Science.gov

Sample records for reduces medical costs

  1. Gauging the feasibility of cost-sharing and medical student interest groups to reduce interview costs.

    PubMed

    Lieber, Bryan A; Wilson, Taylor A; Bell, Randy S; Ashley, William W; Barrow, Daniel L; Wolfe, Stacey Quintero

    2014-11-01

    Indirect costs of the interview tour can be prohibitive. The authors sought to assess the desire of interviewees to mitigate these costs through ideas such as sharing hotel rooms and transportation, willingness to stay with local students, and the preferred modality to coordinate this collaboration. A survey link was posted on the Uncle Harvey website and the Facebook profile page of fourth-year medical students from 6 different medical schools shortly after the 2014 match day. There were a total of 156 respondents to the survey. The majority of the respondents were postinterview medical students (65.4%), but preinterview medical students (28.2%) and current residents (6.4%) also responded to the survey. Most respondents were pursuing a field other than neurosurgery (75.0%) and expressed a desire to share a hotel room and/or transportation (77.4%) as well as stay in the dorm room of a medical student at the program in which they are interviewing (70.0%). Students going into neurosurgery were significantly more likely to be interested in sharing hotel/transportation (89.2% neurosurgery vs 72.8% nonneurosurgery; p = 0.040) and in staying in the dorm room of a local student when on interviews (85.0% neurosurgery vs 57.1% nonneurosurgery; p = 0.040) than those going into other specialties. Among postinterview students, communication was preferred to be by private, email identification-only chat room. Given neurosurgery resident candidates' interest in collaborating to reduce interview costs, consideration should be given to creating a system that could allow students to coordinate cost sharing between interviewees. Moreover, interviewees should be connected to local students from neurosurgery interest groups as a resource.

  2. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    ERIC Educational Resources Information Center

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  3. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

    PubMed Central

    Finnie, Ramona K.C.; Acharya, Sushama D.; Jacob, Verughese; Proia, Krista K.; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

    2015-01-01

    Introduction Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients’ adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. Methods We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Results Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of −$127 per person per year. Conclusion ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence. PMID:26605708

  4. Fitness costs of animal medication: antiparasitic plant chemicals reduce fitness of monarch butterfly hosts.

    PubMed

    Tao, Leiling; Hoang, Kevin M; Hunter, Mark D; de Roode, Jacobus C

    2016-09-01

    The emerging field of ecological immunology demonstrates that allocation by hosts to immune defence against parasites is constrained by the costs of those defences. However, the costs of non-immunological defences, which are important alternatives to canonical immune systems, are less well characterized. Estimating such costs is essential for our understanding of the ecology and evolution of alternative host defence strategies. Many animals have evolved medication behaviours, whereby they use antiparasitic compounds from their environment to protect themselves or their kin from parasitism. Documenting the costs of medication behaviours is complicated by natural variation in the medicinal components of diets and their covariance with other dietary components, such as macronutrients. In the current study, we explore the costs of the usage of antiparasitic compounds in monarch butterflies (Danaus plexippus), using natural variation in concentrations of antiparasitic compounds among plants. Upon infection by their specialist protozoan parasite Ophryocystis elektroscirrha, monarch butterflies can selectively oviposit on milkweed with high foliar concentrations of cardenolides, secondary chemicals that reduce parasite growth. Here, we show that these antiparasitic cardenolides can also impose significant costs on both uninfected and infected butterflies. Among eight milkweed species that vary substantially in their foliar cardenolide concentration and composition, we observed the opposing effects of cardenolides on monarch fitness traits. While high foliar cardenolide concentrations increased the tolerance of monarch butterflies to infection, they reduced the survival rate of caterpillars to adulthood. Additionally, although non-polar cardenolide compounds decreased the spore load of infected butterflies, they also reduced the life span of uninfected butterflies, resulting in a hump-shaped curve between cardenolide non-polarity and the life span of infected butterflies

  5. Long-Term Care Benefits May Reduce End-of-Life Medical Care Costs

    PubMed Central

    Evered, Sharrilyn R.; Center, Bruce A.

    2014-01-01

    Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan (“claimants”) to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332–339) PMID:24784144

  6. Reducing medical waste.

    PubMed

    Conrardy, Julie; Hillanbrand, Mary; Myers, Sandra; Nussbaum, George F

    2010-06-01

    Medical waste is a necessary by-product of any hospital environment; however, the majority of regulated medical waste is produced in the OR from the use of disposable surgical supplies (eg, drapes, gowns, basins, gloves, sponges). We conducted a concept comparison project in the ORs of two large medical centers in Bethesda, Maryland, and Washington, DC, to evaluate the effects of using reusable surgical basins, gowns, and table and Mayo stand covers in place of disposable products. Survey results indicated that surgeons and surgical technologists found the reusable products to be preferable to the disposable products currently in use. In addition, using reusable products provided a means to decrease regulated medical waste generated in the OR by an average of 65% as well as reduce the cost of waste disposal. AORN recommends evaluating the environmental effects of using reusable, reposable, and disposable products; our findings provide evidence that may be useful to surgical facilities that seek to adopt a "green" approach.

  7. Reducing Life-Cycle Costs.

    ERIC Educational Resources Information Center

    Roodvoets, David L.

    2003-01-01

    Presents factors to consider when determining roofing life-cycle costs, explaining that costs do not tell the whole story; discussing components that should go into the decision (cost, maintenance, energy use, and environmental costs); and concluding that important elements in reducing life-cycle costs include energy savings through increased…

  8. Leveraging Technology to Reduce Patient Transaction Costs.

    PubMed

    Edlow, Richard C

    2015-01-01

    Medical practices are under significant pressure to provide superior customer service in an environment of declining or flat reimbursement. The solution for many practices involves the integration of a variety of third-party technologies that conveniently interface with one's electronic practice management and medical records systems. Typically, the applications allow the practice to reduce the cost of each patient interaction. Drilling down to quantify the cost of each individual patient interaction helps to determine the practicality of implementation.

  9. Managing Costs and Medical Information

    Cancer.gov

    People with cancer may face major financial challenges and need help dealing with the high costs of care. Cancer treatment can be very expensive, even when you have insurance. Learn ways to manage medical information, paperwork, bills, and other records.

  10. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    PubMed

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system.

  11. Tandem motors reduce well costs

    SciTech Connect

    Hooper, M.; Daigle, C.; Crowe, R.

    1995-10-01

    The new generation of tandem mud motors that recently appeared on the drilling scene is significantly affecting drilling efficiency worldwide. These motors provide drillers with increased horsepower at the bit, higher torque, and faster rates of penetration (ROP). With advanced engineering and more durable materials, motor life is being extended, thereby increasing the time between bit trips and reducing drilling costs. This article reviews the performance, design, and operation of these motors.

  12. Bioventing reduces soil cleanup costs

    SciTech Connect

    Leahy, M.C.; Erickson, G.P.

    1995-08-01

    An offshoot technology from soil venting, bioventing offers a win-win solution for soils contaminated with volatile organic compounds (VOCs) and nonvolatile contaminants such as diesel and fuel oil. Using low air flowrates through permeable soils, bioventing injects sufficient oxygen to support naturally-occurring bacteria, which biodegraded the VOCs and other contaminants into benign byproducts. Waste gas can be directly discharged to atmosphere without further treatment. This results in no offgas treatment required. Bioventing is a cost-effective alternative to traditional soil-venting techniques. Soil venting uses air to volatilize organic-compound contamination from the vadose zone, the unsaturated soil layer above groundwater. Unfortunately, this simple-and-fast approach creates a waste offgas that requires further treatment before discharge, thus adding significantly to overall project costs. In contrast, bioventing uses low air flowrates, which require lower capital and operating costs. No offgas treatment further reduces equipment and operating costs and often eliminates air permitting. As in all treatment strategies, the process must meet the cleanup objectives. Bioventing is an alternative technique making inroads into refining and petrochemical soil-remediation applications.

  13. Accounting for future costs in medical cost-effectiveness analysis.

    PubMed

    Meltzer, D

    1997-02-01

    Most medical cost-effectiveness analyses include future costs only for related illnesses, but this approach is controversial. This paper demonstrates that cost-effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non-medical expenditures. Estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost-effectiveness of medical interventions, particularly when an intervention increases length of life more than quality of life. In older populations, current methods overstate the cost-effectiveness of interventions which extend life compared to interventions which improve the quality of life.

  14. A Probabilistic Model for Reducing Medication Errors

    PubMed Central

    Nguyen, Phung Anh; Syed-Abdul, Shabbir; Iqbal, Usman; Hsu, Min-Huei; Huang, Chen-Ling; Li, Hsien-Chang; Clinciu, Daniel Livius; Jian, Wen-Shan; Li, Yu-Chuan Jack

    2013-01-01

    Background Medication errors are common, life threatening, costly but preventable. Information technology and automated systems are highly efficient for preventing medication errors and therefore widely employed in hospital settings. The aim of this study was to construct a probabilistic model that can reduce medication errors by identifying uncommon or rare associations between medications and diseases. Methods and Finding(s) Association rules of mining techniques are utilized for 103.5 million prescriptions from Taiwan’s National Health Insurance database. The dataset included 204.5 million diagnoses with ICD9-CM codes and 347.7 million medications by using ATC codes. Disease-Medication (DM) and Medication-Medication (MM) associations were computed by their co-occurrence and associations’ strength were measured by the interestingness or lift values which were being referred as Q values. The DMQs and MMQs were used to develop the AOP model to predict the appropriateness of a given prescription. Validation of this model was done by comparing the results of evaluation performed by the AOP model and verified by human experts. The results showed 96% accuracy for appropriate and 45% accuracy for inappropriate prescriptions, with a sensitivity and specificity of 75.9% and 89.5%, respectively. Conclusions We successfully developed the AOP model as an efficient tool for automatic identification of uncommon or rare associations between disease-medication and medication-medication in prescriptions. The AOP model helps to reduce medication errors by alerting physicians, improving the patients’ safety and the overall quality of care. PMID:24312659

  15. Non-medical costs of colonoscopy

    PubMed Central

    Kempiński, Radosław; Michałowicz, Jerzy; Poniewierka, Elżbieta

    2014-01-01

    Colorectal cancer is one of the most common malignancies in Europe and North America. Colonoscopy done every 10 years beginning at age 50 is the preferred method of screening. In Poland and some other countries examinations are offered to subjects free of charge. However, as well as direct medical costs there are direct non-medical costs, which include the cost of transportation and costs related to caregivers’ time, and indirect costs, which are costs related to patients’ time. These costs essentially augment the total societal costs of colonoscopy. PMID:25396000

  16. The Costs and Risks of Medical Care

    PubMed Central

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

    1982-01-01

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

  17. Can disease management reduce health care costs by improving quality?

    PubMed

    Fireman, Bruce; Bartlett, Joan; Selby, Joe

    2004-01-01

    Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

  18. RVU costing in a medical group practice.

    PubMed

    Berlin, M F; Faber, B P; Berlin, L M

    1997-10-01

    As risk-and-reward reimbursement arrangements proliferate, medical group practices should use cost accounting to measure costs of services delivered by physicians. The resource-based relative value scale (RBRVS) is a method of determining physicians' fees on the basis of the various resources used to provide procedures or services. Two cost-per-procedure methods can be used in RBRVS cost accounting. One method uses relative value units (RVUs), and the other uses component RVUs, which comprise work, practice, and malpractice costs. Though the two methods produce different calculated costs, using both together can produce a cost range medical practice administrators can use to ensure that the costs of delivering services are reimbursed adequately.

  19. New pharmaceuticals reduce cost of illness.

    PubMed

    Hansen, R W

    1986-06-01

    The cost of illness includes not only the funds required to treat illness, but also the effect on the patient's quality of life. Recent concern about rising health costs have focused on the direct expenditures without noting that the cost of illness in terms of mortality and morbidity has declined significantly. Pharmaceuticals have played a major role in reducing the total cost of illness. Several studies of the cost-effectiveness of past introductions of vaccines and pharmaceuticals reveal large cost savings. Although the focus of most studies has been on major advances, the continuing process of less dramatic therapeutic improvements has significantly trimmed the cost of illness. Cost-benefit studies of new drugs or changes in drug use, while more difficult to perform, make it possible to influence the selection of therapy. Since pharmaceuticals represent less than 10% of total treatment costs, reduction in the cost of pharmaceutical products can only have a minor impact on the total cost of illness. Pharmaceuticals can reduce the cost of illness by providing alternative therapies that reduce direct treatment cost or improve the public health.

  20. Reducing energy costs in nursing homes

    SciTech Connect

    Not Available

    1981-01-01

    The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryers to gas was analyzed. (MCW)

  1. Cost analysis of medical assistance in dying in Canada

    PubMed Central

    Trachtenberg, Aaron J.; Manns, Braden

    2017-01-01

    BACKGROUND: The legalization of medical assistance in dying will affect health care spending in Canada. Our aim was to determine the potential costs and savings associated with the implementation of medical assistance in dying. METHODS: Using published data from the Netherlands and Belgium, where medically assisted death is legal, we estimated that medical assistance in dying will account for 1%–4% of all deaths; 80% of patients will have cancer; 50% of patients will be aged 60–80 years; 55% will be men; 60% of patients will have their lives shortened by 1 month; and 40% of patients will have their lives shortened by 1 week. We combined current mortality data for the Canadian population with recent end-of-life cost data to calculate a predicted range of savings associated with the implementation of medical assistance in dying. We also estimated the direct costs associated with offering medically assisted death, including physician consultations and drug costs. RESULTS: Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5–$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of mdedical assistance in dying will likely remain at least cost neutral. INTERPRETATION: Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system, and could result in substantial savings. Additional data on patients who choose medical assistance in dying in Canada should be collected to enable more precise estimates of the impact of medically assisted death on health care spending and to enable further economic evaluation. PMID:28246154

  2. Strategies for Reducing Text Book Costs

    ERIC Educational Resources Information Center

    Board of Governors, State University System of Florida, 2008

    2008-01-01

    In recent years, the price of college textbooks has become a growing concern for students and others who care about keeping college costs affordable. As policymakers and higher education systems explore the issue further, there are actions that can be taken immediately on college campuses to reduce the cost of textbooks. This brief presents…

  3. Reducing arthroplasty costs via vendor contracts

    PubMed Central

    Johnston, D. William C.; Beaupré, Lauren A.; Davies, Donna M.; Hessels, Rick

    1999-01-01

    Objective To describe a method of reducing the costs of implants in hip and knee arthroplasty. Design Implant costs were compared before and after the implementation of a 2-year contract with implant vendors, providing increased volume for decreased implant cost. An additional 20% of arthroplasties could be done outside the contract for research or special purposes. Setting A regional health authority involving 2 acute care hospitals. Method Costs were obtained for 942 hip and knee arthroplasties performed in 1993/94 and compared with costs of 1656 hip and knee arthroplasties performed in 1996/97. Outcome Measures Implant cost and number of joint arthroplasty procedures performed. Results A 40% decrease in the cost per implant for primary knee arthroplasty and an 18% decrease in the cost per implant for primary hip arthroplasty were achieved. A rebate, calculated as a percentage of volume used, was received from the vendor to support general orthopedic research and education. A new contract for 3 years has recently been signed with 3 vendors designated as primary vendors for 80% of the volume. Conclusion The vendor-contract economic strategy effectively reduced the cost of hip and knee arthroplasty and may be useful at other centres looking for cost reduction methods that maintain adequate patient care and support clinical research and education. PMID:10593246

  4. Direct medical costs attributable to osteoporotic fractures.

    PubMed

    Gabriel, S E; Tosteson, A N A; Leibson, C L; Crowson, C S; Pond, G R; Hammond, C S; Melton, L J

    2002-01-01

    Osteoporotic fractures are a major cause of morbidity in the elderly, the most rapidly growing segment of our population. We characterized the incremental direct medical costs following such fractures in a population-based cohort of men and women in Olmsted County, Minnesota. Cases included all County residents 50 years of age and older with an incident fracture due to minimal or moderate trauma between January 1, 1989 and January 1, 1992. For each case, a control of the same age (+/- 1 year) and sex who was attended in the local medical system in the same year was identified. Total incremental costs (cases - controls) in the year after fracture were estimated. Unit costs for each health service/procedure were obtained through the Mayo Cost Data Warehouse, which provides a standardized, inflation-adjusted estimate reflecting the national average cost of providing the service. Regression analysis was used to identify factors associated with incremental costs. There were 1263 case/control pairs; their average age was 73.8 years and 78% were female. Median total direct medical costs were $761 and $625, respectively, for cases and nonfracture controls in the year prior to fracture, and $3884 and $712, respectively, in the year following fracture. The highest median incremental costs were for distal femur ($11756) and hip fractures ($11241), whereas the lowest were for rib fractures ($213). Although hip fractures resulted in more incremental cost than any other fracture type, this amounted to only 37% of the total incremental cost of all moderate-trauma fractures combined. Regression analyses revealed that age, prior year costs and type of fracture were significant predictors of incremental costs (p<0.03 for all comparisons). The incremental costs of osteoporotic fractures are therefore substantial. Whereas hip fractures contributed disproportionately, they accounted for only one-third of the total incremental cost of fractures in our cohort. The use of incremental

  5. Reduce generating costs and eliminate brownouts

    SciTech Connect

    Nogaja, R.; Menezes, M.

    2007-06-15

    Improving the manoeuverability of a coal-fired plant to allow it to participate in primary frequency support will reduce generation cost and minimize brownouts. The challenge is to do so without compromising efficiency or emissions. This article describes an approach - activation of stored energy - that is cost-effective and applicable to both greenfield and brownfield installations. It requires a new control philosophy, plus the correct application of new level and flow measurement 'best practices'. 4 refs., 1 tab.

  6. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    SciTech Connect

    Kickuth, Ralph Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-12-15

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization.

  7. Cascaded Microinverter PV System for Reduced Cost

    SciTech Connect

    Bellus, Daniel R.; Ely, Jeffrey A.

    2013-04-29

    In this project, a team led by Delphi will develop and demonstrate a novel cascaded photovoltaic (PV) inverter architecture using advanced components. This approach will reduce the cost and improve the performance of medium and large-sized PV systems. The overall project objective is to develop, build, and test a modular 11-level cascaded three-phase inverter building block for photovoltaic applications and to develop and analyze the associated commercialization plan. The system will be designed to utilize photovoltaic panels and will supply power to the electric grid at 208 VAC, 60 Hz 3-phase. With the proposed topology, three inverters, each with an embedded controller, will monitor and control each of the cascade sections, reducing costs associated with extra control boards. This report details the final disposition on this project.

  8. Reducing Financing Costs for Federal ESPCs

    SciTech Connect

    Hughes, P.J.

    2005-01-28

    This report documents the recommendations of a working group commissioned by the Federal Energy Management Program (FEMP) in 2002 to identify ways to reduce financing costs in federal energy savings performance contract (ESPC) projects. The working group is part of continuing efforts launched by FEMP since the award of the Department of Energy's (DOE's) Super ESPCs in 1998 and 1999 to ensure that practical, flexible, and cost-effective alternative financing for energy-efficiency improvements is available to all federal agencies. During FY 2002-2004, the working group pursued extensive fact finding, consulted with government and private-sector finance experts, and analyzed data from federal and local government ESPC programs. The working group observed that both competition and transparency were lacking in federal ESPCs. The working group also found that the government often falls short of full compliance with certain provisions of the final rule that codifies the federal ESPC authority into regulation (10 CFR 436), which speak to due diligence in determining fair and reasonable pricing. Based on these findings, the working group formulated their short-term recommendations of actions that agencies can take immediately to reduce ESPC financing costs. The working group recommended requiring competitive solicitation of offers from prospective financiers of ESPC projects, standardization of processes to keep the playing field level and reduce energy service companies (ESCOs) project development costs, and assuring transparency by specifying that the government will see and review all bids. The reforms are intended to enable the government to determine quickly and reliably whether the portion of price related to financing is fair and reasonable and to provide auditable records of the transaction. The working group's recommendations were incorporated into modifications to the Super ESPCs and requirements to be included in the Super ESPC delivery order request for proposal

  9. Reducing home heating and cooling costs

    SciTech Connect

    Not Available

    1994-07-01

    This report is in response to a request from the House Committee on Energy and Commerce that the Energy Information Administration (EIA) undertake a neutral, unbiased analysis of the cost, safety, and health and environmental effects of the three major heating fuels: heating oil, natural gas, and electricity. The Committee also asked EIA to examine the role of conservation in the choice of heating and cooling fuel. To accommodate a wide audience, EIA decided to respond to the Committee`s request in the context of a report on reducing home heating and cooling costs. Accordingly, this report discusses ways to weatherize the home, compares the features of the three major heating and cooling fuels, and comments on the types of heating and cooling systems on the market. The report also includes a worksheet and supporting tables that will help in the selection of a heating and/or cooling system.

  10. Reducing costs through electronic data interchange.

    PubMed

    Chapin-Strike, S

    1994-01-01

    The times have never been riper for an investment in EDI to pay off for healthcare providers. As suppliers attain their implementation goals for electronic purchase orders, they are expanding their EDI capabilities. One area which seems to be attracting considerable attention is the entire contracting cycle, where there are numerous opportunities for reducing administrative costs and improving accuracy. A detailed example using a buying group's contract cycle shows how EDI can be used at every step of the way, from request for quotation to funds transfer and monthly purchase summaries. EDI can be implemented at any level, from PC to mainframe. Implementation is not cheap and integration may not be easy, but the benefits can justify the cost. The first step to successful implementation is to identify and quantify, throughout the entire organization, reengineering opportunities in which EDI can be used. Two industry organizations, the Health Industry Distributors Association (HIDA) and the Healthcare EDI Corporation (HEDIC) have taken leadership roles in simplifying the implementation process.

  11. Cost in Medical Education: One Hundred and Twenty Years Ago

    ERIC Educational Resources Information Center

    Walsh, Kieran

    2015-01-01

    The first full paper that is dedicated to cost in medical education appears in the "BMJ" in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons…

  12. Can Weight Loss Reduce the Need for Blood Pressure Medication?

    MedlinePlus

    ... weight loss reduce the need for blood pressure medication? Answers from Sheldon G. Sheps, M.D. If ... possible to reduce your dose of blood pressure medication — or stop taking your blood pressure medication completely. ...

  13. Autonomous exoskeleton reduces metabolic cost of walking.

    PubMed

    Mooney, Luke M; Rouse, Elliott J; Herr, Hugh M

    2014-01-01

    We developed an autonomous powered leg exoskeleton capable of providing large amounts of positive mechanical power to the wearer during powered plantarflexion phase of walking. The autonomous exoskeleton consisted of a winch actuator fasted to the shin which pulled on fiberglass struts attached to a boot. The fiberglass struts formed a rigid extension of the foot when the proximal end of the strut was pulled in forward by the winch actuator. This lightweight, geometric transmission allowed the electric winch actuator to efficiently produce biological levels of power at the ankle joint. The exoskeleton was powered and controlled by lithium polymer batteries and motor controller worn around the waist. Preliminary testing on two subjects walking at 1.4 m/s resulted in the exoskeleton reducing the metabolic cost of walking by 6-11% as compared to not wearing the device. The exoskeleton provided a peak mechanical power of over 180 W at each ankle (mean standard ± deviation) and an average positive mechanical power of 27 ± 1 W total to both ankles, while electrically using 75-89 W of electricity. The batteries (800 g) used in this experiment are estimated to be capable of providing this level of assistance for up to 7 km of walking.

  14. The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan.

    PubMed

    Yoritaka, Asako; Fukae, Jiro; Hatano, Taku; Oda, Eisei; Hattori, Nobutaka

    2016-01-01

    Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.

  15. Activity Analysis and Cost Analysis in Medical Schools.

    ERIC Educational Resources Information Center

    Koehler, John E.; Slighton, Robert L.

    There is no unique answer to the question of what an ongoing program costs in medical schools. The estimates of program costs generated by classical methods of cost accounting are unsatisfactory because such accounting cannot deal with the joint production or joint cost problem. Activity analysis models aim at calculating the impact of alternative…

  16. The Cost of Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Palmer, Eurica; Haté, Vibhuti; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources. PMID:27783612

  17. Methods Reduce Cost, Enhance Quality of Nanotubes

    NASA Technical Reports Server (NTRS)

    2009-01-01

    For all the challenges posed by the microgravity conditions of space, weight is actually one of the more significant problems NASA faces in the development of the next generation of U.S. space vehicles. For the Agency s Constellation Program, engineers at NASA centers are designing and testing new vessels as safe, practical, and cost-effective means of space travel following the eventual retirement of the space shuttle. Program components like the Orion Crew Exploration Vehicle, intended to carry astronauts to the International Space Station and the Moon, must be designed to specific weight requirements to manage fuel consumption and match launch rocket capabilities; Orion s gross liftoff weight target is about 63,789 pounds. Future space vehicles will require even greater attention to lightweight construction to help conserve fuel for long-range missions to Mars and beyond. In order to reduce spacecraft weight without sacrificing structural integrity, NASA is pursuing the development of materials that promise to revolutionize not only spacecraft construction, but also a host of potential applications on Earth. Single-walled carbon nanotubes are one material of particular interest. These tubular, single-layer carbon molecules - 100,000 of them braided together would be no thicker than a human hair - display a range of remarkable characteristics. Possessing greater tensile strength than steel at a fraction of the weight, the nanotubes are efficient heat conductors with metallic or semiconductor electrical properties depending on their diameter and chirality (the pattern of each nanotube s hexagonal lattice structure). All of these properties make the nanotubes an appealing material for spacecraft construction, with the potential for nanotube composites to reduce spacecraft weight by 50 percent or more. The nanotubes may also feature in a number of other space exploration applications, including life support, energy storage, and sensor technologies. NASA s various

  18. Processor Units Reduce Satellite Construction Costs

    NASA Technical Reports Server (NTRS)

    2014-01-01

    As part of the effort to build the Fast Affordable Science and Technology Satellite (FASTSAT), Marshall Space Flight Center developed a low-cost telemetry unit which is used to facilitate communication between a satellite and its receiving station. Huntsville, Alabama-based Orbital Telemetry Inc. has licensed the NASA technology and is offering to install the cost-cutting units on commercial satellites.

  19. Reducing the Cost of Solar Cells

    SciTech Connect

    Scanlon, B.

    2012-04-01

    Solar-powered electricity prices could soon approach those of power from coal or natural gas thanks to collaborative research with solar startup Ampulse Corporation at the National Renewable Energy Laboratory. Silicon wafers account for almost half the cost of today's solar photovoltaic panels, so reducing or eliminating wafer costs is essential to bringing prices down. Current crystalline silicon technology converts energy in a highly efficient manner; however, that technology is manufactured with processes that could stand some improvement. The industry needs a method that is less complex, creates less waste and uses less energy. First, half the refined silicon is lost as dust in the wafer-sawing process, driving module costs higher. Wafers are sawn off of large cylindrical ingots, or boules, of silicon. A typical 2-meter boule loses as many as 6,000 potential wafers during sawing. Second, the wafers produced are much thicker than necessary. To efficiently convert sunlight into electricity, the wafers need be only one-tenth the typical thickness. NREL, the Oak Ridge National Laboratory and Ampulse have partnered on an approach to eliminate this waste and dramatically lower the cost of the finished solar panels. By using a chemical vapor deposition process to grow the silicon on inexpensive foil, Ampulse is able to make the solar cells just thick enough to convert most of the solar energy into electricity. No more sawdust - and no more wasting refined silicon materials. NREL developed the technology to grow high-quality silicon and ORNL developed the metal foil that has the correct crystal structure to support that growth. Ampulse is installing a pilot manufacturing line in NREL's Process Development Integration Laboratory, where solar companies can work closely with lab scientists on integrated equipment to answer pressing questions related to their technology development, as well as rapidly overcoming R and D challenges and risk. NREL's program is focused on

  20. Cost-shifting in the current medical environment

    NASA Astrophysics Data System (ADS)

    Gruber, William H.

    1994-12-01

    `Cost shifting' occurs when there is not a fair or accurate match of the payment and use of medical services. A common `cost shifting' occurs when an insured patient is charged more to cover free services provided to an uninsured patient. This paper documents the multiple negative consequences of the many categories of cost shifting, reviews forces which are leading both to an increase and decrease in the magnitude of cost shifting, and evaluates the consequences of cost shifting on the goals of U.S. health care reform and investment in medical technology. Policy to minimize the negative consequences of cost shifting is recommended.

  1. Can managed care reduce employers' retiree medical liability?

    PubMed

    Taylor, R S; Newton, B

    1991-01-01

    The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future.

  2. Manual for Reducing Educational Unit Costs in Latin American Countries.

    ERIC Educational Resources Information Center

    Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

    Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

  3. Mining internal data to reduce clinical costs.

    PubMed

    Teffeteller, Scott L; Kish, Thomas M

    2012-12-01

    Hospitals and health systems should undertake the following steps in pinpointing areas for clinical cost reduction: Identify potential areas of opportunity through an analysis of top discharges. Use severity-adjusted data to review variability by case. Review length of stay and resource consumption at a high level. Examine granular charge data and practice patterns. Determine action steps for improvement.

  4. Hummingbird: Dramatically Reducing Interplanetary Mission Cost

    NASA Astrophysics Data System (ADS)

    Wertz, J. R.; Van Allen, R. E.; Sarzi-Amade, N.; Shao, A.; Taylor, C.

    2012-06-01

    The Hummingbird interplanetary spacecraft has an available delta V of 2 to 4 km/sec and a recurring cost of 2 to 3 million, depending on the payload and configuration. The baseline telescope has a resolution of 30 cm at a distance of 100 km.

  5. Integrated Design Tools Reduce Risk, Cost

    NASA Technical Reports Server (NTRS)

    2012-01-01

    Thanks in part to a SBIR award with Langley Research Center, Phoenix Integration Inc., based in Wayne, Pennsylvania, modified and advanced software for process integration and design automation. For NASA, the tool has resulted in lower project costs and reductions in design time; clients of Phoenix Integration are experiencing the same rewards.

  6. Risk management: Reducing brownfield cleanup costs

    SciTech Connect

    Graves, N.

    1997-08-01

    Balancing environmental protection with economic vitality is crucial to maintaining competitiveness in world markets. One key initiative that has been identified as important to both environmental protection and the economy is the redevelopment of brownfields. Brownfield redevelopment can stimulate local economies that have been devastated by lost jobs and can recycle industrial land use, thereby preserving undeveloped lands. Many existing brownfield sites appear on the US Environmental Protection Agency`s (EPA) National Priority List (NPL), which designates over 1200 sites and is expected to grow to more than 2000 by the end of the decade. EPA estimates the cost of remediating the sites on the current list will approach $30 billion, with the average cost of remediating a site close to $25 million. Thousands of additional brownfield sites that do not appear on the NPL are listed under state cleanup programs.

  7. Medical cost-offset following treatment referral for alcohol and other drug use disorders in a group model HMO.

    PubMed

    Polen, Michael R; Freeborn, Donald K; Lynch, Frances L; Mullooly, John P; Dickinson, Daniel M

    2006-07-01

    The purpose of this study was to determine whether specialty alcohol and other drug (AOD) treatment is associated with reduced subsequent medical care costs. AOD treatment costs and medical costs in a group model health maintenance organization (HMO) were collected for up to 6 years on 1,472 HMO members who were recommended for specialty AOD treatment, and on 738 members without AOD diagnoses or treatment. Addiction Severity Index measures were also obtained from a sample of 293 of those recommended for treatment. Changes in medical costs did not differ between treatment and comparison groups. Nor did individuals with improved treatment outcomes have greater reductions in medical costs. AOD treatment costs were not inversely related to subsequent medical costs, except for a subgroup with recent AOD treatment. In the interviewed sample, better treatment outcomes did not predict lower subsequent medical costs. Multiple treatment episodes may hold promise for producing cost-offsets.

  8. Research requirements to reduce maintenance costs of civil helicopters

    NASA Technical Reports Server (NTRS)

    Million, D. J.; Waters, K. T.

    1978-01-01

    The maintenance problems faced by the operators of civil helicopters that result in high costs are documented. Existing technology that can be applied to reduce maintenance costs and research that should be carried out were identified. Good design practice and application of existing technology were described as having a significant impact on reducing maintenance costs immediately. The research and development that have potential for long range reduction of maintenance costs are presented.

  9. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran.

