 550 °C than SOFCs operating at 800 °C.

Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients.

PubMed

Osnabrugge, Ruben L J; Head, Stuart J; Genders, Tessa S S; Van Mieghem, Nicolas M; De Jaegere, Peter P T; van der Boon, Robert M A; Kerkvliet, J Marco; Kalesan, Bindu; Bogers, Ad J J C; Kappetein, A Pieter; Hunink, M G Myriam

2012-12-01

Transcatheter aortic valve replacement (TAVR) offers a new treatment option for patients with aortic stenosis, but costs may play a decisive role in decision making. Current studies are evaluating TAVR in an intermediate-risk population. We assessed the in-hospital and 1-year follow-up costs of patients undergoing TAVR and surgical aortic valve replacement (SAVR) at intermediate operative risk and identified important cost components. We prospectively collected clinical data on 141 patients undergoing TAVR and 405 undergoing SAVR. Propensity score matching yielded 42 matched pairs at intermediate risk. Costs were assessed using a detailed resource-use approach and compared using bootstrap methods. In-hospital costs were higher in TAVR patients than in SAVR patients (€40802 vs €33354, respectively; p=0.010). The total costs at 1 year were €46217 vs €35511, respectively (p=0.009). The TAVR was less costly with regard to blood products, operating room use, and length-of-stay. For intermediate-risk patients with severe aortic stenosis the costs at 1 year are higher for TAVR than for SAVR. The difference was mainly caused by the higher costs of the transcatheter valve and was not compensated by the lower costs for blood products and hospital stay in TAVR patients. Therefore, SAVR remains a clinically and economically attractive treatment option. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A cost analysis comparing xeroradiography to film technics for intraoral radiography.

PubMed

Gratt, B M; Sickles, E A

1986-01-01

In the United States during 1978 $730 million was spent on dental radiographic services. Currently there are three alternatives for the processing of intraoral radiographs: manual wet-tanks, automatic film units, or xeroradiography. It was the intent of this study to determine which processing system is the most economical. Cost estimates were based on a usage rate of 750 patient images per month and included a calculation of the average cost per radiograph over a five-year period. Capital costs included initial processing equipment and site preparation. Operational costs included labor, supplies, utilities, darkroom rental, and breakdown costs. Clinical time trials were employed to measure examination times. Maintenance logs were employed to assess labor costs. Indirect costs of training were estimated. Results indicated that xeroradiography was the most cost effective ($0.81 per image) compared to either automatic film processing ($1.14 per image) or manual processing ($1.35 per image). Variations in projected costs indicated that if a dental practice performs primarily complete-mouth surveys, exposes less than 120 radiographs per month, and pays less than +6.50 per hour in wages, then manual (wet-tank) processing is the most economical method for producing intraoral radiographs.

[Self-owned versus accredited network: comparative cost analysis in a Brazilian health insurance provider].

PubMed

Souza, Marcos Antônio de; Salvalaio, Dalva

2010-10-01

to analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. for this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. the choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties.

Optimal estimation and scheduling in aquifer management using the rapid feedback control method

NASA Astrophysics Data System (ADS)

Ghorbanidehno, Hojat; Kokkinaki, Amalia; Kitanidis, Peter K.; Darve, Eric

2017-12-01

Management of water resources systems often involves a large number of parameters, as in the case of large, spatially heterogeneous aquifers, and a large number of "noisy" observations, as in the case of pressure observation in wells. Optimizing the operation of such systems requires both searching among many possible solutions and utilizing new information as it becomes available. However, the computational cost of this task increases rapidly with the size of the problem to the extent that textbook optimization methods are practically impossible to apply. In this paper, we present a new computationally efficient technique as a practical alternative for optimally operating large-scale dynamical systems. The proposed method, which we term Rapid Feedback Controller (RFC), provides a practical approach for combined monitoring, parameter estimation, uncertainty quantification, and optimal control for linear and nonlinear systems with a quadratic cost function. For illustration, we consider the case of a weakly nonlinear uncertain dynamical system with a quadratic objective function, specifically a two-dimensional heterogeneous aquifer management problem. To validate our method, we compare our results with the linear quadratic Gaussian (LQG) method, which is the basic approach for feedback control. We show that the computational cost of the RFC scales only linearly with the number of unknowns, a great improvement compared to the basic LQG control with a computational cost that scales quadratically. We demonstrate that the RFC method can obtain the optimal control values at a greatly reduced computational cost compared to the conventional LQG algorithm with small and controllable losses in the accuracy of the state and parameter estimation.

Finding the optimal lengths for three branches at a junction.

PubMed

Woldenberg, M J; Horsfield, K

1983-09-21

This paper presents an exact analytical solution to the problem of locating the junction point between three branches so that the sum of the total costs of the branches is minimized. When the cost per unit length of each branch is known the angles between each pair of branches can be deduced following reasoning first introduced to biology by Murray. Assuming the outer ends of each branch are fixed, the location of the junction and the length of each branch are then deduced using plane geometry and trigonometry. The model has applications in determining the optimal cost of a branch or branches at a junction. Comparing the optimal to the actual cost of a junction is a new way to compare cost models for goodness of fit to actual junction geometry. It is an unambiguous measure and is superior to comparing observed and optimal angles between each daughter and the parent branch. We present data for 199 junctions in the pulmonary arteries of two human lungs. For the branches at each junction we calculated the best fitting value of x from the relationship that flow alpha (radius)x. We found that the value of x determined whether a junction was best fitted by a surface, volume, drag or power minimization model. While economy of explanation casts doubt that four models operate simultaneously, we found that optimality may still operate, since the angle to the major daughter is less than the angle to the minor daughter. Perhaps optimality combined with a space filling branching pattern governs the branching geometry of the pulmonary artery.

Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness.

PubMed

Polignano, Francesco M; Quyn, Aaron J; de Figueiredo, Rodrigo S M; Henderson, Nikola A; Kulli, Christoph; Tait, Iain S

2008-12-01

Reduction in hospital stay, blood loss, postoperative pain and complications are common findings after laparoscopic liver resection, suggesting that the laparoscopic approach may be a suitable alternative to open surgery. Some concerns have been raised regarding cost effectiveness of this procedure and potential implications of its large-scale application. Our aim has been to determine cost effectiveness of laparoscopic liver surgery by a case-matched, case-control, intention-to-treat analysis of its costs and short-term clinical outcomes compared with open surgery. Laparoscopic liver segmentectomies and bisegmentectomies performed at Ninewells Hospital and Medical School between 2005 and 2007 were considered. Resections involving more than two Couinaud segments, or involving any synchronous procedure, were excluded. An operation-magnitude-matched control group was identified amongst open liver resections performed between 2004 and 2007. Hospital costs were obtained from the Scottish Health Service Costs Book (ISD Scotland) and average national costs were calculated. Cost of theatre time, disposable surgical devices, hospital stay, and high-dependency unit (HDU) and intensive care unit (ICU) usage were the main endpoints for comparison. Secondary endpoints were morbidity and mortality. Statistical analysis was performed with Student's t-test, chi(2) and Fisher exact test as most appropriate. Twenty-five laparoscopic liver resections were considered, including atypical resection, segmentectomy and bisegmentectomy, and they were compared to 25 matching open resections. The two groups were homogeneous by age, sex, coexistent morbidity, magnitude of resection, prevalence of liver cirrhosis and indications. Operative time (p < 0.03), blood loss (p < 0.0001), Pringle manoeuvre (p < 0.03), hospital stay (p < 0.003) and postoperative complications (p < 0.002) were significantly reduced in the laparoscopic group. Overall hospital cost was significantly lower in the laparoscopic group by an average of 2,571 pounds sterling (p < 0.04). Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections. Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care programmes.

Cost analysis of mandibular distraction versus tracheostomy in neonates with Pierre Robin sequence.

PubMed

Runyan, Christopher M; Uribe-Rivera, Armando; Karlea, Audrey; Meinzen-Derr, Jareen; Rothchild, Dawn; Saal, Howard; Hopkin, Robert J; Gordon, Christopher B

2014-11-01

To evaluate costs associated with surgical treatment for neonates with Pierre Robin sequence (PRS). Retrospective cohort study. Cincinnati Children's Hospital Medical Center. With Institutional Review Board approval, we retrospectively studied neonates with PRS treated from 2001 to 2009 with either tracheostomy (Trach), mandibular distraction (MD), or Trach with subsequent MD (Trach+MD). Actual charges over a 3-year period associated with operative costs, hospital stay, imaging and sleep studies, clinic visits, and related emergency room visits were collected. Home tracheostomy care charges were estimated individually for each patient. Charges were compared using regression and appropriate statistical analyses. Forty-seven neonates were included in the study (MD, n = 26; Trach, n = 12; Trach+MD, n = 9). Trach group patients had 2.6-fold higher charges than the MD group despite no difference in length of hospital stay. This difference increased to 7.3-fold when including home trach care-related costs. Trach+MD group patients had longer hospital lengths of stay and higher operation room (OR) fees, but no increased total charges compared with the Trach only group. For patients with severe PRS, mandibular distraction provides significant cost savings over tracheostomy ($300,000 per patient over 3 years). Increased costs with tracheostomy come from greater hospital-related charges, more frequent airway procedures, a higher incidence of gastrostomy tube feeds, and home trach care costs. A careful examination of long-term outcomes will be critical as mandibular distraction continues to gain acceptance for treatment of PRS. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

LMSS SERVICES FINANCIAL REPORT PROGRAM

NASA Technical Reports Server (NTRS)

Chamberlain, R. G.

1994-01-01

The objective of this Services Finance Report program is to provide a means for comparing alternative designs of LMSS systems or other services systems. This program is actually a Multiplan worksheet. The labels used in the worksheet were chosen for a satellite-based cellular communication service (LMSS - Land Mobile Satellite System) but the analysis is not restricted to such cases. A comprehensive financial model is used to calculate a 'figure of merit' which can be used to compare effects of equipment and operating costs, pricing strategy, and customer demand for different systems. The program also calculates the price that a company would have to charge customers to meet all its expenses and make a specified profit. A price estimate can be obtained for almost any service which is heavily dependent on capital investment and which has operating costs that depend on the amount of service sold. The economic analysis has two main components: supplier finances and customer finances. Supplier finances include amortization, interest, insurance, taxes, and operating and maintenance expenses. Customer finances include usage rate, subscription fees, equipment costs, and estimated traffic. Prices can defined as real or nominal to account for effects of escalation and inflation, and the profits can be regulated or unrestricted This program is written for interactive execution with Multiplan (version 1.2) and has been implemented on an IBM PC series computer operating under DOS (version 2.11). The LMSS worksheet has a space requirement of approximately 38K of 8 bit bytes. This worksheet was developed in 1984.

Local or General Anesthesia for Open Hernia Repair: A Randomized Trial

PubMed Central

O’Dwyer, Patrick J.; Serpell, Michael G.; Millar, Keith; Paterson, Caron; Young, David; Hair, Alan; Courtney, Carol-Ann; Horgan, Paul; Kumar, Sudhir; Walker, Andrew; Ford, Ian

2003-01-01

Objective To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial. Summary Background Data LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA. Methods All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs. Results Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA. Conclusions There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia. PMID:12677155

The latest developments and outlook for hydrogen liquefaction technology

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

Ohlig, K.; Decker, L.

2014-01-29

Liquefied hydrogen is presently mainly used for space applications and the semiconductor industry. While clean energy applications, for e.g. the automotive sector, currently contribute to this demand with a small share only, their demand may see a significant boost in the next years with the need for large scale liquefaction plants exceeding the current plant sizes by far. Hydrogen liquefaction for small scale plants with a maximum capacity of 3 tons per day (tpd) is accomplished with a Brayton refrigeration cycle using helium as refrigerant. This technology is characterized by low investment costs but lower process efficiency and hence highermore » operating costs. For larger plants, a hydrogen Claude cycle is used, characterized by higher investment but lower operating costs. However, liquefaction plants meeting the potentially high demand in the clean energy sector will need further optimization with regard to energy efficiency and hence operating costs. The present paper gives an overview of the currently applied technologies, including their thermodynamic and technical background. Areas of improvement are identified to derive process concepts for future large scale hydrogen liquefaction plants meeting the needs of clean energy applications with optimized energy efficiency and hence minimized operating costs. Compared to studies in this field, this paper focuses on application of new technology and innovative concepts which are either readily available or will require short qualification procedures. They will hence allow implementation in plants in the close future.« less

Estimating the Value of Improved Distributed Photovoltaic Adoption Forecasts for Utility Resource Planning

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

Gagnon, Pieter; Barbose, Galen L.; Stoll, Brady

Misforecasting the adoption of customer-owned distributed photovoltaics (DPV) can have operational and financial implications for utilities; forecasting capabilities can be improved, but generally at a cost. This paper informs this decision-space by using a suite of models to explore the capacity expansion and operation of the Western Interconnection over a 15-year period across a wide range of DPV growth rates and misforecast severities. The system costs under a misforecast are compared against the costs under a perfect forecast, to quantify the costs of misforecasting. Using a simplified probabilistic method applied to these modeling results, an analyst can make a first-ordermore » estimate of the financial benefit of improving a utility’s forecasting capabilities, and thus be better informed about whether to make such an investment. For example, under our base assumptions, a utility with 10 TWh per year of retail electric sales who initially estimates that DPV growth could range from 2% to 7.5% of total generation over the next 15 years could expect total present-value savings of approximately $4 million if they could reduce the severity of misforecasting to within ±25%. Utility resource planners can compare those savings against the costs needed to achieve that level of precision, to guide their decision on whether to make an investment in tools or resources.« less

Lost opportunity cost of surgical training in the Australian private sector.

PubMed

Aitken, R James

2012-03-01

To meet Australia's future demands, surgical training in the private sector will be required. The aim of this study was to estimate the time and lost opportunity cost of training in the private sector. A literature search identified studies that compared the operation time required by a supervised trainee with a consultant. This time was costed using a business model. In 22 studies (34 operations), the median operation duration of a supervised trainee was 34% longer than the consultant. To complete a private training list in the same time as a consultant list, one major case would have to be dropped. A consultant's average lost opportunity cost was $1186 per list ($106,698 per year). Training in rooms and administration requirements increased this to $155,618 per year. To train 400 trainees in the private sector to college standards would require 54,000 training lists per year. The consultants' national lost opportunity cost would be $137 million per year. The average lost hospital case payment was $5894 per list, or $330 million per year nationally. The total lost opportunity cost of surgical training in the private sector would be about $467 million per year. When trainee salaries, other specialties and indirect expenses are included, the total cost will be substantially greater. It is unlikely that surgeons or hospitals will be prepared to absorb these costs. There needs to be a public debate about the funding implications of surgical training in the private sector. © 2012 The Author. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Personalized Vehicle Energy Efficiency & Range Predictor/MyGreenCar

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

SAXENA, SAMVEG

MyGreenCar provides users with the ability to predict the range capabilities, fuel economy, and operating costs for any vehicle for their individual driving patterns. Users launce the MyGreeCar mobile app on their smartphones to collect their driving patterns over any duration (e.g. serval days, weeks, months, etc) using a phones's locational capabilities. Using vehicle powertrain models for any user-specified vehicle type, MyGreenCar, calculates the component-level energy and power interactions for the chosen vehicle to predict several important quantities, including: 1. For Evs: Alleviating range anxiety 2. Comparing fuel economy, operating costs, and payback time across models and types.

A fixed tilt solar collector employing reversible vee-trough reflectors and vacuum tube receivers for solar heating and cooling systems

NASA Technical Reports Server (NTRS)

Selcuk, M. K.

1977-01-01

The usefulness of vee-trough concentrators in improving the efficiency and reducing the cost of collectors assembled from evacuated tube receivers was studied in the vee-trough/vacuum tube collector (VTVTC) project. The VTVTC was analyzed rigorously and various mathematical models were developed to calculate the optical performance of the vee-trough concentrator and the thermal performance of the evacuated tube receiver. A test bed was constructed to verify the mathematical analyses and compare reflectors made out of glass, Alzak and aluminized FEP Teflon. Tests were run at temperatures ranging from 95 to 180 C. Vee-trough collector efficiencies of 35 to 40% were observed at an operating temperature of about 175 C. Test results compared well with the calculated values. Predicted daily useful heat collection and efficiency values are presented for a year's duration of operation temperatures ranging from 65 to 230 C. Estimated collector costs and resulting thermal energy costs are presented. Analytical and experimental results are discussed along with a complete economic evaluation.

Vehicle conversion to hybrid gasoline/alternative fuel operation

NASA Technical Reports Server (NTRS)

Donakowski, T. D.

1982-01-01

The alternative fuels considered are compressed natural gas (CNG), liquefied natural gas (LNG), liquid petroleum gas (LPG), and methanol; vehicles were required to operate in a hybrid or dual-fuel gasoline/alternative fuel mode. Economic feasibility was determined by comparing the costs of continued use of gasoline fuel with the use of alternative fuel and retrofitted equipment. Differences in the amounts of future expenditures are adjusted by means of a total life-cycle costing. All fuels studied are technically feasible to allow a retrofit conversion to hybrid gasoline/alternative fuel operation except for methanol. Conversion to LPG is not recommended for vehicles with more than 100,000 km (60,000 miles) of prior use. Methanol conversion is not recommended for vehicles with more than 50,00 km (30,000 miles).

Optimal design of reverse osmosis module networks

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

Maskan, F.; Wiley, D.E.; Johnston, L.P.M.

2000-05-01

The structure of individual reverse osmosis modules, the configuration of the module network, and the operating conditions were optimized for seawater and brackish water desalination. The system model included simple mathematical equations to predict the performance of the reverse osmosis modules. The optimization problem was formulated as a constrained multivariable nonlinear optimization. The objective function was the annual profit for the system, consisting of the profit obtained from the permeate, capital cost for the process units, and operating costs associated with energy consumption and maintenance. Optimization of several dual-stage reverse osmosis systems were investigated and compared. It was found thatmore » optimal network designs are the ones that produce the most permeate. It may be possible to achieve economic improvements by refining current membrane module designs and their operating pressures.« less

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

PubMed

Gillis, Joshua A; Williams, Jason G

2017-08-01

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

24 CFR 583.125 - Grants for operating costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

PubMed

Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

2013-10-01

To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

The economic burden of gallstone lithotripsy. Will cost determine its fate?

PubMed Central

Nealon, W H; Urrutia, F; Fleming, D; Thompson, J C

1991-01-01

Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice. PMID:2039296

The economic burden of gallstone lithotripsy. Will cost determine its fate?

PubMed

Nealon, W H; Urrutia, F; Fleming, D; Thompson, J C

1991-06-01

Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice.

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.

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

PubMed

Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

2016-01-01

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board. Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement. Level III, therapeutic study.

Autonomous Aerobraking Using Thermal Response Surface Analysis

NASA Technical Reports Server (NTRS)

Prince, Jill L.; Dec, John A.; Tolson, Robert H.

2007-01-01

Aerobraking is a proven method of significantly increasing the science payload that can be placed into low Mars orbits when compared to an all propulsive capture. However, the aerobraking phase is long and has mission cost and risk implications. The main cost benefit is that aerobraking permits the use of a smaller and cheaper launch vehicle, but additional operational costs are incurred during the long aerobraking phase. Risk is increased due to the repeated thermal loading of spacecraft components and the multiple attitude and propulsive maneuvers required for successful aerobraking. Both the cost and risk burdens can be significantly reduced by automating the aerobraking operations phase. All of the previous Mars orbiter missions that have utilized aerobraking have increasingly relied on onboard calculations during aerobraking. Even though the temperature of spacecraft components has been the limiting factor, operational methods have relied on using a surrogate variable for mission control. This paper describes several methods, based directly on spacecraft component maximum temperature, for autonomously predicting the subsequent aerobraking orbits and prescribing apoapsis propulsive maneuvers to maintain the spacecraft within specified temperature limits. Specifically, this paper describes the use of thermal response surface analysis in predicting the temperature of the spacecraft components and the corresponding uncertainty in this temperature prediction.

Use of a cost accounting system to evaluate costs of a VA special program.

PubMed

Menke, T J; Wray, N P

1999-04-01

The Department of Veterans Affairs (VA) established six mobile clinics to provide care for rural veterans. Each was operated by a parent VA Medical Center (VAMC). To describe the use of a cost-accounting system which does not provide costs at the service or patient level to determine the costs of the mobile clinics. Costs per visit were compared among the mobile clinics with the parent VAMCs and with simulated fixed-location clinics. Cost data came from VA's Centralized Accounting for Local Management (CALM) data. Utilization data came from VA's outpatient file. Information was obtained from the VAMCs' fiscal services to reallocate costs among the CALM subaccounts to generate cost data that was comparable among the mobile clinics. Costs per visit for the mobile clinics were twice as high as those of the parent VAMCs. Costs per visit would be lower at fixed-location clinics unless the volume were substantially less than that provided by the mobile clinics. Differences between cost allocations for accounting purposes and research are likely to necessitate adjusting cost accounting data for research purposes. Fortunately, information from the accountants or primary data can lead to a cost database which is appropriate for research evaluations. In the mobile clinics study, the analysis of cost accounting data led to the conclusion that mobile clinics were not a cost-effective way in which to provide care to rural veterans.

CALiPER Report 21.3: Cost-Effectiveness of Linear (T8) LED Lamps

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

Miller, Naomi J.; Perrin, Tess E.; Royer, Michael P.

2014-05-27

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15more » minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.« less

CALiPER Report 21.3. Cost Effectiveness of Linear (T8) LED Lamps

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

None

2014-05-01

Meeting performance expectations is important for driving adoption of linear LED lamps, but cost-effectiveness may be an overriding factor in many cases. Linear LED lamps cost more initially than fluorescent lamps, but energy and maintenance savings may mean that the life-cycle cost is lower. This report details a series of life-cycle cost simulations that compared a two-lamp troffer using LED lamps (38 W total power draw) or fluorescent lamps (51 W total power draw) over a 10-year study period. Variables included LED system cost ($40, $80, or $120), annual operating hours (2,000 hours or 4,000 hours), LED installation time (15more » minutes or 30 minutes), and melded electricity rate ($0.06/kWh, $0.12/kWh, $0.18/kWh, or $0.24/kWh). A full factorial of simulations allows users to interpolate between these values to aid in making rough estimates of economic feasibility for their own projects. In general, while their initial cost premium remains high, linear LED lamps are more likely to be cost-effective when electric utility rates are higher than average and hours of operation are long, and if their installation time is shorter.« less

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

Crawford, Aladsair J.; Viswanathan, Vilayanur V.; Stephenson, David E.

A robust performance-based cost model is developed for all-vanadium, iron-vanadium and iron chromium redox flow batteries. Systems aspects such as shunt current losses, pumping losses and thermal management are accounted for. The objective function, set to minimize system cost, allows determination of stack design and operating parameters such as current density, flow rate and depth of discharge (DOD). Component costs obtained from vendors are used to calculate system costs for various time frames. A 2 kW stack data was used to estimate unit energy costs and compared with model estimates for the same size electrodes. The tool has been sharedmore » with the redox flow battery community to both validate their stack data and guide future direction.« less

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

PubMed

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

2012-07-04

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

A Low-Cost Indigenous Intervention which has Revolutionized the Drilling Technology and Changed the Life of Millions of Farmers in the State of Uttar Pradesh, India

NASA Astrophysics Data System (ADS)

Chaurasia, Pratik Ranjan; Subhash

2018-06-01

An unknown indigenous driller combined the percussion and circulation drilling principles, resulting in the development of low cost, low weight manual boring set in the year 1990-1991/1991-1992, which revolutionized the shallow well drilling technology and made possible to drill about 4.5 million shallow bore wells in the State. This has changed the landscape of irrigated agriculture, changing the life of millions of small and marginal farmers and contributed a lot in increasing crop production and crop productivity. The developed drilling equipment locally known as "Pressure Boring Set" is manually operated, low cost and can be transported on bicycles. Drilling cost is also less. This low cost and simple technology made it possible to drill large number of shallow bore wells in comparatively short time span and less cost, consequently enhancing the rate of increase in irrigated area and in turn crop production and productivity. Cost of the boring set is also low, as compared to traditional sand pump hand boring set and suitable for alluvial areas.