    PubMed

    Gharekhani, Afshin; Kanani, Negin; Khalili, Hossein; Dashti-Khavidaki, Simin

    2014-09-01

    Medication errors are ongoing problems among hospitalized patients especially those with multiple co-morbidities and polypharmacy such as patients with renal diseases. This study evaluated the frequency, types and direct related cost of medication errors in nephrology ward and the role played by clinical pharmacists. During this study, clinical pharmacists detected, managed, and recorded the medication errors. Prescribing errors including inappropriate drug, dose, or treatment durations were gathered. To assess transcription errors, the equivalence of nursery charts and physician's orders were evaluated. Administration errors were assessed by observing drugs' preparation, storage, and administration by nurses. The changes in medications costs after implementing clinical pharmacists' interventions were compared with the calculated medications costs if the medication errors were continued up to patients' discharge time. More than 85% of patients experienced medication error. The rate of medication errors was 3.5 errors per patient and 0.18 errors per ordered medication. More than 95% of medication errors occurred at prescription nodes. Most common prescribing errors were omission (26.9%) or unauthorized drugs (18.3%) and low drug dosage or frequency (17.3%). Most of the medication errors happened on cardiovascular drugs (24%) followed by vitamins and electrolytes (22.1%) and antimicrobials (18.5%). The number of medication errors was correlated with the number of ordered medications and length of hospital stay. Clinical pharmacists' interventions decreased patients' direct medication costs by 4.3%. About 22% of medication errors led to patients' harm. In conclusion, clinical pharmacists' contributions in nephrology wards were of value to prevent medication errors and to reduce medications cost.

  10. Research requirements to reduce civil helicopter life cycle cost

    NASA Technical Reports Server (NTRS)

    Blewitt, S. J.

    1978-01-01

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

  11. Reducing Risks Associated with Medical Device Misconnections

    MedlinePlus

    ... Devices Radiation-Emitting Products Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products Medical Devices Home Medical Devices ... Devices Radiation-Emitting Products Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products

  12. Reduce air, reduce compliance cost new patented spray booth technology

    SciTech Connect

    McGinnis, F.

    1997-12-31

    A New Paint Spray Booth System that dramatically reduces air volumes normally required for capturing and controlling paint overspray that contains either Volatile Organic Compounds (VOC) or Hazardous Air Pollutants (HAP), or both. In turn, a substantial reduction in capital equipment expenditures for air abatement systems and air make-up heaters as well as related annual operating expenses is realized.

  13. Increasing Density and Reducing Costs of Data Acquisition

    NASA Technical Reports Server (NTRS)

    Schmalzel, J. L.; Krchnavek, R. R.; Figueroa, J. Fernando; Solano, Wanda

    2001-01-01

    There are a number of reasons why it is important to increase the density of data acquisition functions. Sensor fusion seeks to integrate large numbers of sensors into a decision network. Addition of health monitoring functions may incur additional sensor requirements. But at the same time, it is important to reduce the per-channel costs of data acquisition systems. Often the most significant cost is the management of data acquisition networks, which incurs substantial costs associated with transducer installation, configuration, calibration, and maintenance. Alternatives that lower the cost of the transducer system and reduce the data acquisition system channel count will directly impact initial system costs. Other techniques that affect maintenance and operating costs will contribute to reducing life cycle costs. This paper describes work undertaken to explore alternative architectures for lowering the cost per transducer function using a MEMS-based accelerometer as the model.

  14. Developments in medical care costs: an update.

    PubMed

    Vincenzino, J V

    1993-01-01

    The nation spent roughly $830 billion on all categories of medical care in 1992. Available data for personal health care expenditures and prices indicate that their increases slightly slowed last year, but the burden placed on the economy by the total health care sector continues to mount. Although the uncertainty of the Presidential election is over, the debate on health care reform will continue.

  15. Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

    PubMed Central

    2012-01-01

    Background Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens. The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective. Material and methods A decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). Results Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (€3,062), followed by risperidone (€3,194), haloperidol (€3,322), olanzapine (€3,893), amisulpride (€4,247) and aripiprazole (€4,712). In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were €23,621/QALY gained, €91,584/QALY gained and €94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. Conclusions Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia. Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain

  16. Costs of Venous Thromboembolism Associated with Hospitalization for Medical Illness

    PubMed Central

    Cohoon, Kevin P.; Leibson, Cynthia L.; Ransom, Jeanine E.; Ashrani, Aneel A.; Petterson, Tanya M.; Long, Kirsten Hall; Bailey, Kent R.; Heit, John A.

    2015-01-01

    Objective To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Study Design Population-based cohort study conducted in Olmsted County, Minn. Methods Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days of hospitalization for acute medical illness over the 18-year period, 1988–2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case on event date (± 1 year), duration of prior medical history and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or 12/31/2011 (study end date). We censored follow-up such that each case and match control had similar periods of observation. We also controlled for length of follow-up from index to up to 5-years post-index. We used generalized linear modeling (controlling for age, sex, pre-existing conditions and costs 1 year before index) to predict costs for cases and controls. Results Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P=<0.001) from index to up to 5-years post-index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared to controls for up to 3 years. Conclusions VTE during or after recent hospitalization for medical illness contributes a substantial economic burden. PMID:26244788

  17. A Flexible Model for Correlated Medical Costs, with Application to Medical Expenditure Panel Survey Data

    PubMed Central

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T.; Zhang, Daowen; Severini, Thomas A.

    2016-01-01

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines is used to estimate unknown functions, and a modification to Akaike Information Criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey (MEPS) dataset. Simulation studies are conducted to assess the performance of our method. PMID:26403805

  18. A flexible model for correlated medical costs, with application to medical expenditure panel survey data.

    PubMed

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T; Zhang, Daowen; Severini, Thomas A

    2016-03-15

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines are used to estimate unknown functions, and a modification to Akaike information criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey dataset. Simulation studies are conducted to assess the performance of our method.

  19. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

  20. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  1. The relationship between medical care costs and personal bankruptcy.

    PubMed

    Brotman, Billie Ann

    2006-01-01

    The number of personal bankruptcy filings has broken records over the last few years. Filings for nonbusiness bankruptcy protection totaled 1,650,279 in 2003, an increase of 9.6 percent between the years 2002 and 2003. This article examines the relationship in the United States between personal bankruptcy filings, and medical care costs and coverage. There seems to be a positive, statistically significant relationship between medical care costs and nonbusiness bankruptcy numbers; however, medical care coverage has limited or no explanatory value as a factor explaining total nonbusiness bankruptcy filings. The regression models suggest a weak or no relationship between the number of nonbusiness bankruptcy filings and health insurance coverage.

  2. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  3. Trend of cost and utilization of COPD medication in Korea

    PubMed Central

    Lee, Jongmin; Lee, Jae Ha; Kim, Jee-Ae; Rhee, Chin Kook

    2017-01-01

    Background There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Methods Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. Results The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. Conclusion This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD. PMID:28031708

  4. Auditing medical records helps reduce liability.

    PubMed

    Ganguli, G; Winfrey, S

    1990-10-01

    An internal audit of a hospital's medical records department compares the department to standards developed by the hospital and to benchmarks set by accrediting organizations. An auditor can review the department's economy and effectiveness through employee surveys, direct observation, and interviews. By uncovering deficiencies and making recommendations for their correction, an internal audit can help limit a hospital's liability exposure.

  5. Strategies Used by Adults to Reduce Their Prescription Drug Costs

    MedlinePlus

    ... or private coverage to use strategies to save money on prescription drugs. Figure 3. Percentages of adults aged 18–64 ... doctor for a lower cost medication to save money …You bought prescription drugs from another country to save money …You ...

  6. How Are the Costs of Care for Medical Falls Distributed? The Costs of Medical Falls by Component of Cost, Timing, and Injury Severity

    ERIC Educational Resources Information Center

    Bohl, Alex A.; Phelan, Elizabeth A.; Fishman, Paul A.; Harris, Jeffrey R.

    2012-01-01

    Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…

  7. Patient cost sharing and medical expenditures for the Elderly.

    PubMed

    Fukushima, Kazuya; Mizuoka, Sou; Yamamoto, Shunsuke; Iizuka, Toshiaki

    2016-01-01

    Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes.

  8. Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs

    PubMed Central

    Hahn, Kathryn L.

    2011-01-01

    Background The use of prescription opioid drugs has the potential to lead to patient abuse of these medications, addiction, and diversion. Such an abuse is associated with increased costs because of excessive healthcare utilization. Finding ways to minimize the risk for abuse and addiction can enhance patient outcomes and reduce costs to patients and to payers. Objective To review current strategies that may reduce the risk for misuse and abuse of opioid medications, which in turn can enhance patient outcomes and lower costs to health insurers and patients. Discussion Implementing approaches that will encourage the use of safe practices (universal precautions) in pain management by providers can reduce the risk for abuse and misuse associated with chronic pain medications, especially opioids. These approaches include, but are not limited to, extensive physician and patient education regarding these medications and their associated risks for abuse; the development of prescription monitoring programs to detect physician or pharmacy shopping; the detection of inappropriate prescribing and medical errors; the use of physician-patient contracts concerning opioid treatment; the requirement of presenting a photo identification to pick up an opioid prescription at the pharmacy; urine drug toxicology screening; provisions for safe disposal of unused opioids; referrals to pain and addiction specialists; and potentially encouraging the use of opioid formulations aimed at reducing abuse. Conclusion Supporting such approaches by health insurers and educating providers and patients on the risks associated with chronic pain medications can help minimize the risk of prescription opioid abuse, addiction, and diversion; reduce health services utilization associated with opioid abuse; improve patient outcomes; and reduce overall costs. PMID:25126342

  9. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

    ERIC Educational Resources Information Center

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-01-01

    Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

  10. Reducing biosolids disposal costs using land application in forested areas

    SciTech Connect

    Huffines, R.L.

    1995-11-01

    Switching biosolids land application from a reclamation site to a forested site significantly reduced the cost of biosolids disposal at the Savannah River Site. Previous beneficial reuse programs focused on reclamation of existing borrow pits. While extremely beneficial, this program became very costly due to the regulatory requirements for groundwater monitoring, soil monitoring and frequent biosolids analyses. A new program was developed to reuse biosolids in forested areas where the biosolids could be used as a soil conditioner and fertilizer to enhance timber yield. The forested land application site was designed so that groundwater monitoring and soil monitoring could be eliminated while biosolids monitoring and site maintenance were minimized. Monitoring costs alone were reduced by 80%. Capital costs for site preparation were also significantly reduced since there was no longer a need for expensive groundwater monitoring wells.

  11. Reducing Design Cycle Time and Cost Through Process Resequencing

    NASA Technical Reports Server (NTRS)

    Rogers, James L.

    2004-01-01

    In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

  12. Medical education, cost and policy: what are the drivers for change? Commentary.

    PubMed

    Walsh, Kieran

    2014-01-01

    Medical education is expensive. Its expense has led many stakeholders to speculate on how costs could be reduced. In an ideal world such decisions would be made on sound evidence; however this is impossible in the absence of evidence. Sometimes practice will be informed by policy, but policy will not always be evidence based. So how is policy in the field of cost and value in medical education actually developed? The foremost influence on policy in cost and value should be evidence-based knowledge. Unfortunately policy is sometimes influenced by what might at best be termed tradition and at worst inertia. Another influence on policy will be people--but some individuals may have more influence than others. A further influence on policy in this field is events, and mainly events that have gone wrong. One final influence on emerging policy in medical education cost analysis is that of the media.

  13. FMEA: a model for reducing medical errors.

    PubMed

    Chiozza, Maria Laura; Ponzetti, Clemente

    2009-06-01

    Patient safety is a management issue, in view of the fact that clinical risk management has become an important part of hospital management. Failure Mode and Effect Analysis (FMEA) is a proactive technique for error detection and reduction, firstly introduced within the aerospace industry in the 1960s. Early applications in the health care industry dating back to the 1990s included critical systems in the development and manufacture of drugs and in the prevention of medication errors in hospitals. In 2008, the Technical Committee of the International Organization for Standardization (ISO), licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. Here we describe the main steps of the FMEA process and review data available on the application of this technique to laboratory medicine. A significant reduction of the risk priority number (RPN) was obtained when applying FMEA to blood cross-matching, to clinical chemistry analytes, as well as to point-of-care testing (POCT).

  14. How To Reduce the Cost of Vandalism Losses.

    ERIC Educational Resources Information Center

    Edwards, L. F.

    This speech discusses security measures that could be implemented in school buildings to reduce vandalism and its associated costs. Some suggested methods for reducing vandalism include (1) employment of security guards, (2) 24-hour deployment of custodial staff, (3) installation of unbreakable doors and tamper-proof locks, and (4) use of an…

  15. Potential impact of pharmacist interventions to reduce cost for Medicare Part D beneficiaries.

    PubMed

    Thatcher, Erin E; Vanwert, Elizabeth M; Erickson, Steven R

    2013-06-01

    The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients' therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients' pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program.

  16. Prospects for reducing the processing cost of lithium ion batteries

    NASA Astrophysics Data System (ADS)

    Wood, David L.; Li, Jianlin; Daniel, Claus

    2015-02-01

    A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: 1) elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; 2) doubling the thicknesses of the anode and cathode to raise energy density; and 3) reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and a standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from 502.8 kW h-1-usable to 370.3 kW h-1-usable, a savings of 132.5/kWh (or 26.4%).

  17. MEDICAL COSTS OF OSTEOPOROSIS IN THE ELDERLY MEDICARE POPULATION

    PubMed Central

    Blume, Steven W; Curtis, JR

    2013-01-01

    Introduction National cost estimates of osteoporosis and fractures in the U.S. have been based on diverse sets of provider data or selected commercial insurance claims. We sought to characterize prevalence and costs for osteoporosis using a random population-based sample of older adults. Methods A cross-sectional estimate of medical cost was made with 2002 data from the Medicare Current Beneficiary Survey (MCBS). MCBS combines health interviews with claims information from all payers to profile a random sample of 12,700 Medicare recipients. Three cohorts aged 65 or over were defined: 1) patients experiencing a fracture-related claim in 2002; 2) patients with a diagnosis, medication, or self-report for osteoporosis or past hip fracture; and 3) non-case controls. The total cost of patient claims was compared to that of controls using multivariate regression. Results Of 30.2 million elderly Medicare recipients in 2002, 1.6 million (5%) were treated for a fracture that year and an additional 7.2 million (24%) have osteoporosis without a fracture. The estimated mean impact of fractures on annual medical cost was $8600 (95%CI: $6400 to $10,800), implying a U.S. cost of $14 billion ($10 to $17 billion). Half of the non-fracture osteoporosis patients received drug treatment, averaging $500 per treated patient, or $2 billion nationwide. Conclusions The annual cost of osteoporosis and fractures in the U.S. elderly was estimated at $16 billion, using a national 2002 population-based sample. This amount corroborates previous estimates based on substantially different methodologies. Projected to 2008, the national cost of osteoporosis and fractures was $22 billion. PMID:21165602

  18. The blood parasite Haemoproteus reduces survival in a wild bird: a medication experiment

    PubMed Central

    la Puente, Josué Martínez-de; Merino, Santiago; Tomás, Gustavo; Moreno, Juan; Morales, Judith; Lobato, Elisa; García-Fraile, Sonia; Belda, Eduardo Jorge

    2010-01-01

    While avian chronic haemoparasite infections induce reproductive costs, infection has not previously been shown to affect survival. Here, we experimentally reduced, through medication, the intensity of infection by Haemoproteus parasites in wild-breeding female blue tits Cyanistes caeruleus. However, this treatment did not reduce the intensity of infection in males or the intensity of infection by Leucocytozoon. Medicated females, but not males, showed increased local survival until the next breeding season compared with control birds. To our knowledge, this is the first empirical evidence showing long-term direct survival costs of chronic Haemoproteus infections in wild birds. PMID:20181556

  19. Surgical Cost Disclosure May Reduce Operating Room Expenditures.

    PubMed

    Austin, Luke S; Tjoumakaris, Fotios P; Ong, Alvin C; Lombardi, Nicholas J; Wowkanech, Charles D; Mehnert, Michael J

    2017-03-01

    Health care expenditures are rising in the United States. Recent policy changes are attempting to reduce spending through the development of value-based payment systems that rely heavily on cost transparency. This study was conducted to investigate whether cost disclosure influences surgeons to reduce operating room expenditures. Beginning in 2012, surgeon scorecards were distributed at a regional health care system. The scorecard reported the actual direct supply cost per case for a specific procedure and compared each surgeon's data with those of other surgeons in the same subspecialty. Rotator cuff repair was chosen for analysis. Actual direct supply cost per case was calculated quarterly and collected over a 2-year period. Surgeons were given a questionnaire to determine their interest in the scorecard. Actual direct supply cost per rotator cuff repair procedure decreased by $269 during the study period. A strong correlation (R(2)=0.77) between introduction of the scorecards and cost containment was observed. During the study period, a total of $39,831 was saved. Of the surgeons who were queried, 89% were interested in the scorecard and 56% altered their practice as a result. Disclosure of surgical costs may be an effective way to control operating room spending. The findings suggest that providing physicians with knowledge about their surgical charges can alter per-case expenditures. [Orthopedics. 2017; 40(2):e269-e274.].

  20. Using a Cost-Construction Model To Assess the Cost of Educating Undergraduate Medical Students at the University of Texas-Houston Medical School.

    ERIC Educational Resources Information Center

    Franzini, Luisa; And Others

    1997-01-01

    Using a cost-construction model, cost of the University of Texas-Houston Medical School program, instructional costs, educational costs, and milieu costs were calculated. Sensitivity analysis revealed the financial effects of various factors, some of which increased and some of which decreased cost. Despite inherent complexities of the method and…

  1. With the advent of domestic 3-dimensional (3D) printers and their associated reduced cost, is it now time for every medical school to have their own 3D printer?

    PubMed

    Balestrini, Christopher; Campo-Celaya, Tatiana

    2016-01-01

    Anatomy is the backbone of medical education and new techniques to improve learning are frequently explored. With the introduction of 3D printers specifically for the home market, the price of this technology has reached affordable levels. Using patient scan data, accurate 3D models can be printed that represent real human variation in anatomy to provide an innovative, inexpensive and valuable adjunct to anatomical teaching. Is it now time for every medical school to have their own 3D printer?

  2. Comparative Cost-Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction

    PubMed Central

    Ito, Kouta; Shrank, William H; Avorn, Jerry; Patrick, Amanda R; Brennan, Troyen A; Antman, Elliot M; Choudhry, Niteesh K

    2012-01-01

    Objective To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. Data Sources/Study Setting Cost-effectiveness analysis. Study Design We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. Data Collection/Extraction Methods Model inputs were extracted from published literature. Principal Findings Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month. Conclusions Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence. PMID:22998129

  3. Optimizing Ice Thermal Storage to Reduce Energy Cost

    NASA Astrophysics Data System (ADS)

    Hall, Christopher L.

    Energy cost for buildings is an issue of concern for owners across the U.S. The bigger the building, the greater the concern. A part of this is due to the energy required to cool the building and the way in which charges are set when paying for energy consumed during different times of the day. This study will prove that designing ice thermal storage properly will minimize energy cost in buildings. The effectiveness of ice thermal storage as a means to reduce energy costs lies within transferring the time of most energy consumption from on-peak to off-peak periods. Multiple variables go into the equation of finding the optimal use of ice thermal storage and they are all judged with the final objective of minimizing monthly energy costs. This research discusses the optimal design of ice thermal storage and its impact on energy consumption, energy demand, and the total energy cost. A tool for optimal design of ice thermal storage is developed, considering variables such as chiller and ice storage sizes and charging and discharge times. The simulations take place in a four-story building and investigate the potential of Ice Thermal Storage as a resource in reducing and minimizing energy cost for cooling. The simulations test the effectiveness of Ice Thermal Storage implemented into the four-story building in ten locations across the United States.

  4. Reduced cost and improved figure of sapphire optical components

    NASA Astrophysics Data System (ADS)

    Walters, Mark; Bartlett, Kevin; Brophy, Matthew R.; DeGroote Nelson, Jessica; Medicus, Kate

    2015-10-01

    Sapphire presents many challenges to optical manufacturers due to its high hardness and anisotropic properties. Long lead times and high prices are the typical result of such challenges. The cost of even a simple 'grind and shine' process can be prohibitive. The high precision surfaces required by optical sensor applications further exacerbate the challenge of processing sapphire thereby increasing cost further. Optimax has demonstrated a production process for such windows that delivers over 50% time reduction as compared to traditional manufacturing processes for sapphire, while producing windows with less than 1/5 wave rms figure error. Optimax's sapphire production process achieves significant improvement in cost by implementation of a controlled grinding process to present the best possible surface to the polishing equipment. Following the grinding process is a polishing process taking advantage of chemical interactions between slurry and substrate to deliver excellent removal rates and surface finish. Through experiments, the mechanics of the polishing process were also optimized to produce excellent optical figure. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. Through specially developed polishing slurries, the peak-to-valley figure error of spherical sapphire parts is reduced by over 80%.

  5. Standardization - A method of reducing auxiliary propulsion systems costs

    NASA Technical Reports Server (NTRS)

    Jones, L. W.

    1977-01-01

    This paper deals with the efforts of the National Aeronautics and Space Administration to take advantage of the economies made possible by the Space Shuttle by reducing the costs of acquiring and flying payloads for the Shuttle. Specifically, the paper addresses the route that NASA's Low Cost Systems Office is following in order to reduce the cost of auxiliary propulsion systems. This approach emphasizes the establishment of standard hardware items, which will be used on as many spacecraft as possible. The method by which a standard is selected and how it is maintained as a standard are discussed. The process by which the 5 Newton hydrazine thruster was adopted is described, as a typical example.

  6. Rightsizing HVAC Systems to Reduce Capital Costs and Save Energy

    ERIC Educational Resources Information Center

    Sebesta, James

    2010-01-01

    Nearly every institution is faced with the situation of having to reduce the cost of a construction project from time to time through a process generally referred to as "value engineering." Just the mention of those words, however, gives rise to all types of connotations, thoughts, and memories (usually negative) for those in the…

  7. Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

    ERIC Educational Resources Information Center

    Martini, Gilbert R., Jr.

    1991-01-01

    A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

  8. Adapting smartphones for low-cost optical medical imaging

    NASA Astrophysics Data System (ADS)

    Pratavieira, Sebastião.; Vollet-Filho, José D.; Carbinatto, Fernanda M.; Blanco, Kate; Inada, Natalia M.; Bagnato, Vanderlei S.; Kurachi, Cristina

    2015-06-01

    Optical images have been used in several medical situations to improve diagnosis of lesions or to monitor treatments. However, most systems employ expensive scientific (CCD or CMOS) cameras and need computers to display and save the images, usually resulting in a high final cost for the system. Additionally, this sort of apparatus operation usually becomes more complex, requiring more and more specialized technical knowledge from the operator. Currently, the number of people using smartphone-like devices with built-in high quality cameras is increasing, which might allow using such devices as an efficient, lower cost, portable imaging system for medical applications. Thus, we aim to develop methods of adaptation of those devices to optical medical imaging techniques, such as fluorescence. Particularly, smartphones covers were adapted to connect a smartphone-like device to widefield fluorescence imaging systems. These systems were used to detect lesions in different tissues, such as cervix and mouth/throat mucosa, and to monitor ALA-induced protoporphyrin-IX formation for photodynamic treatment of Cervical Intraepithelial Neoplasia. This approach may contribute significantly to low-cost, portable and simple clinical optical imaging collection.

  9. Children with medical complexity and Medicaid: spending and cost savings.

    PubMed

    Berry, Jay G; Hall, Matt; Neff, John; Goodman, Denise; Cohen, Eyal; Agrawal, Rishi; Kuo, Dennis; Feudtner, Chris

    2014-12-01

    A small but growing population of children with medical complexity, many of whom are covered by Medicaid, accounts for a high proportion of pediatric health care spending. We first describe the expenditures for children with medical complexity insured by Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for these children, relative to the small amount of primary care and home care spending. We then present a business case that estimates how cost savings might be achieved for children with medical complexity from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.

  10. Reducing medication errors in critical care: a multimodal approach

    PubMed Central

    Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad

    2014-01-01

    The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478

  11. Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

    PubMed

    Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

    2015-05-01

    Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

  12. Cost-effectiveness of reducing sulfur emissions from ships.

    PubMed

    Wang, Chengfeng; Corbett, James J; Winebrake, James J

    2007-12-15

    We model cost-effectiveness of control strategies for reducing SO2 emissions from U.S. foreign commerce ships traveling in existing European or hypothetical U.S. West Coast SO(x) Emission Control Areas (SECAs) under international maritime regulations. Variation among marginal costs of control for individual ships choosing between fuel-switching and aftertreatment reveals cost-saving potential of economic incentive instruments. Compared to regulations prescribing low sulfur fuels, a performance-based policy can save up to $260 million for these ships with 80% more emission reductions than required because least-cost options on some individual ships outperform standards. Optimal simulation of a market-based SO2 control policy for approximately 4,700 U.S. foreign commerce ships traveling in the SECAs in 2002 shows that SECA emissions control targets can be achieved by scrubbing exhaust gas of one out of ten ships with annual savings up to $480 million over performance-based policy. A market-based policy could save the fleet approximately $63 million annually under our best-estimate scenario. Spatial evaluation of ship emissions reductions shows that market-based instruments can reduce more SO2 closer to land while being more cost-effective for the fleet. Results suggest that combining performance requirements with market-based instruments can most effectively control SO2 emissions from ships.

  13. Small Habitat Commonality Reduces Cost for Human Mars Missions

    NASA Technical Reports Server (NTRS)

    Griffin, Brand N.; Lepsch, Roger; Martin, John; Howard, Robert; Rucker, Michelle; Zapata, Edgar; McCleskey, Carey; Howe, Scott; Mary, Natalie; Nerren, Philip (Inventor)

    2015-01-01

    Most view the Apollo Program as expensive. It was. But, a human mission to Mars will be orders of magnitude more difficult and costly. Recently, NASA's Evolvable Mars Campaign (EMC) mapped out a step-wise approach for exploring Mars and the Mars-moon system. It is early in the planning process but because approximately 80% of the total life cycle cost is committed during preliminary design, there is an effort to emphasize cost reduction methods up front. Amongst the options, commonality across small habitat elements shows promise for consolidating the high bow-wave costs of Design, Development, Test and Evaluation (DDT&E) while still accommodating each end-item's functionality. In addition to DDT&E, there are other cost and operations benefits to commonality such as reduced logistics, simplified infrastructure integration and with inter-operability, improved safety and simplified training. These benefits are not without a cost. Some habitats are sub-optimized giving up unique attributes for the benefit of the overall architecture and because the first item sets the course for those to follow, rapidly developing technology may be excluded. The small habitats within the EMC include the pressurized crew cabins for the ascent vehicle,

  14. Elders Who Delay Medication because of Cost: Health Insurance, Demographic, Health, and Financial Correlates

    ERIC Educational Resources Information Center

    Klein, Dawn; Turvey, Carolyn; Wallace, Robert

    2004-01-01

    Purpose: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost.…

  15. Leveraging metal matrix composites to reduce costs in space mechanisms

    NASA Technical Reports Server (NTRS)

    Nye, Ted; Claridge, Rex; Walker, Jim

    1994-01-01

    Advanced metal matrix composites may be one of the most promising technologies for reducing cost in structural components without compromise to strength or stiffness. A microlight 12.50 N (2.81 lb), two-axis, solar array drive assembly (SADA) was made for the Advanced Materials Applications to Space Structures (AMASS) Program flight experiment. The SADA had both its inner and outer axis housings fabricated from silicon carbide particulate reinforced alumimun. Two versions of the housings were made. The first was machined from a solid billet of material. The second was plaster cast to a near net shape that required minimal finish machining. Both manufacturing methods were compared upon completion. Results showed a cost savings with the cast housing was possible for quantities greater than one and probable for quantities greater than two. For quantities approaching ten, casting resulted in a reduction factor of almost three in the cost per part.

  16. Copper-nickel piping reduces costs, biofouling/corrosion

    SciTech Connect

    Albaugh, E.K.

    1984-11-01

    Seawater piping systems for offshore drilling rigs and platforms are typically plagued by biofouling and/or corrosion, with piping failures occurring in only a few years. Discussed are alternate pipe materials with the emphasis on the testing of a copper-nickel alloy in the Gulf of Mexico. Results show that although initially more expensive, use of this alloy can extend system life to 20 years or more while improving productivity and reducing overall costs when compared to a comparable steel system.

  17. Advanced transfer chute reduces dust at lower cost

    SciTech Connect

    Blazek, C.

    2005-10-01

    Dominion Resources' Kincaid Generating Station in Illinois is recognized as a leader in handling and burning PRB coal. Since being named the Powder Plant of the Year in 2001 and 2004 by the PRB Coal Users' Group, Kincaid has improved its coal handling by installing an InteliFlo controlled-flow transfer chute from Benetech. The InteliFlo design eliminates the need for skirt boards, conveyor discharge hoods, and complex load bed designs, and reduces O & M costs. 4 figs.

  18. Retail medical clinics: increasing access to low cost medical care amongst a developing legal environment.

    PubMed

    Schleiter, Kristin E

    2010-01-01

    Retail medical clinics are an innovation in health care with the potential to increase access to low-cost basic health care services while changing the delivery model for routine, non-urgent medical care. However, the few states that attempted to directly regulate retail medical clinics have been met with criticism by the FTC due to the proposed legislations' anticompetitive undertones. The relationship between retail medical clinics and the host stores or pharmacies that house them has the potential to spark fraud and abuse concerns. Retail medical clinics must abide by state-specific regulation on scope of practice of the various mid-level practitioners who work for the clinics, particularly to minimize exposure to litigation and keep within the clinics' intended purpose of a supplement to primary care physician offices. The author concludes that the consumer benefits of cost and convenience, combined with the potential for growth and expanded consumer base from a retailers' perspective, make the legal challenge inherent in running a retail medical clinic well worth the effort.

  19. Population-based medical and disease management: an evaluation of cost and quality.

    PubMed

    Wise, Christopher G; Bahl, Vinita; Mitchell, Rita; West, Brady T; Carli, Thomas

    2006-02-01

    Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services. Evaluation of the difference in utilization was based on the difference in the cost per-member-per-month (PMPM) in a 1-year measurement period, after adjusting for differences in fee schedules, case-mix and healthcare benefit design. After adjustments for both case-mix and benefit differences, the study group is $63 PMPM less costly than the comparison population for all members. Cost differences are largest in the 55-64 and 65 and above age groups. The study group is $115 PMPM lower than the comparison population for the age category of 65 years and older, after adjustments for case-mix and benefits. Health Plan Employer and Data Information Set (HEDIS)-based quality outcomes are near the 90th percentile for most indications. The cost outcomes of a population served by proactive, population-based disease management and complex care management, compared to an unmanaged population, demonstrates the potential of coordinated medical and disease management programs. Further studies utilizing appropriate methodologies would be beneficial.

  20. Reducing costs with well tractors for horizontal wells

    SciTech Connect

    Hallundbaek, J.

    1995-12-31

    The Well Tractor is a new concept for a down hole tool that significantly reduces operation costs for servicing horizontal wells. The Well Tractor is a cost effective alternative to the very expensive and time consuming conventional drill pipe conveyed operations. The Well Tractor is capable of pulling coiled tubing and/or wireline horizontally beyond 10,000 ft. The Well Tractor is capable of pulling more then 25,000 ft of coiled tubing and/or wireline into a highly deviated well. Furthermore the tool is designed for pushing other tools into the hole, e.g. logging tools, video cameras. The lateral reach capacity with coiled tubing is therefore increased considerably. Time consuming production logging operations of horizontal wells utilizing jointed pipe can be carried out by the Well Tractor as a wireline job.

  1. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1986-01-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Company, acting as Contractor of the City of Long Beach, Operator of the Long Beach Unit. Thums Long Beach Company currently operates 700 submersible pump installations located on four man-made islands and one land fill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100 percent pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from utilizing higher efficiency pumps and a reduced frequency of pulling submersible equipment.

  2. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1989-02-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Co., acting as contractor for the City of Long Beach, operator of the Long Beach Unit. Thums Long Beach Co. currently operates 700 submersible pump installations located on four manmade islands and one landfill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100% pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and to lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump-performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from using more efficient pumps and a reduced frequency of pulling submersible equipment.