A Low-Cost Indigenous Intervention which has Revolutionized the Drilling Technology and Changed the Life of Millions of Farmers in the State of Uttar Pradesh, India

NASA Astrophysics Data System (ADS)

Chaurasia, Pratik Ranjan; Subhash

2018-02-01

An unknown indigenous driller combined the percussion and circulation drilling principles, resulting in the development of low cost, low weight manual boring set in the year 1990-1991/1991-1992, which revolutionized the shallow well drilling technology and made possible to drill about 4.5 million shallow bore wells in the State. This has changed the landscape of irrigated agriculture, changing the life of millions of small and marginal farmers and contributed a lot in increasing crop production and crop productivity. The developed drilling equipment locally known as "Pressure Boring Set" is manually operated, low cost and can be transported on bicycles. Drilling cost is also less. This low cost and simple technology made it possible to drill large number of shallow bore wells in comparatively short time span and less cost, consequently enhancing the rate of increase in irrigated area and in turn crop production and productivity. Cost of the boring set is also low, as compared to traditional sand pump hand boring set and suitable for alluvial areas.

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

NASA Technical Reports Server (NTRS)

1971-01-01

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

Cost-effectiveness of a ROPS retrofit education campaign.

PubMed

Myers, M L; Cole, H P; Westneat, S C

2004-05-01

A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

Beyond cost-of-energy, the value-of-energy metric and value-centric approaches to design, operations, and maintenance of wind turbines

NASA Astrophysics Data System (ADS)

Fernandes, Kevin

This thesis is oriented toward developers, owners, operators and investors of renewable energy projects. With increasing demand of renewables, our energy dependence comes down to reducing costs associated with this sector so as to compete with the existing sources. One way of valuing investment potential is to determine and then compare the overall value derived by investing in a particular project. Several engineering and financial levers, one of which is operation and maintenance, affect this value. This thesis provides a useful visual aid to owners and operators by which they can operate and maintain their wind farm so as to achieve maximum value throughout its lifetime. All the necessary components that go into developing a business model of a wind farm project will be discussed. Finally, this tool is valid within the assumptions that are explicitly stated. Real world data and trends are used to provide a practical approach to the optimization.

Impact of youth injuries on the uninsured farm family's economic viability.

PubMed

Zaloshnja, Eduard; Miller, Ted R

2012-01-01

The objective of this study is to estimate the impact of youth injuries on the uninsured farm family's economic viability. Using farm prototypes, we compared farm profits with costs of farm youth injuries. We built profit models for two types of farms, dairy and soybean farms. Then we estimated the cost impact of farm youth injuries of different levels of severity on a farm family with no health insurance. A severe child injury that requires at least 10 days of hospitalisation would cost almost equal to the operating profit of the average dairy farm with no health insurance and would turn the operating profit of the average soybean farm into a severe loss of $99,499. Prevention of child agricultural injuries would significantly improve the financial situation for farm families that lack health insurance.

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

Code of Federal Regulations, 2011 CFR

2011-04-01

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

Intra-operative cell salvage in urological surgery; a systematic review and meta-analysis of comparative studies.

PubMed

Kinnear, Ned; O'Callaghan, Michael; Hennessey, Derek; Liddell, Heath; Newell, Bradley; Bolt, John; Lawrentschuk, Nathan

2018-05-03

To systematically evaluate the safety and efficacy of intra-operative cell salvage (ICS) in urology. A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English utilising ICS in urology. Primary outcomes were allogeneic transfusion rates (ATR) and tumour recurrence. Secondary outcomes were complications and cost. Fourteen observational studies were identified, totaling 4,536 patients. ICS was compared to no blood conservation technique (seven studies), pre-operative autologous donation (PAD) (five) or both (two). Cohorts underwent open prostatectomy (eleven studies), open cystectomy (two) or open partial nephrectomy (one). Meta-analysis was possible only for ATR within prostatectomy studies. In this setting, ICS reduced ATR compared with no blood conservation technique (OR 0.34, 95% CI 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATR amongst ICS patients was significantly higher or similar in one and two studies respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight) or not measured (four). All six studies reporting complications found no difference for ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS cheaper than no blood conservation technique. Due to inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. Low level evidence exists that compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations are short. Small size and short follow-up negate conclusions on recurrence following nephrectomy or cystectomy. Randomised trials with long term follow-up evaluating ICS in urology are required. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

PubMed

De Deyne, Cathy; Heylen, René

2004-01-01

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

Uninterruptible Power Systems: Operational and Cost Considerations.

DTIC Science & Technology

1977-03-01

functions are degraded by power line disturbances to an extent that some type of power conditioning equipment is warranted. Possibly, the management policy...disasters, or attack; i.e., at exactly the times when commercial power utility service is most likely to be disrupted or degraded . In the past... degradation of readiness in emergencies are more pertinent criteria, but unfortunately are not readily comparable to the cost of equipment required

Metrics to Compare Aircraft Operating and Support Costs in the Department of Defense

DTIC Science & Technology

2015-01-01

a phenomenon in regression analysis called multicollinear - ity, which makes problematic the interpretation of the coefficient esti- mates of highly...indicating a very high amount of multicollinearity and suggesting that the magnitude of the coefficients on those variables should be treated with caution... multicollinearity between these independent variables, one must be cautious when interpreting the statistical relationship between flying hours and cost. The

Conversion of Army Heating Plants to Coal: Three Case Studies

DTIC Science & Technology

1982-03-01

compared to the 50% wet sludge flue gas desulfurized product. All fly ash produced is collected without further processing. The product can be used to...Existing Turbine Generators 26 11 Picatinny Arsenal -- Summary of Capital Costs for Stoker Boilers, Flue Gas Desulfurization . New Turbine Generators...27 12 Picatinny Arsenal -- Summary of Operating Costs for Stoker Boilers, Flue Gas Desulfurization . New Turbine Generators 28 13 Picatinny Arsenal

Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

PubMed

Holloran-Schwartz, M Brigid; Gavard, Jeffrey A; Martin, Jared C; Blaskiewicz, Robert J; Yeung, Patrick P

2016-01-01

To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. A randomized controlled trial (Canadian Task Force Classification I). An academic hospital. Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2010-01-01

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

Proposed Array-based Deep Space Network for NASA

NASA Technical Reports Server (NTRS)

Bagri, Durgadas S.; Statman, Joseph I.; Gatti, Mark S.

2007-01-01

The current assets of the Deep Space Network (DSN) of the National Aeronautics and Space Administration (NASA), especially the 70-m antennas, are aging and becoming less reliable. Furthermore, they are expensive to operate and difficult to upgrade for operation at Ka-band (321 GHz). Replacing them with comparable monolithic large antennas would be expensive. On the other hand, implementation of similar high-sensitivity assets can be achieved economically using an array-based architecture, where sensitivity is measured by G/T, the ratio of antenna gain to system temperature. An array-based architecture would also provide flexibility in operations and allow for easy addition of more G/T whenever required. Therefore, an array-based plan of the next-generation DSN for NASA has been proposed. The DSN array would provide more flexible downlink capability compared to the current DSN for robust telemetry, tracking and command services to the space missions of NASA and its international partners in a cost effective way. Instead of using the array as an element of the DSN and relying on the existing concept of operation, we explore a broader departure in establishing a more modern concept of operations to reduce the operations costs. This paper presents the array-based architecture for the next generation DSN. It includes system block diagram, operations philosophy, user's view of operations, operations management, and logistics like maintenance philosophy and anomaly analysis and reporting. To develop the various required technologies and understand the logistics of building the array-based lowcost system, a breadboard array of three antennas has been built. This paper briefly describes the breadboard array system and its performance.

Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study.

PubMed

Saramago, Pedro; Cooper, Nicola J; Sutton, Alex J; Hayes, Mike; Dunn, Ken; Manca, Andrea; Kendrick, Denise

2014-05-16

The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK. We carried out a decision model-based probabilistic cost-effectiveness analysis. We used a hypothetical population of newborns and evaluated the impact of living in a household with or without a functioning smoke alarm during the first 5 years of their life on overall lifetime costs and quality of life from a public health perspective. We compared seven interventions, ranging from usual care to more complex interventions comprising of education, free/low cost equipment giveaway, equipment fitting and/or home safety inspection. Education and free/low cost equipment was the most cost-effective intervention with an estimated incremental cost-effectiveness ratio of £34,200 per QALY gained compared to usual care. This was reduced to approximately £4,500 per QALY gained when 1.8 children under the age of 5 were assumed per household. Assessing cost-effectiveness, as well as effectiveness, is important in a public sector system operating under a fixed budget restraint. As highlighted in this study, the more effective interventions (in this case the more complex interventions) may not necessarily be the ones considered the most cost-effective.

An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea

PubMed Central

Kim, Richard D.; Kapur, Vishesh K.; Redline-Bruch, Julie; Rueschman, Michael; Auckley, Dennis H.; Benca, Ruth M.; Foldvary-Schafer, Nancy R.; Iber, Conrad; Zee, Phyllis C.; Rosen, Carol L.; Redline, Susan; Ramsey, Scott D.

2015-01-01

Study Objectives: We conducted an economic analysis of the HomePAP study, a multicenter randomized clinical trial that compared home-based versus laboratory-based testing for the diagnosis and management of obstructive sleep apnea (OSA). Design: A cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent. Setting: Seven academic sleep centers. Participants: There were 373 subjects at high risk for moderate to severe OSA. Interventions: Subjects were randomized to either home-based limited channel portable monitoring followed by unattended autotitration with continuous positive airway pressure (CPAP), versus a traditional pathway of in-laboratory sleep study and CPAP titration. Measurements and Results: From the payer perspective, per subject costs for the laboratory-based pathway were $1,840 (95% confidence interval [CI] $1,660, $2,015) compared to $1,575 (95% CI $1,439, $1,716) for the home-based pathway under the base case. Costs were $264 (95% CI $39, $496, P = 0.02) in favor of the home arm. From the provider perspective, per subject costs for the laboratory arm were $1,697 (95% CI $1,566, $1,826) compared to $1,736 (95% CI $1,621, $1,857) in the home arm, for a difference of $40 (95% CI −$213, $142, P = 0.66) in favor of the laboratory arm under the base case. The provider operating margin was $142 (95% CI $85, $202,P < 0.01) in the laboratory arm, compared to a loss of −$161 (95% CI −$202, −$120, P < 0.01) in the home arm. Conclusions: For payers, a home-based diagnostic pathway for obstructive sleep apnea with robust patient support incurs fewer costs than a laboratory-based pathway. For providers, costs are comparable if not higher, resulting in a negative operating margin. Clinicaltrials.gov Identifier: NCT00642486. Citation: Kim RD, Kapur VK, Redline-Bruch J, Rueschman M, Auckley DH, Benca RM, Foldvary-Schafer NR, Iber C, Zee PC, Rosen CL, Redline S, Ramsey SD. An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea. SLEEP 2015;38(7):1027–1037. PMID:26118558

Mind the Costs: Rescaling and Multi-Level Environmental Governance in Venice Lagoon

PubMed Central

Fritsch, Oliver

2010-01-01

Competences over environmental matters are distributed across agencies at different scales on a national-to-local continuum. This article adopts a transaction costs economics perspective in order to explore the question whether, in the light of a particular problem, the scale at which a certain competence is attributed can be reconsidered. Specifically, it tests whether a presumption of least-cost operation concerning an agency at a given scale can hold. By doing so, it investigates whether the rescaling of certain tasks, aiming at solving a scale-related problem, is likely to produce an increase in costs for day-to-day agency operations as compared to the status quo. The article explores such a perspective for the case of Venice Lagoon. The negative aspects of the present arrangement concerning fishery management and morphological remediation are directly linked to the scale of the agencies involved. The analysis suggests that scales have been chosen correctly, at least from the point of view of the costs incurred to the agencies involved. Consequently, a rescaling of those agencies does not represent a viable option. PMID:20162274

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

PubMed

Hanning, Brian W T

2004-12-13

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

Mind the Costs: Rescaling and Multi-Level Environmental Governance in Venice Lagoon

NASA Astrophysics Data System (ADS)

Roggero, Matteo; Fritsch, Oliver

2010-07-01

Competences over environmental matters are distributed across agencies at different scales on a national-to-local continuum. This article adopts a transaction costs economics perspective in order to explore the question whether, in the light of a particular problem, the scale at which a certain competence is attributed can be reconsidered. Specifically, it tests whether a presumption of least-cost operation concerning an agency at a given scale can hold. By doing so, it investigates whether the rescaling of certain tasks, aiming at solving a scale-related problem, is likely to produce an increase in costs for day-to-day agency operations as compared to the status quo. The article explores such a perspective for the case of Venice Lagoon. The negative aspects of the present arrangement concerning fishery management and morphological remediation are directly linked to the scale of the agencies involved. The analysis suggests that scales have been chosen correctly, at least from the point of view of the costs incurred to the agencies involved. Consequently, a rescaling of those agencies does not represent a viable option.