  3. Reducing costs in aircraft: The metals affordability initiative consortium

    NASA Astrophysics Data System (ADS)

    Martin, Rick; Evans, Daniel

    2000-03-01

    Emerging metallic materials, processing, and manufacturing technologies offer an important opportunity to meet current aircraft-airframe and jet-engine affordability goals, due to their inherent low material costs and excellent producibility characteristics. But to successfully meet systems goals within this new affordability-driven scenario, a consolidation ofindustry and military-agency development resources and technology-implementation activities is necessary to positively impact the military-aircraft production and sustainment infrastructure. To address this need, a consortium of aircraft and engine manufacturers and key material-and engine manufacturers and key material-and component-supplier companies has been formed to identify critical affordable metal technologies, develop a strategic roadmap for accelerated development and insertion of these technologies, and oversee execution of development activities by integrated industry teams. the goal of the Metals Affordability Initiative is to reduce the cost of metallic components by 50 percent while accelerating the implementation time.

  4. Reducing Development and Operations Costs using NASA's "GMSEC" Systems Architecture

    NASA Technical Reports Server (NTRS)

    Smith, Dan; Bristow, John; Crouse, Patrick

    2007-01-01

    This viewgraph presentation reviews the role of Goddard Mission Services Evolution Center (GMSEC) in reducing development and operation costs in handling the massive data from NASA missions. The goals of GMSEC systems architecture development are to (1) Simplify integration and development, (2)Facilitate technology infusion over time, (3) Support evolving operational concepts, and (4) All for mix of heritage, COTS and new components. First 3 missions (i.e., Tropical Rainforest Measuring Mission (TRMM), Small Explorer (SMEX) missions - SWAS, TRACE, SAMPEX, and ST5 3-Satellite Constellation System) each selected a different telemetry and command system. These results show that GMSEC's message-bus component-based framework architecture is well proven and provides significant benefits over traditional flight and ground data system designs. The missions benefit through increased set of product options, enhanced automation, lower cost and new mission-enabling operations concept options .

  5. Reducing the Time and Cost of Testing Engines

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Producing a new aircraft engine currently costs approximately $1 billion, with 3 years of development time for a commercial engine and 10 years for a military engine. The high development time and cost make it extremely difficult to transition advanced technologies for cleaner, quieter, and more efficient new engines. To reduce this time and cost, NASA created a vision for the future where designers would use high-fidelity computer simulations early in the design process in order to resolve critical design issues before building the expensive engine hardware. To accomplish this vision, NASA's Glenn Research Center initiated a collaborative effort with the aerospace industry and academia to develop its Numerical Propulsion System Simulation (NPSS), an advanced engineering environment for the analysis and design of aerospace propulsion systems and components. Partners estimate that using NPSS has the potential to dramatically reduce the time, effort, and expense necessary to design and test jet engines by generating sophisticated computer simulations of an aerospace object or system. These simulations will permit an engineer to test various design options without having to conduct costly and time-consuming real-life tests. By accelerating and streamlining the engine system design analysis and test phases, NPSS facilitates bringing the final product to market faster. NASA's NPSS Version (V)1.X effort was a task within the Agency s Computational Aerospace Sciences project of the High Performance Computing and Communication program, which had a mission to accelerate the availability of high-performance computing hardware and software to the U.S. aerospace community for its use in design processes. The technology brings value back to NASA by improving methods of analyzing and testing space transportation components.

  6. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  7. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  8. Reducing Mission Costs by Leveraging Previous Investments in Space

    NASA Technical Reports Server (NTRS)

    Miller, Ron; Adams, W. James

    1999-01-01

    The Rapid Spacecraft Development Office (RSDO) at NASA's Goddard Space Flight Center has been charged with the responsibility to reduce mission cost by allowing access to previous developments on government and commercial space missions. RSDO accomplishes this responsibility by implementing two revolutionary contract vehicles, the Rapid Spacecraft Acquisition (RSA) and Quick Ride. This paper will describe the concept behind these contracts, the current capabilities available to missions, analysis of pricing trends to date using the RSDO processes, and future plans to increase flexibility and capabilities available to mission planners.

  9. Economical evolution: microbes reduce the synthetic cost of extracellular proteins.

    PubMed

    Smith, Daniel R; Chapman, Matthew R

    2010-08-24

    Protein evolution is not simply a race toward improved function. Because organisms compete for limited resources, fitness is also affected by the relative economy of an organism's proteome. Indeed, many abundant proteins contain relatively high percentages of amino acids that are metabolically less taxing for the cell to make, thus reducing cellular cost. However, not all abundant proteins are economical, and many economical proteins are not particularly abundant. Here we examined protein composition and found that the relative synthetic cost of amino acids constrains the composition of microbial extracellular proteins. In Escherichia coli, extracellular proteins contain, on average, fewer energetically expensive amino acids independent of their abundance, length, function, or structure. Economic pressures have strategically shaped the amino acid composition of multicomponent surface appendages, such as flagella, curli, and type I pili, and extracellular enzymes, including type III effector proteins and secreted serine proteases. Furthermore, in silico analysis of Pseudomonas syringae, Mycobacterium tuberculosis, Saccharomyces cerevisiae, and over 25 other microbes spanning a wide range of GC content revealed a broad bias toward more economical amino acids in extracellular proteins. The synthesis of any protein, especially those rich in expensive aromatic amino acids, represents a significant investment. Because extracellular proteins are lost to the environment and not recycled like other cellular proteins, they present a greater burden on the cell, as their amino acids cannot be reutilized during translation. We hypothesize that evolution has optimized extracellular proteins to reduce their synthetic burden on the cell.

  10. An Application of Six Sigma to Reduce Supplier Quality Cost

    NASA Astrophysics Data System (ADS)

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

    2016-01-01

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

  11. Brand name versus generic drugs: the ethical quandary in caring for our sophisticated patients while trying to reduce health-care costs: facts and controversies.

    PubMed

    Payette, Michael; Grant-Kels, Jane M

    2013-01-01

    Medical ethics are the values and guidelines that govern decisions made in medical practice. Four prima facie moral principles can serve as a framework to help physicians analyze problems and make ethical decisions: (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice. With the cost of health care rising, all parties involved in the delivery of health care need to work to reduce costs, while continuing to provide quality care to our patients. One mechanism to reduce costs is to increase utilization of generic medications in daily practice, but there are many ethical issues inherent in utilizing brand name versus generic medications in dermatology.

  12. Fixed-point image orthorectification algorithms for reduced computational cost

    NASA Astrophysics Data System (ADS)

    French, Joseph Clinton

    Imaging systems have been applied to many new applications in recent years. With the advent of low-cost, low-power focal planes and more powerful, lower cost computers, remote sensing applications have become more wide spread. Many of these applications require some form of geolocation, especially when relative distances are desired. However, when greater global positional accuracy is needed, orthorectification becomes necessary. Orthorectification is the process of projecting an image onto a Digital Elevation Map (DEM), which removes terrain distortions and corrects the perspective distortion by changing the viewing angle to be perpendicular to the projection plane. Orthorectification is used in disaster tracking, landscape management, wildlife monitoring and many other applications. However, orthorectification is a computationally expensive process due to floating point operations and divisions in the algorithm. To reduce the computational cost of on-board processing, two novel algorithm modifications are proposed. One modification is projection utilizing fixed-point arithmetic. Fixed point arithmetic removes the floating point operations and reduces the processing time by operating only on integers. The second modification is replacement of the division inherent in projection with a multiplication of the inverse. The inverse must operate iteratively. Therefore, the inverse is replaced with a linear approximation. As a result of these modifications, the processing time of projection is reduced by a factor of 1.3x with an average pixel position error of 0.2% of a pixel size for 128-bit integer processing and over 4x with an average pixel position error of less than 13% of a pixel size for a 64-bit integer processing. A secondary inverse function approximation is also developed that replaces the linear approximation with a quadratic. The quadratic approximation produces a more accurate approximation of the inverse, allowing for an integer multiplication calculation

  13. Urban water infrastructure optimization to reduce environmental impacts and costs.

    PubMed

    Lim, Seong-Rin; Suh, Sangwon; Kim, Jung-Hoon; Park, Hung Suck

    2010-01-01

    Urban water planning and policy have been focusing on environmentally benign and economically viable water management. The objective of this study is to develop a mathematical model to integrate and optimize urban water infrastructures for supply-side planning and policy: freshwater resources and treated wastewater are allocated to various water demand categories in order to reduce contaminants in the influents supplied for drinking water, and to reduce consumption of the water resources imported from the regions beyond a city boundary. A case study is performed to validate the proposed model. An optimal urban water system of a metropolitan city is calculated on the basis of the model and compared to the existing water system. The integration and optimization decrease (i) average concentrations of the influents supplied for drinking water, which can improve human health and hygiene; (ii) total consumption of water resources, as well as electricity, reducing overall environmental impacts; (iii) life cycle cost; and (iv) water resource dependency on other regions, improving regional water security. This model contributes to sustainable urban water planning and policy.

  14. Service company alliance reduces tight sands frac costs

    SciTech Connect

    Hunter, J.L. ); Stuchly, S.G. )

    1994-08-15

    Smaller, multiple-stage fracture treatments, worked out by an alliance between a producing and a service company, were a significant element in reducing costs for fracturing Carthage Cotton Valley infill wells in Panola County, Texas. Pennzoil's infill drilling program takes advantage of the Texas Railroad Commission's (RRC) ruling that allows optional 80-acre well spacing in this tight gas-sand reservoir. Pennzoil spudded 29 wells between September 1992 and December 1993 and expects to spud 20 more in 1994. The Pennzoil-Halliburton alliance began in September 1992 for the purpose of drilling and completing Cotton Valley infill wells through 1993. The two companies share the cost of new technology development, with Pennzoil providing the rig times to test Halliburton technology. To date, the alliance has experimented with an elastic strain relaxation, a six-arm extensometer, and a water-recovery surfactant. Some of the features of the alliance are: Halliburton guarantees the availability of crews and equipment to meet Pennzoil's drilling and completion schedule; Halliburton technical advisor studies existing wells to find candidates for workover or refracture; the technical advisor analyzes, plants, and evaluates the ongoing program; and the alliance is not rigidly structured, and other service companies perform part of the work. Both parties have benefited financially from the alliance and well performance has met or exceeded expectations. The alliance has enabled Pennzoil to stay on a rigid and aggressive drilling schedule and through efforts of the alliance, fracture orientation has been confirmed.

  15. Global cost estimates of reducing carbon emissions through avoided deforestation.

    PubMed

    Kindermann, Georg; Obersteiner, Michael; Sohngen, Brent; Sathaye, Jayant; Andrasko, Kenneth; Rametsteiner, Ewald; Schlamadinger, Bernhard; Wunder, Sven; Beach, Robert

    2008-07-29

    Tropical deforestation is estimated to cause about one-quarter of anthropogenic carbon emissions, loss of biodiversity, and other environmental services. United Nations Framework Convention for Climate Change talks are now considering mechanisms for avoiding deforestation (AD), but the economic potential of AD has yet to be addressed. We use three economic models of global land use and management to analyze the potential contribution of AD activities to reduced greenhouse gas emissions. AD activities are found to be a competitive, low-cost abatement option. A program providing a 10% reduction in deforestation from 2005 to 2030 could provide 0.3-0.6 Gt (1 Gt = 1 x 10(5) g) CO(2).yr(-1) in emission reductions and would require $0.4 billion to $1.7 billion.yr(-1) for 30 years. A 50% reduction in deforestation from 2005 to 2030 could provide 1.5-2.7 Gt CO(2).yr(-1) in emission reductions and would require $17.2 billion to $28.0 billion.yr(-1). Finally, some caveats to the analysis that could increase costs of AD programs are described.

  16. Unique Tuft Test Facility Dramatically Reduces Brush Seal Development Costs

    NASA Technical Reports Server (NTRS)

    Fellenstein, James A.

    1997-01-01

    Brush seals have been incorporated in the latest turbine engines to reduce leakage and improve efficiency. However, the life of these seals is limited by wear. Studies have shown that optimal sealing characteristics for a brush seal occur before the interference fit between the brush and shaft is excessively worn. Research to develop improved tribopairs (brush and coating) with reduced wear and lower friction has been hindered by the lack of an accurate, low-cost, efficient test methodology. Estimated costs for evaluating a new material combination in an engine company seal test program are on the order of $100,000. To address this need, the NASA Lewis Research Center designed, built, and validated a unique, innovative brush seal tuft tester that slides a single tuft of brush seal wire against a rotating shaft under controlled loads, speeds, and temperatures comparable to those in turbine engines. As an initial screening tool, the brush seal tuft tester can tribologicaly evaluate candidate seal materials for 1/10th the cost of full-scale seal tests. Previous to the development of the brush seal tuft tester facility, most relevant tribological data had been obtained from full-scale seal tests conducted primarily to determine seal leakage characteristics. However, from a tribological point of view, these tests included the confounding effects of varying contact pressures, bristle flaring, high-temperature oxidation, and varying bristle contact angles. These confounding effects are overcome in tuft testing. The interface contact pressures can be either constant or varying depending on the tuft mounting device, and bristle wear can be measured optically with inscribed witness marks. In a recent cooperative program with a U.S. turbine engine manufacturer, five metallic wire candidates were tested against a plasma-sprayed Nichrome-bonded chrome carbide. The wire materials used during this collaboration were either nickel-chrome- or cobaltchrome-based superalloys. These

  17. National Burden of Preventable Adverse Drug Events Associated with Inpatient Injectable Medications: Healthcare and Medical Professional Liability Costs

    PubMed Central

    Lahue, Betsy J.; Pyenson, Bruce; Iwasaki, Kosuke; Blumen, Helen E.; Forray, Susan; Rothschild, Jeffrey M.

    2012-01-01

    Background Harmful medication errors, or preventable adverse drug events (ADEs), are a prominent quality and cost issue in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The national burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs have not been previously described in the literature. Objective To quantify the economic burden of preventable ADEs related to inpatient injectable medications in the United States. Methods Medical error data (MedMarx 2009–2011) were utilized to derive the distribution of errors by injectable medication types. Hospital data (Premier 2010–2011) identified the numbers and the types of injections per hospitalization. US payer claims (2009–2010 MarketScan Commercial and Medicare 5% Sample) were used to calculate the incremental cost of ADEs by payer and by diagnosis-related group (DRG). The incremental cost of ADEs was defined as inclusive of the time of inpatient admission and the following 4 months. Actuarial calculations, assumptions based on published literature, and DRG proportions from 17 state discharge databases were used to derive the probability of preventable ADEs per hospitalization and their annual costs. MPL costs were assessed from state- and national-level industry reports, premium rates, and from closed claims databases between 1990 and 2011. The 2010 American Hospital Association database was used for hospital-level statistics. All costs were adjusted to 2013 dollars. Results Based on this medication-level analysis of reported harmful errors and the frequency of inpatient administrations with actuarial projections, we estimate that preventable ADEs associated with injectable medications impact 1.2 million hospitalizations annually. Using a matched cohort analysis of healthcare claims as a basis for evaluating incremental

  18. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions.

  19. Maternal antibodies reduce costs of an immune response during development.

    PubMed

    Grindstaff, Jennifer L

    2008-03-01

    Young vertebrates are dependent primarily on innate immunity and maternally derived antibodies for immune defense. This reliance on innate immunity and the associated inflammatory response often leads to reduced growth rates after antigenic challenge. However, if offspring have maternal antibodies that recognize an antigen, these antibodies should block stimulation of the inflammatory response and reduce growth suppression. To determine whether maternal and/or offspring antigen exposure affect antibody transmission and offspring growth, female Japanese quail (Coturnix japonica) and their newly hatched chicks were immunized. Mothers were immunized with lipopolysaccharide (LPS), killed avian reovirus vaccine (AR), or were given a control, phosphate-buffered saline, injection. Within each family, one-third of offspring were immunized with LPS, one-third were immunized with AR, and one-third were given the control treatment. Maternal immunization significantly affected the specific types of antibodies that were transmitted. In general, immunization depressed offspring growth. However, offspring immunized with the same antigen as their mother exhibited elevated growth in comparison to siblings immunized with a different antigen. This suggests that the growth suppressive effects of antigen exposure during development can be partially ameliorated by the presence of maternal antibodies, but in the absence of specific maternal antibodies, offspring are dependent on more costly innate immune defenses. Together, the results suggest that the local disease environment of mothers prior to reproduction significantly affects maternal antibody transmission and these maternal antibodies may allow offspring to partially maintain growth during infection in addition to providing passive humoral immune defense.

  20. Strategies to reduce medication errors in ambulatory practice.

    PubMed Central

    Adubofour, Kwabena O. M.; Keenan, Craig R.; Daftary, Ashok; Mensah-Adubofour, Josepha; Dachman, William D.

    2004-01-01

    Medication errors generally refer to mistakes made in the processes of ordering, transcribing, dispensing, administering or monitoring of pharmaceutical agents used in clinical practice. The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has helped raise public awareness surrounding the issue of patient safety within our hospitals. A number of legislative and regulatory steps have resulted in hospital authorities putting in place various systems to allow for error reporting and prevention. Medication errors are being closely scrutinized as part of these hospital-based efforts. Most Americans, however, receive their healthcare in the ambulatory primary care setting. Primary care physicians are involved in the writing of several million prescriptions annually. The steps underway in our hospitals to reduce medication errors should occur concurrently with steps to increase awareness of this problem in the out-patient setting. This article provides an overview of strategies that can be adopted by primary care physicians to decrease medication errors in ambulatory practice. PMID:15622685

  1. Reducing long-term remedial costs by transport modeling optimization.

    PubMed

    Becker, David; Minsker, Barbara; Greenwald, Robert; Zhang, Yan; Harre, Karla; Yager, Kathleen; Zheng, Chunmiao; Peralta, Richard

    2006-01-01

    The Department of Defense (DoD) Environmental Security Technology Certification Program and the Environmental Protection Agency sponsored a project to evaluate the benefits and utility of contaminant transport simulation-optimization algorithms against traditional (trial and error) modeling approaches. Three pump-and-treat facilities operated by the DoD were selected for inclusion in the project. Three optimization formulations were developed for each facility and solved independently by three modeling teams (two using simulation-optimization algorithms and one applying trial-and-error methods). The results clearly indicate that simulation-optimization methods are able to search a wider range of well locations and flow rates and identify better solutions than current trial-and-error approaches. The solutions found were 5% to 50% better than those obtained using trial-and-error (measured using optimal objective function values), with an average improvement of approximately 20%. This translated into potential savings ranging from 600,000 dollars to 10,000,000 dollars for the three sites. In nearly all cases, the cost savings easily outweighed the costs of the optimization. To reduce computational requirements, in some cases the simulation-optimization groups applied multiple mathematical algorithms, solved a series of modified subproblems, and/or fit "meta-models" such as neural networks or regression models to replace time-consuming simulation models in the optimization algorithm. The optimal solutions did not account for the uncertainties inherent in the modeling process. This project illustrates that transport simulation-optimization techniques are practical for real problems. However, applying the techniques in an efficient manner requires expertise and should involve iterative modification to the formulations based on interim results.

  2. Cost and value in medical education--what we can learn from the past.

    PubMed

    Walsh, K

    2014-01-01

    What lessons can be learned from the history of cost and value in medical education? First, the issue of cost and value in medical education has been around for a long time. Rising costs and an economic recession have made us focus on the subject more, but the issue has been just below the surface for over 200 years. A problem like this will not go away by itself - we must tackle it now. Second, the history of cost and value in medical education makes us look critically at who should pay. Should it be students, institutions or governments? We can see from the past that several different models have been tried; that all have their advantages and disadvantages; and that none are perfect. Third, looking at the past should make us realise that the issue of cost in medical education cannot be viewed in isolation. Medical educators throughout history have looked at how cost can affect selection for medical school, how costs can be related to benefits, and the effect of rising costs on career choices. Cost in medical education has always had far reaching consequences and implications. It probably always will. Looking at issues in medical education from the perspective of cost often makes them more stark and explicit - this in turn may help us to start to find solutions. In the future our solutions must be evidence based and must take account of cost.

  3. Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD

    PubMed Central

    Ayala, Diana E.; Mojón, Artemio; Fernández, José R.

    2011-01-01

    Time of ingestion of hypertension medications can affect circadian patterns of BP, but whether this translates into an effect on clinical outcomes is unknown. Here, in an open-label trial, we randomly assigned 661 patients with CKD either to take all prescribed hypertension medications upon awakening or to take at least one of them at bedtime. We measured 48-hour ambulatory BP at baseline and 3 months after any adjustment in treatment or, at the least, annually. After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0.31; 95% CI 0.21 to 0.46; P < 0.001). Bedtime dosing demonstrated a similar significant reduction in risk for a composite outcome of cardiovascular death, myocardial infarction, and stroke (adjusted HR 0.28; 95% CI 0.13 to 0.61; P < 0.001). Furthermore, patients on bedtime treatment had a significantly lower mean sleep-time BP and a greater proportion demonstrated control of their ambulatory BP (56% versus 45%, P = 0.003). Each 5-mmHg decrease in mean sleep-time systolic BP was associated with a 14% reduction in the risk for cardiovascular events during follow-up (P < 0.001). In conclusion, among patients with CKD and hypertension, taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events. PMID:22025630

  4. Global Medical Device Nomenclature: The Concept for Reducing Device-Related Medical Errors

    PubMed Central

    Anand, K; Saini, SK; Singh, BK; Veermaram, C

    2010-01-01

    In the medical device field, there are a number of players, having quite different responsibilities and levels of understanding of the processes, but all with one common interest, that of ensuring the availability of sound medical devices to the general public. To assist in this very important process, there is a need for a common method for describing and identifying these medical devices in an unambiguous manner. The Global Medical Device Nomenclature (GMDN) now provides, for the first time, an international tool for identifying all medical devices, at the generic level, in a meaningful manner that can be understood by all users. Prior to the GMDN, many nomenclature systems existed, all built upon different structures, and used locally or nationally for special purposes, with unusual approaches. These diverse systems, although often workable in their own right, have had no impact on improving the overall situation of providing a common platform, whereby, medical devices could be correctly identified and the related data safely exchanged between the involved parties. Work by standard organizations such as, CEN (European Committee for Standardization) and ISO (International Organization for Standardization), from 1993 to 1996, resulted in a standard that specified a structure for a new nomenclature, for medical devices. In this article we are trying to explain GMDN as the prime method to reduce medical device errors, and to understand the concept of GMDN, to regulate the medical device throughout the globe. Here we also make an attempt to explain various aspects of the GMDN system, such as, the process of development of the GMDN-CEN report, purpose, benefits, and their structural considerations. In addition, there will be an explanation of the coding system, role of the GMDN agency, and their utilization in the unique device identification (UDI) System. Finally, the current area of focus and vision for the future are also mentioned. PMID:21264103

  5. Endometriosis in Italy: from cost estimates to new medical treatment.

    PubMed

    Luisi, Stefano; Lazzeri, Lucia; Ciani, Valentina; Petraglia, Felice

    2009-11-01

    Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. The data collected from Italy showed that around 3 million women are affected by endoemtriosis and the condition was predominantly found in women of reproductive age (50% of women were in the 29-39 age range), only 25% of women were asymptomatic. The associated symptoms can create an impact in general physical, mental, and social well-being. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. The annual cost for hospital admission can be estimated to be in a total around 54 million euros. The average time for right diagnosis is around 9 years still today and it follows a long and expensive diagnostic search. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.

  6. Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review

    PubMed Central

    Smeets, Hugo M; Hoes, Arno W; de Wit, Niek J

    2007-01-01

    Background Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD). Methods A systematic review of intervention studies with a design according to research quality criteria and outcomes related to the effect of reduction of ASD medication retrieved from Medline, Embase and the Cochrane Library. Outcome measures were the strategy of intervention, quality of methodology and results of treatment to differences of ASD prescriptions and costs. Results The intervention varied from a single passive method to multiple active interactions with GPs. Reports of study quality had shortcomings on subjects of data-analysis. Not all outcomes were calculated but if so rction of prescriptions varied from 8% up to 40% and the cost effectiveness was in some cases negative and in others positive. Few studies demonstrated good effects from the interventions to reduce ASD. Conclusion Poor quality of some studies is limiting the evidence for effective interventions. Also it is difficult to compare cost-effectiveness between studies. However, RCT studies demonstrate that active interventions are required to reduce ASD volume. Larger multi-intervention studies are necessary to evaluate the most successful intervention instruments. PMID:17983477

  7. Direct medical costs and their predictors in South Korean patients with systemic lupus erythematosus.

    PubMed

    Park, So-Yeon; Joo, Young Bin; Shim, Jeeseon; Sung, Yoon-Kyoung; Bae, Sang-Cheol

    2015-11-01

    We aimed to estimate the annual direct medical costs of South Korean systemic lupus erythematosus (SLE) patients, and their predictors. The 2010 annual direct medical costs of SLE patients in the Hanyang BAE Lupus cohort in South Korea were assessed. The information was taken directly from the hospital database and medical records, and included clinical characteristics, disease activity, organ damage, and healthcare utilization. Cost predictors were estimated with a multivariate linear regression model. A total of 749 SLE patients (92.7 % female, mean age 35.7 ± 11.3 years, mean disease duration 9.6 ± 4.9 years) were studied. Their mean annual direct medical costs amounted to USD 3305. The largest component of these costs was the cost of medication (USD 1269, 38.4 %), followed by those of diagnostic procedures and tests (USD 1177, 35.6 %). Regression analysis showed that adjusted mean SLE disease activity index score (p < 0.0001), systemic damage index (p < 0.0001), and renal (p = 0.0039) and hematologic (p = 0.0353) involvement were associated with increased direct medical costs, whereas longer disease duration was associated with lower direct medical costs. Greater disease activity and greater organ damage predict higher costs for South Korean SLE patients. Major organ involvement such as renal disorder and hematologic involvement also predicts higher costs, whereas longer duration of disease predicts lower costs.

  8. Reducing the Manufacturing Cost of Tubular SOFC Technology

    SciTech Connect

    George, R.A.; Bessette, N.F.

    1997-12-31

    In recent years, Westinghouse Electric Corporation has made great strides in advancing tubular solid oxide fuel cell (SOFC) technology towards commercialization by the year 2001. In 1993, Westinghouse initiated a program to develop a `MWe Class` (1-3 MWe) pressurized SOFC (PSOFC) gas turbine (GT) combined cycle power system for distributed power applications because of its: (1) ultra high efficiency (approx. 63% net AC/LHV CH{sub 4}), (2) its compatibility with a factory packaged, minimum site work philosophy, and (3) its cost effectiveness. Since then two cost studies on this market entry product performed by consultants to the U.S. Department of Energy have confirmed Westinghouse cost studies that fully installed costs of under $1300/kWe can be achieved in the early commercialization years for such small PSOFC/GT power systems. The paper will present the results of these cost studies in the areas of cell manufacturing cost, PSOFC generator manufacturing cost, balance-of-plant (BOP) cost, and system installation cost. In addition, cost of electricity calculations will be presented.

  9. An innovative approach to reducing medical care utilization and expenditures.

    PubMed

    Orme-Johnson, D W; Herron, R E

    1997-01-01

    In a retrospective study, we assessed the impact on medical utilization and expenditures of a multicomponent prevention program, the Maharishi Vedic Approach to Health (MVAH). We compared archival data from Blue Cross/Blue Shield Iowa for MVAH (n = 693) with statewide norms for 1985 through 1995 (n = 600,000) and with a demographically matched control group (n = 4,148) for 1990, 1991, 1994, and 1995. We found that the 4-year total medical expenditures per person in the MVAH group were 59% and 57% lower than those in the norm and control groups, respectively; the 11-year mean was 63% lower than the norm. The MVAH group had lower utilization and expenditures across all age groups and for all disease categories. Hospital admission rates in the control group were 11.4 times higher than those in the MVAH group for cardiovascular disease, 3.3 times higher for cancer, and 6.7 times higher for mental health and substance abuse. The greatest savings were seen among MVAH patients older than age 45, who had 88% fewer total patients days compared with control patients. Our results confirm previous research supporting the effectiveness of MVAH for preventing disease. Our evaluation suggests that MVAH can be safely used as a cost-effective treatment regimen in the managed care setting.

  10. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-11

    ... BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... the cost of inpatient medical services furnished by military treatment facilities through...

  11. 77 FR 69504 - Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-19

    ... the cost of outpatient medical and dental services furnished by military treatment facilities through... BUDGET Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable...

  12. Graphic Warning Labels and the Cost Savings from Reduced Smoking among Pregnant Women.

    PubMed

    Tauras, John A; Peck, Richard M; Cheng, Kai-Wen; Chaloupka, Frank J

    2017-02-08

    Introduction: The U.S. Food and Drug Administration (FDA) has estimated the economic impact of Graphic Warning Labels (GWLs). By omitting the impact on tobacco consumption by pregnant women, the FDA analysis underestimates the economic benefits that would occur from the proposed regulations. There is a strong link between the occurrence of low birth weight babies and smoking while pregnant. Low birth weight babies in turn generate much higher hospital costs than normal birth weight babies. This study aims to fill the gap by quantifying the national hospital cost savings from the reductions in prenatal smoking that will arise if GWLs are implemented in the U.S. Data and Methods: This study uses several data sources. It uses Natality Data from the National Vital Statistics System of the National Center for Health Statistics (NCHS) in 2013 to estimate the impact of prenatal smoking on the likelihood of having a low-birth-weight baby, controlling for socio-economic and demographic characteristics as well as medical and non-medical risk factors. Using these estimates, along with the estimates of Huang et al. (2014) regarding the effect of GWLs on smoking, we calculate the change in the number of LBW (low birth weight) babies resulting from decreased prenatal smoking due to GWLs. Using this estimated change and the estimates from Russell et al. (2007) and AHRQ (2013) on the excess hospital costs of LBW babies, we calculate cost saving that arises from reduced prenatal smoking in response of GWLs. Results and Conclusions: Our results indicated that GWLs for this population could lead to hospital cost savings of 1.2 billion to 2.0 billion dollars over a 30 year horizon.

  13. Graphic Warning Labels and the Cost Savings from Reduced Smoking among Pregnant Women

    PubMed Central

    Tauras, John A.; Peck, Richard M.; Cheng, Kai-Wen; Chaloupka, Frank J.

    2017-01-01

    Introduction: The U.S. Food and Drug Administration (FDA) has estimated the economic impact of Graphic Warning Labels (GWLs). By omitting the impact on tobacco consumption by pregnant women, the FDA analysis underestimates the economic benefits that would occur from the proposed regulations. There is a strong link between the occurrence of low birth weight babies and smoking while pregnant. Low birth weight babies in turn generate much higher hospital costs than normal birth weight babies. This study aims to fill the gap by quantifying the national hospital cost savings from the reductions in prenatal smoking that will arise if GWLs are implemented in the U.S. Data and Methods: This study uses several data sources. It uses Natality Data from the National Vital Statistics System of the National Center for Health Statistics (NCHS) in 2013 to estimate the impact of prenatal smoking on the likelihood of having a low-birth-weight baby, controlling for socio-economic and demographic characteristics as well as medical and non-medical risk factors. Using these estimates, along with the estimates of Huang et al. (2014) regarding the effect of GWLs on smoking, we calculate the change in the number of LBW (low birth weight) babies resulting from decreased prenatal smoking due to GWLs. Using this estimated change and the estimates from Russell et al. (2007) and AHRQ (2013) on the excess hospital costs of LBW babies, we calculate cost saving that arises from reduced prenatal smoking in response of GWLs. Results and Conclusions: Our results indicated that GWLs for this population could lead to hospital cost savings of 1.2 billion to 2.0 billion dollars over a 30 year horizon. PMID:28208749

  14. Advanced Fuels Can Reduce the Cost of Getting Into Space

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    1998-01-01

    Rocket propellant and propulsion technology improvements can reduce the development time and operational costs of new space vehicle programs, and advanced propellant technologies can make space vehicles safer and easier to operate, and can improve their performance. Five major areas have been identified for fruitful research: monopropellants, alternative hydrocarbons, gelled hydrogen, metallized gelled propellants, and high-energy-density propellants. During the development of the NASA Advanced Space Transportation Plan, these technologies were identified as those most likely to be effective for new NASA vehicles. Several NASA research programs had fostered work in fuels under the topic Fuels and Space Propellants for Reusable Launch Vehicles in 1996 to 1997. One component of this topic was to promote the development and commercialization of monopropellant rocket fuels, hypersonic fuels, and high-energy-density propellants. This research resulted in the teaming of small business with large industries, universities, and Government laboratories. This work is ongoing with seven contractors. The commercial products from these contracts will bolster advanced propellant research. Work also is continuing under other programs, which were recently realigned under the "Three Pillars" of NASA: Global Civil Aviation, Revolutionary Technology Leaps, and Access to Space. One of the five areas is described below, and its applications and effect on future missions is discussed. This work is being conducted at the NASA Lewis Research Center with the assistance of the NASA Marshall Space Flight Center. The regenerative cooling of spacecraft engines and other components can improve overall vehicle performance. Endothermic fuels can absorb energy from an engine nozzle and chamber and help to vaporize high-density fuel before it enters the combustion chamber. For supersonic and hypersonic aircraft, endothermic fuels can absorb the high heat fluxes created on the wing leading edges and

  15. Improving Learning and Reducing Costs: Fifteen Years of Course Description

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2015-01-01

    Recognizing that tuition increases can no longer be used as a safety valve to avoid dealing with the underlying issues of why costs increase so much, campuses have begun the hard work of cost containment. After sharpening priorities, sometimes making tough choices in light of those priorities, campuses are still groping for ways to wrestle costs…

  16. Reduce Operating Costs with an EnergySmart School Project

    ERIC Educational Resources Information Center

    US Department of Energy, 2008

    2008-01-01

    Energy costs are a school district's second highest expenditure after personnel. Public schools currently spend more than $8 billion per year for energy. School energy expenditures rose, on average, 20 percent per year between 2000 and 2002--and the costs continue to rise. Natural gas prices alone increased 14 percent annually between 2003 and…

  17. Emergency department outpatient treatment of alcohol-intoxicated bicyclists increases the cost of medical care in Japan

    PubMed Central

    Yamauchi, Sunao; Mizobe, Michiko; Nakashima, Yoshiyuki; Takahashi, Jin; Funakoshi, Hiraku; Urayama, Kevin Y.; Ohde, Sachiko; Takahashi, Osamu; Shiga, Takashi

    2017-01-01

    Riding a bicycle under the influence of alcohol is illegal in Japan. Nevertheless, intoxicated bicyclists are frequently treated at hospital emergency departments for bicycle-related injuries. This patient population usually requires more hospital resources, even for relatively minor injuries. Therefore, we hypothesized that bicycle-related crashes involving bicyclists under the influence of alcohol cost more to treat than those that do not involve alcohol intoxication. The aim of the present study was to examine the costs associated with bicycle-related minor injuries and alcohol intoxication of the bicyclist. The study was conducted at the Tokyo Bay Urayasu Ichikawa Medical Center Emergency Department, Japan. All minor bicycle crashes involving 217 individuals aged ≥20 years treated from September 1, 2012 to August 31, 2013 were included in the analysis of data obtained from medical records. Variables included alcohol intoxication, sex, age, collision with a motor vehicle, Glasgow Coma Scale, injury severity score (ISS), laboratory tests, treatment of wounds, number of X-ray images, number of computed tomography scans, and medical costs. Multiple linear regression analysis was performed to evaluate the association between alcohol intoxication and medical costs. Seventy (32%) patients consumed alcohol, and the median medical cost was 253 USD (interquartile range [IQR], 164–330). Multivariable analysis showed that alcohol intoxication was independently associated with higher medical costs (p = 0.030, adjusted R-square value = 0.55). These findings support our hypothesis and should encourage authorities to implement comprehensive measures to prohibit bicycling under the influence of alcohol to prevent injuries and to reduce medical costs. PMID:28329002

  18. An Analysis of Medical Imaging Costs in Military Treatment Facilities

    DTIC Science & Technology

    2014-09-01

    American College of Radiology, practice costs excluding physician compensation, average 39% for a non-academic radiology practice (Sunshine...the hospital’s cost data as military radiologists are usually trained in the Health Professions Scholarship Program which pays 100% of tuition and...alone. It is difficult to determine the effect of this education cost 2. The total cost of $323,490 is comprised of $218,898 for tuition expenses

  19. Reducing annotation cost and uncertainty in computer-aided diagnosis through selective iterative classification

    NASA Astrophysics Data System (ADS)

    Riely, Amelia; Sablan, Kyle; Xiaotao, Thomas; Furst, Jacob; Raicu, Daniela

    2015-03-01

    Medical imaging technology has always provided radiologists with the opportunity to view and keep records of anatomy of the patient. With the development of machine learning and intelligent computing, these images can be used to create Computer-Aided Diagnosis (CAD) systems, which can assist radiologists in analyzing image data in various ways to provide better health care to patients. This paper looks at increasing accuracy and reducing cost in creating CAD systems, specifically in predicting the malignancy of lung nodules in the Lung Image Database Consortium (LIDC). Much of the cost in creating an accurate CAD system stems from the need for multiple radiologist diagnoses or annotations of each image, since there is rarely a ground truth diagnosis and even different radiologists' diagnoses of the same nodule often disagree. To resolve this issue, this paper outlines an method of selective iterative classification that predicts lung nodule malignancy by using multiple radiologist diagnoses only for cases that can benefit from them. Our method achieved 81% accuracy while costing only 46% of the method that indiscriminately used all annotations, which achieved a lower accuracy of 70%, while costing more.

  20. Low cost RFID real lightweight binding proof protocol for medication errors and patient safety.

    PubMed

    Yu, Yao-Chang; Hou, Ting-Wei; Chiang, Tzu-Chiang

    2012-04-01

    An Institute of Medicine Report stated there are 98,000 people annually who die due to medication related errors in the United States, and hospitals and other medical institutions are thus being pressed to use technologies to reduce such errors. One approach is to provide a suitable protocol that can cooperate with low cost RFID tags in order to identify patients. However, existing low cost RFID tags lack computational power and it is almost impossible to equip them with security functions, such as keyed hash function. To address this issue, a so a real lightweight binding proof protocol is proposed in this paper. The proposed protocol uses only logic gates (e.g. AND, XOR, ADD) to achieve the goal of proving that two tags exist in the field simultaneously, without the need for any complicated security algorithms. In addition, various scenarios are provider to explain the process of adopting this binding proof protocol with regard to guarding patient safety and preventing medication errors.

  1. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    ERIC Educational Resources Information Center

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  2. Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center

    PubMed Central

    Fargo, Kelly L.; Johnston, Jessica; Stevenson, Kurt B.; Deutscher, Meredith

    2015-01-01

    Background: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. Objective: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. Methods: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)–adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. Results: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. Conclusion: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated. PMID:26405341

  3. Medical costs of smoking in the United States: estimates, their validity, and their implications

    PubMed Central

    Warner, K.; Hodgson, T.; Carroll, C.

    1999-01-01

    OBJECTIVE—To compare estimates of the medical costs of smoking in the United States and to consider their relevance to assessing the costs of smoking in developing countries and the net economic burden of smoking.
DATA SOURCES—A Medline search through early 1999 using keywords "smoking" and "cost", with review of article reference lists.
STUDY SELECTION—Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population.
DATA EXTRACTION—Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings.
DATA SYNTHESIS—With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. The exception, a recent study, found much larger attributable expenditures. The lower estimates may reflect the limitation of analysis to costs associated with the principal smoking-related diseases. The higher estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range.
CONCLUSIONS—The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing the magnitude of their current cost-of-smoking burden and their future burdens, with differences in tobacco use histories and the availability of chronic disease treatment affecting country-specific estimates. The debate over the use of gross or net medical cost estimates is likely to intensify with the proliferation of lawsuits against the tobacco industry to recover expenditures on tobacco-produced disease.


Keywords: medical

  4. Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

    PubMed

    Geiling, James; Rosen, Joseph M; Edwards, Ryan D

    2012-11-01

    War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

  5. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

    PubMed Central

    Afulani, Patience; Coleman-Jensen, Alisha; Harrison, Gail G.

    2015-01-01

    Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households. PMID:26270308

  6. Owner-controlled insurance programs: Reducing O&M costs

    SciTech Connect

    Charette, M.; Brady, N.

    1994-02-01

    The economic recession, increased competition from nonutility generators, and escalating Workers` Compensation costs are forcing electric utilities to reexamine how they finance the cost of risk. In addition to managed care programs, larger deductibles, and aggressive safety campaigns, utility risk and insurance executives are turning more than ever to Owner-Controlled Insurance Programs (OCIPs) to lower operation and maintenance (O&M) expenses. While electric utilities long have used OCIPs to control insurance costs during generating station and office building construction, this approach is now being employed for other projects. In the last few years, utilities have expanded the use of OCIPs to include scrubber installation, plant retrofit, and, more recently, for ongoing contract and maintenance work at operating fossil and nuclear plants. These OCIPs are also known as {open_quotes}gate{close_quotes} or {open_quotes}maintenance{close_quotes} wrap-ups.

  7. Leasing strategies reduce the cost of financing healthcare equipment.

    PubMed

    Bayless, M E; Diltz, J D

    1985-10-01

    Prospective payment has increased the importance of controlling capital costs. One area where this may be possible is lease financing. Reasons commonly cited in favor of leasing may be of questionable validity, but, under an easily identified set of circumstances, lease financing can be cost effective. Recent developments in finance make it possible to not only evaluate the financial attractiveness of a given lease, but also to accurately predict bounds within which the terms of the lease must fall. Hospital administrators armed with this information should be able to negotiate more favorable lease terms under given tax and economic environments.

  8. Reducing maintenance costs in agreement with CNC machine tools reliability

    NASA Astrophysics Data System (ADS)

    Ungureanu, A. L.; Stan, G.; Butunoi, P. A.

    2016-08-01

    Aligning maintenance strategy with reliability is a challenge due to the need to find an optimal balance between them. Because the various methods described in the relevant literature involve laborious calculations or use of software that can be costly, this paper proposes a method that is easier to implement on CNC machine tools. The new method, called the Consequence of Failure Analysis (CFA) is based on technical and economic optimization, aimed at obtaining a level of required performance with minimum investment and maintenance costs.

  9. Revisiting the cost of medical student education: a measure of the experience of UT Medical School-Houston.

    PubMed

    Gammon, Elizabeth; Franzini, Luisa

    2011-01-01

    This study uses a cost construction model to estimate the cost of a four-year undergraduate medical education at the University of Texas-Houston Medical School (UT-Houston) in 2006-2007 compared to 1994-1995. The model computes the cost by measuring increasingly inclusive definitions of the educational mission: instructional (direct-contact teaching), educational (instructional plus general supervision), and milieu (educational plus research costs). Using the model and adjusting for inflation, annual cost per student enrolled decreased by 16 percent in 2006-2007 compared to 1994-1995 and total cost decreased by 9 percent. Additionally, the model predicted 190 full-time equivalent (FTE) faculty and 187 FTE residents for 2006-2007 compared to 201 FTE faculty and 258 FTE residents for 1994-1995. Decreases in the cost of educating medical students were driven by (1) the reduction in the number of educator contact hours required for curriculum delivery; (2) change in the mix of educators; and (3) an increase in medical school class size.

  10. Providing Medical Services to Undocumented Immigrants: Costs and Public Policy.

    ERIC Educational Resources Information Center

    Arnold, Fred

    1979-01-01

    Reviews cost estimates for treating illegal aliens made by hospitals and county governments. Discusses patterns of utilization of health services by illegal immigrant groups and the difficulties in arriving at accurate cost estimates. Describes the current status of legislative programs that address this issue. (Author/GC)

  11. Reducing Building HVAC Costs with Site-Recovery Energy

    ERIC Educational Resources Information Center

    Pargeter, Stephen J.

    2012-01-01

    Building owners are caught between two powerful forces--the need to lower energy costs and the need to meet or exceed outdoor air ventilation regulations for occupant health and comfort. Large amounts of energy are wasted each day from commercial, institutional, and government building sites as heating, ventilation, and air conditioning (HVAC)…

  12. Improving Benefits and Reducing Costs: Managing Educational Secondments.

    ERIC Educational Resources Information Center

    McMichael, Paquita; And Others

    1995-01-01

    A (British) educational "secondment" involves resource allocation from one institution to another and new forms of employee accountability and commitment. This article examines management implications of educational secondments, exploring costs and benefits accruing to 50 secondees, their seconding organizations, and those to which they…

  13. Reducing High Absenteeism through Low-Cost Incentives.

    ERIC Educational Resources Information Center

    North Chaplik, Barbara D.; Engel, Ross A.

    1984-01-01

    Describes a study of the effects of a low-cost incentive program--including daily, weekly, and monthly reinforcements such as attention, approval, and inexpensive awards--on the absenteeism of high-absence employees in an urban school district's transportation department. A 20-percent reduction in absenteeism was achieved. (TE)

  14. 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Vedder, Richard; Gillen, Andrew; Bennett, Daniel; Denhart, Matthew; Robe, Jonathan; Holbrook, Todd; Neiger, Peter; Coleman, James; Templeton, Jordan; Leirer, Jonathan; Myers, Luke; Brady, Ryan; Malesick, Michael

    2010-01-01

    The Center for College Affordability and Productivity (CCAP) is an independent, nonprofit research center based in Washington, DC that is dedicated to researching public policy and economic issues relating to postsecondary education. CCAP aims to facilitate a broader dialogue that challenges conventional thinking about costs, efficiency and…

  15. RAM - A concept for reducing space payload costs.

    NASA Technical Reports Server (NTRS)

    Powell, D. J.

    1972-01-01

    The post-Apollo era in manned space flight will be dominated in the short term by development of the space shuttle as an economical transportation system for payloads to low earth orbit. Research and Applications Modules (RAM) are a related group of shuttle-launched carriers for such payloads which can be used many times over, thus effecting great savings over currently conventional methods of implementing a program of this type. In order to maximize the potential savings, development and unit costs of the RAM vehicles must be minimized. All of the mission and operating modes can be covered in an economical fashion by the use of only three basic RAM elements - a pressurized module, an unpressurized pallet, and a pressurizable free-flying unit utilized in several combinations. These have been developed as a least cost approach through the consideration of such cost/weight related drivers as available crew size, separability of costly subsystems for multiple use, easy accessibility for maintenance/refurbishment for reuse, and a maximum commonality of hardware with existing and projected space projects.

  16. A novel approach to reduce greenhouse energy costs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Irradiance, temperature, and carbon dioxide (CO2) are three environmental parameters growers can control during greenhouse production to alter crop growth, quality, and timing. Significant costs are incurred every year, especially during winter and early-spring production, to heat and light the gre...

  17. Improving Learning and Reducing Costs: New Models for Online Learning.

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2003-01-01

    Describes five course redesign models (supplemental, replacement, emporium, fully online, and buffet) used by grantees of the Program in Course Redesign sponsored by the Pew Charitable Trusts. The grants helped colleges redesign instruction using technology to achieve quality enhancements as well as cost savings. (EV)

  18. EOS Operations Systems: EDOS Implemented Changes to Reduce Operations Costs

    NASA Technical Reports Server (NTRS)

    Cordier, Guy R.; Gomez-Rosa, Carlos; McLemore, Bruce D.

    2007-01-01

    The authors describe in this paper the progress achieved to-date with the reengineering of the Earth Observing System (EOS) Data and Operations System (EDOS), the experience gained in the process and the ensuing reduction of ground systems operations costs. The reengineering effort included a major methodology change, applying to an existing schedule driven system, a data-driven system approach.

  19. Target Context Specification Can Reduce Costs in Nonfocal Prospective Memory

    ERIC Educational Resources Information Center

    Lourenço, Joana S.; White, Katherine; Maylor, Elizabeth A.

    2013-01-01

    Performing a nonfocal prospective memory (PM) task results in a cost to ongoing task processing, but the precise nature of the monitoring processes involved remains unclear. We investigated whether target context specification (i.e., explicitly associating the PM target with a subset of ongoing stimuli) can trigger trial-by-trial changes in task…

  20. Low-cost medical image storage and manipulation using optical disk subsystems

    NASA Astrophysics Data System (ADS)

    Glenn, William V., Jr.; Marx, Peter S.

    1990-08-01

    Traditionally, medical imaging has required large capital investments into workstations and storage subsystems. Many vendors have chosen to offer proprietary systems which are expensive to develop and costly to the institutions which purchase them. Our experience has been that this is unnecessary; most traditional imaging functions in the digital modalities of computed tomography (CT) and magnetic resonance imaging (MM) can be performed using off-the-shelf hardware with relatisely inexpensive software. In order to reduce the cost of medical imaging, our approach has been to choose computers and storage subsystems that are efficient, inexpensive, and easy-to-use (after all, the users are interested in practicing medicine, not computer science.) With these goals in mind, we chose to use a general purpose computer (the Apple Macintosh Ilci) with two types of high-capacity optical storage devices (both magneto-optical and write once, read multiple (WORM) disc subsystems.) We have developed a powerful, yet user-friendly medical imaging workstation oriented towards radiologists, orthopadic surgeons, neurosurgeons, and other users of medical images. In addition to providing inexpensive storage, the workstation is capable of multiplanar reformatting (MPR), 3D MM angiography, and other image processing functions. The resulting images may be annotated, windowed, and filmed on to 14x17" radiology film for presentation to the referring physicians and their patients. This system can be considered to be a picture archiving and communication system (PACS) for private physicians and small clinics; further, it is small enough for desktop environments and inexpensive enough for clinicians to purchase.

  1. 75 FR 18514 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-12

    ... Practices to Reduce Medication Errors; Public Workshop; Request for Comments AGENCY: Food and Drug... Packaging Practices to Reduce Medication Errors.'' The purpose of the public workshop is to initiate... practices to develop proprietary names to reduce medication errors. The input from this workshop will...

  2. A cost analysis of an internet based medication adherence intervention for people living with HIV

    PubMed Central

    Page, Timothy F.; Horvath, Keith J.; Danilenko, Gene P.; Williams, Mark

    2012-01-01

    The purpose of the study was to document development costs and estimate implementation costs of an internet based medication adherence intervention for people living with HIV in the US. Participants (n=61) were enrolled in the 8 week study in 2011 and entered the intervention website remotely in the setting of their choice. Development costs were obtained from a feasibility and acceptability study of an internet based medication adherence intervention. Implementation costs were estimated based on an 8 week trial period during the feasibility and acceptability study. Results indicated that although developing an internet based medication adherence intervention is expensive, the monthly cost of implementing and delivering the intervention is low. If the efficacy of similar interventions can be established, these results suggest the internet could be an effective method for delivering medication adherence interventions to persons residing in areas with limited access to in-person adherence services. PMID:22362156

  3. Reducing costly zebra mussel infestations at power plants

    SciTech Connect

    Smythe, G.

    1994-10-01

    The fast-spreading-zebra mussel has significant potential to foul intakes and other water systems at North American hydro projects. Chemical controls can be effective in reducing infestations, but most have environmental and other drawbacks. Several non-chemical methods promise to help project operators reduce problems associated with the mussels.

  4. Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Haté, Vibhuti; McPherson, Dacia; Palmer, Eurica; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    In 2010, South Africa launched a countrywide effort to scale up its voluntary medical male circumcision (VMMC) program on the basis of compelling evidence that circumcision reduces men’s risk of acquiring HIV through heterosexual intercourse. Even though VMMC is free there, clients can incur indirect out-of-pocket costs (for example transportation cost or foregone income). Because these costs can be barriers to increasing the uptake of VMMC services, we assessed them from a client perspective, to inform VMMC demand creation policies. Costs (calculated using a bottom-up approach) and demographic data were systematically collected through 190 interviews conducted in 2015 with VMMC clients or (for minors) their caregivers at 25 VMMC facilities supported by the government and the President’s Emergency Plan for AIDS Relief in eight of South Africa’s nine provinces. The average age of VMMC clients was 22 years and nearly 92% were under 35 years of age. The largest reported out-of-pocket expenditure was transportation, at an average of US$9.20 (R 100). Only eight clients (4%) reported lost days of work. Indirect expenditures were childcare costs (one client) and miscellaneous items such as food or medicine (20 clients). Given competing household expense priorities, spending US$9.20 (R100) per person on transportation to access VMMC services could be a significant burden on clients and households, and a barrier to South Africa’s efforts to create demand for VMMC. Thus, we recommend a more focused analysis of clients’ transportation costs to access VMMC services. PMID:27783635

  5. Study of the cost-benefit analysis of electronic medical record systems in general hospital in China.

    PubMed

    Li, Kai; Naganawa, Shinji; Wang, Kai; Li, Ping; Kato, Ken; Li, Xiu; Zhang, Jie; Yamauchi, Kazunobu

    2012-10-01

    Electronic medical record (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medical record systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medical record. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medical record creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medical record creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors.

  6. Action video game experience reduces the cost of switching tasks.

    PubMed

    Cain, Matthew S; Landau, Ayelet N; Shimamura, Arthur P

    2012-05-01

    Video game expertise has been shown to have beneficial effects for visual attention processes, but the effects of action video game playing on executive functions, such as task switching and filtering out distracting information, are less well understood. In the main experiment presented here, video game players (VGPs) and nonplayers (nVGPs) switched between two tasks of unequal familiarity: a familiar task of responding in the direction indicated by an arrow, and a novel task of responding in the opposite direction. nVGPs had large response time costs for switching from the novel task to the familiar task, and small costs for switching from the familiar task to the novel task, replicating prior findings. However, as compared to the nVGPs, VGPs were more facile in switching between tasks, producing overall smaller and more symmetric switching costs, suggesting that experience with action video games produces improvements in executive functioning. In contrast, VGPs and nVGPs did not differ in filtering out the irrelevant flanking stimuli or in remembering details of aurally presented stories. The lack of global differences between the groups suggests that the improved task-switching performance seen in VGPs was not due to differences in global factors, such as VGPs being more motivated than nVGPs.

  7. The cost of postgraduate medical education and continuing medical education: re-examining the status fifty years back.

    PubMed

    Walsh, Kieran

    2015-03-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care.

  8. The Cost of Postgraduate Medical Education and Continuing Medical Education: Re-Examining the Status Fifty Years Back

    PubMed Central

    2015-01-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care. PMID:25802685

  9. Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

    PubMed

    Calvo-Vargas, C G; Parra Carrillo, J Z; Grover Páez, F; Fonseca Reyes, S

    1998-04-01

    In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

  10. Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.

    PubMed

    Lin, Jay; Wong, Bruce; Offord, Steve; Mirski, Dario

    2013-07-01

    Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67 ± 0.34 vs. 0.56 ± 0.35; p < 0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-$5,981 ± $16,554 vs. 758 ± 14,328, p < 0.001). The change in costs of outpatient care also favored LAI medications ($134 ± 8,280 vs. 658 ± 3,260, p = 0.023). Drug costs of LAI antipsychotics were higher ($4,132 ± 4,533 vs. 2,562 ± 2,714, p < 0.001). Schizophrenia patients initiating LAI antipsychotics incur less healthcare costs in comparison to patients initiating oral antipsychotics.

  11. Utilization of UV Curing Technology to Significantly Reduce the Manufacturing Cost of LIB Electrodes

    SciTech Connect

    Voelker, Gary; Arnold, John

    2015-11-30

    Previously identified novel binders and associated UV curing technology have been shown to reduce the time required to apply and finish electrode coatings from tens of minutes to less than one second. This revolutionary approach can result in dramatic increases in process speeds, significantly reduced capital (a factor of 10 to 20) and operating costs, reduced energy requirements, and reduced environmental concerns and costs due to the virtual elimination of harmful volatile organic solvents and associated solvent dryers and recovery systems. The accumulated advantages of higher speed, lower capital and operating costs, reduced footprint, lack of VOC recovery, and reduced energy cost is a reduction of 90% in the manufacturing cost of cathodes. When commercialized, the resulting cost reduction in Lithium batteries will allow storage device manufacturers to expand their sales in the market and thereby accrue the energy savings of broader utilization of HEVs, PHEVs and EVs in the U.S., and a broad technology export market is also envisioned.

  12. Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Study objective We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Methods Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. Results There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Conclusion Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. PMID:20554078

  13. NASA operations: An agency wide approach to reduce cost

    NASA Technical Reports Server (NTRS)

    Squibb, Gael F.

    1996-01-01

    The NASA Space Operations Management Office (SOMO) is presented. The SOMO concept is based on continuing the distributed participation of the various NASA field centers and agencies, while employing consolidated management through a single lead center. The aim is to determine the duplicity and the overlap between the different agencies that independently developed their own operations management approaches in order to enable more cost effective mission operations by providing common services to the NASA programs. The space operations management will be performed in a distributed manner with a greater degree of contractor involvement than in the past. The changes, approaches and anticipated benefits of this approach to operations are discussed.

  14. The environmental cost of reducing agricultural fine particulate matter emissions.

    PubMed

    Funk, Paul A

    2010-06-01

    The U.S. Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) in 2006, reducing acceptable fine particulate matter (PM2.5) levels; state environmental protection agencies in states with nonattainment areas are required to draft State Implementation Plans (SIPs) detailing measures to reduce regional PM2.5 levels by reducing PM2.5 and PM2.5 precursor emissions. These plans need to account for increases in emissions caused by operating control technologies. Potential PM2.5 emissions reductions realized by adding a second set of dust cyclones were estimated for the cotton ginning industry. Increases in energy consumption were calculated based on dust cyclone air pressure drop. Additional energy required was translated into increased emissions using published emission factors and state emissions inventories. Reductions in gin emissions were compared with increases in emissions at the power plant. Because of the electrical energy required, reducing one unit of agricultural PM2.5 emissions at a cotton gin results in emitting 0.11-2.67 units of direct PM2.5, 1.39-69.1 units of PM2.5 precursors, 1.70-76.8 units of criteria pollutants, and 692-15,400 units of greenhouse gases at the point where electricity is produced. If regulations designed to reduce rural PM2.5 emissions increase electrical power consumption, the unintended net effect may be more emissions, increased environmental damage, and a greater risk to public health.

  15. Reduce, reuse and recycle: a green solution to Canada's medical isotope shortage.

    PubMed

    Galea, R; Ross, C; Wells, R G

    2014-05-01

    Due to the unforeseen maintenance issues at the National Research Universal (NRU) reactor at Chalk River and coincidental shutdowns of other international reactors, a global shortage of medical isotopes (in particular technetium-99m, Tc-99m) occurred in 2009. The operation of these research reactors is expensive, their age creates concerns about their continued maintenance and the process results in a large amount of long-lived nuclear waste, whose storage cost has been subsidized by governments. While the NRU has since revived its operations, it is scheduled to cease isotope production in 2016. The Canadian government created the Non-reactor based medical Isotope Supply Program (NISP) to promote research into alternative methods for producing medical isotopes. The NRC was a member of a collaboration looking into the use of electron linear accelerators (LINAC) to produce molybdenum-99 (Mo-99), the parent isotope of Tc-99m. This paper outlines NRC's involvement in every step of this process, from the production, chemical processing, recycling and preliminary animal studies to demonstrate the equivalence of LINAC Tc-99m with the existing supply. This process stems from reusing an old idea, reduces the nuclear waste to virtually zero and recycles material to create a green solution to Canada's medical isotope shortage.

  16. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    PubMed Central

    Savitz, Lucy A.; Savitz, Samuel T.

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided. PMID:27830055

  17. Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

    PubMed Central

    Alouki, Koffi; Delisle, Hélène; Besançon, Stéphane; Baldé, Naby; Sidibé-Traoré, Assa; Drabo, Joseph; Djrolo, François; Mbanya, Jean-Claude; Halimi, Serge

    2015-01-01

    AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularly patients with complications. METHODS: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin, Burkina Faso, Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines, published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications. RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes (in the public sector) would amount to 21%-34% of the country’s gross national income per capita, 26%-47% in the presence of retinopathy, and above 70% for nephropathy, the most expensive complication. CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction, it is innovative and of interest for several stakeholders. PMID:26617974

  18. "Green Oncology": the Italian medical oncologists' challenge to reduce the ecological impact of their clinical activity.

    PubMed

    Bretti, Sergio; Porcile, Gianfranco; Romizi, Roberto; Palazzo, Salvatore; Oliani, Cristina; Crispino, Sergio; Labianca, Roberto

    2014-01-01

    For decades Western medicine has followed a biomedical model based on linear thinking and an individualized, disease-oriented doctor-patient relationship. Today this framework must be replaced by a biopsychosocial model based on complexity theory and a person-oriented medical team-patient relationship, taking into account the psychological and social determinants of health and disease. However, the new model is already proving no longer adequate or appropriate, and current events are urging us to develop an ecological model in which the medical team takes into account both individual illness and population health as a whole, since we are all part of the biosphere. In recent years, the rising costs of cancer treatment have raised a serious issue of economic sustainability. As the population of our planet, we now need to rapidly address this issue, and everyone of us must try to reduce their ecological footprint, measured as CO2 production. Medical oncologists need to reduce the ecological footprint of their professional activity by lowering the consumption of economic resources and avoiding environmental damage as much as possible. This new paradigm is endorsed by the Italian College of Hospital Medical Oncology Directors (CIPOMO). A working group of this organization has drafted the "Green Oncology Position Paper": a proposal of Italian medical oncology (in accordance with international guidelines) that oncologists, while aiming for the same end results, make a commitment toward the more appropriate management of health care and the careful use of resources in order to protect the environment and the ecosphere during the daily exercise of their professional activities.

  19. Cost Effectiveness of a Novel Attempt to Reduce Readmission after Ileostomy Creation

    PubMed Central

    Raza, Ahsan; Huang, Emina; Goldstein, Lindsey; Hughes, Steven J.; Tan, Sanda A.

    2017-01-01

    Background and Objectives: Dehydration is a common complication after ileostomy creation and is the most frequent reason for postoperative readmission to the hospital. We sought to determine the clinical and economic impact of an outpatient intervention to decrease readmissions for dehydration after ileostomy creation. Methods: All new ileostomates from 09/2011 through 10/2012 at the University of Florida were enrolled to receive an ileostomy education and management protocol and a daily telephone call for 3 weeks after discharge. Counseling and medication adjustments were provided, with a satisfaction survey at the end. Outcomes of these patients were compared to those in a historical control cohort. A cost analysis was conducted to calculate the savings to the hospital. Results: Thirty-eight patients were enrolled. All patients required telephone counseling, and the mean satisfaction score rating was 4.69, on a scale of 1 to 5. The readmission rate for dehydration within 30 days of discharge decreased significantly from 65% before intervention to 16% (5/32 patients) after intervention (P = .002). The length of readmission hospital stay decreased from a mean of 4.2 days before the introduction of the intervention to 3 days after. Cost analysis revealed that the actual total hospital cost of dehydration-specific readmission decreased from $88,858 to $25,037, a saving of $63,821. Conclusion: A standardized ileostomy pathway with comprehensive patient education and outpatient telephone follow-up is cost effective, has a positive influence on patient satisfaction, and reduces dehydration-related readmission rates. PMID:28144122

  20. Leg exoskeleton reduces the metabolic cost of human hopping.

    PubMed

    Grabowski, Alena M; Herr, Hugh M

    2009-09-01

    During bouncing gaits such as hopping and running, leg muscles generate force to enable elastic energy storage and return primarily from tendons and, thus, demand metabolic energy. In an effort to reduce metabolic demand, we designed two elastic leg exoskeletons that act in parallel with the wearer's legs; one exoskeleton consisted of a multiple leaf (MLE) and the other of a single leaf (SLE) set of fiberglass springs. We hypothesized that hoppers, hopping on both legs, would adjust their leg stiffness while wearing an exoskeleton so that the combination of the hopper and exoskeleton would behave as a linear spring-mass system with the same total stiffness as during normal hopping. We also hypothesized that decreased leg force generation while wearing an exoskeleton would reduce the metabolic power required for hopping. Nine subjects hopped in place at 2.0, 2.2, 2.4, and 2.6 Hz with and without an exoskeleton while we measured ground reaction forces, exoskeletal compression, and metabolic rates. While wearing an exoskeleton, hoppers adjusted their leg stiffness to maintain linear spring-mass mechanics and a total stiffness similar to normal hopping. Without accounting for the added weight of each exoskeleton, wearing the MLE reduced net metabolic power by an average of 6% and wearing the SLE reduced net metabolic power by an average of 24% compared with hopping normally at frequencies between 2.0 and 2.6 Hz. Thus, when hoppers used external parallel springs, they likely decreased the mechanical work performed by the legs and substantially reduced metabolic demand compared with hopping without wearing an exoskeleton.

  1. Reducing The Operating Costs Of An Apartment Building

    NASA Astrophysics Data System (ADS)

    Takács, Ján; Rácz, Lukáš

    2015-09-01

    Circulation pumps are mechanical devices, which are used to create the overpressure required for the transportation of a heat-transfer medium in heating technology as well as in other related technologies. In a circulation pump the mechanical energy generated by the drive machine - an electric motor is transformed to hydraulic energy, which consists of kinetic and static energy. In the pipeline of a heating system circulation pumps represent a source of hydraulic energy (positive differential pressure), which is consumed to transport the heat-transfer medium. During the flow, the heat-transfer medium puts up resistance to the so-called passive resistors, which consist of pressure losses from friction in the pipes and pressure losses due to local resistance. In this article the authors analyze the effect of a circulation pump on the operating costs in an apartment building. Different types of circulating pumps, ranging from the most unfavorable to the optimal, were selected.