Mind the costs: rescaling and multi-level environmental governance in Venice lagoon.

PubMed

Roggero, Matteo; Fritsch, Oliver

2010-07-01

Competences over environmental matters are distributed across agencies at different scales on a national-to-local continuum. This article adopts a transaction costs economics perspective in order to explore the question whether, in the light of a particular problem, the scale at which a certain competence is attributed can be reconsidered. Specifically, it tests whether a presumption of least-cost operation concerning an agency at a given scale can hold. By doing so, it investigates whether the rescaling of certain tasks, aiming at solving a scale-related problem, is likely to produce an increase in costs for day-to-day agency operations as compared to the status quo. The article explores such a perspective for the case of Venice Lagoon. The negative aspects of the present arrangement concerning fishery management and morphological remediation are directly linked to the scale of the agencies involved. The analysis suggests that scales have been chosen correctly, at least from the point of view of the costs incurred to the agencies involved. Consequently, a rescaling of those agencies does not represent a viable option.

Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single center.

PubMed

Carron, Michele; Baratto, Fabio; Zarantonello, Francesco; Ori, Carlo

2016-01-01

The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management. We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective. The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845). Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost.

Accelerating Pathology Image Data Cross-Comparison on CPU-GPU Hybrid Systems

PubMed Central

Wang, Kaibo; Huai, Yin; Lee, Rubao; Wang, Fusheng; Zhang, Xiaodong; Saltz, Joel H.

2012-01-01

As an important application of spatial databases in pathology imaging analysis, cross-comparing the spatial boundaries of a huge amount of segmented micro-anatomic objects demands extremely data- and compute-intensive operations, requiring high throughput at an affordable cost. However, the performance of spatial database systems has not been satisfactory since their implementations of spatial operations cannot fully utilize the power of modern parallel hardware. In this paper, we provide a customized software solution that exploits GPUs and multi-core CPUs to accelerate spatial cross-comparison in a cost-effective way. Our solution consists of an efficient GPU algorithm and a pipelined system framework with task migration support. Extensive experiments with real-world data sets demonstrate the effectiveness of our solution, which improves the performance of spatial cross-comparison by over 18 times compared with a parallelized spatial database approach. PMID:23355955

Timing characterization and analysis of the Linux-based, closed loop control computer for the Subaru Telescope laser guide star adaptive optics system

NASA Astrophysics Data System (ADS)

Dinkins, Matthew; Colley, Stephen

2008-07-01

Hardware and software specialized for real time control reduce the timing jitter of executables when compared to off-the-shelf hardware and software. However, these specialized environments are costly in both money and development time. While conventional systems have a cost advantage, the jitter in these systems is much larger and potentially problematic. This study analyzes the timing characterstics of a standard Dell server running a fully featured Linux operating system to determine if such a system would be capable of meeting the timing requirements for closed loop operations. Investigations are preformed on the effectiveness of tools designed to make off-the-shelf system performance closer to specialized real time systems. The Gnu Compiler Collection (gcc) is compared to the Intel C Compiler (icc), compiler optimizations are investigated, and real-time extensions to Linux are evaluated.

Contemporary Costs Associated With Transcatheter Aortic Valve Replacement: A Propensity-Matched Cost Analysis.

PubMed

Ailawadi, Gorav; LaPar, Damien J; Speir, Alan M; Ghanta, Ravi K; Yarboro, Leora T; Crosby, Ivan K; Lim, D Scott; Quader, Mohammed A; Rich, Jeffrey B

2016-01-01

The Placement of Aortic Transcatheter Valve (PARTNER) trial suggested an economic advantage for transcatheter aortic valve replacement (TAVR) for high-risk patients. The purpose of this study was to evaluate the cost effectiveness of TAVR in the "real world" by comparing TAVR with surgical aortic valve replacement (SAVR) in intermediate-risk and high-risk patients. A multiinstitutional database of The Society of Thoracic Surgeons (STS) (2011 to 2013) linked with estimated cost data was evaluated for isolated TAVR and SAVR operations (n = 5,578). TAVR-treated patients (n = 340) were 1:1 propensity matched with SAVR-treated patients (n = 340). Patients undergoing SAVR were further stratified into intermediate-risk (SAVR-IR: predicted risk of mortality [PROM] 4% to 8%) and high-risk (SAVR-HR: PROM >8%) cohorts. Median STS PROM for TAVR was 6.32% compared with 6.30% for SAVR (SAVR-IR 4.6% and SAVR-HR 12.4%). A transfemoral TAVR approach was most common (61%). Mortality was higher for TAVR (10%) compared with SAVR (6%, p < 0.047), whereas the SAVR group accrued higher major morbidity (27% vs 14%, p < 0.001) and longer postoperative hospital duration (7 days vs 6 days, p < 0.001). Importantly, TAVR incurred twice the median total costs compared with SAVR ($69,921 vs $33,598, p < 0.001). The increased cost of TAVR was largely driven by the cost of the valve (all p < 0.001). Intermediate-risk patients undergoing SAVR demonstrated the most exaggerated cost savings versus TAVR. TAVR was associated with greater total costs and mortality compared with SAVR in intermediate-risk and high-risk patients while conferring lower major morbidity and improved resource use. Increased cost of TAVR appears largely related to the cost of the valve. Until the price of TAVR valves decreases, these data suggest that TAVR may not provide the most cost-effective strategy, particularly for intermediate-risk patients. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Private and social costs of surface mine reforestation performance criteria.

PubMed

Sullivan, Jay; Amacher, Gregory S

2010-02-01

We study the potentially unnecessary costs imposed by strict performance standards for forest restoration of surface coal mines in the Appalachian region under the Surface Mining Control and Reclamation Act of 1977 (SMCRA) that can vary widely across states. Both the unnecessary private costs to the mine operator and costs to society (social costs) are reported for two performance standards, a ground cover requirement, and a seedling survival target. These standards are examined using numerical analyses under a range of site productivity class and market conditions. We show that a strict (90%) ground cover standard may produce an unnecessary private cost of more than $700/ha and a social cost ranging from $428/ha to $710/ha, as compared with a 70% standard. A strict tree survival standard of 1235 trees/ha, as compared with the more typical 1087 trees/ha standard, may produce an unnecessary private cost of approximately $200/ha, and a social cost in the range of $120 to $208/ha. We conclude that strict performance standards may impose substantial unnecessary private costs and social costs, that strict performance standards may be discouraging the choice of forestry as a post-mining land use, and that opportunities exist for reform of reforestation performance standards. Our study provides a basis for evaluating tradeoffs between regulatory efficiency and optimal reforestation effort.

Analysis and evaluation of processes and equipment in tasks 2 and 4 of the low-cost solar array project

NASA Technical Reports Server (NTRS)

Goldman, H.; Wolf, M.

1978-01-01

Several experimental and projected Czochralski crystal growing process methods were studied and compared to available operations and cost-data of recent production Cz-pulling, in order to elucidate the role of the dominant cost contributing factors. From this analysis, it becomes apparent that the specific add-on costs of the Cz-process can be expected to be reduced by about a factor of three by 1982, and about a factor of five by 1986. A format to guide in the accumulation of the data needed for thorough techno-economic analysis of solar cell production processes was developed.

Engineering a responsive, low cost, tactical satellite, TACSAT-1

NASA Astrophysics Data System (ADS)

Hurley, M.; Duffey, T.; Huffine, Christopher; Weldy, Ken; Clevland, Jeff; Hauser, Joe

2004-11-01

The Secretary of Defense's Office of Force Transformation (OFT) is currently undertaking an initiative to develop a low-cost, responsive, operationally relevant space capability using small satellites. The Naval Research Laboratory (NRL) is tasked to be program manger for this initiative, which seeks to make space assets and capabilities available to operational users. TacSat-1 is the first in a series of small satellites that will result in rapid, tailored, and operationally relevant experimental space capabilities for tactical forces. Components of the resulting tactical architecture include a highly automated small satellite bus, modular payloads, common launch and payload interfaces, tasking and data dissemination using the SIPRNET (Secret Internet Protocol Routing Network), and low cost, rapid response launches. The overall goal of TacSat-1 is to demonstrate the utility of a broader complementary business model and provide a catalyst for energizing DoD and industry in the operational space area. This paper first provides a brief overview of the TacSat- 1 experiment and then discusses the engineering designs and practices used to achieve the aggressive cost and schedule goals. Non-standard approaches and engineering philosophies that allowed the TacSat-1 spacecraft to be finished in twelve months are detailed and compared with "normal" satellite programs where applicable. Specific subsystem design, integration and test techniques, which contributed to the successful completion of the TacSat-1 spacecraft, are reviewed. Finally, lessons learned are discussed.

PHENIX Work Breakdown Structure. Cost and schedule review copy

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

Not Available

1994-02-01

The Work Breakdown Structure (WBS) Book begins with this Overview section, which contains the high-level summary cost estimate, the cost profile, and the global construction schedule. The summary cost estimate shows the total US cost and the cost in terms of PHENIX construction funds for building the PHENIX detector. All costs in the WBS book are shown in FY 1993 dollars. Also shown are the institutional and foreign contributions, the level of pre-operations funding, and the cost of deferred items. Pie charts are presented at PHENIX WBS level 1 and 2 that show this information. The PHENIX construction funds aremore » shown broken down to PHENIX WBS level 3 items per fiscal year, and the resulting profile is compared to the RHIC target profile. An accumulated difference of the two profiles is also shown. The PHENIX global construction schedule is presented at the end of the Overview section. Following the Overview are sections for each subsystem. Each subsystem section begins with a summary cost estimate, cost profile, and critical path. The total level 3 cost is broken down into fixed costs (M&S), engineering costs (EDIA) and labor costs. Costs are further broken down in terms of PHENIX construction funds, institutional and foreign contributions, pre-operations funding, and deferred items. Also shown is the contingency at level 3 and the level 4 breakdown of the total cost. The cost profile in fiscal years is shown at level 3. The subsystem summaries are followed by the full cost estimate and schedule sheets for that subsystem. These detailed sheets are typically carried down to level 7 or 8. The cost estimate shows Total, M&S, EDIA, and Labor breakdowns, as well as contingency, for each WBS entry.« less

24 CFR 891.150 - Operating cost standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Molten salt power towers operating at 600–650 °C: Salt selection and cost benefits

DOE PAGES

Turchi, Craig S.; Vidal, Judith; Bauer, Matthew

2018-03-14

This analysis examines the potential benefit of adopting the supercritical carbon dioxide (sCO 2) Brayton cycle at 600-650 degrees C compared to the current state-of-the-art power tower operating a steam-Rankine cycle with solar salt at approximately 574 degrees C. The analysis compares a molten-salt power tower configuration using direct storage of solar salt (60:40 wt% sodium nitrate: potassium nitrate) or single-component nitrate salts at 600 degrees C or alternative carbonate- or chloride-based salts at 650 degrees C.

Molten salt power towers operating at 600–650 °C: Salt selection and cost benefits

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

Turchi, Craig S.; Vidal, Judith; Bauer, Matthew

This analysis examines the potential benefit of adopting the supercritical carbon dioxide (sCO 2) Brayton cycle at 600-650 degrees C compared to the current state-of-the-art power tower operating a steam-Rankine cycle with solar salt at approximately 574 degrees C. The analysis compares a molten-salt power tower configuration using direct storage of solar salt (60:40 wt% sodium nitrate: potassium nitrate) or single-component nitrate salts at 600 degrees C or alternative carbonate- or chloride-based salts at 650 degrees C.

U.S. healthcare fix: leveraging the lessons from the food supply chain.

PubMed

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Accounting for the relationship between per diem cost and LOS when estimating hospitalization costs.