  2. Processing, compliance options can reduce cost of producing new gasoline

    SciTech Connect

    Not Available

    1994-07-11

    The price difference between US conventional and reformulated gasolines is expected to be 3.1[cents]/gal higher, less than the 4[cents]/gal difference indicated in May by the New York Mercantile Exchange. The difference will be set by the central Atlantic and New England areas, which Bonner Moore projects to be significantly short on reformulated gasoline and long on conventional gasoline. Bonner Moore consultants, in an unpublished report, say refiners in the central Atlantic will not be able to economically convert much more than 70% of their gasoline output to reformulated gasoline. As a result, gasoline movements through the pipeline system supplying Petroleum Administration for Defense District (PADD) 1-the US East Coast-will have to increase to deliver reformulated gasoline produced on the Gulf Coast to New England and the Central Atlantic region. The paper discusses production costs, processing options, price differential, compliance, and benefits from averaging both oxygen and benzene parameters.

  3. Reduce the cost of producing TAME. [Tertiary Amyl Methyl Ethers

    SciTech Connect

    Rock, K.L.; Gildert, G.R. )

    1994-01-01

    The high atmospheric reactivity and resulting high ozone formation have been previously documented for C5 olefins. Other features such as low octane number and high vapor pressure limit their usefulness as gasoline blendstocks. Conversion of C[sub 5] olefins to TAME is a good way to upgrade these components into high value gasoline blendstocks. The TAME product has high octane and low vapor pressure as well as contained oxygen. The other option is to alkylate the C[sub 5] olefins. This route produces greater volume but with higher vapor pressure and lower octane value. The TAME route also achieves lower capital and operating cost than alkylation. The paper describes a process in which reactive Isoamylenes can be converted to TAME by etherification with methanol. The reactive isoamylenes include 2-methyl butene-1 and 2-methyl butene-2.

  4. Streamlining: Reducing costs and increasing STS operations effectiveness

    NASA Technical Reports Server (NTRS)

    Petersburg, R. K.

    1985-01-01

    The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

  5. Phase correlator reduces mm-wave radar cost

    NASA Astrophysics Data System (ADS)

    Weiss, R., Sr.; Hobbs, P.; Locatelli, J.

    1986-03-01

    A technique involving the IC storage of magnetron phase for reference has been developed to make possible the use of the low-cost efficient magnetron in obtaining phase coherent signals for pulse Doppler radar. In the new external coherence method, the recorded random midpulse-region phase is compared with the frequency of the echo allowing Doppler information, free of phase noise, to be extracted. The gated magnetron was tested at Ka-band in a 35-GHz radar, and good agreement with the CP-4 5.5 GHz radar was shown. With good accuracy down to 10 cm/s, the present system, especially in the mm-wave region, has important applications to meteorological and military radar.

  6. Offshore technology aims for reduced costs, greater safety

    SciTech Connect

    Dempsey, P.

    1985-04-01

    OFFSHORE TECHNOLOGY continued to make headway last year, although dramatic breakthroughs were few and far between. Major oil companies have been spending heavily on acquisitions and the service companies, which historically have done much innovative work, have been forced to curtail their engineering budgets. The Weir hydraulic pump has been vetted for offshore service and a production model is being installed on a North Sea platform. A CO/sub 2/ fire-control system has been developed for both offshore and onshore applications, and Drilco's Trans-Wate pipe promises to extend drillstring life. And, perhaps most significantly, the Poseidon project is healthy and flourishing. If successful, Poseidon could cut development costs by more than half.

  7. Direct medical costs associated with Parkinson's disease: a population-based study.

    PubMed

    Leibson, Cynthia L; Long, Kirsten Hall; Maraganore, Demetrius M; Bower, James H; Ransom, Jeanine E; O'Brien, Peter C; Rocca, Walter A

    2006-11-01

    The objective was to provide population-based estimates of incremental medical costs associated with Parkinson's disease (PD) from onset forward. All Olmsted County, Minnesota, residents with confirmed PD onset from 1987 through 1995 (n = 92) and one age- and sex-matched non-PD referent subject per case were identified with retrospective record review and followed in provider-linked billing data for direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before index (i.e., year of symptom onset) through 10 years after index. Costs for each referent subject were subtracted from those for his/her matched case. Tests for statistical significance used Wilcoxon signed ranks. Preindex costs were similar [median difference in annual costs (MD) = -3 dollars; P = 0.59]. One year post index, PD subjects exhibited borderline significantly higher costs compared to referent subjects (MD = 581 dollars; P = 0.052); the difference diminished over 5 years (MD = 118 dollars; P = 0.82). By 5 to 10 years, however, PD subjects exhibited significantly higher costs (MD = 1,146 dollars; P = 0.01). Over the full 10 years, excess costs were concentrated among PD subjects without rest tremor (MD = 2,261 dollars, P < 0.01, for those without tremor and -229 dollars, P = 0.99, for those with tremor). These population-based estimates of PD-associated direct medical costs from onset forward can uniquely inform policy decisions and cost-effectiveness research.

  8. Examining the medical resource utilization and costs of relapsed and refractory chronic lymphocytic leukemia in Ontario

    PubMed Central

    Hassan, S.; Seung, S.J.; Cheung, M.C.; Fraser, G.; Kuriakose, B.; Trambitas, C.; Mittmann, N.

    2017-01-01

    Purpose The purpose of the present study was to collect medical resource utilization data and costs in Ontario for the management of patients with relapsed or refractory chronic lymphocytic lymphoma (cll) who have undergone at least 1 treatment course and have been stratified by Rai staging. Methods This retrospective longitudinal cohort study, conducted by chart review, analyzed anonymized patient records from two cancer centres in Ontario. Comprehensive records of 86 patients meeting the inclusion criteria were used to obtain resource utilization, which, multiplied by unit costs, were used to determine overall and mean costs. Descriptive statistics are presented for patient demographics, medical resource utilization, and costing data. Results The total cost for the cohort was $2.2 million over a mean follow-up period of 4.7 years. The mean total cost per patient (regardless of follow-up) was $25,736. In terms of Rai staging, overall mean costs were highest for stage iv patients. Almost 50% of the total cost was attributable to cll treatments, among which fludarabine-based treatments had the highest utilization. Conclusions For this Canadian cll cohort, medical resource utilization and costs were determined to be $2.2 million, with cll treatments accounting for about half the cost. Costs generally increased with Rai stage. PMID:28270732

  9. Cost of reducing aromatics and sulfur levels in motor-vehicle fuels. Volume 2. Final report

    SciTech Connect

    Felten, J.R.; McCarthy, K.M.

    1988-08-01

    Linear-programming (LP) models were developed for five refineries representative of the California refining industry and validated against historic operation. Process options to reduce gasoline and diesel contaminants were selected and represented in the LP models. Costs were estimated to separately reduce aromatics levels in automotive gasoline, aromatics in diesel, and sulfur in diesel for 1991 and 1995. Cost impacts were scaled up to obtain the overall cost impact in California. Estimates were made of total aromatics and benzene levels in gasoline and of sulfur, aromatics, and cetane levels in diesel. Estimates were made of the impact on refinery emissions, automotive emissions, and automotive performance. The cost to reduce diesel sulfur level to .05% was 6.3 cents/gallon. The cost to reduce diesel aromatics level to 10% was 27.6 cents/gallon. The cost to reduce gasoline aromatics levels by 18% was 7.0 cents/gallon.

  10. Current pulse: can a production system reduce medical errors in health care?

    PubMed

    Printezis, Antonios; Gopalakrishnan, Mohan

    2007-01-01

    One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

  11. Unhealthy Lifestyle Practices and Medical-Care Costs in the Military

    DTIC Science & Technology

    1994-03-01

    NAVAL POSTGRADUATE SCHOOL & Monterey, California AD-A279 580 STTTIC ELECTE • S MAY•2 5.1994 THESIS UNHEALTHY LIFESTYLE PRACTICES AND MEDICAL-CARE...5. FUNDING NUMBERS Unhealthy Lifestyle Practices and Medical-Care Costs in the Military 6. AUTHOR(S) Timothy H. Weber 7. PERFORMING ORGANIZATION NAME...associated costs, can be pr. vented through personal decisions not to use unhealthy lifestyle practices (e.g., smoking, not exercising). A statistical

  12. Improving the Defense Acquisition System and Reducing System Costs

    DTIC Science & Technology

    1981-03-30

    Reliability Bendix Corporation Mr. Arnold Pazomik Assistant Vice President and Director of Contracts ARINC Research Corporation Mr. Harvey Kishner...Acquisition Executive 4 8 E. DSARC Review Criteria 49 F. DSARC-PPBS Interface 50 G. Program Manager Control 52 H. Improving Reliability and Support 54... Reliability and Support X X USDRE X X 17. Reduce DSARC Briefing and Data Requirements X X USDRE X XX XX 18. Budgeting for Inflation X X ASD(C

  13. Lean Six Sigma for Reduced Cycle Costs and Improved Readiness

    DTIC Science & Technology

    2006-09-30

    and/or training) increases the cycle-time, which in turn decreases readiness, Ao. Therefore, the warfighters are J3-= forced to satisfy mission...technique that aims to develop and deliver near- perfect products and services. The primary goal of Six Sigma is to improve customer satisfaction (and...thereby, profitability) by reducing and eliminating defects. In this case, the defects may be related to any aspect of customer satisfaction

  14. Aircraft Geared Architecture Reduces Fuel Cost and Noise

    NASA Technical Reports Server (NTRS)

    2015-01-01

    In an effort to increase fuel efficiency and reduce noise in commercial airplanes, NASA aeronautics teamed up with East Hartford, Connecticut-based Pratt & Whitney through a Space Act Agreement to help the company increase the efficiency of its turbofan engine. The company's new PurePower line of engines is 15 percent more fuel-efficient and up to 75 percent quieter than its competitors.

  15. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ..., or dental care. This change responds to the increase in medical costs since 1992, when the current... Part 43 Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States... intervening period, the cost of medical care and treatment has increased substantially. That increase...

  16. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... costs for graduate medical education programs. CMS makes an additional payment to hospitals for indirect medical education costs using the following procedures: (a) Basic data. CMS determines the following...

  17. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  18. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  19. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland.

    PubMed

    Lippuner, Kurt; Golder, Matthias; Greiner, Roger

    2005-03-01

    the age of 65 years. The direct medical cost of hospitalization of patients with osteoporosis and/or related fractures was 357 million CHF. Hip fractures accounted for approximately half of these costs in women and men. Among other common diseases in women and men, osteoporosis ranked number 1 in women and number 2 (behind COPD) in men. When compared with data from 1992, the average length of stay had shortened by 8.4 days for women and 4.7 days for men, leading to a decrease of almost 40% in direct medical costs related to acute hospitalizations. This apparent decrease in cost might result from a shift into the ambulatory cost segment, for which the assessment and management tools need to be developed. We conclude that, in 2000, osteoporosis continued to be a heavy burden on the Swiss healthcare system. Lack of awareness of the disease and its consequences prevents widespread use of drugs with anti-fracture efficacy. This limits their potential to reduce costs.

  20. Fiber Optic Sensing Monitors Strain and Reduces Costs

    NASA Technical Reports Server (NTRS)

    2008-01-01

    In applications where stress on a structure may vary widely and have an unknown impact on integrity, a common engineering strategy has been overbuilding to ensure a sufficiently robust design. While this may be appropriate in applications where weight concerns are not paramount, space applications demand a bare minimum of mass, given astronomical per-pound launch costs. For decades, the preferred solution was the tactic of disassembly and investigation between flights. Knowing there must be a better way, Dr. Mark Froggatt, of Langley Research Center, explored alternate means of monitoring stresses and damage to the space shuttle. While a tear-it-apart-and-have-a-look strategy was effective, it was also a costly and time consuming process that risked further stresses through the very act of disassembly and reassembly. An alternate way of monitoring the condition of parts under the enormous stresses of space flight was needed. Froggatt and his colleagues at Langley built an early-warning device to provide detailed information about even minuscule cracks and deformations by etching a group of tiny lines, or grating, on a fiber optic cable five-thousandths of an inch thick with ultraviolet light. By then gluing the fiber to the side of a part, such as a fuel tank, and shining a laser beam down its length, reflected light indicated which gratings were under stress. Inferring this data from measurements in light rather than in bonded gauges saved additional weight. Various shuttle components now employ the ultrasonic dynamic vector stress sensor (UDVSS), allowing stress detection by measuring light beamed from a built-in mini-laser. By measuring changes in dynamic directional stress occurring in a material or structure, and including phase-locked loop, synchronous amplifier, and contact probe, the UDVSS proved especially useful among manufacturers of aerospace and automotive structures for stress testing and design evaluation. Engineers could ensure safety in airplanes

  1. Soil Segregation Methods for Reducing Transportation and Disposal Costs - 13544

    SciTech Connect

    Frothingham, David; Andrews, Shawn; Barker, Michelle; Boyle, James; Buechi, Stephen; Graham, Marc; Houston, Linda; Polek, Michael; Simmington, Robert; Spector, Harold; Elliott, Robert 'Dan'; Durham, Lisa

    2013-07-01

    At Formerly Utilized Sites Remedial Action Program (FUSRAP) sites where the selected alternative for contaminated soil is excavation and off-site disposal, the most significant budget items of the remedial action are the costs for transportation and disposal of soil at an off-site facility. At these sites, the objective is to excavate and dispose of only those soils that exceed derived concentration guideline levels. In situ soil segregation using gross gamma detectors to guide the excavation is often challenging at sites where the soil contamination is overlain by clean soil or where the contaminated soil is located in isolated, subsurface pockets. In addition, data gaps are often identified during the alternative evaluation and selection process, resulting in increased uncertainty in the extent of subsurface contamination. In response, the U.S. Army Corps of Engineers, Buffalo District is implementing ex situ soil segregation methods. At the remediated Painesville Site, soils were excavated and fed through a conveyor-belt system, which automatically segregated them into above- and below-cleanup criteria discharge piles utilizing gamma spectroscopy. At the Linde Site and the Shallow Land Disposal Area (SLDA) Site, which are both in the remediation phase, soils are initially segregated during the excavation process using gross gamma detectors and then transported to a pad for confirmatory manual surveying and sampling. At the Linde Site, the ex situ soils are analyzed on the basis of a site-specific method, to establish compliance with beneficial reuse criteria that were developed for the Linde remediation. At the SLDA Site, the ex situ soils are surveyed and sampled based on Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) final status survey guidance to demonstrate compliance with the derived concentration guideline levels. At all three sites, the ex situ soils that meet the site- specific DCGLs are retained on-site and used as backfill

  2. Nisin Production Utilizing Skimmed Milk Aiming to Reduce Process Cost

    NASA Astrophysics Data System (ADS)

    Jozala, Angela Faustino; de Andrade, Maura Sayuri; de Arauz, Luciana Juncioni; Pessoa, Adalberto; Penna, Thereza Christina Vessoni

    Nisin is a natural additive for conservation of food, pharmaceutical, and dental products and can be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. This study was performed to optimize large-scale nisin production in skimmed milk and subproducts aiming at low-costs process and stimulating its utilization. Lactococcus lactis American Type Culture Collection (ATCC) 11454 was developed in a rotary shaker (30°C/36 h/100 rpm) in diluted skimmed milk and nisin activity, growth parameters, and media components were also studied. Nisin activity in growth media was expressed in arbitrary units (AU/mL) and converted to standard nisin concentration (Nisaplin®, 25 mg of pure nisin is 1.0×106 AU/mL). Nisin activity in skimmed milk 2.27 gtotal solids was up to threefold higher than transfers in skimmed milk 4.54 gtotal solids and was up to 85-fold higher than transfers in skimmed milk 1.14 gtotal solids. L. lactis was assayed in a New Brunswick fermentor with 1.5 L of diluted skimmed milk (2.27 gtotal solids) and airflow of 1.5 mL/min (30°C/36/200 rpm), without pH control. In this condition nisin activity was observed after 4 h (45.07 AU/mL) and in the end of 36 h process (3312.07 AU/mL). This work shows the utilization of a low-cost growth medium (diluted skimmed milk) to nisin production with wide applications. Furthermore, milk subproducts (milk whey) can be exploited in nisin production, because in Brazil 50% of milk whey is disposed with no treatment in rivers and because of high organic matter concentrations it is considered an important pollutant. In this particular case an optimized production of an antimicrobial would be lined up with industrial disposal recycling.

  3. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

  4. A Summary of: 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Center for College Affordability and Productivity (NJ1), 2010

    2010-01-01

    Almost everyone agrees that colleges have become costly to attend and are a growing burden on society to finance. Rising tuition costs threaten the ability and desire of students to attend college. Are there things that can be done to significantly reduce the cost of college? The answer is an emphatic "yes." The Center for College Affordability…

  5. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    SciTech Connect

    Weinstein, Marvin; Auerbach, Assa; Chandra, V.Ravi; /Technion

    2011-11-04

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. The lattice of size N is partitioned into two subclusters. At each iteration the Lanczos vector is projected into a set of n{sub svd} smaller subcluster vectors using singular value decomposition. For low entanglement entropy S{sub ee}, (satisfied by short range Hamiltonians), we expect the truncation error to vanish as exp(-n{sup 1/S{sub ee}}{sub svd}). Convergence is tested for the Heisenberg model on Kagome clusters of up to 36 sites, with no symmetries exploited, using less than 15GB of memory. Generalization to multiple partitioning is discussed.

  6. Estimated Lifetime Medical and Work-Loss Costs of Fatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Simon, Thomas; Haegerich, Tamara; Luo, Feijun; Zhou, Chao

    2015-10-02

    Injury-associated deaths have substantial economic consequences. In 2013, unintentional injury was the fourth leading cause of death, suicide was the tenth, and homicide was the sixteenth; these three causes accounted for approximately 187,000 deaths in the United States. To assess the economic impact of fatal injuries, CDC analyzed death data from the National Vital Statistics System for 2013, along with cost of injury data using the Web-Based Injury Statistics Query and Reporting System. This report updates a previous study that analyzed death data from the year 2000, and employs recently revised methodology for determining the costs of injury outcomes, which uses the most current economic data and incorporates improvements for estimating medical costs associated with injury. Number of deaths, crude and age-specific death rates, and total lifetime work-loss costs and medical costs were calculated for fatal injuries by sex, age group, intent (intentional versus unintentional), and mechanism of injury. During 2013, the rate of fatal injury was 61.0 per 100,000 population, with combined medical and work-loss costs exceeding $214 billion. Costs from fatal injuries represent approximately one third of the total $671 billion medical and work-loss costs associated with all injuries in 2013. The magnitude of the economic burden associated with injury-associated deaths underscores the need for effective prevention.

  7. Continuing medical education costs and benefits: lessons for competing in a changing health care economy.

    PubMed

    Mazmanian, Paul E

    2009-01-01

    Current approaches to evaluation in continuing medical education (CME) feature results defined as changes in participation, satisfaction, knowledge, behavior, and patient outcomes. Few studies link costs and effectiveness of CME to improved quality of care. As continuing education programs compete for scarce resources, cost-inclusive evaluation offers strategies to measure change and to determine value for resources spent.

  8. Reducing memory cost of exact diagonalization using singular value decomposition.

    PubMed

    Weinstein, Marvin; Auerbach, Assa; Chandra, V Ravi

    2011-11-01

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements, without restricting to variational ansatzes. The lattice of size N is partitioned into two subclusters. At each iteration the Lanczos vector is projected into two sets of n(svd) smaller subcluster vectors using singular value decomposition. For low entanglement entropy S(ee), (satisfied by short-range Hamiltonians), the truncation error is expected to vanish as exp(-n(svd)(1/S(ee))). Convergence is tested for the Heisenberg model on Kagomé clusters of 24, 30, and 36 sites, with no lattice symmetries exploited, using less than 15 GB of dynamical memory. Generalization of the Lanczos-SVD algorithm to multiple partitioning is discussed, and comparisons to other techniques are given.

  9. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    NASA Astrophysics Data System (ADS)

    Weinstein, Marvin; Chandra, Ravi; Auerbach, Assa

    2012-02-01

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. In contrast to variational approaches and most implementations of DMRG, Lanczos rotations towards the ground state do not involve incremental minimizations, (e.g. sweeping procedures) which may get stuck in false local minima. The lattice of size N is partitioned into two subclusters. At each iteration the rotating Lanczos vector is compressed into two sets of nsvd small subcluster vectors using singular value decomposition. For low entanglement entropy See, (satisfied by short range Hamiltonians), the truncation error is bounded by (-nsvd^1/See). Convergence is tested for the Heisenberg model on Kagom'e clusters of 24, 30 and 36 sites, with no lattice symmetries exploited, using less than 15GB of dynamical memory. Generalization of the Lanczos-SVD algorithm to multiple partitioning is discussed, and comparisons to other techniques are given. Reference: arXiv:1105.0007

  10. Incident User Cohorts for Assessing Medication Cost-Offsets

    PubMed Central

    Stuart, Bruce; Loh, F Ellen; Roberto, Pamela; Miller, Laura

    2014-01-01

    Objective To develop and test incident drug user designs for assessing cost savings from statin use in diabetics. Data Source Random 5 percent sample of Medicare beneficiaries, 2006–2008. Study Design Seven-step incident user design to assess impact of statin initiation on subsequent Medicare spending: (1) unadjusted pre/post initiation test; (2) unadjusted difference-in-difference (DID) with comparison series; (3) adjusted DID; (4) propensity score (PS)-matched DID with static and dynamic baseline covariates; (5) PS-matched DID by drug adherence strata; (6) PS-matched DID for high adherers controlling for healthy adherer bias; and (7) replication for ACE-inhibitor/ARB initiators. Data Collection/Extraction Methods Subjects with prevalent diabetes and no statin use (January–June 2006) and statin initiation (July 2006–January 2008) compared to nonusers with a random “potential-initiation” month. Monthly Medicare spending tracked 24 months pre- and post-initiation. Principal Findings Statistically significant savings in Medicare spending were observed beginning 7 months post-initiation for statins and 13 months post-initiation for ACEIs/ARBs. However, these savings were only observed for adherent patients in steps 5 and 6. Conclusions Drug initiator designs are more robust to confounding than prevalent user designs in assessing cost-offsets from drug use but still require other adjustments and sensitivity analysis to ensure proper inference. PMID:24628528

  11. Direct medical costs of liquid intravenous immunoglobulins in children, adolescents, and adults in Spain.

    PubMed

    Darbà, Josep; Restovic, Gabriela; Kaskens, Lisette; de Agustín, Tuy

    2012-04-01

    The aim of this study was to determine health care resource utilization and direct medical costs in Spanish patients treated with intravenous immunoglobulins (IVIGs) in 2009. Cost-of-illness analyses were performed to estimate direct medical costs of patients treated with IVIGs. Prevalence data were obtained from the Spanish Primary Immunodeficiency registry. A semi-structured questionnaire was used to collect data on health care resource utilization and patient distribution. Drug, administration, and premedication costs were considered from the payer's perspective. Separate analyses were conducted for children and adolescents versus adults. The numbers of children and adolescents with replacement therapy were 724, with immunomodulation 243, and with allogeneic bone marrow transplantation 30. The numbers of adult patients were, respectively, 3450, 1134, and 172. Mean annual costs for children and adolescents were 6293 € with Privigen, 6292 € with Kiovig, 6939 € with Flebogamma, and 6559 € with Octagamocta. For adults, estimations were 17 106 € with Privigen, 17 103 € with Kiovig, 18 077 € with Flebogamma, and 17 423 € with Octagamocta. Direct medical costs for IVIGs were approximately 91.8 million €. Drug costs represented 94% of total costs. The choice for a certain IVIG treatment depends on individual patient characteristics and cost considerations.

  12. 75 FR 33629 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-14

    ... Practices to Reduce Medication Errors; Public Workshop; Change of Meeting Location AGENCY: Food and Drug... Practices to Reduce Medication Errors.'' A new address is given for those attending the workshop. DATES: The... on describing practices for naming, labeling, and packaging drugs and biologics to reduce...

  13. Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

    PubMed Central

    Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

    2014-01-01

    Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

  14. Using Cost as an Independent Variable (CAIV) to Reduce Total Ownership Cost

    DTIC Science & Technology

    2006-01-31

    CAIV pilot programs in each of the DoD Components that might yield valuable lessons- learned for the acquisition community. Without designated CAIV...Costs,” that comprises a collection of the lessons- learned and best practices garnered from the R-TOC Pilot programs.7 Expert Interviews Published...each of the DoD Components that might yield valuable lessons- learned for the acquisition community. However, for unknown reasons, none has been

  15. Effects of reduced cost-sharing on children's health: Evidence from Japan.

    PubMed

    Takaku, Reo

    2016-02-01

    Although childhood health status is widely recognized as an important determinant for future achievement and health, there are few studies on the impact of patient cost-sharing on children's health. This paper investigates whether reduced cost-sharing leads to an improvement of health status among preschool and school-age children in Japan, exploiting regional disparities in expansions of municipality-level subsidy programs for out-of-pocket expenditure. With the eligibility for this subsidy program, known as the Medical Subsidy for Children and Infants (MSCI), the coinsurance rate generally decreases from 30% or 20% to zero for outpatient health care services and drug prescriptions. In order to uncover the impact of this program, I conducted an original survey of all municipalities in Japan to understand the time-series evolution of the eligible age for the MSCI in October 2013 (weighted response rate = 75%), and the probability of being eligible for the MSCI was then calculated by the age, prefecture of residence, and year. These probabilities were matched to children's health data from the Comprehensive Survey of Living Conditions from 1995 to 2010. The results show that eligibility for the MSCI improves subjective measures of health status among preschool children (n = 115,019). However, I find no such improvement among school-age children (n = 133,855). In addition, MSCI eligibility does not reduce hospitalization among either preschool or school-age children. Taken together, this study finds no discernible effects on health among school-age children, suggesting recent rapid expansions of the MSCI for this age group have not been associated with the improvement of health status.

  16. Reducing need and demand for medical services in high-risk persons. A health education approach.

    PubMed Central

    Fries, J F; McShane, D

    1998-01-01

    We undertook this study to identify persons with high medical use to target them for health promotion and self-management interventions specific to their problems. We compared the reductions in cost and health risk of a health education program aimed at high-risk persons with a similar program addressed to all risk levels. We compared health risk and use in 2,586 high-risk persons with those of employee (N = 50,576) and senior (N = 39,076) groups and contrasted results in specific high-risk disease or behavior categories (modules)--arthritis, back pain, high blood pressure, diabetes mellitus, heart disease, smoking, and obesity--against each other, using validated self-report measures, over a 6-month period. Interventions were a standard generic health education program and a similar program directed at high risk individuals (Healthtrac). Health risk scores improved by 11% in the overall high-risk group compared with 9% in the employee group and 6% in the senior group. Physician use decreased by 0.8 visits per 6 months in the high-risk group compared with 0.05 and 0.15 visits, respectively, per 6 months in the employee and senior groups. Hospital stays decreased by 0.2 days per 6 months in the high-risk group compared with 0.05 days in the comparison groups. The duration of illness or confinement to home decreased by 0.9 days per 6 months in the high-risk group and 0.15 and 0.25, respectively, in the employee and senior groups. Using imputed costs of $130 per physician visit, $1,000 per hospital day, and $200 per sick day, previous year costs were $1,138 in direct costs for the high-risk groups compared with $352 and $995 in the employee and senior groups, respectively. At 6 months, direct costs were reduced by $304 in the high-risk group compared with $57 and $70 in the comparison groups. Total costs were reduced $484 in the high-risk groups compared with $87 in the employee group and $120 in the senior group. The return on investment was about 6:1 in the high

  17. Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions

    PubMed Central

    Nerat, Tomaž; Locatelli, Igor; Kos, Mitja

    2016-01-01

    Introduction Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered. Aims The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer. Methods Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia. Results Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg). Conclusion The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized

  18. Surgical versus medical treatment of ocular surface squamous neoplasia: A cost comparison

    PubMed Central

    Moon, Christina S.; Nanji, Afshan A.; Galor, Anat; McCollister, Kathryn E.; Karp, Carol L.

    2016-01-01

    Purpose The objective of this study was to compare the cost associated with surgical versus interferon (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). Design A matched, case-control study. Participants Ninety-eight patients with OSSN; 49 of whom were treated surgically and 49 of whom were treated medically. Methods Patients with OSSN treated with IFNα2b were matched to surgery patients based on age and date of treatment initiation. Financial cost to the patient was calculated using two different methods (hospital billing and Medicare allowable charges) and compared between the two 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 two groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. Main outcome measures Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. Results When considering cost in terms of time, the medical group had an average of 2 more actual and imputed number of visits over 1 year compared to the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean $17,598, SD $7,624) when compared to the IFNα2b group (mean $4,986, SD $2,040). However, cost between the two groups was comparable when calculated based on Medicare allowable charges (surgical group: mean $3,528, SD $1,610; medical group: mean $2,831, SD $1,082; P = 1.00). The highest cost category in the surgical group was the excisional biopsy (Hospital billing $17,598; Medicare allowable $3,528) while the highest cost in the medical group was interferon ($1,172 for drops, average 8.0 bottles; $370 for injections, average 5.4 injections). Conclusion Our data in this group of patients previously

  19. Cost-Effectiveness of Zoledronic Acid to Prevent and Treat Postmenopausal Osteoporosis in Comparison with Routine Medical Treatment

    PubMed Central

    Golmohamdi, Fateme Rostami; Abbasi, Mahnaz; Karyani, Ali Kazemi; Sari, Ali Akbari

    2016-01-01

    Introduction Fractures caused by osteoporosis are prevalent among elderly females, which reduce quality of life significantly. This study aimed at comparing cost-effectiveness of Zoledronic acid in preventing and treating post-menopause osteoporosis as compared with routine medical treatment. Methods This cost-effectiveness study was carried out retrospectively from the Ministry of Health and insurance organizations perspective. Costs were evaluated based on the cost estimation of a sample of patients. Outcomes were obtained from a systematic review. The Cost-Effectiveness Ratio (CER) and incremental cost-effectiveness ratio (ICER) for outcome of femoral neck Bone Mineral Density (BMD), hip trochanter BMD, total hip BMD and lumbar spine BMD and cost-benefit of consuming Zoledronic Acid were calculated for fracture outcome obtained from reviewing hospital records. Results The results and the ICER calculated for study outcomes indicated that one percent increase of BMD on femoral neck BMD requires further cost of $386. One percent increase of BMD on hip trochanter BMD requires further cost of $264. One percent increase of BMD on total hip BMD requires further cost of $388, one percent increase of BMD on lumbar spine BMD requires further cost of $347. The Cost Benefit Analysis (CBA) calculated for vertebral and hip fracture, non-vertebral fracture, any clinical fracture, and morphometric fracture for a 36-month period were about 0.82, 0.57, and 1.06, respectively. Vertebral and hip fractures, and non-vertebral fractures or any clinical fracture for a 12-month period were calculated as 1.14 and 0.64, respectively. In other words, Zoledronic acid consumption approach is a cheaper and better approach based on an economic assessment, and it can be considered as a dominant approach. Conclusion According to the cost-effectiveness of zoledronic acid in the prevention and treatment of osteoporosis in women, despite the costs, it is recommended that insurance coverage for the

  20. Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention.

    PubMed

    Latimer, Sharon; Hewitt, Jayne; Stanbrough, Rebecca; McAndrew, Ron

    2017-02-14

    Medication errors are a patient safety and quality of care issue. There is evidence to suggest many undergraduate nursing curricula do not adequately educate students about the factors that contribute to medication errors and possible strategies to prevent them. We designed and developed a suite of teaching strategies that raise students' awareness of medication error producing situations and their prevention.