PubMed

Ishak, K Jack; Stolar, Marilyn; Hu, Ming-yi; Alvarez, Piedad; Wang, Yamei; Getsios, Denis; Williams, Gregory C

2012-12-01

Hospitalization costs in clinical trials are typically derived by multiplying the length of stay (LOS) by an average per-diem (PD) cost from external sources. This assumes that PD costs are independent of LOS. Resource utilization in early days of the stay is usually more intense, however, and thus, the PD cost for a short hospitalization may be higher than for longer stays. The shape of this relationship is unlikely to be linear, as PD costs would be expected to gradually plateau. This paper describes how to model the relationship between PD cost and LOS using flexible statistical modelling techniques. An example based on a clinical study of clevidipine for the treatment of peri-operative hypertension during hospitalizations for cardiac surgery is used to illustrate how inferences about cost-savings associated with good blood pressure (BP) control during the stay can be affected by the approach used to derive hospitalization costs.Data on the cost and LOS of hospitalizations for coronary artery bypass grafting (CABG) from the Massachusetts Acute Hospital Case Mix Database (the MA Case Mix Database) were analyzed to link LOS to PD cost, factoring in complications that may have occurred during the hospitalization or post-discharge. The shape of the relationship between LOS and PD costs in the MA Case Mix was explored graphically in a regression framework. A series of statistical models including those based on simple logarithmic transformation of LOS to more flexible models using LOcally wEighted Scatterplot Smoothing (LOESS) techniques were considered. A final model was selected, using simplicity and parsimony as guiding principles in addition traditional fit statistics (like Akaike's Information Criterion, or AIC). This mapping was applied in ECLIPSE to predict an LOS-specific PD cost, and then a total cost of hospitalization. These were then compared for patients who had good vs. poor peri-operative blood-pressure control. The MA Case Mix dataset included data from over 10,000 patients. Visual inspection of PD vs. LOS revealed a non-linear relationship. A logarithmic model and a series of LOESS and piecewise-linear models with varying connection points were tested. The logarithmic model was ultimately favoured for its fit and simplicity. Using this mapping in the ECLIPSE trials, we found that good peri-operative BP control was associated with a cost savings of $5,366 when costs were derived using the mapping, compared with savings of $7,666 obtained using the traditional approach of calculating the cost. PD costs vary systematically with LOS, with short stays being associated with high PD costs that drop gradually and level off. The shape of the relationship may differ in other settings. It is important to assess this and model the observed pattern, as this may have an impact on conclusions based on derived hospitalization costs.

Accounting for the relationship between per diem cost and LOS when estimating hospitalization costs

PubMed Central

2012-01-01

Background Hospitalization costs in clinical trials are typically derived by multiplying the length of stay (LOS) by an average per-diem (PD) cost from external sources. This assumes that PD costs are independent of LOS. Resource utilization in early days of the stay is usually more intense, however, and thus, the PD cost for a short hospitalization may be higher than for longer stays. The shape of this relationship is unlikely to be linear, as PD costs would be expected to gradually plateau. This paper describes how to model the relationship between PD cost and LOS using flexible statistical modelling techniques. Methods An example based on a clinical study of clevidipine for the treatment of peri-operative hypertension during hospitalizations for cardiac surgery is used to illustrate how inferences about cost-savings associated with good blood pressure (BP) control during the stay can be affected by the approach used to derive hospitalization costs. Data on the cost and LOS of hospitalizations for coronary artery bypass grafting (CABG) from the Massachusetts Acute Hospital Case Mix Database (the MA Case Mix Database) were analyzed to link LOS to PD cost, factoring in complications that may have occurred during the hospitalization or post-discharge. The shape of the relationship between LOS and PD costs in the MA Case Mix was explored graphically in a regression framework. A series of statistical models including those based on simple logarithmic transformation of LOS to more flexible models using LOcally wEighted Scatterplot Smoothing (LOESS) techniques were considered. A final model was selected, using simplicity and parsimony as guiding principles in addition traditional fit statistics (like Akaike’s Information Criterion, or AIC). This mapping was applied in ECLIPSE to predict an LOS-specific PD cost, and then a total cost of hospitalization. These were then compared for patients who had good vs. poor peri-operative blood-pressure control. Results The MA Case Mix dataset included data from over 10,000 patients. Visual inspection of PD vs. LOS revealed a non-linear relationship. A logarithmic model and a series of LOESS and piecewise-linear models with varying connection points were tested. The logarithmic model was ultimately favoured for its fit and simplicity. Using this mapping in the ECLIPSE trials, we found that good peri-operative BP control was associated with a cost savings of $5,366 when costs were derived using the mapping, compared with savings of $7,666 obtained using the traditional approach of calculating the cost. Conclusions PD costs vary systematically with LOS, with short stays being associated with high PD costs that drop gradually and level off. The shape of the relationship may differ in other settings. It is important to assess this and model the observed pattern, as this may have an impact on conclusions based on derived hospitalization costs. PMID:23198908

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

PubMed Central

Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

2017-01-01

Objective Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). Setting The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Results Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Conclusions Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings. PMID:28882905

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

The cost of cancer registry operations: Impact of volume on cost per case for core and enhanced registry activities

PubMed Central

Subramanian, Sujha; Tangka, Florence K.L.; Beebe, Maggie Cole; Trebino, Diana; Weir, Hannah K.; Babcock, Frances

2016-01-01

Background Cancer registration data is vital for creating evidence-based policies and interventions. Quantifying the resources needed for cancer registration activities and identifying potential efficiencies are critically important to ensure sustainability of cancer registry operations. Methods Using a previously validated web-based cost assessment tool, we collected activity-based cost data and report findings using 3 years of data from 40 National Program of Cancer Registry grantees. We stratified registries by volume: low-volume included fewer than 10,000 cases, medium-volume included 10,000–50,000 cases, and high-volume included >50,000 cases. Results Low-volume cancer registries incurred an average of $93.11 to report a case (without in-kind contributions) compared with $27.70 incurred by high-volume registries. Across all registries, the highest cost per case was incurred for data collection and abstraction ($8.33), management ($6.86), and administration ($4.99). Low- and medium-volume registries have higher costs than high-volume registries for all key activities. Conclusions Some cost differences by volume can be explained by the large fixed costs required for administering and performing registration activities, but other reasons may include the quality of the data initially submitted to the registries from reporting sources such as hospitals and pathology laboratories. Automation or efficiency improvements in data collection can potentially reduce overall costs. PMID:26702880

Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia: A Cost Comparison.

PubMed

Moon, Christina S; Nanji, Afshan A; Galor, Anat; McCollister, Kathryn E; Karp, Carol L

2016-03-01

The objective of this study was to compare the cost associated with surgical versus interferon-alpha 2b (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). A matched, case-control study. A total of 98 patients with OSSN, 49 of whom were treated surgically and 49 of whom were treated medically. Patients with OSSN treated with IFNα2b were matched to patients treated with surgery on the basis of age and date of treatment initiation. Financial cost to the patient was calculated using 2 different methods (hospital billing and Medicare allowable charges) and compared between the 2 groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the 2 groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. When considering cost in terms of time, the medical group had an average of 2 more visits over 1 year compared with the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean, $17 598; standard deviation [SD], $7624) when compared with the IFNα2b group (mean, $4986; SD, $2040). However, cost between the 2 groups was comparable when calculated on the basis of Medicare allowable charges (surgical group: mean, $3528; SD, $1610; medical group: mean, $2831; SD, $1082; P = 1.00). The highest cost in the surgical group was the excisional biopsy (hospital billing $17 598; Medicare allowable $3528), and the highest cost in the medical group was interferon ($1172 for drops, average 8.0 bottles; $370 for injections, average 5.4 injections). Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. In this article, we consider costs of therapy and found that medical treatment involved two more office visits, whereas surgical treatment could be more or equally costly depending on insurance coverage. Copyright © 2016 American Academy of Ophthalmology. All rights reserved.

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

Not Available

The Work Breakdown Structure (WBS) Book begins with this Overview section, which contains the high-level summary cost estimate, the cost profile, and the global construction schedule. The summary cost estimate shows the total US cost and the cost in terms of PHENIX construction funds for building the PHENIX detector. All costs in the WBS book are shown in FY 1993 dollars. Also shown are the institutional and foreign contributions, the level of pre-operations funding, and the cost of deferred items. Pie charts are presented at PHENIX WBS level 1 and 2 that show this information. The PHENIX construction funds aremore » shown broken down to PHENIX WBS level 3 items per fiscal year, and the resulting profile is compared to the RHIC target profile. An accumulated difference of the two profiles is also shown. The PHENIX global construction schedule is presented at the end of the Overview section. Following the Overview are sections for each subsystem. Each subsystem section begins with a summary cost estimate, cost profile, and critical path. The total level 3 cost is broken down into fixed costs (M&S), engineering costs (EDIA) and labor costs. Costs are further broken down in terms of PHENIX construction funds, institutional and foreign contributions, pre-operations funding, and deferred items. Also shown is the contingency at level 3 and the level 4 breakdown of the total cost. The cost profile in fiscal years is shown at level 3. The subsystem summaries are followed by the full cost estimate and schedule sheets for that subsystem. These detailed sheets are typically carried down to level 7 or 8. The cost estimate Total, M&S, EDIA, and Labor breakdowns, as well as contingency, for each WBS entry.« less

A Comparison of Recidivism Rates for Operation Outward Reach (OOR) Participants and Control Groups of Non-Participants for the Years 1990 through 1994.

ERIC Educational Resources Information Center

Ryan, Thomas P.; Desuta, Joesph F.

2000-01-01

A 5-year study of Operation Outward Reach, a nonprofit program providing community-based vocational training in carpentry and masonry for Pennsylvania inmates, compared completers and control groups. Results showed average differences in recidivism between the groups of 16% per year. Fiscal and social cost savings were also identified. (JOW)

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

PubMed

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

2011-04-01

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

[Modified Misgav-Labach at a tertiary hospital].

PubMed

Martínez Ceccopieri, David Alejandro; Barrios Prieto, Ernesto; Martínez Ríos, David

2012-08-01

According to several studies from around the globe, the modified Misgav Ladach technique simplifies the surgical procedure for cesarean section, reduces operation time, costs, and complications, and optimizes obstetric and perinatal outcomes. Compare obstetric outcomes between patients operated on using traditional cesarean section technique and those operated on using modified Misgav Ladach technique. The study included 49 patients operated on using traditional cesarean section technique and 47 patients operated on using modified Misgav Ladach technique to compare the outcomes in both surgical techniques. The modified Misgav Ladach technique was associated with more benefits than those of the traditional technique: less surgical bleeding, less operation time, less analgesic total doses, less rescue analgesic doses and less need of more than one analgesic drug. The modified Misgav Ladach surgical technique was associated with better obstetric results than those of the traditional surgical technique; this concurs with the results reported by other national and international studies.

National Fuel Cell Bus Program: Accelerated Testing Evaluation Report #2, Alameda-Contra Costa Transit District (AC Transit) and Appendices

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

Eudy, L.; Chandler, K.

2010-06-01

This is an evaluation of hydrogen fuel cell transit buses operating at AC Transit in revenue service since March 20, 2006, comparing similar diesel buses operating from the same depot. It covers November 2007 through February 2010. Results include implementation experience, fueling station operation, evaluation results at AC Transit (bus usage, availability, fuel economy, maintenance costs, and road calls), and a summary of achievements and challenges encountered during the demonstration.

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

PubMed

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

2012-09-01

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

FBI fingerprint identification automation study. AIDS 3 evaluation report. Volume 4: Economic feasibility

NASA Technical Reports Server (NTRS)

Mulhall, B. D. L.

1980-01-01

The results of the economic analysis of the AIDS 3 system design are presented. AIDS 3 evaluated a set of economic feasibility measures including life cycle cost, implementation cost, annual operating expenditures and annual capital expenditures. The economic feasibility of AIDS 3 was determined by comparing the evaluated measures with the same measures, where applicable, evaluated for the current system. A set of future work load scenarios was constructed using JPL's environmental evaluation study of the fingerprint identification system. AIDS 3 and the current system were evaluated for each of the economic feasibility measures for each of the work load scenarios. They were compared for a set of performance measures, including response time and accuracy, and for a set of cost/benefit ratios, including cost per transaction and cost per technical search. Benefit measures related to the economic feasibility of the system are also presented, including the required number of employees and the required employee skill mix.

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

PubMed Central

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

2013-01-01

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

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

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

Stebbins, P.E.

1993-09-01

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

Process cost and facility considerations in the selection of primary cell culture clarification technology.

PubMed

Felo, Michael; Christensen, Brandon; Higgins, John

2013-01-01

The bioreactor volume delineating the selection of primary clarification technology is not always easily defined. Development of a commercial scale process for the manufacture of therapeutic proteins requires scale-up from a few liters to thousands of liters. While the separation techniques used for protein purification are largely conserved across scales, the separation techniques for primary cell culture clarification vary with scale. Process models were developed to compare monoclonal antibody production costs using two cell culture clarification technologies. One process model was created for cell culture clarification by disc stack centrifugation with depth filtration. A second process model was created for clarification by multi-stage depth filtration. Analyses were performed to examine the influence of bioreactor volume, product titer, depth filter capacity, and facility utilization on overall operating costs. At bioreactor volumes <1,000 L, clarification using multi-stage depth filtration offers cost savings compared to clarification using centrifugation. For bioreactor volumes >5,000 L, clarification using centrifugation followed by depth filtration offers significant cost savings. For bioreactor volumes of ∼ 2,000 L, clarification costs are similar between depth filtration and centrifugation. At this scale, factors including facility utilization, available capital, ease of process development, implementation timelines, and process performance characterization play an important role in clarification technology selection. In the case study presented, a multi-product facility selected multi-stage depth filtration for cell culture clarification at the 500 and 2,000 L scales of operation. Facility implementation timelines, process development activities, equipment commissioning and validation, scale-up effects, and process robustness are examined. © 2013 American Institute of Chemical Engineers.

Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection.

PubMed

Stephen, Antonia E; Berger, David L

2003-03-01

Patient care pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. The average hospital stay after colonic resection is 5 to 10 days. This study describes a clinical pathway for colon resections and examines patient outcome before and after institution of the pathway. One hundred thirty-eight patients underwent elective colon resections at our institution by a single surgeon before (n = 52) and after (n = 86) introduction of a clinical pathway. Length of stay, postoperative complications, readmissions, and cost per patient were compared between the 2 groups. Mean total length of stay (+/- standard deviation [SD]) was less in the postclinical pathway patients (3.7 +/- 1.5 days) compared to preclinical pathway patients (6.6 +/- 3.3 days) (P <.001). When adjusted for age, sex, diagnosis, and type of operation, the difference in length of stay remains statistically significant (P <.001). There was 1 readmission in the prepathway group and 8 readmissions in the postpathway group. When the readmissions were added to the original admissions, the mean length of stay in the postpathway patients was 4.2 +/- 2.8 days and in the prepathway patients was 6.9 +/- 4.1 days (P <.001). The average cost per patient (+/- standard error of the mean), with readmission costs added, was 9310 +/- 5170 US dollars in the prepathway group and 7070 +/- 3670 US dollars in the postpathway group (P =.002). The institution of a clinical pathway for elective, open colon resections can be done safely with improvements in cost and length of stay.

How can sludge dewatering devices be assessed? Development of a new DSS and its application to real case studies.

PubMed

Bertanza, Giorgio; Papa, Matteo; Canato, Matteo; Collivignarelli, Maria Cristina; Pedrazzani, Roberta

2014-05-01

A key issue in biological Waste Water Treatment Plants (WWTPs) operation is represented by the sludge management. Mechanical dewatering is a crucial stage for sludge volume reduction; though, being a costly operation, its optimization is required. We developed an original experimental methodology to evaluate the technical (dewatering efficiency) and financial (total treatment costs) performance of dewatering devices, which might be used as a DSS (Decision Support System) for WWTP managers. This tool was then applied to two real case studies for comparing, respectively, three industrial size centrifuges, and two different operation modes of the same machine (fixed installation vs. outsourcing service). In both the cases, the best option was identified, based jointly on economic and (site-specific) technical evaluations. Copyright © 2014 Elsevier Ltd. All rights reserved.

42 CFR 417.930 - Initial costs of operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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.

A cost comparison of traditional drainage and SUDS in Scotland.

PubMed

Duffy, A; Jefferies, C; Waddell, G; Shanks, G; Blackwood, D; Watkins, A

2008-01-01

The Dunfermline Eastern Expansion (DEX) is a 350 ha mixed development which commenced in 1996. Downstream water quality and flooding issues necessitated a holistic approach to drainage planning and the site has become a European showcase for the application of Sustainable Urban Drainage Systems (SUDS). However, there is minimal data available regarding the real costs of operating and maintaining SUDS to ensure they continue to perform as per their design function. This remains one of the primary barriers to the uptake and adoption of SUDS. This paper reports on what is understood to be the only study in the UK where actual costs of constructing and maintaining SUDS have been compared to an equivalent traditional drainage solution. To compare SUDS costs with traditional drainage, capital and maintenance costs of underground storage chambers of analogous storage volumes were estimated. A whole life costing methodology was then applied to data gathered. The main objective was to produce a reliable and robust cost comparison between SUDS and traditional drainage. The cost analysis is supportive of SUDS and indicates that well designed and maintained SUDS are more cost effective to construct, and cost less to maintain than traditional drainage solutions which are unable to meet the environmental requirements of current legislation. (c) IWA Publishing 2008.

Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

PubMed

Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

2017-01-01

Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

Levelized cost of energy (LCOE) metric to characterize solar absorber coatings for the CSP industry

DOE PAGES

Boubault, Antoine; Ho, Clifford K.; Hall, Aaron; ...

2015-07-08

The contribution of each component of a power generation plant to the levelized cost of energy (LCOE) can be estimated and used to increase the power output while reducing system operation and maintenance costs. The LCOE is used in order to quantify solar receiver coating influence on the LCOE of solar power towers. Two new parameters are introduced: the absolute levelized cost of coating (LCOC) and the LCOC efficiency. Depending on the material properties, aging, costs, and temperature, the absolute LCOC enables quantifying the cost-effectiveness of absorber coatings, as well as finding optimal operating conditions. The absolute LCOC is investigatedmore » for different hypothetic coatings and is demonstrated on Pyromark 2500 paint. Results show that absorber coatings yield lower LCOE values in most cases, even at significant costs. Optimal reapplication intervals range from one to five years. At receiver temperatures greater than 700 °C, non-selective coatings are not always worthwhile while durable selective coatings consistently reduce the LCOE—up to 12% of the value obtained for an uncoated receiver. Moreover the absolute LCOC is a powerful tool to characterize and compare different coatings, not only considering their initial efficiencies but also including their durability.« less

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study.

PubMed

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

2018-05-01

Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

Uganda experience-Using cost assessment of an established registry to project resources required to expand cancer registration.

PubMed

Wabinga, Henry; Subramanian, Sujha; Nambooze, Sarah; Amulen, Phoebe Mary; Edwards, Patrick; Joseph, Rachael; Ogwang, Martin; Okongo, Francis; Parkin, D Maxwell; Tangka, Florence

2016-12-01

The objectives of this study are (1) to estimate the cost of operating the Kampala Cancer Registry (KCR) and (2) to use cost data from the KCR to project the resource needs and cost of expanding and sustaining cancer registration in Uganda, focusing on the recently established Gulu Cancer Registry (GCR) in rural Northern Uganda. We used Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) to estimate the KCR's activity-based cost for 2014. We grouped the registry activities into fixed cost, variable core cost, and variable other cost activities. After a comparison KCR and GCR characteristics, we used the cost of the KCR to project the likely ongoing costs for the new GCR. The KCR incurred 42% of its expenditures in fixed cost activities, 40% for variable core cost activities, and the remaining 18% for variable other cost activities. The total cost per case registered was 28,201 Ugandan shillings (approximately US $10 in 2014) to collect and report cases using a combination of passive and active cancer data collection approaches. The GCR performs only active data collection, and covers a much larger area, but serves a smaller population compared to the KCR. After identifying many differences between KCR and GCR that could potentially affect the cost of registration, our best estimate is that the GCR, though newer and in a rural area, should require fewer resources than the KCR to sustain operations as a stand-alone entity. The optimal structure of the GCR needs to be determined in the future. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2016-05-01

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

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

PubMed

Wang, Yu-ting; Huang, Gang

2012-08-01

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

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

PubMed

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

2007-11-01

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

Simulation of tunneling construction methods of the Cisumdawu toll road

NASA Astrophysics Data System (ADS)

Abduh, Muhamad; Sukardi, Sapto Nugroho; Ola, Muhammad Rusdian La; Ariesty, Anita; Wirahadikusumah, Reini D.

2017-11-01

Simulation can be used as a tool for planning and analysis of a construction method. Using simulation technique, a contractor could design optimally resources associated with a construction method and compare to other methods based on several criteria, such as productivity, waste, and cost. This paper discusses the use of simulation using Norwegian Method of Tunneling (NMT) for a 472-meter tunneling work in the Cisumdawu Toll Road project. Primary and secondary data were collected to provide useful information for simulation as well as problems that may be faced by the contractor. The method was modelled using the CYCLONE and then simulated using the WebCYCLONE. The simulation could show the duration of the project from the duration model of each work tasks which based on literature review, machine productivity, and several assumptions. The results of simulation could also show the total cost of the project that was modeled based on journal construction & building unit cost and online websites of local and international suppliers. The analysis of the advantages and disadvantages of the method was conducted based on its, wastes, and cost. The simulation concluded the total cost of this operation is about Rp. 900,437,004,599 and the total duration of the tunneling operation is 653 days. The results of the simulation will be used for a recommendation to the contractor before the implementation of the already selected tunneling operation.

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

NASA Astrophysics Data System (ADS)

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

2015-11-01

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

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

NASA Astrophysics Data System (ADS)

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

2018-04-01

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

Differentiated protection method in passive optical networks based on OPEX

NASA Astrophysics Data System (ADS)

Zhang, Zhicheng; Guo, Wei; Jin, Yaohui; Sun, Weiqiang; Hu, Weisheng

2011-12-01

Reliable service delivery becomes more significant due to increased dependency on electronic services all over society and the growing importance of reliable service delivery. As the capability of PON increasing, both residential and business customers may be included in a PON. Meanwhile, OPEX have been proven to be a very important factor of the total cost for a telecommunication operator. Thus, in this paper, we present the partial protection PON architecture and compare the operational expenditures (OPEX) of fully duplicated protection and partly duplicated protection for ONUs with different distributed fiber length, reliability requirement and penalty cost per hour. At last, we propose a differentiated protection method to minimize OPEX.

Managing risks and hazardous in industrial operations

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

Almaula, S.C.

1996-12-31

The main objective of this paper is to demonstrate that it makes good business sense to identify risks and hazards of an operation and take appropriate steps to manage them effectively. Developing and implementing an effective risk and hazard management plan also contibutes to other industry requirements and standards. Development of a risk management system, key elements of a risk management plan, and hazards and risk analysis methods are outlined. Comparing potential risk to the cost of prevention is also discussed. It is estimated that the cost of developing and preparing the first risk management plan varies between $50,000 tomore » $200,000. 3 refs., 2 figs., 1 tab.« less

Design and economics of a photovoltaic concentrator array for off-grid applications

NASA Astrophysics Data System (ADS)

Maish, A. B.; Rios, M., Jr.

1982-09-01

The array design and expected operation of a photovoltaic concentrator are discussed. A second generation stand alone 680 W/sub p/ photovoltaic (PV) concentrating array for low power, nongrid connected applications was designed. The array consists of six passive cooled point focus Fresnel lens concentrating modules on a two axis polar mount tracking structure. The new array design incorporates several major improvements to the first generation design. These include 50% more array area and a control system which allows unattended, fully automatic operation. The life cycle energy costs are calculated and compared to the equivalent energy costs of a 3 kW diesel electric generator set and an equivalent flat panel PV system.