  1. Can eHealth Reduce Medical Expenditures of Chronic Diseases?

    PubMed

    Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

    2015-01-01

    The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

  2. Cost-effectiveness of glaucoma management with monotherapy medications in Egypt

    PubMed Central

    El-Khamery, Amal Abd-Elaal; Mohamed, Amir Ibrahim; Swify, Hassan Eisa Hassan; Mohamed, Alaa Ibrahim

    2017-01-01

    Glaucoma is a serious chronic ophthalmic disease since it causes irreversible visual disability if untreated can lead to blindness. Treatment options include medications (classified into five major classes of drugs which are muscarinic cholinergic agonists, alpha-2 adrenergic agonists, beta-1 adrenergic antagonists, prostaglandins [PGs], and carbonic anhydrase inhibitors); use of laser therapy or conventional surgery. Pharmacoeconomic analysis helps in choosing among this variety of treatments. There is a great need for such analysis in Egypt since undergoing of it in different countries or societies may produce different results. This work aimed to compare cost-effectiveness of bimatoprost 0.03% once daily versus brimonidine 0.2% twice daily and timolol 0.5% twice daily as monotherapy treatment in Egyptian patients with open-angle glaucoma or ocular hypertension. Clinical data revealed that all treatments decreased intraocular pressure (IOP) significantly but bimatoprost 0.03% showed the highest efficacy (27.7% decrease in IOP from baseline), while timolol 0.5% reduced IOP by 22.5% then brimonidine 0.2% which decreased IOP by 20.8%. From the cost-effectiveness view, it would be preferable to initiate treatment with timolol in case of absence of any contraindications. PG analog can be used as add-on therapy in low responder patients or as alternative treatment in case of presence of contraindication to use of beta blockers. PMID:28217551

  3. Development of a fixed abrasive slicing technique (FAST) for reducing the cost of photovoltaic wafers

    SciTech Connect

    Schmid, F. )

    1991-12-01

    This report examines a wafer slicing technique developed by Crystal Systems, Inc. that reduces the cost of photovoltaic wafers. This fixed, abrasive slicing technique (FAST) uses a multiwire bladepack and a diamond-plated wirepack; water is the coolant. FAST is in the prototype production stage and reduces expendable material costs while retaining the advantages of a multiwire slurry technique. The cost analysis revealed that costs can be decreased by making more cuts per bladepack and slicing more wafers per linear inch. Researchers studied the degradation of bladepacks and increased wirepack life. 21 refs.

  4. Reducing intraoperative red blood cell unit wastage in a large academic medical center

    PubMed Central

    Whitney, Gina M.; Woods, Marcella C.; France, Daniel J.; Austin, Thomas M.; Deegan, Robert J.; Paroskie, Allison; Booth, Garrett S.; Young, Pampee P.; Dmochowski, Roger R.; Sandberg, Warren S.; Pilla, Michael A.

    2015-01-01

    BACKGROUND The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. STUDY DESIGN AND METHODS Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. RESULTS Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p <0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15–0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. CONCLUSIONS These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. PMID:26202213

  5. Excerpta Medica abstracting journals: a case study of costs to medical school libraries.

    PubMed

    La Rocco, A; Feng, C

    1977-04-01

    A cost comparison study was made of Excerpta Medica's abstracting journals, based upon actual costs to a library. Unit costs were determined for six sections of EM as compared with six corresponding abstract journals. On average, EM sections were found to be 138% more costly than corresponding abstract journals. The effects of splitting of EM journal titles were also analyzed. This practice increases the price of a total subscription to EM and makes comprehensive information retrieval more difficult. A survey of medical school librarians as users of EM points to dissatisfaction with its increasing price, particularly when it results from title splitting.

  6. Impact of Physician-Coordinated Intensive Follow-Up on Long-Term Medical Costs in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Jia, Jing-Jing; Dong, Ping-Shuan; Du, Lai-Jing; Li, Zhi-Guo; Lai, Li-Hong; Yang, Xu-Ming; Wang, Shao-Xin; Yang, Xi-Shan; Li, Zhi-Juan; Shang, Xi-Yan; Fan, Xi-Mei

    2017-01-01

    Background To investigate the impact of professional physician-coordinated intensive follow-up on long-term expenditures after percutaneous coronary intervention (PCI) in unstable angina (UA) patients. Methods In this study, there were 669 UA patients who underwent successful PCI and followed up for 3 years, then divided into the intensive follow-up group (N = 337), and the usual follow-up group (N = 332). Patients were provided with detailed discharge information and individualized follow-up schedules. The intensive group received the extra follow-up times and medical consultations, and all patients were followed up for approximately 3 years. Results At the 3-year mark after PCI, the cumulative major adverse cardiac events (MACE), recurrence of myocardial ischemia, cardiac death, all-cause death and revascularization in the intensive group were lower than in the usual group. Additionally, the proportion of good medication adherence was significantly higher than in the usual group (56.4% vs. 46.1%, p < 0.001). The hospitalization daytime, total hospitalization cost and total medical cost in the intensive group were lower. Multiple linear regression showed that diabetes, hypertension, intensive follow-up and good medication adherence were associated with emergency and regular clinical cost (p < 0.05), the re-hospitalization cost (p < 0.05) and the total medical cost (p < 0.05) of patient care. Intensive follow-up and good adherence were negatively correlated with the cost of re-hospitalization (standardized coefficients = -0.132, -0.128, p < 0.05) and total medical costs (standardized coefficients = -0.072, -0.086, p < 0.05). Conclusions Intensive follow-up can reduce MACE, improve medication adherence and save long-term total medical costs, just by increasing the emergency and regular clinical visits cost in UA patients after PCI. PMID:28344421

  7. Medical costs of asbestos-related diseases in Spain between 2004 and 2011

    PubMed Central

    GARCÍA-GÓMEZ, Montserrat; GARRIDO, Rosa URBANOS; LÓPEZ, Rosario CASTAÑEDA; MENÉNDEZ-NAVARRO, Alfredo

    2016-01-01

    The objective of this article was to estimate the medical costs derived from malignant ARD treatment in the Spanish National Health System (NHS) between 2004 and 2011. Estimation of direct healthcare costs was based on national primary data on the cost of specialized care for inpatients and outpatients treated at NHS hospitals and on national and regional secondary data on costs of primary healthcare and pharmaceutical prescriptions. A prevalence approach was used to estimate the overall burden of ARDs. Direct medical costs of 37,557 ARDs attended in Spanish NHS facilities in 2004–2011 were estimated at 464 million euros; specialist care accounted for 50.9% of total costs, primary healthcare 10.15%, and drug prescription 38.9%. The cost was 27.8-fold higher in males than in females. Bronchopulmonary cancers represented the greatest healthcare cost, 281 million euros. The cost of delivering healthcare to ARDs victims in Spain has a negative economic impact on the NHS due to the gross under-recognition of occupational victims under the Spanish National Insurance System. PMID:27334423

  8. 78 FR 62709 - Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... the cost of outpatient medical, dental and cosmetic surgery services furnished by military treatment... BUDGET Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... Outpatient Medical, Dental, and Cosmetic Surgery rates referenced are effective upon publication of...

  9. 76 FR 72003 - Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... the cost of outpatient medical, dental, and cosmetic surgery services furnished by military treatment... BUDGET Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... outpatient medical, dental, and cosmetic surgery services rates referenced are effective upon publication...

  10. 76 FR 15349 - Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... the cost of outpatient medical, dental and cosmetic surgery services furnished by military treatment... BUDGET Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously...

  11. Toward efficient medication error reduction: error-reducing information management systems.

    PubMed

    Chung, Kyusuk; Choi, Young B; Moon, Sangho

    2003-12-01

    Hospitals and other health-care providers today are being pressed more than ever to use technologies for reducing medical errors. Particularly, medication errors are likely to increase fast as Americans age. This paper intends to provide a starting point for understanding information technologies and database systems supporting such technologies as Computerized Physician Order Entry (CPOE), Automated Dispensing System (ADS), and Bar Coding System designed to reduce medication errors in hospitals. Although vendors provide the necessary communication software and applications, actions involving governments, technology vendors, pharmaceutical companies, and clinical researchers are needed to put to actual use the applications with a massive potential to significantly reduce medication-related errors.

  12. Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis

    PubMed Central

    John-Baptiste, A.; Sowerby, L.J.; Chin, C.J.; Martin, J.; Rotenberg, B.W.

    2016-01-01

    Background: When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). Methods: We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. Results: The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. Interpretation: Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems. PMID:27975045

  13. Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs

    PubMed Central

    Turakhia, Mintu; Fogarty, Thomas J.

    2016-01-01

    In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year. Individuals with AF are three times more likely to be hospitalized over the span of a year when compared to medically matched control groups. The considerably large clinical population of individuals with AF mandates that the cost-effectiveness and efficacy of current treatment regimens for AF have egregious implications for health care spending and public health. Unfortunately, catheter ablation for AF treatment has been shown to make only modest gains in quality-adjusted life years, has yet to demonstrate cost-utility advantages over conventional therapies for AF, and has a reported rate of recurrence for AF that is notably high. Thus, there is a major unmet clinical need for a therapeutic option to treat AF that produces more consistent and efficacious results that are cost-effective. Cardiac radiosurgery as a therapy for AF has the potential to be remarkably cost-effective and produce robust patient outcomes. CyberHeart Inc. has developed the world’s first-ever cardiac radiosurgery (CRS) system designed to ablate the heart non-invasively. Procedures that ablate the heart utilizing the Cyberheart CRS system are anticipated to allow higher efficacy and more consistent results than current techniques such as catheter ablation. The aim of this study is to present the current healthcare utilization and expenditures in AF treatment, report the cost-effectiveness of catheter ablation for AF, and project the potential cost-effectiveness of cardiac radiosurgery for the treatment of AF. PMID:27625906

  14. Reducing Enzyme Costs Increases the Market Potential of Biofuels (Fact Sheet)

    SciTech Connect

    Not Available

    2013-08-01

    Cellulosic ethanol prices depend heavily on the cost of the cellulase enzymes used to break down the biomass into fermentable sugars. To reduce these costs, NREL partnered with two leading enzyme companies, Novozymes and Genencor, to engineer new cellulase enzymes that are exceptionally good at breaking down cellulose. Genencor is now part of DuPont Industrial Biosciences.

  15. Mixed-Mode Surveys: A Strategy to Reduce Costs and Enhance Response Rates

    ERIC Educational Resources Information Center

    Tobin, Daniel; Thomson, Joan; Radhakrishna, Rama; LaBorde, Luke

    2012-01-01

    Mixed-mode surveys present one opportunity for Extension to determine program outcomes at lower costs. In order to conduct a follow-up evaluation, we implemented a mixed-mode survey that relied on communication using the Web, postal mailings, and telephone calls. Using multiple modes conserved costs by reducing the number of postal mailings yet…

  16. Reducing Energy Cost and Greenhouse Gas Emission in the Corporate Sector, a Delphi Study

    ERIC Educational Resources Information Center

    Kramer, Maxim L.

    2013-01-01

    The study is titled "Reducing energy cost and GreenHouse Gas emission in the corporate sector, A Delphi Study". The study applied the Delphi methodology and focused on the Green IT solutions that can help the modern corporate organizations with less than 1000 employees to decrease their energy costs and GHG emissions. The study presents…

  17. Cost of unneeded proteins in E. coli is reduced after several generations in exponential growth.

    PubMed

    Shachrai, Irit; Zaslaver, Alon; Alon, Uri; Dekel, Erez

    2010-06-11

    When E. coli cells express unneeded protein, they grow more slowly. Such penalty to fitness associated with making proteins is called protein cost. Protein cost is an important component in the cost-benefit tradeoffs that underlie the evolution of protein circuits, but its origins are still poorly understood. Here, we ask how the protein cost varies during the exponential growth phase of E. coli. We find that cells growing exponentially following an upshift from overnight culture show a large cost when producing unneeded proteins. However, after several generations, while still in exponential growth, the cells enter a phase where cost is much reduced despite vigorous unneeded protein production. We find that this reduced-cost phase depends on the ppGpp system, which adjusts the amount of ribosomes in the cell and does not occur after a downshift from rich to poor medium. These findings suggest that protein cost is a transient phenomenon that happens upon an upshift in conditions and that cost is reduced when ribosomes and other cellular systems have increased to their appropriate steady-state level in the new condition.

  18. Inhaler Costs and Medication Nonadherence Among Seniors With Chronic Pulmonary Disease

    PubMed Central

    Rogers, William H.; Safran, Dana Gelb; Wilson, Ira B.

    2010-01-01

    Background: Chronic pulmonary diseases (CPDs) such as asthma and COPD are associated with particularly high rates of cost-related medication nonadherence (CRN), but the degree to which inhaler costs contribute to this is not known. Here, we examine the relationship between inhaler-specific out-of-pocket costs and CRN in CPD. Methods: Using data obtained in 2006 in a national stratified random sample (N = 16,072) of community-dwelling Medicare beneficiaries aged ≥ 65 years, we used logistic regression to examine the relationship between inhaled medications, various types of out-of-pocket costs, and CRN in persons with CPD. Results: The prevalence of CRN in Medicare recipients with CPD using inhalers was 31%. In multivariate models, the odds that respondents with CPD using inhalers would report CRN was 1.43 (95% CI, 1.21-1.69) compared with respondents without CPD who were not using inhalers. Adjustment for out-of-pocket inhaler costs—but not adjustment for total medication costs or non-inhaler costs—eliminated this excess risk of CRN (OR, 0.95; 95% CI, 0.71-1.28). Patients paying > $20 per month for inhalers were at significantly higher risk for CRN compared with those who had no out-of-pocket inhaler costs. Conclusions: Individuals with CPD and high out-of-pocket inhaler costs are at increased risk for CRN relative to individuals on other medications. Physicians should be aware that inhalers can pose a particularly high risk of medication nonadherence for some patients. PMID:20418367

  19. Digital methods for reducing radiation exposure during medical fluoroscopy

    NASA Astrophysics Data System (ADS)

    Edmonds, Ernest W.; Rowlands, John A.; Hynes, David M.; Toth, B. D.; Porter, Anthony J.

    1990-07-01

    There is increased concern over radiation exposure to the general population from many sources. One of the most significant sources is that received by the patient during medical diagnostic procedures, and of these, the procedure with the greatest potential hazard is fluoroscopy. The legal limit for fluoroscopy in most jurisdictions is SR per minute skin exposure rate. Fluoroscopes are often operated in excess of this figure, and in the case of interventional procedures, fluorocopy times may exceed 20 minutes. With improvements in medical technology these procedures are being performed more often, and also are being carried out on younger age groups. Radiation exposure during fluoroscopy, both to patient and operator, is therefore becoming a matter of increasing concern to regulating authorities, and it is incumbent on us to develop digital technology to minimise the radiation hazard in these procedures. This paper explores the technical options available for radiation exposure reduction, including pulsed fluoroscopy, digital noise reduction, or simple reduction in exposure rate to the x-ray image intensifier. We also discuss educational aspects of fluoroscopy which radiologists should be aware of which can be more important than the technological solutions. A "work in progress" report gives a completely new approach to the implementation of a large number of possible digital algorithms, for the investigation of clinical efficacy.

  20. The Costs, Benefits, and Cost-Effectiveness of Interventions to Reduce Maternal Morbidity and Mortality in Mexico

    PubMed Central

    Hu, Delphine; Bertozzi, Stefano M.; Gakidou, Emmanuela; Sweet, Steve; Goldie, Sue J.

    2007-01-01

    Background In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5 - to reduce maternal mortality by three-quarters by 2015 - will be met. Methodology/Principal Findings We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. Conclusions/Significance Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will

  1. Overburdened and overwhelmed: the struggles of communities with high medical cost burdens.

    PubMed

    Cunningham, Peter J

    2007-11-01

    The number of people with potentially high medical cost burdens varies widely across the nation, reflecting differences in the number of people who lack health insurance coverage and people who have coverage but nevertheless have high costs relative to their income. To address this problem, many states are undertaking expansions of insurance coverage, but federal support will be critical, particularly in states with large numbers of low-income residents.

  2. The cost to successfully apply for level 3 medical home recognition

    PubMed Central

    Mottus, Kathleen; Reiter, Kristin; Mitchell, C. Madeline; Donahue, Katrina E.; Gabbard, Wilson M.; Gush, Kimberly

    2016-01-01

    BACKGROUND The NCQA Patient Centered Medical Home (PCMH) recognition program provides practices an opportunity to implement Medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work. METHODS Practice coaches identified 5 exemplar practices that received level 3 recognition (3 pediatric and 2 family medicine practices). This analysis focuses on 4 that received 2011 recognition. Clinical, informatics and administrative staff participated in 2–3 hour interviews. We collected the time required to develop, implement and maintain required activities. We categorized costs as: 1) non-personnel, 2) developmental 3) those to implement activities 4) those to maintain activities, 5) those to document the work and 6) consultant costs. Only incremental costs were included and are presented as costs per full-time equivalent provider (pFTE) RESULTS Practice size ranged from 2.5 – 10.5 pFTE’s, payer mixes from 7–43 % Medicaid. There was variation in the distribution of costs by activity by practice; but the costs to apply were remarkably similar ($11,453–$15,977 pFTE). CONCLUSION The costs to apply for 2011 recognition were noteworthy. Work to enhance care coordination and close loops were highly valued. Financial incentives were key motivators. Future efforts to minimize the burden of low value activities could benefit practices. PMID:26769879

  3. Near field communications technology and the potential to reduce medication errors through multidisciplinary application

    PubMed Central

    Pegler, Joe; Lehane, Elaine; Livingstone, Vicki; McCarthy, Nora; Sahm, Laura J.; Tabirca, Sabin; O’Driscoll, Aoife; Corrigan, Mark

    2016-01-01

    Background Patient safety requires optimal management of medications. Electronic systems are encouraged to reduce medication errors. Near field communications (NFC) is an emerging technology that may be used to develop novel medication management systems. Methods An NFC-based system was designed to facilitate prescribing, administration and review of medications commonly used on surgical wards. Final year medical, nursing, and pharmacy students were recruited to test the electronic system in a cross-over observational setting on a simulated ward. Medication errors were compared against errors recorded using a paper-based system. Results A significant difference in the commission of medication errors was seen when NFC and paper-based medication systems were compared. Paper use resulted in a mean of 4.09 errors per prescribing round while NFC prescribing resulted in a mean of 0.22 errors per simulated prescribing round (P=0.000). Likewise, medication administration errors were reduced from a mean of 2.30 per drug round with a Paper system to a mean of 0.80 errors per round using NFC (P<0.015). A mean satisfaction score of 2.30 was reported by users, (rated on seven-point scale with 1 denoting total satisfaction with system use and 7 denoting total dissatisfaction). Conclusions An NFC based medication system may be used to effectively reduce medication errors in a simulated ward environment. PMID:28293602

  4. Reducing a cost of traumatic insemination: female bedbugs evolve a unique organ.

    PubMed Central

    Reinhardt, Klaus; Naylor, Richard; Siva-Jothy, Michael T

    2003-01-01

    The frequent wounding of female bedbugs (Cimex lectularius: Cimicidae) during copulation has been shown to decrease their fitness, but how females have responded to this cost in evolutionary terms is unclear. The evolution of a unique anatomical structure found in female bedbugs, the spermalege, into which the male's intromittent organ passes during traumatic insemination, is a possible counteradaptation to harmful male traits. Several functions have been proposed for this organ, and we test two hypotheses related to its role in sexual conflict. We examine the hypotheses that the spermalege functions to (i) defend against pathogens introduced during traumatic insemination; and (ii) reduce the costs of wound healing during traumatic insemination. Our results support the 'defence against pathogens' hypothesis, suggesting that the evolution of this unique cimicid organ resulted, at least partly, from selection to reduce the costs of mating-associated infection. We found no evidence that the spermalege reduces the costs of wound healing. PMID:14667353

  5. Reducing a cost of traumatic insemination: female bedbugs evolve a unique organ.

    PubMed

    Reinhardt, Klaus; Naylor, Richard; Siva-Jothy, Michael T

    2003-11-22

    The frequent wounding of female bedbugs (Cimex lectularius: Cimicidae) during copulation has been shown to decrease their fitness, but how females have responded to this cost in evolutionary terms is unclear. The evolution of a unique anatomical structure found in female bedbugs, the spermalege, into which the male's intromittent organ passes during traumatic insemination, is a possible counteradaptation to harmful male traits. Several functions have been proposed for this organ, and we test two hypotheses related to its role in sexual conflict. We examine the hypotheses that the spermalege functions to (i) defend against pathogens introduced during traumatic insemination; and (ii) reduce the costs of wound healing during traumatic insemination. Our results support the 'defence against pathogens' hypothesis, suggesting that the evolution of this unique cimicid organ resulted, at least partly, from selection to reduce the costs of mating-associated infection. We found no evidence that the spermalege reduces the costs of wound healing.

  6. Measuring time costs in interventions designed to reduce behavior problems among children and youth.

    PubMed

    Foster, E Michael; Johnson-Shelton, Deborah; Taylor, Ted K

    2007-09-01

    The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist's understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. We consider the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a prominent intervention in the field, the Incredible Years Program. We find that the time costs are potentially rather large and consider the implications for public policy of ignoring them.

  7. A comprehensive framework for determining the cost of an emergency medical services system.

    PubMed

    Lerner, E Brooke; Nichol, Graham; Spaite, Daniel W; Garrison, Herbert G; Maio, Ronald F

    2007-03-01

    To determine the cost of an emergency medical services (EMS) system, researchers, policymakers, and EMS providers need a framework with which to identify the components of the system that must be included in any cost calculations. Such a framework will allow for cost comparisons across studies, communities, and interventions. The objective of this article is to present an EMS cost framework. This framework was developed by a consensus panel after analysis of existing peer-reviewed and non-peer-reviewed resources, as well as independent expert input. The components of the framework include administrative overhead, bystander response, communications, equipment, human resources, information systems, medical oversight, physical plant, training, and vehicles. There is no hierarchical rank to these components; they are all necessary. Within each component, there are subcomponents that must be considered. This framework can be used to standardize the calculation of EMS system costs to a community. Standardizing the calculation of EMS cost will allow for comparisons of costs between studies, communities, and interventions.

  8. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    ERIC Educational Resources Information Center

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  9. Evaluating the impact of library services on the quality and cost of medical care.

    PubMed Central

    Hardy, M C; Yeoh, J W; Crawford, S

    1985-01-01

    Recent federal regulations have minimized the role of the hospital library in contributing to the quality of medical care and in lowering hospital costs. We trace the events that have led to these assumptions and discuss the complex problem of evaluating the impact of library services. Current research on the value and effectiveness of information is outlined. PMID:3978294

  10. The Impact of Living in Rural and Urban Areas: Vitamin D and Medical Costs in Veterans

    ERIC Educational Resources Information Center

    Bailey, Beth A.; Manning, Todd; Peiris, Alan N.

    2012-01-01

    Purpose: Living in a rural region is associated with significant health disparities and increased medical costs. Vitamin D deficiency, which is increasingly common, is also associated with many adverse health outcomes. The purpose of this study was to determine whether rural-urban residence status of veterans was related to vitamin D levels, and…

  11. What Does Not Explain the Variation in the Direct Costs of Graduate Medical Education.

    ERIC Educational Resources Information Center

    Anderson, Gerard F.

    1996-01-01

    A study investigating factors in the variation in direct costs of medical residency programs across hospitals found that much of the current variation is attributable to accounting and not structural or location-related factors. A federal policy providing for a national payment rate per resident is proposed to replace the current system based on…

  12. Lowering medical costs through the sharing of savings by physicians and patients: inclusive shared savings.

    PubMed

    Schmidt, Harald; Emanuel, Ezekiel J

    2014-12-01

    Current approaches to controlling health care costs have strengths and weaknesses. We propose an alternative, "inclusive shared savings," that aims to lower medical costs through savings that are shared by physicians and patients. Inclusive shared savings may be particularly attractive in situations in which treatments, such as those for gastric cancer, are similar in clinical effectiveness and have modest differences in convenience but substantially differ in cost. Inclusive shared savings incorporates features of typical insurance coverage, shared savings, and value-based insurance design but differs from value-based insurance design, which merely seeks to decrease or eliminate out-of-pocket costs. Inclusive shared savings offers financial incentives to physicians and patients to promote the use of lower-cost, but equally effective, interventions and should be evaluated in a rigorous trial or demonstration project.

  13. Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

    PubMed Central

    Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

    2014-01-01

    Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

  14. New molecular strategies for reducing implantable medical devices associated infections.

    PubMed

    Holban, Alina Maria; Gestal, Monica Cartelle; Grumezescu, Alexandru Mihai

    2014-01-01

    Due to the great prevalence of persistent and recurrent implanted device associated-infections novel and alternative therapeutic approaches are intensely investigated. For reducing complications and antibiotic resistance development, one major strategy is using natural or synthetic modulators for targeting microbial molecular pathways which are not related with cell multiplication and death, as Quorum Sensing, virulence and biofilm formation. The purpose of this review paper is to discuss the most recent in vitro approaches, investigating the efficiency of some novel antimicrobial products and the nano-technologic progress performed in order to increase their effect and stability.

  15. Review of cost estimates for reducing CO2 emissions. Final report, Task 9

    SciTech Connect

    Not Available

    1990-10-01

    Since the ground breaking work of William Nordhaus in 1977, cost estimates for reducing CO{sub 2} emissions have been developed by numerous groups. The various studies have reported sometimes widely divergent cost estimates for reducing CO{sub 2} emissions. Some recent analyses have indicated that large reductions in CO{sub 2} emissions could be achieved at zero or negative costs (e.g. Rocky Mountain Institute 1989). In contrast, a recent study by Alan Manne of Stanford and Richard Richels of the Electric Power Research Institute (Manne-Richels 1989) concluded that in the US the total discounted costs of reducing CO{sub 2} emissions by 20 percent below the 1990 level could be as much as 3.6 trillion dollars over the period from 1990 to 2100. Costs of this order of magnitude would represent about 5 percent of US GNP. The purpose of this briefing paper is to summarize the different cost estimates for CO{sub 2} emission reduction and to identify the key issues and assumptions that underlie these cost estimates.

  16. A cost analysis of web-enhanced training to reduce alcohol sales to intoxicated bar patrons

    PubMed Central

    Page, Timothy F.; Nederhoff, Dawn M.; Ecklund, Alexandra M.; Horvath, Keith J.; Nelson, Toben F.; Erickson, Darin J.; Toomey, Traci L.

    2016-01-01

    Objective The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a “real world”, non-research setting. Methods Data for this study were obtained retrospectively from a randomized controlled trial of the eARM intervention, which was conducted across 15 communities in a Midwestern metropolitan area. Inputs and their costs were obtained from records maintained during the randomized controlled trial. Total development and testing costs were computed, and implementation costs were estimated with input from the research team. The average implementation cost per establishment was calculated by dividing the total estimated implementation cost by the number of establishments that participated in the study. This provides an estimate of the resources needed to support a broader dissemination of interventions such as eARM. Results Direct development and testing costs were $484,904. Including the University's overhead cost rate of 51 percent, total development and testing costs were $732,205. Total estimated implementation costs were $179,999 over a 12 month period. The average cost per establishment was $1,588. Conclusions Given the large damage liability awards faced by establishments that serve alcohol to drunk drivers, establishments or their insurance companies may be willing to pay the $1,588 estimated implementation cost in order to limit their exposure to these large damage awards. Therefore, making interventions such as eARM available could be an effective and sustainable policy for reducing alcohol-related incidents. PMID:27087708

  17. Reducing health care delivery costs using clinical paths: a case study on improving hospital profitability.

    PubMed

    Clare, M; Sargent, D; Moxley, R; Forthman, T

    1995-01-01

    The process of merging and benchmarking clinical and financial data is pivotal to the development of appropriate clinical pathways. Bristol Regional Medical Center (BRMC), facing the challenge of managed care organizations (MCOs), instituted this process and achieved significant cost savings, largely because of the working partnership between the administration and its medical staff. In DRG 89, Simple Pneumonia and Pleurisy, Age Greater than 17 with CC, data adjusted for severity of illness and cost of living were furnished to BRMC by HCIA Inc. Major benchmark or "best practice" variations were incorporated into new clinical pathways, leading to decreased resource use, no compromise in the quality of care, and a beneficial halo effect on other unrelated DRGs.

  18. Air Force Remotely Piloted Aircraft (RPA) Warrant Officers: Meeting Requirements while Reducing Costs

    DTIC Science & Technology

    2012-04-13

    Reconnaissance (ISR) mission requirements. Discussion: Continued DoD budget cuts require each service branch to look at different ways to reduce costs...transition from makes the greatest difference in length of time and cost for their training. This results in the most expensive method of sourcing...Army began their official use of the WO grade in 1918 as part of the Army Mine Planter Service where they served on mine planting vessels as masters

  19. The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

    PubMed Central

    Devjee, Jaymala; Moodley, Jack

    2017-01-01

    Background Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. Conclusion This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication

  20. Paying for outpatient care in rural China: cost escalation under China's New Co-operative Medical Scheme.

    PubMed

    Yang, Wei; Wu, Xun

    2015-03-01

    China's New Co-operative Medical Scheme (NCMS), a government-subsidized health insurance programme, was launched in 2003 in response to deterioration in access to health services in rural areas. Initially designed to cover inpatient care, it has begun to expand its benefit package to cover outpatient care since 2007. The impacts of this initiative on outpatient care costs have raised growing concern, in particular regarding whether it has in fact reduced out-of-pocket (OOP) payments for services among rural participants. This study investigates the impacts on outpatient costs by analysing data from an individual-level longitudinal survey, the China Health and Nutrition Survey, for 2004 and 2009, years shortly before and after NCMS began coverage of outpatient services in 2007. Various health econometrics strategies were employed in the analysis of these data, including the Two-Part Model, the Heckman Selection Model and Propensity Score Matching with the Differences-in-Differences model, to estimate the effects of the 2007 NCMS initiative on per episode outpatient costs. We find that NCMS outpatient coverage starting in 2007 had little impact on reducing its participants' OOP payments for outpatient services. The new coverage may also have contributed to an observed increase in total per episode outpatient costs billed to the insured patients. This increase was more pronounced among village clinics and township health centres-the backbone of the health system for rural residents-than at county and municipal hospitals.

  1. Technology Needs for Reduced Design and Manufacturing Cost of Commercial Transport Engines

    NASA Technical Reports Server (NTRS)

    Rohn, Douglas A.

    1997-01-01

    The objective of the study was to assess the needs in the design and manufacturing processes and identify areas where technology could impact in cost and cycle-time reduction. At the highest level, the team first identified the goals that were in line with long-range needs of the aeropropulsion industry, and to which technology and process improvements would be required to contribute. These goals are to reduce the time and costs in the development cycle of aircraft engines by a factor of two, reduce production cycle time by a factor of four, and to reduce production costs by 25%. Also, it was the intent of the team to identify the highest impact technologies that could be developed and demonstrated in five years.

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

    PubMed

    Patiño-Echeverri, Dalia; Hoppock, David C

    2012-01-17

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

  3. 3D-printing and the effect on medical costs: a new era?

    PubMed

    Choonara, Yahya E; du Toit, Lisa C; Kumar, Pradeep; Kondiah, Pierre P D; Pillay, Viness

    2016-01-01

    3D-printing (3DP) is the art and science of printing in a new dimension using 3D printers to transform 3D computer aided designs (CAD) into life-changing products. This includes the design of more effective and patient-friendly pharmaceutical products as well as bio-inspired medical devices. It is poised as the next technology revolution for the pharmaceutical and medical-device industries. After decorous implementation scientists in collaboration with CAD designers have produced innovative medical devices ranging from pharmaceutical tablets to surgical transplants of the human face and skull, spinal implants, prosthetics, human organs and other biomaterials. While 3DP may be cost-efficient, a limitation exists in the availability of 3D printable biomaterials for most applications. In addition, the loss of skilled labor in producing medical devices such as prosthetics and other devices may affect developing economies. This review objectively explores the potential growth and impact of 3DP costs in the medical industry.

  4. How Much Does Medical Education Cost? A Review. Health Manpower Policy Discussion Paper Series No. A3.

    ERIC Educational Resources Information Center

    MacBride, Owen

    This survey of studies of medical school costs was made in order to evaluate and compare the methodologies and findings of those studies. The survey covered studies of one or more medical schools that either produced figures for average annual per-student cost of education and/or discussed the methodologies and problems involved in producing such…

  5. Implementation and opportunity costs of reducing deforestation and forest degradation in Tanzania

    NASA Astrophysics Data System (ADS)

    Fisher, Brendan; Lewis, Simon L.; Burgess, Neil D.; Malimbwi, Rogers E.; Munishi, Panteleo K.; Swetnam, Ruth D.; Kerry Turner, R.; Willcock, Simon; Balmford, Andrew

    2011-06-01

    The Cancún Agreements provide strong backing for a REDD+ (Reducing Emissions from Deforestation and Forest Degradation) mechanism whereby developed countries pay developing ones for forest conservation. REDD+ has potential to simultaneously deliver cost-effective climate change mitigation and human development. However, most REDD+ analysis has used coarse-scale data, overlooked important opportunity costs to tropical forest users and failed to consider how to best invest funds to limit leakage, that is, merely displacing deforestation. Here we examine these issues for Tanzania, a REDD+ country, by comparing district-scale carbon losses from deforestation with the opportunity costs of carbon conservation. Opportunity costs are estimated as rents from both agriculture and charcoal production (the most important proximate causes of regional forest conversion). As an alternative we also calculate the implementation costs of alleviating the demand for forest conversion--thereby addressing the problem of leakage--by raising agricultural yields on existing cropland and increasing charcoal fuel-use efficiency. The implementation costs exceed the opportunity costs of carbon conservation (medians of US$6.50 versus US$3.90 per Mg CO2), so effective REDD+ policies may cost more than simpler estimates suggest. However, even if agricultural yields are doubled, implementation is possible at the competitive price of ~US$12 per Mg CO2.

  6. Does recyclable separation reduce the cost of municipal waste management in Japan?

    PubMed

    Chifari, Rosaria; Lo Piano, Samuele; Matsumoto, Shigeru; Tasaki, Tomohiro

    2017-02-01

    Municipal solid waste (MSW) management is a system involving multiple sub-systems that typically require demanding inputs, materials and resources to properly process generated waste throughput. For this reason, MSW management is generally one of the most expensive services provided by municipalities. In this paper, we analyze the Japanese MSW management system and estimate the cost elasticity with respect to the waste volumes at three treatment stages: collection, processing, and disposal. Although we observe economies of scale at all three stages, the collection cost is less elastic than the disposal cost. We also examine whether source separation at home affects the cost of MSW management. The empirical results show that the separate collection of the recyclable fraction leads to reduced processing costs at intermediate treatment facilities, but does not change the overall waste management cost. Our analysis also reveals that the cost of waste management systems decreases when the service is provided by private companies through a public tender. The cost decreases even more when the service is performed under the coordination of adjacent municipalities.

  7. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries - United States, 2014.

    PubMed

    Luo, Feijun; Florence, Curtis

    2017-01-13

    Injury-associated deaths have substantial economic consequences in the United States. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 were $214 billion (1). In 2014, unintentional injury, suicide, and homicide (the fourth, tenth, and seventeenth leading causes of death, respectively) accounted for 194,635 deaths in the United States (2). In 2014, a total of 199,756 fatal injuries occurred in the United States, and the associated lifetime medical and work-loss costs were $227 billion (3). This report examines the state-level economic burdens of fatal injuries by extending a previous national-level study (1). Numbers and rates of fatal injuries, lifetime costs, and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for four injury intent categories (all intents, unintentional, suicide, and homicide). During 2014, injury mortality rates and economic burdens varied widely among the states and DC. Among fatal injuries of all intents, the mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 per 100,000 and $491 (New York). States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas.

  8. How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?

    PubMed Central

    Larson, Bruce; Tindikahwa, Allan; Mwidu, George; Kibuuka, Hannah; Magala, Fred

    2015-01-01

    Background The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015). Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites). The difference between such costs is the cost of improving access to VMMC. Methods A micro-costing approach was used to estimate costs from the service provider’s perspective of a circumcision. Supply chain and higher-level program support costs are not included. Results The average cost (US$2012) of resources used per circumcision was $61 in the mobile program ($72 for more remote locations) compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time. Conclusion The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment. PMID:25774677

  9. The cost of medical management of pulmonary nontuberculous mycobacterial disease in Ontario, Canada.

    PubMed

    Leber, A; Marras, T K

    2011-05-01

    Treatment of pulmonary nontuberculous mycobacterial (NTM) infection is complex, requiring multiple antibiotics and a prolonged treatment course. We determined the monthly cost of treating patients with pulmonary NTM infections in our clinic, a tertiary care centre in Toronto, Ontario, Canada. We reviewed records of a single clinic at the University Health Network (Toronto) for all patients with pulmonary NTM isolates. Pharmacological and nonpharmacological treatment costs were calculated using a number of Canadian references. 172 patients were reviewed, 91 of whom were treated pharmacologically. The median total duration and cost per treated patient were 14 months (interquartile range (IQR) 9-23 months) and CAD 4,916 (IQR CAD 2,934-9,063), respectively. Median monthly drug treatment cost was CAD 321 (IQR CAD 254-458) for all patients, CAD 289 (IQR CAD 237-341) for patients receiving exclusively oral antibiotics and CAD 1,161 (IQR CAD 795-1,646) for patients whose treatment included i.v. antibiotics. The most costly oral regiment consisted of a fluroquinolone, macrolide and rifampin. In multivariable analysis, Mycobacterium abscessus infection, i.v. therapy and Mycobacterium xenopi infection were all associated with increased monthly treatment costs. The direct medical costs of NTM infections are substantial. Less expensive alternative therapies might be most helpful for M. abscessus infection and when i.v. antibiotics are deemed necessary.

  10. A flexible model for the mean and variance functions, with application to medical cost data.

    PubMed

    Chen, Jinsong; Liu, Lei; Zhang, Daowen; Shih, Ya-Chen T

    2013-10-30

    Medical cost data are often skewed to the right and heteroscedastic, having a nonlinear relation with covariates. To tackle these issues, we consider an extension to generalized linear models by assuming nonlinear associations of covariates in the mean function and allowing the variance to be an unknown but smooth function of the mean. We make no further assumption on the distributional form. The unknown functions are described by penalized splines, and the estimation is carried out using nonparametric quasi-likelihood. Simulation studies show the flexibility and advantages of our approach. We apply the model to the annual medical costs of heart failure patients in the clinical data repository at the University of Virginia Hospital System.

  11. Cost-effective means of reducing ammonia emissions from UK agriculture using the NARSES model

    NASA Astrophysics Data System (ADS)

    Webb, J.; Ryan, M.; Anthony, S. G.; Brewer, A.; Laws, J.; Aller, M. F.; Misselbrook, T. H.

    To comply with International agreements to improve air quality, signatory states need to reduce emissions of ammonia (NH 3). Since the majority of NH 3 emissions come from agriculture, measures may need to be implemented by the farming industry. Member states of the EU will, by 2010, require large pig and poultry production units to reduce NH 3 emissions to comply with the integrated pollution prevention and control directive (IPPC). The NARSES model uses a mass-flow method to estimate NH 3 emission from UK agriculture and to identify the most cost-effective means of reducing NH 3 emissions. Model runs were carried out to assess the likely impact of the IPPC Directive on UK NH 3 emissions and the sensitivity of model output to input data on the costs and abatement efficiencies of proposed abatement measures. The impact of the IPPC Directive is likely to be small, offering a reduction of c. 8700 t, 3.5% of total UK agricultural NH 3 emissions. Even large (30%) changes in our estimates of cost or changes of 10% in our estimates of abatement efficiency will make little difference to the ranking of abatement techniques according to cost-effectiveness. The most cost-effective reductions may be achieved by replacing urea fertilizer with ammonium nitrate, immediate incorporation of manures and slurries to tillage land by discs, storing all FYM and poultry manures before spreading to land and applying slurries to grassland by trailing shoe.

  12. Costs and efficacy of public health interventions to reduce aflatoxin–induced human disease

    PubMed Central

    Khlangwiset, Pornsri; Wu, Felicia

    2010-01-01

    This study reviews available information on the economics and efficacy of aflatoxin risk-reduction interventions, and provides an approach for analysis of the cost-effectiveness of public health interventions to reduce aflatoxin-induced human disease. Many strategies have been developed to reduce aflatoxin or its adverse effects in the body. However, a question that has been under-addressed is how likely these strategies will be adopted in the countries that need them most to improve public health. This study evaluates two aspects crucial to adoption of new technologies and methods: the costs and the efficacy of different strategies. First, we describe and categorize different aflatoxin risk-reduction strategies into preharvest, postharvest, dietary, and clinical settings. Then we compile and discuss relevant data on the costs and efficacy of each strategy, in reducing either aflatoxin in food or its metabolites in the body. In addition, we describe which crops are affected by each intervention, who is likely to pay for the control strategy, and who is likely to benefit. A framework is described for how to evaluate cost-effectiveness of strategies according to World Health Organization standards. Finally, we discuss which strategies are likely to be cost-effective and helpful under different conditions worldwide of regulations, local produce and soil ecology, and potential health emergencies. PMID:20419532

  13. Commentary: Exploiting the overlap: using utilization management to reduce medical malpractice.

    PubMed

    Dulworth, Sherrie

    2003-01-01

    This report presents a practical way in which hospitals can reduce medical malpractice exposure that is related to omissions and delays in care. We illustrate our approach using the results of a risk/medical management study performed at an acute-care hospital. Traditional risk management (RM) often focuses retrospectively on adverse events and may miss opportunities to prevent errors related to omissions and delays in care. Close-to-real-time utilization management (UM) activity offers ready potential to improve quality and reduce medical malpractice--but only if UM can work synergistically with RM. It is our conclusion that hospitals can implement systematic processes to identify and intervene in patterns of omissions and delays and improve the communication and synergy among stakeholders and thereby improve patient safety and reduce their medical malpractice risks.

  14. Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia

    PubMed Central

    Swanson, Jeffrey W.; Swartz, Marvin S.; Van Dorn, Richard A.; Volavka, Jan; Monahan, John; Stroup, T. Scott; McEvoy, Joseph P.; Wagner, H. Ryan; Elbogen, Eric B.; Lieberman, Jeffrey A.

    2008-01-01

    Background Violence is an uncommon but significant problem associated with schizophrenia. Aims To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months, identify prospective predictors of violence and examine the impact of medication adherence on reduced violence. Method Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications. Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication. Results Violence declined from 16% to 9% in the retained sample and from 19% to 14% in the intention-to-treat sample. No difference by medication group was found, except that perphenazine showed greater violence reduction than quetiapine in the retained sample. Medication adherence reduced violence, but not in patients with a history of childhood antisocial conduct. Prospective predictors of violence included childhood conduct problems, substance use, victimisation, economic deprivation and living situation. Negative psychotic symptoms predicted lower violence. Conclusions Newer antipsychotics did not reduce violence more than perphenazine. Effective antipsychotics are needed, but may not reduce violence unrelated to acute psychopathology. PMID:18700216

  15. The role of technology in reducing health care costs. Phase II and phase III.

    SciTech Connect

    Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray; Tebo, Michael A.; Murphy, Martin D.; Hightower, Marion Michael; Gallagher, Linda K.; Craft, Richard Layne, II; Garcia, Rudy John

    2004-04-01

    In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care delivery costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.

  16. Supply and demand: negotiating the prescription drug labyrinth to reduce costs.

    PubMed

    DeStefino, Kevin

    2003-01-01

    Prescription drug costs are increasing at a rate of 15% to 17% a year and a look into the future does not bring much better news. Employers can expect to see more numbers like these as doctors more aggressively treat diseases using drug therapy, the population continues to age and pharmaceutical companies continue to spend billions of dollars on direct-to-consumer advertising aimed at consumers who are desensitized to the true costs of their prescriptions. In this environment, it is unlikely that companies can realistically expect to reverse costs of even to avoid cost increases. However, this article provides employers with a prudent approach to managing both the supply and demand sides of the prescription drug equation in order to reduce their level of increase. Supply-side management focuses on negotiations with vendors, while the demand side focuses on managing employee utilization.

  17. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    SciTech Connect

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; Sanyal, Jibonananda; Starke, Michael R.

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype, we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.

  18. Cost-effective retrofit technology for reducing peak power demand in small and medium commercial buildings

    DOE PAGES

    Nutaro, James J.; Fugate, David L.; Kuruganti, Teja; ...

    2015-05-27

    We describe a cost-effective retrofit technology that uses collective control of multiple rooftop air conditioning units to reduce the peak power consumption of small and medium commercial buildings. The proposed control uses a model of the building and air conditioning units to select an operating schedule for the air conditioning units that maintains a temperature set point subject to a constraint on the number of units that may operate simultaneously. A prototype of this new control system was built and deployed in a large gymnasium to coordinate four rooftop air conditioning units. Based on data collected while operating this prototype,more » we estimate that the cost savings achieved by reducing peak power consumption is sufficient to repay the cost of the prototype within a year.« less

  19. Cognitive Distance Learning Problem Solver Reduces Search Cost through Learning Processes

    NASA Astrophysics Data System (ADS)

    Yamakawa, Hiroshi; Miyamoto, Yuji; Baba, Takayuki; Okada, Hiroyuki

    Our proposed cognitive distance learning problem solver generates sequence of actions from initial state to goal states in problem state space. This problem solver learns cognitive distance (path cost) of arbitrary combination of two states. Action generation at each state is selection of next state that has minimum cognitive distance to the goal, like Q-learning agent. In this paper, first, we show that our proposed method reduces search cost than conventional search method by analytical simulation in spherical state space. Second, we show that an average search cost is more reduced more the prior learning term is long and our problem solver is familiar to the environment, by a computer simulation in a tile world state space. Third, we showed that proposed problem solver is superior to the reinforcement learning techniques when goal is changed by a computer simulation. Forth, we found that our simulation result consist with psychological experimental results.

  20. Reducing operating costs for struvite formation with a carbon dioxide stripper.

    PubMed

    Fattah, K P; Sabrina, N; Mavinic, D S; Koch, F A

    2008-01-01

    One of the major operational costs of phosphorus recovery as struvite is the cost of caustic chemical that is added to maintain a desired level of operative pH. A study was conducted at the Lulu Island Wastewater Treatment Plant (LIWWTP), Richmond, BC, using a struvite crystallizer and a cascade stripper designed at the University of British Columbia (UBC). The stripper was tested under different operating conditions to determine the effectiveness of CO(2) stripping in increasing the pH of the water matrix and thereby reducing caustic chemical use. This reduction is expected to reduce the operational costs of struvite production. Throughout the project, a high percentage (90%) of phosphorus removal was achieved under each condition. The cascade stripper was very effective in saving caustic usage, ranging from 35% to 86%, depending on the operating conditions. However, the stripper showed relatively poor performance regarding ammonia stripping.

  1. SunShot solar power reduces costs and uncertainty in future low-carbon electricity systems.

    PubMed

    Mileva, Ana; Nelson, James H; Johnston, Josiah; Kammen, Daniel M

    2013-08-20

    The United States Department of Energy's SunShot Initiative has set cost-reduction targets of $1/watt for central-station solar technologies. We use SWITCH, a high-resolution electricity system planning model, to study the implications of achieving these targets for technology deployment and electricity costs in western North America, focusing on scenarios limiting carbon emissions to 80% below 1990 levels by 2050. We find that achieving the SunShot target for solar photovoltaics would allow this technology to provide more than a third of electric power in the region, displacing natural gas in the medium term and reducing the need for nuclear and carbon capture and sequestration (CCS) technologies, which face technological and cost uncertainties, by 2050. We demonstrate that a diverse portfolio of technological options can help integrate high levels of solar generation successfully and cost-effectively. The deployment of GW-scale storage plays a central role in facilitating solar deployment and the availability of flexible loads could increase the solar penetration level further. In the scenarios investigated, achieving the SunShot target can substantially mitigate the cost of implementing a carbon cap, decreasing power costs by up to 14% and saving up to $20 billion ($2010) annually by 2050 relative to scenarios with Reference solar costs.

  2. Communicative diagnosis of cost-saving options for reducing nitrogen emission from pig finishing.

    PubMed

    Van Meensel, Jef; Lauwers, Ludwig; Van Huylenbroeck, Guido

    2010-11-01

    Reducing nitrogen emission from livestock production is usually perceived as costly. Nevertheless, production process related measures addressing the transformation of input(s) into output(s) may result in a cost-saving reduction of nitrogen emission. This paper explores the separate and combined use of traditional key performance indicators and an environmentally adjusted Data Envelopment Analysis (DEA) to reveal firm-specific cost-saving mechanisms for pig-finishing farms. Traditional key performance indicators are easy to communicate but have shortcomings when assessing benchmarks for comparative farm analysis. The environmentally adjusted DEA decomposes both cost and environmental efficiencies into technical and allocative efficiency components, separating the physical production analysis from price and nutrient content information. DEA makes efficiency benchmarks and improvement paths explicit, but the practical value of such efficiency scores is low. This paper proposes to take advantage of both methods: concrete benchmarks and eligible improvement paths are assessed using frontier methods, while the decision variables that steer farmers towards changes are described in terms of traditional key performance indicators. This leads to an improved diagnosis that is easy to communicate to farmers and may therefore facilitate decision support. Our pig-finishing case study shows that farms can achieve economic-environmental win-win situations through improving technical, cost allocative and cost efficiencies, which are mainly driven by feed conversion. Less technical efficient farms are found to require a lower delivery weight in order to minimize costs, which shows the farm-specificity of economic-environmental improvement advice.

  3. An assessment of monitoring requirements and costs of 'Reduced Emissions from Deforestation and Degradation'

    PubMed Central

    Böttcher, Hannes; Eisbrenner, Katja; Fritz, Steffen; Kindermann, Georg; Kraxner, Florian; McCallum, Ian; Obersteiner, Michael

    2009-01-01

    Background Negotiations on a future climate policy framework addressing Reduced Emissions from Deforestation and Degradation (REDD) are ongoing. Regardless of how such a framework will be designed, many technical solutions of estimating forest cover and forest carbon stock change exist to support policy in monitoring and accounting. These technologies typically combine remotely sensed data with ground-based inventories. In this article we assess the costs of monitoring REDD based on available technologies and requirements associated with key elements of REDD policy. Results We find that the design of a REDD policy framework (and specifically its rules) can have a significant impact on monitoring costs. Costs may vary from 0.5 to 550 US$ per square kilometre depending on the required precision of carbon stock and area change detection. Moreover, they follow economies of scale, i.e. single country or project solutions will face relatively higher monitoring costs. Conclusion Although monitoring costs are relatively small compared to other cost items within a REDD system, they should be shared not only among countries but also among sectors, because an integrated monitoring system would have multiple benefits for non-REDD management. Overcoming initialization costs and unequal access to monitoring technologies is crucial for implementation of an integrated monitoring system, and demands for international cooperation. PMID:19709413

  4. [Reduce Energy Costs While Maintaining Healthy IAQ.] "Indoor Air Quality Tools for Schools" Update #17

    ERIC Educational Resources Information Center

    US Environmental Protection Agency, 2009

    2009-01-01

    This issue of "Indoor Air Quality Tools for Schools" Update ("IAQ TfS" Update) contains the following items: (1) News and Events; (2) Feature Article: Reduce Energy Costs while Maintaining Healthy IAQ; (3) Insight into Excellence: North East Independent School District ; (4) School Building Week 2009; and (5) Have Your Questions Answered!

  5. Texas hospitals share creative uses of non-clinical staff to reduce ER costs.

    PubMed

    2006-01-01

    Texas hospitals share creative uses of non-clinical staff to reduce ER costs. In central Texas, Christus Spohn Hospital and Seton Health Care are independently exploring the use of non-clinical staff to improve utilization of clinical and emergency services, but their existing programs employ different structures and outcomes measurements.

  6. Development of Advanced Technologies to Reduce Design, Fabrication and Construction Costs for Future Nuclear Power Plants

    SciTech Connect

    DiNunzio, Camillo A.; Gupta, Abhinav; Golay, Michael; Luk, Vincent; Turk, Rich; Morrow, Charles; Jin, Geum-Taek

    2002-11-30

    This report presents a summation of the third and final year of a three-year investigation into methods and technologies for substantially reducing the capital costs and total schedule for future nuclear plants. In addition, this is the final technical report for the three-year period of studies.

  7. Opportunity Analysis and Selection: 50 or More Ways To Reduce Costs. Mendip Papers.

    ERIC Educational Resources Information Center

    Kedney, Bob; Davies, Trefor

    This paper discusses activity analysis and the identification of options as the first two stages of a structured approach to achieving budget savings at postsecondary institutions, focusing on schools and practices in the United Kingdom. It presents five checklists of opportunities for reducing spending and controlling costs. The checklists cover:…

  8. Coal flow aids reduce coke plant operating costs and improve production rates

    SciTech Connect

    Bedard, R.A.; Bradacs, D.J.; Kluck, R.W.; Roe, D.C.; Ventresca, B.P.

    2005-06-01

    Chemical coal flow aids can provide many benefits to coke plants, including improved production rates, reduced maintenance and lower cleaning costs. This article discusses the mechanisms by which coal flow aids function and analyzes several successful case histories. 2 refs., 10 figs., 1 tab.

  9. Medical decision making for patients with Parkinson disease under Average Cost Criterion.

    PubMed

    Goulionis, John E; Vozikis, Athanassios

    2009-06-24

    Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels.

  10. Patterns and Costs of Health Care Use of Children With Medical Complexity

    PubMed Central

    Cohen, Eyal; Berry, Jay G.; Camacho, Ximena; Anderson, Geoff; Wodchis, Walter

    2012-01-01

    BACKGROUND AND OBJECTIVE: Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada. METHODS: Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period. RESULTS: The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA. CONCLUSIONS: Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care. PMID:23184117

  11. A PERMISSION SYSTEM FOR CARBAPENEM USE REDUCED INCIDENCE OF DRUG-RESISTANT BACTERIA AND COST OF ANTIMICROBIALS AT A GENERAL HOSPITAL IN JAPAN

    PubMed Central

    IKEDA, YOSHIAKI; MAMIYA, TAKAYOSHI; NISHIYAMA, HIDEKI; NARUSAWA, SHIHO; KOSEKI, TAKENAO; MOURI, AKIHIRO; NABESHIMA, TOSHITAKA

    2012-01-01

    ABSTRACT Some drug management systems have been established in Japanese hospitals to reduce medical costs and regulate drug usage. Among the many available prescription drugs, antimicrobials should be given special attention because their inappropriate use often leads to sudden outbreaks of resistant bacteria. As drug specialists, pharmacists should monitor the use of all drugs, particularly antimicrobials. Carbapenems are a class of broad-spectrum antimicrobials that are widely used to treat infections worldwide. However, their inappropriate use has led to an increase in the incidence of drug-resistant bacteria and consequently, medical costs, at hospitals. To reduce inappropriate use and drug resistance, we have established a permission system to control the use of carbapenems at the Japanese Red Cross Nagoya Daiichi Hospital. In this study, we retrospectively evaluated the applicability of the new permission system compared to that of the notification system and the non control system for 14 months each. The two management systems were able to maintain total antibiotic use density and control the outbreak of drug-resistant bacteria (P. aeruginosa, E. coli, and K. pneumoniae). The number of carbapenem prescriptions was decreased dramatically when this permission system was enforced. Compared to the non control system, the cost of antimicrobials was reduced by $757,470 for the 14-month study period using the permission system. These results suggest that our system to control the use of antimicrobials can efficiently suppress the incidence of drug-resistant bacteria and medical costs at hospitals. PMID:22515115

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

    SciTech Connect

    Lybarger, J.A.; Spengler, R.F.; Brown, D.R.; Lee, R.; Vogt, D.P. |; Perhac, R.M. Jr. |

    1998-10-01

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

  13. Causation, incidence, and costs of traumatic brain injury in the U.S. military medical system.

    PubMed

    Ommaya, A K; Ommaya, A K; Dannenberg, A L; Salazar, A M

    1996-02-01

    Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system. The age-adjusted head injury rates for ages 15-44 years are higher in active-duty individuals compared with other beneficiaries (1.6 times greater for men and 2.5 times greater for women). The total cost for hospitalization in this population was $43 million. Private facility rehabilitation accounted for 26% of all private facility costs but only 6% of head injury cases. Firearms and motor vehicle crashes caused the most severe injuries for cases admitted to military facilities. Motor vehicle crashes, falls, and fighting accounted for 80% of the total military facility cost for head injuries. Military active-duty individuals are at increased risk for noncombat head injury. Prevention of head injury in military settings should focus on motor vehicle crashes, fist fights (assault), and falls.

  14. Comparison of Direct Medical Costs Between Automated and Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Cortés-Sanabria, Laura; Rodríguez-Arreola, Brenda E.; Ortiz-Juárez, Victor R.; Soto-Molina, Herman; Pazarín-Villaseñor, Leonardo; Martínez-Ramírez, Héctor R.; Cueto-Manzano, Alfonso M.

    2013-01-01

    ♦ Objective: We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated. ♦ Methods: Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries. ♦ Results: No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component—except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008. ♦ Conclusions: The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were

  15. Cost-Effectiveness of a Specialist Geriatric Medical Intervention for Frail Older People Discharged from Acute Medical Units: Economic Evaluation in a Two-Centre Randomised Controlled Trial (AMIGOS)

    PubMed Central

    Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Edmans, Judi; Conroy, Simon; Bradshaw, Lucy E.; Gladman, John R. F.; Elliott, Rachel A.

    2015-01-01

    Background Poor outcomes and high resource-use are observed for frail older people discharged from acute medical units. A specialist geriatric medical intervention, to facilitate Comprehensive Geriatric Assessment, was developed to reduce the incidence of adverse outcomes and associated high resource-use in this group in the post-discharge period. Objective To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit, compared with standard care. Methods Economic evaluation was conducted alongside a two-centre randomised controlled trial (AMIGOS). 433 patients (aged 70 or over) at risk of future health problems, discharged from acute medical units within 72 hours of attending hospital, were recruited in two general hospitals in Nottingham and Leicester, UK. Participants were randomised to the intervention, comprising geriatrician assessment in acute units and further specialist management, or to control where patients received no additional intervention over and above standard care. Primary outcome was incremental cost per quality adjusted life year (QALY) gained. Results We undertook cost-effectiveness analysis for 417 patients (intervention: 205). The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 (95% confidence interval [CI]: -0.009, 0.007). Total adjusted secondary and social care costs, including direct costs of the intervention, at 3 months were £4412 (€5624, $6878) and £4110 (€5239, $6408) for the intervention and standard care groups, the incremental cost was £302 (95% CI: 193, 410) [€385, $471]. The intervention was dominated by standard care with probability of 62%, and with 0% probability of cost-effectiveness (at £20,000/QALY threshold). Conclusions The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on

  16. Urinary Incontinence Management Costs are Reduced Following Burch or Sling Surgery for Stress Incontinence

    PubMed Central

    Subak, Leslee L.; Goode, Patricia S.; Brubaker, Linda; Kusek, John W.; Schembri, Mr. Michael; Lukacz, Emily S.; Kraus, Stephen R.; Chai, Toby C.; Norton, Peggy; Tennstedt, Sharon L.

    2014-01-01

    Objective To estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months post-operatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. Methods Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months post-surgery and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the two surgical groups were combined to examine change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. Results At baseline mean (±SD) age of participants was 53±10 years, and frequency of weekly UI episodes was 23±21. Weekly UI episodes decreased by 86% at 24 months (P<0.001). Mean weekly cost was $16.60±$27 (median $9.39) at baseline and $4.57±$15 (median $0.10) at 24 months (P<0.001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38±$0.77 per week for each decrease of 1 UI episode per day (P<0.001) and was strongly associated with greater improvement in UDI and IIQ scores (P<0.001) and decreased 24-hour pad weight (P<0.02). Conclusion Following Burch or fascial sling surgery, UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures. PMID:24631433

  17. Reducing six-month inpatient psychiatric recidivism and costs through case management.

    PubMed

    Kolbasovsky, Andrew; Reich, Leonard; Meyerkopf, Neil

    2010-01-01

    The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program. The six-month recidivism rate for BG members was 49.67% compared to 22.07% among IG members. Forward stepwise regression results indicated a significant main effect for the ICM intervention on inpatient psychiatric costs. Inpatient psychiatric costs for the six-month outcome period were $4,982.90 lower per member in the IG group. Additional models demonstrated that the ICM intervention was associated with significantly lower inpatient substance abuse costs and psychiatric emergency department costs. There were no statistically significant increases in utilization associated with the ICM intervention. After factoring in program costs, it is estimated that the ICM services contributed to almost $1,500,000 in cost savings over the six-month outcome period. The ICM intervention was associated with significant reductions in inpatient, psychiatric six-month readmission rates and associated costs among adult members who are at elevated risk of inpatient, psychiatric recidivism. The intervention, enrollment process, and measurement strategies can be adapted for use by health plans looking to reduce psychiatric costs.

  18. The Direct Medical Costs of Outpatient Cares of Type 2 Diabetes in Iran: A Retrospective Study

    PubMed Central

    Davari, Majid; Boroumand, Zahra; Amini, Masoud; Aslani, Abolfazl; Hosseini, Mohsen

    2016-01-01

    Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC) by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients’ profiles manually. The incidence of major diabetes complications were also examined from the subjects’ profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients’ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country. PMID:27217937

  19. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

    PubMed Central

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

    2016-01-01

    Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022). Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

  20. Restructuring materiel management functions: a method for prioritizing changes and reducing costs.

    PubMed

    Craig, K W

    1992-02-01

    The success of any manager depends highly on the ability to seize on opportunities that will achieve the organization's goals. Hospitals are currently searching for ways to reduce costs while maintaining or enhancing the quality of services. Quality services are increasingly being defined as those that are most responsive to customer needs. It is important, as hospital management restructures materiel systems or methods of operation for reduced costs, to focus on the user departments as the customers. The consolidation of materiel management activity should not be seen as a loss of control at the user department level. Instead it can be seen as a new way of providing service with higher quality. User departments should see concrete benefits on a weekly basis, including reduced time spent on materiel management functions; increased planning of purchasing, inventory, and distribution functions; and assistance in meeting restricted supply budgets.

  1. Reducing the cost (and increasing the availability) of low-expansion fused glass mirror blanks

    NASA Astrophysics Data System (ADS)

    Connell, Steven J.; Griffith, B.; Federico, Dan R.; Mehle, Gregory V.

    2003-12-01

    For many years, lightweighted sandwich-style mirror blanks made from Corning's Ultra-Low Expansion glass (ULE) have been used in space telescope systems that demand superior optical performance. Despite the superior performance of this technology, the historically high cost and long schedule to procure such a blank has limited their use to only the most elite missions. Future missions, such as JWST, will seek to dramatically reduce the historical cost/schedule paradigm for ULE blanks by capitalizing on economies-of-scale associated with a multi-segment design. However, for this blank technology to become accessible to a broader range of missions, fundamental changes in technical and business approaches are needed. Over the last four years, ATK COI has worked to develop the requisite technologies to produce ULE mirror blanks in-house, with an emphasis on reducing cost and schedule. Our focus has been in three areas: process development to enable reclamation of ULE glass residuals, glass fusion process qualification, and tooling cost reduction. The status of each of these areas is presented, and conclusions drawn about possible future costs of lightweight ULE mirror blanks.

  2. Application of the Discrimination Inference to Reduce Expected Cost Technique (DIRECT) to a Contaminant Transport Problem.

    NASA Astrophysics Data System (ADS)

    Bayley, T. W.; Ferré, T. P. A.

    2014-12-01

    There is growing recognition in the hydrologic community that deterministic hydrologic models are imperfect tools for decision support. Despite this insight, the state of practice for a hydrologic investigation follows this sequence: data collection, conceptual model development, numerical model development, and finally decision making based on model projections. This approach, based on relatively unconsidered design of data collection, may result in uninformative data. As a result, it is commonly repeated several times to resolve critical uncertainties. We present a novel two step multi-model approach to optimizing data collection to aid decision making, risk analysis. Here, we describe the application this approach (Discrimination Inference to Reduce Expected Cost Technique - DIRECT) for a contaminant transport problem. DIRECT has 7 steps. First, outcomes of concern were defined explicitly. Next a probabilistic analysis of the outcomes was conducted that incorporated multiple conceptual and parametric realizations. The likelihood of each model was assessed based on goodness of fit to existing data. A cost function was developed and used to define the projected costs based on the model-predicted outcomes of concern. Data collection was then optimized to identify the data that could test the models of greatest concern (cost) against the other models in the ensemble. Finally a field program was conducted that included gathering lithologic, hydrologic, and chemical data from 22 new wells that were drilled in projected high value locations. The additional data reduced the expected cost of model projections to an acceptable level for defining new site compliance conditions.