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

Martel, Laura; Smith, Paul; Rizea, Steven

The Ocean Thermal Energy Conversion (OTEC) Life Cycle Cost Assessment (OLCCA) is a study performed by members of the Lockheed Martin (LM) OTEC Team under funding from the Department of Energy (DOE), Award No. DE-EE0002663, dated 01/01/2010. OLCCA objectives are to estimate procurement, operations and maintenance, and overhaul costs for two types of OTEC plants: -Plants moored to the sea floor where the electricity produced by the OTEC plant is directly connected to the grid ashore via a marine power cable (Grid Connected OTEC plants) -Open-ocean grazing OTEC plant-ships producing an energy carrier that is transported to designated ports (Energymore » Carrier OTEC plants) Costs are developed using the concept of levelized cost of energy established by DOE for use in comparing electricity costs from various generating systems. One area of system costs that had not been developed in detail prior to this analysis was the operations and sustainment (O&S) cost for both types of OTEC plants. Procurement costs, generally referred to as capital expense and O&S costs (operations and maintenance (O&M) costs plus overhaul and replacement costs), are assessed over the 30 year operational life of the plants and an annual annuity calculated to achieve a levelized cost (constant across entire plant life). Dividing this levelized cost by the average annual energy production results in a levelized cost of electricity, or LCOE, for the OTEC plants. Technical and production efficiency enhancements that could result in a lower value of the OTEC LCOE were also explored. The thermal OTEC resource for Oahu, Hawaii and projected build out plan were developed. The estimate of the OTEC resource and LCOE values for the planned OTEC systems enable this information to be displayed as energy supplied versus levelized cost of the supplied energy; this curve is referred to as an Energy Supply Curve. The Oahu Energy Supply Curve represents initial OTEC deployment starting in 2018 and demonstrates the predicted economies of scale as technology and efficiency improvements are realized and larger more economical plants deployed. Utilizing global high resolution OTEC resource assessment from the Ocean Thermal Extractable Energy Visualization (OTEEV) project (an independent DOE project), Global Energy Supply Curves were generated for Grid Connected and Energy Carrier OTEC plants deployed in 2045 when the predicted technology and efficiencies improvements are fully realized. The Global Energy Supply Curves present the LCOE versus capacity in ascending order with the richest, lowest cost resource locations being harvested first. These curves demonstrate the vast ocean thermal resource and potential OTEC capacity that can be harvested with little change in LCOE.« less

Cost analysis in laccase production.

PubMed

Osma, Johann F; Toca-Herrera, José L; Rodríguez-Couto, Susana

2011-11-01

In this paper the cost of producing the enzyme laccase by the white-rot fungus Trametes pubescens under both submerged (SmF) and solid-state fermentation (SSF) conditions was studied. The fungus was cultured using more than 45 culture medium compositions. The cost of production was estimated by analyzing the cost of the culture medium, the cost of equipment and the operating costs. The cost of the culture medium represented, in all cases, the highest contribution to the total cost, while, the cost of equipment was significantly low, representing less than 2% of the total costs. The cultivation under SSF conditions presented a final cost 50-fold lower than the one obtained when culturing under SmF conditions at flask scale. In addition, the laccase production under SSF conditions in tray bioreactors reduced the final cost 4-fold compared to the one obtained under SSF conditions at flask scale, obtaining a final price of 0.04 cent €/U. Copyright © 2011 Elsevier Ltd. All rights reserved.

Rotary-wing aircraft systems for the short-haul market

NASA Technical Reports Server (NTRS)

Magee, J. P.; Clark, R. D.; Giulianetti, D.

1975-01-01

This paper describes preliminary designs of tilt-rotor and tandem-rotor helicopter V/STOL aircraft for the 1958 short-haul market. These designs include a tilt-rotor aircraft designed for STOL-only operation. The baseline designs are presented with technological and cost data. The impact of noise and ride qualities on aircraft size and cost, and on passenger acceptance are discussed. The results of the study are compared against competitive alternatives in air transportation.

Modeling Operations Costs for Human Exploration Architectures

NASA Technical Reports Server (NTRS)

Shishko, Robert

2013-01-01

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

Estimating airline operating costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

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

Cost-effective cloud computing: a case study using the comparative genomics tool, roundup.

PubMed

Kudtarkar, Parul; Deluca, Todd F; Fusaro, Vincent A; Tonellato, Peter J; Wall, Dennis P

2010-12-22

Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource-Roundup-using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon's Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon's computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing infrastructure.

Alternative communication network designs for an operational Plato 4 CAI system

NASA Technical Reports Server (NTRS)

Mobley, R. E., Jr.; Eastwood, L. F., Jr.

1975-01-01

The cost of alternative communications networks for the dissemination of PLATO IV computer-aided instruction (CAI) was studied. Four communication techniques are compared: leased telephone lines, satellite communication, UHF TV, and low-power microwave radio. For each network design, costs per student contact hour are computed. These costs are derived as functions of student population density, a parameter which can be calculated from census data for one potential market for CAI, the public primary and secondary schools. Calculating costs in this way allows one to determine which of the four communications alternatives can serve this market least expensively for any given area in the U.S. The analysis indicates that radio distribution techniques are cost optimum over a wide range of conditions.

Energy utilization: municipal waste incineration. Final report

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

LaBeck, M.F.

An assessment is made of the technical and economical feasibility of converting municipal waste into useful and useable energy. The concept presented involves retrofitting an existing municipal incinerator with the systems and equipment necessary to produce process steam and electric power. The concept is economically attractive since the cost of necessary waste heat recovery equipment is usually a comparatively small percentage of the cost of the original incinerator installation. Technical data obtained from presently operating incinerators designed specifically for generating energy, documents the technical feasibility and stipulates certain design constraints. The investigation includes a cost summary; description of process andmore » facilities; conceptual design; economic analysis; derivation of costs; itemized estimated costs; design and construction schedule; and some drawings.« less

Techno-economic analysis of a transient plant-based platform for monoclonal antibody production

PubMed Central

Nandi, Somen; Kwong, Aaron T.; Holtz, Barry R.; Erwin, Robert L.; Marcel, Sylvain; McDonald, Karen A.

2016-01-01

ABSTRACT Plant-based biomanufacturing of therapeutic proteins is a relatively new platform with a small number of commercial-scale facilities, but offers advantages of linear scalability, reduced upstream complexity, reduced time to market, and potentially lower capital and operating costs. In this study we present a detailed process simulation model for a large-scale new “greenfield” biomanufacturing facility that uses transient agroinfiltration of Nicotiana benthamiana plants grown hydroponically indoors under light-emitting diode lighting for the production of a monoclonal antibody. The model was used to evaluate the total capital investment, annual operating cost, and cost of goods sold as a function of mAb expression level in the plant (g mAb/kg fresh weight of the plant) and production capacity (kg mAb/year). For the Base Case design scenario (300 kg mAb/year, 1 g mAb/kg fresh weight, and 65% recovery in downstream processing), the model predicts a total capital investment of $122 million dollars and cost of goods sold of $121/g including depreciation. Compared with traditional biomanufacturing platforms that use mammalian cells grown in bioreactors, the model predicts significant reductions in capital investment and >50% reduction in cost of goods compared with published values at similar production scales. The simulation model can be modified or adapted by others to assess the profitability of alternative designs, implement different process assumptions, and help guide process development and optimization. PMID:27559626

Techno-economic analysis of a transient plant-based platform for monoclonal antibody production.

PubMed

Nandi, Somen; Kwong, Aaron T; Holtz, Barry R; Erwin, Robert L; Marcel, Sylvain; McDonald, Karen A

Plant-based biomanufacturing of therapeutic proteins is a relatively new platform with a small number of commercial-scale facilities, but offers advantages of linear scalability, reduced upstream complexity, reduced time to market, and potentially lower capital and operating costs. In this study we present a detailed process simulation model for a large-scale new "greenfield" biomanufacturing facility that uses transient agroinfiltration of Nicotiana benthamiana plants grown hydroponically indoors under light-emitting diode lighting for the production of a monoclonal antibody. The model was used to evaluate the total capital investment, annual operating cost, and cost of goods sold as a function of mAb expression level in the plant (g mAb/kg fresh weight of the plant) and production capacity (kg mAb/year). For the Base Case design scenario (300 kg mAb/year, 1 g mAb/kg fresh weight, and 65% recovery in downstream processing), the model predicts a total capital investment of $122 million dollars and cost of goods sold of $121/g including depreciation. Compared with traditional biomanufacturing platforms that use mammalian cells grown in bioreactors, the model predicts significant reductions in capital investment and >50% reduction in cost of goods compared with published values at similar production scales. The simulation model can be modified or adapted by others to assess the profitability of alternative designs, implement different process assumptions, and help guide process development and optimization.

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers.

PubMed

Roy, Sanjoy; Yoo, Andrew; Yadalam, Sashi; Fegelman, Elliott J; Kalsekar, Iftekhar; Johnston, Stephen S

2017-04-01

To compare economic and clinical outcomes between patients undergoing laparoscopic Roux-en-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Patients (aged ≥21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015) were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. The powered and manual stapler groups comprised 9,851 patients (mean age = 44.6 years; 79.3% female) and 21,558 patients (mean age = 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p = .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p = .003), adjusted mean supply costs ($4,629 vs $5,217, p = .011), and adjusted mean operating room costs ($4,126 vs $4,413, p = .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p = .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. This observational study cannot establish causal linkages. In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.

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

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

Harder, B.J.

1995-03-01

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

HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER): a multicenter comparative observational study.

PubMed

Mahabier, Kiran C; Van Lieshout, Esther M M; Bolhuis, Hugo W; Bos, P Koen; Bronkhorst, Maarten Wga; Bruijninckx, Milko M M; De Haan, Jeroen; Deenik, Axel R; Dwars, Boudewijn J; Eversdijk, Martin G; Goslings, J Carel; Haverlag, Robert; Heetveld, Martin J; Kerver, Albert J H; Kolkman, Karel A; Leenhouts, Peter A; Meylaerts, Sven A G; Onstenk, Ron; Poeze, Martijn; Poolman, Rudolf W; Punt, Bas J; Roerdink, W Herbert; Roukema, Gert R; Sintenie, Jan Bernard; Soesman, Nicolaj M R; Tanka, Andras K F; Ten Holder, Edgar J T; Van der Elst, Maarten; Van der Heijden, Frank H W M; Van der Linden, Frits M; Van der Zwaal, Peer; Van Dijk, Jan P; Van Jonbergen, Hans-Peter W; Verleisdonk, Egbert J M M; Vroemen, Jos P A M; Waleboer, Marco; Wittich, Philippe; Zuidema, Wietse P; Polinder, Suzanne; Verhofstad, Michael H J; Den Hartog, Dennis

2014-02-11

Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery. The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture. The trial is registered at the Netherlands Trial Register (NTR3617).

An Outcome and Cost Analysis Comparing Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Intraoperative Fluoroscopy versus Computed Tomography-Guided Navigation.

PubMed

Khanna, Ryan; McDevitt, Joseph L; Abecassis, Zachary A; Smith, Zachary A; Koski, Tyler R; Fessler, Richard G; Dahdaleh, Nader S

2016-10-01

Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)-based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF. For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective. Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups (P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room (P = 0.868). Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months. Copyright © 2016 Elsevier Inc. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Andrastek, D. A.

1976-01-01

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

Silicon web process development

NASA Technical Reports Server (NTRS)

Duncan, C. S.; Seidensticker, R. G.; Mchugh, J. P.; Hill, F. E.; Skutch, M. E.; Driggers, J. M.; Hopkins, R. H.

1980-01-01

A barrier crucible design which consistently maintains melt stability over long periods of time was successfully tested and used in long growth runs. The pellet feeder for melt replenishment was operated continuously for growth runs of up to 17 hours. The liquid level sensor comprising a laser/sensor system was operated, performed well, and meets the requirements for maintaining liquid level height during growth and melt replenishment. An automated feedback loop connecting the feed mechanism and the liquid level sensing system was designed and constructed and operated successfully for 3.5 hours demonstrating the feasibility of semi-automated dendritic web growth. The sensitivity of the cost of sheet, to variations in capital equipment cost and recycling dendrites was calculated and it was shown that these factors have relatively little impact on sheet cost. Dendrites from web which had gone all the way through the solar cell fabrication process, when melted and grown into web, produce crystals which show no degradation in cell efficiency. Material quality remains high and cells made from web grown at the start, during, and the end of a run from a replenished melt show comparable efficiencies.

Precision vector control of a superconducting RF cavity driven by an injection locked magnetron

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

Chase, Brian; Pasquinelli, Ralph; Cullerton, Ed

The technique presented in this paper enables the regulation of both radio frequency amplitude and phase in narrow band devices such as a Superconducting RF (SRF) cavity driven by constant power output devices i.e. magnetrons [1]. The ability to use low cost high efficiency magnetrons for accelerator RF power systems, with tight vector regulation, presents a substantial cost savings in both construction and operating costs - compared to current RF power system technology. An operating CW system at 2.45 GHz has been experimentally developed. Vector control of an injection locked magnetron has been extensively tested and characterized with a SRFmore » cavity as the load. Amplitude dynamic range of 30 dB, amplitude stability of 0.3% r.m.s, and phase stability of 0.26 degrees r.m.s. has been demonstrated.« less

Flutter suppression by active control and its benefits

NASA Technical Reports Server (NTRS)

Doggett, R. V., Jr.; Townsend, J. C.

1976-01-01

A general discussion of the airplane applications of active flutter suppression systems is presented with focus on supersonic cruise aircraft configurations. Topics addressed include a brief historical review; benefits, risks, and concerns; methods of application; and applicable configurations. Results are presented where the direct operating costs and performance benefits of an arrow wing supersonic cruise vehicle equipped with an active flutter suppression system are compared with corresponding costs and performance of the same baseline airplane where the flutter deficiency was corrected by passive methods (increases in structural stiffness). The design, synthesis, and conceptual mechanization of the active flutter suppression system are discussed. The results show that a substantial weight savings can be accomplished by using the active system. For the same payload and range, airplane direct operating costs are reduced by using the active system. The results also indicate that the weight savings translates into increased range or payload.

Precision vector control of a superconducting RF cavity driven by an injection locked magnetron

DOE PAGES

Chase, Brian; Pasquinelli, Ralph; Cullerton, Ed; ...

2015-03-01

The technique presented in this paper enables the regulation of both radio frequency amplitude and phase in narrow band devices such as a Superconducting RF (SRF) cavity driven by constant power output devices i.e. magnetrons [1]. The ability to use low cost high efficiency magnetrons for accelerator RF power systems, with tight vector regulation, presents a substantial cost savings in both construction and operating costs - compared to current RF power system technology. An operating CW system at 2.45 GHz has been experimentally developed. Vector control of an injection locked magnetron has been extensively tested and characterized with a SRFmore » cavity as the load. Amplitude dynamic range of 30 dB, amplitude stability of 0.3% r.m.s, and phase stability of 0.26 degrees r.m.s. has been demonstrated.« less

An Assessment of Alternate Thermal Protection Systems for the Space Shuttle Orbiter. Volume 1; Executive Summary

NASA Technical Reports Server (NTRS)

Hays, D.

1982-01-01

Alternate thermal protection system (TPS) concepts to the Space Shuttle Orbiter were assessed. Metallic, ablator, and carbon-carbon concepts which are the result of some previous design, manufacturing and testing effort were considered. Emphasis was placed on improved TPS durability, which could potentially reduce life cycle costs and improve Orbiter operational characteristics. Integrated concept/orbiter point designs were generated and analyzed on the basis of Shuttle design environments and criteria. A merit function evaluation methodology based on mission impact, life cycle costs, and risk was developed to compare the candidate concepts and to identify the best alternate. Voids and deficiencies in the technology were identified, along with recommended activities to overcome them. Finally, programmatic plans, including ROM costs and schedules, were developed for all activities required to bring the selected alternate system up to operational readiness.

Optimal power flow with optimal placement TCSC device on 500 kV Java-Bali electrical power system using genetic Algorithm-Taguchi method

NASA Astrophysics Data System (ADS)

Apribowo, Chico Hermanu Brillianto; Ibrahim, Muhammad Hamka; Wicaksono, F. X. Rian

2018-02-01

The growing burden of the load and the complexity of the power system has had an impact on the need for optimization of power system operation. Optimal power flow (OPF) with optimal location placement and rating of thyristor controlled series capacitor (TCSC) is an effective solution used to determine the economic cost of operating the plant and regulate the power flow in the power system. The purpose of this study is to minimize the total cost of generation by placing the location and the optimal rating of TCSC using genetic algorithm-design of experiment techniques (GA-DOE). Simulation on Java-Bali system 500 kV with the amount of TCSC used by 5 compensator, the proposed method can reduce the generation cost by 0.89% compared to OPF without using TCSC.

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

DTIC Science & Technology

2012-06-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Comparison of 3D reconstruction of mandible for pre-operative planning using commercial and open-source software

NASA Astrophysics Data System (ADS)

Abdullah, Johari Yap; Omar, Marzuki; Pritam, Helmi Mohd Hadi; Husein, Adam; Rajion, Zainul Ahmad

2016-12-01

3D printing of mandible is important for pre-operative planning, diagnostic purposes, as well as for education and training. Currently, the processing of CT data is routinely performed with commercial software which increases the cost of operation and patient management for a small clinical setting. Usage of open-source software as an alternative to commercial software for 3D reconstruction of the mandible from CT data is scarce. The aim of this study is to compare two methods of 3D reconstruction of the mandible using commercial Materialise Mimics software and open-source Medical Imaging Interaction Toolkit (MITK) software. Head CT images with a slice thickness of 1 mm and a matrix of 512x512 pixels each were retrieved from the server located at the Radiology Department of Hospital Universiti Sains Malaysia. The CT data were analysed and the 3D models of mandible were reconstructed using both commercial Materialise Mimics and open-source MITK software. Both virtual 3D models were saved in STL format and exported to 3matic and MeshLab software for morphometric and image analyses. Both models were compared using Wilcoxon Signed Rank Test and Hausdorff Distance. No significant differences were obtained between the 3D models of the mandible produced using Mimics and MITK software. The 3D model of the mandible produced using MITK open-source software is comparable to the commercial MIMICS software. Therefore, open-source software could be used in clinical setting for pre-operative planning to minimise the operational cost.

Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study.

PubMed

Goodyear, Stephen J; Yow, Heng; Saedon, Mahmud; Shakespeare, Joanna; Hill, Christopher E; Watson, Duncan; Marshall, Colette; Mahmood, Asif; Higman, Daniel; Imray, Christopher He

2013-05-19

In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction.A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery. We aimed to assess the impact of a CPET-based risk-stratification strategy upon perioperative mortality, length of stay and non-operative costs for elective (open and endovascular) infra-renal AAA patients. A retrospective cohort study was undertaken. Pre-operative CPET-based selection for elective surgical intervention was introduced in 2007. An anonymized cohort of 230 consecutive infra-renal AAA patients (2007 to 2011) was studied. A historical control group of 128 consecutive infra-renal AAA patients (2003 to 2007) was identified for comparison.Comparative analysis of demographic and outcome data for CPET-pass (AT ≥ 11 ml/kg/min), CPET-fail (AT < 11 ml/kg/min) and CPET-submaximal (no AT generated) subgroups with control subjects was performed. Primary outcomes included 30-day mortality, survival and length of stay (LOS); secondary outcomes were non-operative inpatient costs. Of 230 subjects, 188 underwent CPET: CPET-pass n = 131, CPET-fail n = 35 and CPET-submaximal n = 22. When compared to the controls, CPET-pass patients exhibited reduced median total LOS (10 vs 13 days for open surgery, n = 74, P < 0.01 and 4 vs 6 days for EVAR, n = 29, P < 0.05), intensive therapy unit requirement (3 vs 4 days for open repair only, P < 0.001), non-operative costs (£5,387 vs £9,634 for open repair, P < 0.001) and perioperative mortality (2.7% vs 12.6% (odds ratio: 0.19) for open repair only, P < 0.05). CPET-stratified (open/endovascular) patients exhibited a mid-term survival benefit (P < 0.05). In this retrospective cohort study, a pre-operative AT > 11 ml/kg/min was associated with reduced perioperative mortality (open cases only), LOS, survival and inpatient costs (open and endovascular repair) for elective infra-renal AAA surgery.

Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study

PubMed Central

2013-01-01

Background In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction. A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery. We aimed to assess the impact of a CPET-based risk-stratification strategy upon perioperative mortality, length of stay and non-operative costs for elective (open and endovascular) infra-renal AAA patients. Methods A retrospective cohort study was undertaken. Pre-operative CPET-based selection for elective surgical intervention was introduced in 2007. An anonymized cohort of 230 consecutive infra-renal AAA patients (2007 to 2011) was studied. A historical control group of 128 consecutive infra-renal AAA patients (2003 to 2007) was identified for comparison. Comparative analysis of demographic and outcome data for CPET-pass (AT ≥ 11 ml/kg/min), CPET-fail (AT < 11 ml/kg/min) and CPET-submaximal (no AT generated) subgroups with control subjects was performed. Primary outcomes included 30-day mortality, survival and length of stay (LOS); secondary outcomes were non-operative inpatient costs. Results Of 230 subjects, 188 underwent CPET: CPET-pass n = 131, CPET-fail n = 35 and CPET-submaximal n = 22. When compared to the controls, CPET-pass patients exhibited reduced median total LOS (10 vs 13 days for open surgery, n = 74, P < 0.01 and 4 vs 6 days for EVAR, n = 29, P < 0.05), intensive therapy unit requirement (3 vs 4 days for open repair only, P < 0.001), non-operative costs (£5,387 vs £9,634 for open repair, P < 0.001) and perioperative mortality (2.7% vs 12.6% (odds ratio: 0.19) for open repair only, P < 0.05). CPET-stratified (open/endovascular) patients exhibited a mid-term survival benefit (P < 0.05). Conclusion In this retrospective cohort study, a pre-operative AT > 11 ml/kg/min was associated with reduced perioperative mortality (open cases only), LOS, survival and inpatient costs (open and endovascular repair) for elective infra-renal AAA surgery. PMID:24472159

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

PubMed

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

2015-06-01

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

Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

PubMed

El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

2016-01-01

To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p < .001), and the average total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p < .001). Although RSS surgery and CL have comparable clinical outcomes in selected patients, RSS surgery remains associated with increased incremental disposable cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to maximize cost-effectiveness in RSS gynecologic surgery. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

PubMed

Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V

2013-10-01

To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P < 0.0001) higher per capita cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review.

PubMed

Schuurmans, Jaap; Goslings, J C; Schepers, T

2017-04-01

Flail chest is a life-threatening complication of severe chest trauma with a mortality rate of up to 15 %. The standard non-operative management has high comorbidities with pneumonia and often leads to extended Intensive Care Unit (ICU) stay, due to insufficient respiratory function and complications. The aim of this literature study was to investigate how operative management improves patient care for adults with flail chest. Randomized-controlled trials comparing operative management versus non-operative management of flail chest were included in this systematic review and meta-analysis. PubMed, Trip Database, and Google Scholar were used for study identification. We compared operative-to-non-operative management in adult flail chest patients. Mean difference and risk ratio for mortality, pneumonia rate, duration of mechanical ventilation, duration of ICU stay, duration of hospital stay, tracheostomy rate, and treatment costs were calculated by pooling these publication results. Three randomized-controlled trials were included in this systematic review. In total, there were 61 patients receiving operative management compared to 62 patients in the non-operative management group. A positive effect of surgical rib fracture fixation was observed for pneumonia rate [ES 0.5, 95 % CI (0.3, 0.7)], duration of mechanical ventilation (DMV) [ES -6.5 days 95 % CI (-11.9, -1.2)], duration of ICU stay [ES -5.2 days 95 % CI (-6.2, -4.2)], duration of hospital stay (DHS) [ES -11.4 days 95 % CI (-12.4, -10.4)], tracheostomy rate (TRCH) [ES 0.4, 95 % CI (0.2, 0.7)], and treatment costs (saving $9.968,00-14.443,00 per patient). No significant difference was noted in mortality rate [ES 0.6, 95 % CI (0.1, 2.4)] between the two treatment strategies. Despite the relatively small number of patients included, different methodologies and differences in presentation of outcomes, operative management of flail chest seems to be a promising treatment strategy that improves patients' outcomes in various ways. However, the effect on mortality rate remains inconclusive. Therefore, research should continue to explore operative management as a viable method for flail chest injuries.

A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

PubMed

Ginsberg, Gary; Adunsky, Abraham; Rasooly, Iris

2013-01-01

The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

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

PubMed

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

2018-02-09

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