  3. Warmer temperatures reduce the costs of inducible defences in the marine toad, Rhinella marinus.

    PubMed

    van Uitregt, Vincent O; Alton, Lesley A; Heiniger, Jaime; Wilson, R S

    2016-01-01

    Many of the far-reaching impacts of climate change on ecosystem function will be due to alterations in species interactions. However, our understanding of the effects of temperature on the dynamics of interactions between species is largely inadequate. Inducible defences persist in prey populations because defensive traits increase survival in the presence of predators but are costly when they are absent. Large-scale changes in the thermal climate are likely to alter the costs or benefits of these defences for ectotherms, whose physiological processes are driven by environmental temperature. A shift in costs of defensive traits would affect not only predator-prey interactions, but also the strength of selection for inducible defences in natural populations. We investigate the effect of temperature on the costs of behavioural defences in larvae of the marine toad, Rhinella marinus. Larvae were reared in the presence or absence of predator cues at both 25 and 30 °C. When exposed to predation cues, larvae reduced activity and spent less time feeding. Exposure to predation cues also reduced metabolic rate, presumably as a by-product of reducing activity levels. Larvae exposed to predation cues also grew more slowly, were smaller at metamorphosis and were poorer jumpers after metamorphosis--three traits associated with fitness in post-metamorphic anurans. We found that the costs of behavioural defences, in terms of larval growth, post-metamorphic size and jumping performance, were exacerbated at cooler temperatures. The thermal sensitivity of costs associated with defensive traits may explain geographic variation in plasticity of defensive traits in other species and suggests that changes in environmental temperature associated with climate change may affect predator-prey interactions in subtle ways not previously considered.

  4. Case management of chronic ventilator patients. Reduce average length of stay and cost by half.

    PubMed

    Yaksic, J R; DeWoody, S; Campbell, S

    1996-01-01

    The implementation of the case management model and the use of critical pathways has become a major strategy to improve quality of care and cope with measuring and managing costs. Grant Medical Center, a 640-bed Level I Trauma Center, began case managing its chronic ventilator patients in July, 1993. A 30-day critical pathway was developed using a multidisciplinary team approach. In case managing these patients, many problematic issues were identified, such as lack of adequate involvement by staff experienced in specific disciplines and multiple physician decision makers for each case. By increasing multidisciplinary collaboration, care of these patients was systematically changed and streamlined. Over a 2-year period, the average length of stay for chronic ventilator patients decreased from 74.5 days to 41.9 days, and the average cost per case decreased from $189,080 to $107,019.

  5. Analysis of Potential Alternatives to Reduce NASA's Cost of Human Access to Space

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The purpose of this report is to analyze NASA's potential options for significantly reducing the cost of human access to space. The opinions expressed in this report are based on Hawthorne, Krauss & Associates' ("HKA") interaction with NASA and several of its key contractors over the past nine months. This report is not intended to be an exhaustive quantitative analysis of the various options available to NASA. Instead, its purpose is to outline key decision-related issues that the agency should consider prior to making a decision as to which option to pursue. This report attempts to bring a private-sector perspective to bear on the issue of reducing the cost of human access to space. HKA believes that the key to the NASA's success in reducing those costs over the long-term is the involvement of the private-sector incentives and disciplines--which is achieved only through the assumption of risk by the private sector, not through a traditional contractor relationship--is essential to achieve significant long-term cost reductions.

  6. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment

    PubMed Central

    Bode, Nikolai W. F.; Miller, Jordan; O’Gorman, Rick; Codling, Edward A.

    2015-01-01

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations. PMID:26541505

  7. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment

    NASA Astrophysics Data System (ADS)

    Bode, Nikolai W. F.; Miller, Jordan; O'Gorman, Rick; Codling, Edward A.

    2015-11-01

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations.

  8. Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs

    NASA Technical Reports Server (NTRS)

    Pettit, R. G.; Wang, J. J.; Toh, C.

    2000-01-01

    The continual need to reduce airframe cost and the emergence of high speed machining and other manufacturing technologies has brought about a renewed interest in large-scale integral structures for aircraft applications. Applications have been inhibited, however, because of the need to demonstrate damage tolerance, and by cost and manufacturing risks associated with the size and complexity of the parts. The Integral Airframe Structures (IAS) Program identified a feasible integrally stiffened fuselage concept and evaluated performance and manufacturing cost compared to conventional designs. An integral skin/stiffener concept was produced both by plate hog-out and near-net extrusion. Alloys evaluated included 7050-T7451 plate, 7050-T74511 extrusion, 6013-T6511 extrusion, and 7475-T7351 plate. Mechanical properties, structural details, and joint performance were evaluated as well as repair, static compression, and two-bay crack residual strength panels. Crack turning behavior was characterized through panel tests and improved methods for predicting crack turning were developed. Manufacturing cost was evaluated using COSTRAN. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current technology baseline.

  9. Increased costs reduce reciprocal helping behaviour of humans in a virtual evacuation experiment.

    PubMed

    Bode, Nikolai W F; Miller, Jordan; O'Gorman, Rick; Codling, Edward A

    2015-11-06

    Altruistic behaviour is widespread and highly developed in humans and can also be found in some animal species. It has been suggested that altruistic tendencies can depend on costs, benefits and context. Here, we investigate the changes in the occurrence of helping behaviour in a computer-based experiment that simulates an evacuation from a building exploring the effect of varying the cost to help. Our findings illuminate a number of key mechanistic aspects of human decision-making about whether to help or not. In a novel situation where it is difficult to assess the risks associated with higher costs, we reproduce the finding that increasing costs reduce helping and find that the reduction in the frequency of helping behaviour is gradual rather than a sudden transition for a threshold cost level. Interestingly, younger and male participants were more likely to help. We provide potential explanations for this result relating to the nature of our experiment. Finally, we find no evidence that participants in our experiment plan ahead over two consecutive, inter-dependent helping opportunities when conducting cost-benefit trade-offs in spontaneous decisions. We discuss potential applications of our findings to research into decision-making during evacuations.

  10. Stenosis surveillance of hemodialysis grafts by duplex ultrasound reduces hospitalizations and cost of care.

    PubMed

    Dossabhoy, Neville R; Ram, Sunanda J; Nassar, Raja; Work, Jack; Eason, J Mark; Paulson, William D

    2005-01-01

    Most recent randomized controlled trials (RCTs) have found that hemodialysis graft surveillance combined with preemptive correction of stenosis does not prolong graft survival. Nevertheless, such programs may be justified if they reduce other adverse outcomes or decrease the cost of care. This study tested this hypothesis by applying a secondary analysis to our original RCT. This study of 101 patients evaluated correction of stenosis based upon blood flow (Q) and stenosis surveillance. Patients were randomly assigned to control, flow, or stenosis groups, and were followed for up to 28 months. Q was measured monthly by ultrasound dilution; stenosis was measured quarterly by duplex ultrasound. Stenosis of 50% was corrected by percutaneous transluminal angioplasty (PTA) after referral for angiography. Referral criteria were: control group, clinical criteria; flow group, Q < 600 ml/min or clinical criteria; stenosis group, stenosis > 50% or clinical criteria. We compared access-related hospitalizations and cost of care, and use of central venous dialysis catheters (CVCs), among the three groups. Hospitalization rates were higher in the control and flow groups than in the stenosis group (0.50, 0.57, 0.18/patient-year, respectively [p < 0.01]), and hospitalization costs were lowest in the stenosis group (p = 0.026). The stenosis group had a trend toward lowest CVC rates (0.44, 0.32, 0.20/patient-year, respectively [p = 0.20]). The costs of care were higher in the control and flow groups than in the stenosis group (dollar 3727, dollar 4839, dollar 3306/patient-year, respectively [p = 0.015]). The costs of stenosis (dollar 142/patient-year) and Q (dollar 279/patient-year) measurements were minimal compared to the total cost of access-related care. In conclusion, stenosis surveillance by duplex ultrasound combined with preemptive correction yielded reduced hospitalization rates and costs, reduced total cost of access-related care, and a trend of reduced CVC rates. In

  11. The potential for reducing the cost of a heavy ion accelerator for ICF: Final report

    SciTech Connect

    Monsler, M.J.

    1987-02-25

    This study was initiated to identify the high leverage areas for reducing the cost of a 10 MJ heavy ion beam driver for a high gain target development facility. Our efforts to innovate to reach affordable cost have been mostly successful, in that it looks like the $500 M range may indeed be possible. We conclude that heavy ion beams do have substantial promise for an inertial fusion driver. However, the pace of R and D would have to be substantially increased to realize this promise on a timescale necessary for a High Gain Test Facility.

  12. Installation, Operation, and Maintenance Strategies to Reduce the Cost of Offshore Wind Energy

    SciTech Connect

    Maples, B.; Saur, G.; Hand, M.; van de Pieterman, R.; Obdam, T.

    2013-07-01

    Currently, installation, operation, and maintenance (IO&M) costs contribute approximately 30% to the LCOE of offshore wind plants. To reduce LCOE while ensuring safety, this paper identifies principal cost drivers associated with IO&M and quantifies their impacts on LCOE. The paper identifies technology improvement opportunities and provides a basis for evaluating innovative engineering and scientific concepts developed subsequently to the study. Through the completion of a case study, an optimum IO&M strategy for a hypothetical offshore wind project is identified.

  13. An Analysis of the Medical Costs of Obesity for Fifth Graders in California and Texas.

    PubMed

    Levitt, Danielle E; Jackson, Allen W; Morrow, James R

    The prevalence of childhood obesity in the United States increased more than three-fold from 1976 - 1980 to 2007 - 2008. The Presidential Youth Fitness Program's FitnessGram® is the current method recommended by the President's Council on Fitness, Sports & Nutrition for assessing health-related fitness factors, including body composition. FitnessGram® data from California and Texas, the two most populous states, over a three-year time span indicate that more than one-third of fifth grade students, typically ten-year-olds, are obese. Previous studies report that an obese ten-year-old child who remains obese into adulthood will incur elevated direct medical costs beyond his or her normal-weight peers over a lifetime. The recommended elevated cost estimates are approximately $12,660 when comparing against a normal-weight child who gains weight as an adult and approximately $19,000 compared to a child who remains at normal weight as an adult. By applying these figures to FitnessGram® results from California and Texas, each group of fifth grade students in each of the two states will incur between $1.4 and $3.0 billion in direct medical costs over a lifetime. When the percentage of obese fifth graders is extrapolated to the rest of the United States' 4 million ten-year-olds, this results in more than $17 billion (accounting for adulthood weight gain) or $25 billion (not accounting for adulthood weight gain) in added direct lifetime medical costs attributable to obesity for this single-year age cohort. This information should be used to influence spending decisions and resource allocation to obesity reduction and prevention efforts.

  14. Medical students' knowledge of indications for imaging modalities and cost analysis of incorrect requests, shiraz, iran 2011-2012.

    PubMed

    Islami Parkoohi, Parisa; Jalli, Reza; Danaei, Mina; Khajavian, Shiva; Askarian, Mehrdad

    2014-05-01

    Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion (fail to excellent) using Iranian academic grading (0 to 20). In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 (74%). The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled $104303 (public tariff) and $205581 (private tariff). Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns.

  15. Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients With Type 2 Diabetes Mellitus.

    PubMed

    Nichols, Gregory A; Reynolds, Kristi; Olufade, Temitope; Kimes, Teresa M; O'Keeffe-Rosetti, Maureen; Sapp, Daniel S; Anzalone, Deborah; Fortmann, Stephen P

    2017-02-01

    High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with diabetes mellitus who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3 to 15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased ≥5%, change of ≤4.9%, decreased 5% to 29%, decreased ≥30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by ≥30% (-$2,859). Statin monotherapy patients who reduced TG by ≥30% also had a large reduction in adjusted costs (-$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of ≥30% produced a particularly large reduction in 1-year medical costs.

  16. Factors associated with geographic variation in cost per episode of care for three medical conditions

    PubMed Central

    2014-01-01

    Objective To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods We use 2004–2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry’s Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes). Results Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode. Conclusion Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode. PMID:24949281

  17. Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

    NASA Astrophysics Data System (ADS)

    Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

    Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

  18. New ultra-deepwater rig with dual rotaries will reduce costs

    SciTech Connect

    Cole, J.C.; Herrmann, R.P.; Scott, R.J.; Shaughnessy, J.M.

    1997-05-26

    The Discoverer Enterprise, a next generation, ultra-deepwater drill ship with a dual rotary system, will decrease drilling and completion costs by reducing bottom hole assembly (BHA) and tubular preparation time. Transocean Offshore received a contract from Amoco Corp. to build the ultra-deep floating rig and is scheduled to spud its first well in July 1998. It will generally work in water deeper than 6,000 ft. The rig design involves a new approach that addresses the overall well-construction process and equipment required to decrease significantly deepwater drilling time. The Discoverer is the first ultra-deepwater rig designed specifically for handling subsea completions and extended well tests. The paper discusses increased deepwater rig demand, rig construction costs, drillship design, well construction, development drilling, and cost justification.

  19. Economic organization of medicine and the Committee on the Costs of Medical Care.

    PubMed Central

    Perkins, B B

    1998-01-01

    Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. PMID:9807547

  20. Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.

    PubMed

    Beck, Owen N; Taboga, Paolo; Grabowski, Alena Marie

    2017-01-19

    Inspired by the spring-like action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. Yet, manufacturer recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed fifteen trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of three different prosthetic models (Freedom Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with five combinations of stiffness categories (manufacturer recommended and ± 1) and heights (International Paralympic Committee's maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness (fixed effect (β)=0.036; p=0.008) but not height (p≥0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (kN/m), using the Flex-Run (β=-0.139; p=0.044) and 1E90 Sprinter prostheses (β=-0.176; p=0.009) reduced net metabolic costs by 4.3% to 4.9% compared to using the Catapult prostheses, respectively. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β=2.786; p=0.001), stride frequencies (β=0.911; p<0.001), and leg stiffness values (β=0.053; p=0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness, but not height.

  1. A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study

    PubMed Central

    Kandola, Manjinder Singh; Saldana, Fidencio; Kvedar, Joseph C

    2016-01-01

    Background Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. Objective The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Methods Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Results Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants

  2. Assessing the cost burden of United States FDA-mandated post-approval studies for medical devices.

    PubMed

    Wimmer, Neil J; Robbins, Susan; Ssemaganda, Henry; Yang, Erin; Normand, Sharon-Lise; Matheny, Michael E; Herz, Naomi; Rising, Josh; Resnic, Frederic S

    2016-01-01

    Approved medical devices frequently undergo FDA mandated post-approval studies (PAS). However, there is uncertainty as to the value of PAS in assessing the safety of medical devices and the cost of these studies to the healthcare system is unknown. Since PAS costs are funded through device manufacturers who do not share the costs with regulators, we sought to estimate the total PAS costs through interviews with a panel of experts in medical device clinical trial design in order to design a general cost model for PAS which was then applied to the FDA PAS. A total of 277 PAS were initiated between 3/1/05 through 6/30/13 and demonstrated a median cost of $2.16 million per study and an overall cost of $1.22 billion over the 8.25 years of study. While these costs are funded through manufacturers, the ultimate cost is borne by the healthcare system through the medical device costs. Given concerns regarding the informational value of PAS, the resources used to support mandated PAS may be better allocated to other approaches to assure safety.

  3. Assessing the cost burden of United States FDA-mandated post-approval studies for medical devices

    PubMed Central

    Wimmer, Neil J.; Robbins, Susan; Ssemaganda, Henry; Yang, Erin; Normand, Sharon-Lise; Matheny, Michael E.; Herz, Naomi; Rising, Josh; Resnic, Frederic S.

    2016-01-01

    Approved medical devices frequently undergo FDA mandated post-approval studies (PAS). However, there is uncertainty as to the value of PAS in assessing the safety of medical devices and the cost of these studies to the healthcare system is unknown. Since PAS costs are funded through device manufacturers who do not share the costs with regulators, we sought to estimate the total PAS costs through interviews with a panel of experts in medical device clinical trial design in order to design a general cost model for PAS which was then applied to the FDA PAS. A total of 277 PAS were initiated between 3/1/05 through 6/30/13 and demonstrated a median cost of $2.16 million per study and an overall cost of $1.22 billion over the 8.25 years of study. While these costs are funded through manufacturers, the ultimate cost is borne by the healthcare system through the medical device costs. Given concerns regarding the informational value of PAS, the resources used to support mandated PAS may be better allocated to other approaches to assure safety. PMID:28280294

  4. 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.

  5. Preliminary study of reducing the cost of blast shelter for critical workers. Final report

    SciTech Connect

    Chester, C.V.; Holladay, D.W.

    1983-08-01

    The overall purpose of this study was to examine ways to reduce the cost of shelter for critical workers. Shelters for this purpose would be expected to have from 10 to 100 spaces and overpressure protection from 340-1360 kPa (50-200 psi). The civil defense literature on cost was reviewed, and the cost estimates of the best designs were corrected to 1982 dollars. A design and a cost estimate of a corrugated metal shelter exploiting eartharching for 1360 kPa (200 psi) was carried through the concept stage. It is believed the configuration used will enable the occupants to survive both the ground motion and the initial nuclear radiation from megaton weapons at this overpressure. It appears that this shelter can be constructed for somewhat under $500/space, including habitability equipment, when purchased in relatively small numbers. A design concept for a very lightweight, high-overpressure door was developed. This door, using the membrane principle, offers the promise of being the lowest cost entranceway when in mass production.

  6. A female-biased sex ratio reduces the twofold cost of sex

    PubMed Central

    Kobayashi, Kazuya; Hasegawa, Eisuke

    2016-01-01

    The evolution of sexual reproduction remains a fascinating enigma in biology. Theoretically, populations of sexual organisms investing half of their resources into producing male offspring that don’t contribute to reproduction should grow at only half the rate of their asexual counterparts. This demographic disadvantage due to male production is known as the twofold cost of sex. However, the question of whether this cost is truly twofold for sexual females remains unanswered. The cost of producing males should decrease when the number of male offspring is reduced. Here, we report a case where the cost of males is actually less than twofold. By measuring the numbers of sexual strain coexisting with asexual strain among thrips, our survey revealed that the sexual strain showed female-biased sex ratios and that the relative frequency of sexual strain is negatively correlated with the proportion of males in the sexual strain. Using computer simulations, we confirmed that a female-biased sex ratio evolves in sexual individuals due to the coexistence of asexual individuals. Our results demonstrate that there is a cost of producing males that depends on the number of males. We therefore conclude that sexual reproduction can evolve with far fewer benefits than previously assumed. PMID:27035400

  7. Marketplace Subsidies: Changing The 'Family Glitch' Reduces Family Health Spending But Increases Government Costs.

    PubMed

    Buettgens, Matthew; Dubay, Lisa; Kenney, Genevieve M

    2016-07-01

    Under the Affordable Care Act, if one family member has an employer offer of single coverage deemed to be affordable-that is, costing less than 9.66 percent of family income in 2016-then all family members are ineligible for tax credits for Marketplace coverage, even if the cost of providing coverage to the whole family is greater than 9.66 percent of income. More than six million people live in such families and as a result are ineligible for premium tax credits. These families face premiums that can amount to 15.8 percent of income, or 12.0 percent after the tax advantages of employer-sponsored health coverage are factored in. We modeled the potential impact of changing the affordability test to take into account the cost of family coverage. Doing so would reduce spending on premiums from 12.0 percent to 6.3 percent of income, significantly alleviating financial burdens, but would generate little additional coverage. We estimated the additional costs to the federal government for premium tax credits and cost-sharing reductions to be between $3.7 billion and $6.5 billion in 2016.

  8. A female-biased sex ratio reduces the twofold cost of sex

    NASA Astrophysics Data System (ADS)

    Kobayashi, Kazuya; Hasegawa, Eisuke

    2016-04-01

    The evolution of sexual reproduction remains a fascinating enigma in biology. Theoretically, populations of sexual organisms investing half of their resources into producing male offspring that don’t contribute to reproduction should grow at only half the rate of their asexual counterparts. This demographic disadvantage due to male production is known as the twofold cost of sex. However, the question of whether this cost is truly twofold for sexual females remains unanswered. The cost of producing males should decrease when the number of male offspring is reduced. Here, we report a case where the cost of males is actually less than twofold. By measuring the numbers of sexual strain coexisting with asexual strain among thrips, our survey revealed that the sexual strain showed female-biased sex ratios and that the relative frequency of sexual strain is negatively correlated with the proportion of males in the sexual strain. Using computer simulations, we confirmed that a female-biased sex ratio evolves in sexual individuals due to the coexistence of asexual individuals. Our results demonstrate that there is a cost of producing males that depends on the number of males. We therefore conclude that sexual reproduction can evolve with far fewer benefits than previously assumed.

  9. Innovative, High-Pressure, Cryogenic Control Valve: Short Face-to-Face, Reduced Cost

    NASA Technical Reports Server (NTRS)

    Wilkes, Karlin; Larsen, Ed; McCourt, Jackson

    2003-01-01

    A control valve that can throttle high-pressure cryogenic fluid embodies several design features that distinguish it over conventional valves designed for similar applications. Field and design engineers worked together to create a valve that would simplify installation, trim changes, and maintenance, thus reducing overall cost. The seals and plug stem packing were designed to perform optimally in cryogenic temperature ranges. Unlike conventional high-pressure cryogenic valves, the trim size can be changed independent of the body.

  10. Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples

    PubMed Central

    Gao, Lan; Hu, Hao; Zhao, Fei-Li; Li, Shu-Chuen

    2016-01-01

    Objectives To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries. Methods A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted). Results In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP. Conclusions Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data. PMID:26814959

  11. A comparison of response cost and differential reinforcement of other behavior to reduce disruptive behavior in a preschool classroom.

    PubMed

    Conyers, Carole; Miltenberger, Raymond; Maki, Amber; Barenz, Rebecca; Jurgens, Mandy; Sailer, Angela; Haugen, Meredith; Kopp, Brandon

    2004-01-01

    This study investigated the effectiveness of response cost and differential reinforcement of other behavior (DRO) in reducing the disruptive behaviors of 25 children in a preschool classroom. Using an alternating treatments design, disruptive behavior was reduced when the participants earned tokens for the absence of disruptive behavior (DRO) or lost tokens for the occurrence of disruptive behavior (response cost). Initially, DRO was more successful in reducing the number of disruptive behaviors; however, over time, response cost proved to be more effective.

  12. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.

    PubMed

    Anderson, Peter; Chisholm, Dan; Fuhr, Daniela C

    2009-06-27

    This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

  13. Root phenes that reduce the metabolic costs of soil exploration: opportunities for 21st century agriculture.

    PubMed

    Lynch, Jonathan P

    2015-09-01

    Crop genotypes with reduced metabolic costs of soil exploration would have improved water and nutrient acquisition. Three strategies to achieve this goal are (1) production of the optimum number of axial roots; (2) greater biomass allocation to root classes that are less metabolically demanding; and (3) reduction of the respiratory requirement of root tissue. An example of strategy 1 is the case of reduced crown root number in maize, which is associated with greater rooting depth, N capture and yield in low N soil. An example of strategy 2 is the case of increased hypocotyl-borne rooting in bean, which decreases root cost and increases P capture from low P soil. Examples of strategy 3 are the cases of increased formation of root cortical aerenchyma, decreased cortical cell file number and increased cortical cell size in maize, which decrease specific root respiration, increase rooting depth and increase water capture and yield under water stress. Root cortical aerenchyma also increases N capture and yield under N stress. Root phenes that reduce the metabolic cost of soil exploration are promising, underexploited avenues to the climate-resilient, resource-efficient crops that are urgently needed in global agriculture.

  14. Design of a Medical Image Management System: A Practical Cost-Effective Approach

    PubMed Central

    Seshadri, S.B.; Arenson, R.L.; van der Voorde, F.; Khalsa, S.; Kundel, H.; Brikman, I.

    1986-01-01

    Most developmental efforts in the Medical Image Management System (MIMS) arena have focused either on a personal-computer based, inferior-quality, user-unfriendly version for teleradiology which is achievable today, or on the very expensive, technologically-difficult, user-unfriendly but futuristic all-digital system. This presentation will discuss a practical, cost-effective medium-resolution system for archiving, review and comparison. The design of a MIMS will be considered from three perspectives: [List: see text] A prototype MIMS that is presently serving our Medical Intensive Care Unit (MICU) and undergoing clinical trials will be briefly described. A plan to expand this to a hospital wide MIMS will be presented.

  15. The mini electronic medical record: a low-cost, low-risk partial solution.

    PubMed

    Chambliss, M L; Rasco, T; Clark, R D; Gardner, J P

    2001-12-01

    Electronic medical records (EMRs) offer many advantages. However, there are also risks involved with adopting a full commercial EMR. These include high cost, the disruption of clinic routines, and poor or no vendor support. We created and implemented a partial, or miniature EMR (mini EMR) based on Microsoft Access 97 (Microsoft Corporation; Redmond, Wash). This program serves as an electronic front sheet for the patient chart that records International Classification of Diseases--9th revision codes and chronic medications and allergies, and provides reminders for prevention procedures. The mini EMR has been inexpensive, adaptable, easy to maintain, and very well accepted, and it has caused little interruption of our clinical activities. We believe the program can serve as a bridge to a future commercial EMR once that market has matured.

  16. Reducing metal alloy powder costs for use in powder bed fusion additive manufacturing: Improving the economics for production

    NASA Astrophysics Data System (ADS)

    Medina, Fransisco

    Titanium and its associated alloys have been used in industry for over 50 years and have become more popular in the recent decades. Titanium has been most successful in areas where the high strength to weight ratio provides an advantage over aluminum and steels. Other advantages of titanium include biocompatibility and corrosion resistance. Electron Beam Melting (EBM) is an additive manufacturing (AM) technology that has been successfully applied in the manufacturing of titanium components for the aerospace and medical industry with equivalent or better mechanical properties as parts fabricated via more traditional casting and machining methods. As the demand for titanium powder continues to increase, the price also increases. Titanium spheroidized powder from different vendors has a price range from 260/kg-450/kg, other spheroidized alloys such as Niobium can cost as high as $1,200/kg. Alternative titanium powders produced from methods such as the Titanium Hydride-Dehydride (HDH) process and the Armstrong Commercially Pure Titanium (CPTi) process can be fabricated at a fraction of the cost of powders fabricated via gas atomization. The alternative powders can be spheroidized and blended. Current sectors in additive manufacturing such as the medical industry are concerned that there will not be enough spherical powder for production and are seeking other powder options. It is believed the EBM technology can use a blend of spherical and angular powder to build fully dense parts with equal mechanical properties to those produced using traditional powders. Some of the challenges with angular and irregular powders are overcoming the poor flow characteristics and the attainment of the same or better packing densities as spherical powders. The goal of this research is to demonstrate the feasibility of utilizing alternative and lower cost powders in the EBM process. As a result, reducing the cost of the raw material to reduce the overall cost of the product produced with

  17. A propensity score approach to estimating the cost-effectiveness of medical therapies from observational data.

    PubMed

    Mitra, Nandita; Indurkhya, Alka

    2005-08-01

    Health summary measures are commonly used by policy makers to help make decisions on the allocation of societal resources for competing medical treatments. The net monetary benefit is a health summary measure that overcomes the statistical limitations of a popular measure namely, the cost-effectiveness ratio. We introduce a linear model framework to estimate propensity score adjusted net monetary benefit. This method provides less biased estimates in the presence of significant differences in baseline measures and demographic characteristics between treatment groups in quasi-randomized or observational studies. Simulation studies were conducted to better understand the utility of propensity score adjusted estimates of net monetary benefits when important covariates are unobserved. The results indicated that the propensity score adjusted net monetary benefit provides a robust measure of cost-effectiveness in the presence of hidden bias. The methods are illustrated using data from SEER-Medicare for the treatment of bladder cancer.

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

    PubMed Central

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

    2017-01-01

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

  19. Cost-effectiveness of eplerenone in NYHA class II chronic heart failure patients with reduced LVEF: an analysis for Greece

    PubMed Central

    Athanasakis, Kostas; Bilitou, Aikaterini; Lee, Dawn; Karampli, Eleftheria; Karavidas, Apostolos; Parissis, John; Sykara, Georgia; Kyriopoulos, John

    2016-01-01

    Objectives The aim of the study was to evaluate the cost-effectiveness (CE) of treatment with eplerenone versus standard care in adult patients with New York Heart Association class II chronic heart failure and reduced left ventricular ejection fraction from the perspective of the Greek national health care payer. Methods A discrete-event model simulating the clinical course and respective outcomes of eplerenone as an add-on to standard therapy versus standard therapy alone based on the pivotal Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure (EMPHASIS-HF) trial was locally adapted for the Greek setting. Data on medications followed the resource use from eplerenone in mild patients hospitalization and survival study in heart failure and were estimated on a lifetime basis (or until discontinuation). Cost calculations were based on year 2014, event costs (cardiovascular hospitalizations, adverse events, and devices) were sourced from published diagnosis-related groups. A 3% discount rate was applied. In order to test the robustness of the model projections, a range of deterministic and probabilistic sensitivity analyses were carried out. Results Over a patient’s lifetime, the addition of eplerenone to standard care compared to standard care alone led to an incremental gain of 1.33 quality-adjusted life-years (QALYs) (6.53 vs 5.20 QALYs, respectively) as well as an increase in the cost of treatment by €2,160; these outcomes produced an incremental CE ratio of €1,624/QALY for the Greek setting. On the basis of probabilistic sensitivity analysis, there was a 100% likelihood of eplerenone being cost-effective versus standard care at a threshold of €3,500/QALY. Conclusion This analysis indicates that eplerenone may be a cost-effective option versus standard care accompanied by additional clinical benefits and an added incremental cost at an acceptable, if not low, CE ratio. The results are consistent with the previously published

  20. Safety-cost trade-offs in medical device reuse: a Markov decision process model.

    PubMed

    Sloan, Thomas W

    2007-02-01

    Healthcare expenditures in the US are approaching 2 trillion dollars, and hospitals and other healthcare providers are under tremendous pressure to rein in costs. One cost-saving approach which is gaining popularity is the reuse of medical devices which were designed only for a single use. Device makers decry this practice as unsanitary and unsafe, but a growing number of third-party firms are willing to sterilize, refurbish, and/or remanufacture devices and resell them to hospitals at a fraction of the original price. Is this practice safe? Is reliance on single-use devices sustainable? A Markov decision process (MDP) model is formulated to study the trade-offs involved in these decisions. Several key parameters are examined: device costs, device failure probabilities, and failure penalty cost. For each of these parameters, expressions are developed which identify the indifference point between using new and reprocessed devices. The results can be used to inform the debate on the economic, ethical, legal, and environmental dimensions of this complex issue.

  1. Teleconferencing: Cost optimization of satellite and ground systems for continuing progressional education and medical services

    NASA Technical Reports Server (NTRS)

    Dunn, D.; Lusignan, B.

    1972-01-01

    A set of analytical capabilities that are needed to assess the role satellite communications technology will play in public and other services was developed. It is user oriented in that it starts from descriptions of user demand and develops the ability to estimate the cost of satisfying that demand with the lowest cost communications system. To ensure that the analysis could cope with the complexities of the real users, two services were chosen as examples, continuing professional education and medical services. Telecommunications costs are effected greatly by demographic factors, involving distribution of users in urban areas and distances between towns in rural regions. For this reason the analytical tools were exercised on sample locations. San Jose, California and Denver, Colorado were used to represent an urban area and the Rocky Mountain states were used to represent a rural region. In assessing the range of satellite system costs, two example coverage areas were considered, one appropriate to cover the contiguous forty-eight states, a second appropriate to cover about one-third that area.

  2. Cost-effective targeting of conservation investments to reduce the northern Gulf of Mexico hypoxic zone

    PubMed Central

    Rabotyagov, Sergey S.; Campbell, Todd D.; White, Michael; Arnold, Jeffrey G.; Atwood, Jay; Norfleet, M. Lee; Kling, Catherine L.; Gassman, Philip W.; Valcu, Adriana; Richardson, Jeffrey; Turner, R. Eugene; Rabalais, Nancy N.

    2014-01-01

    A seasonally occurring summer hypoxic (low oxygen) zone in the northern Gulf of Mexico is the second largest in the world. Reductions in nutrients from agricultural cropland in its watershed are needed to reduce the hypoxic zone size to the national policy goal of 5,000 km2 (as a 5-y running average) set by the national Gulf of Mexico Task Force’s Action Plan. We develop an integrated assessment model linking the water quality effects of cropland conservation investment decisions on the more than 550 agricultural subwatersheds that deliver nutrients into the Gulf with a hypoxic zone model. We use this integrated assessment model to identify the most cost-effective subwatersheds to target for cropland conservation investments. We consider targeting of the location (which subwatersheds to treat) and the extent of conservation investment to undertake (how much cropland within a subwatershed to treat). We use process models to simulate the dynamics of the effects of cropland conservation investments on nutrient delivery to the Gulf and use an evolutionary algorithm to solve the optimization problem. Model results suggest that by targeting cropland conservation investments to the most cost-effective location and extent of coverage, the Action Plan goal of 5,000 km2 can be achieved at a cost of $2.7 billion annually. A large set of cost-hypoxia tradeoffs is developed, ranging from the baseline to the nontargeted adoption of the most aggressive cropland conservation investments in all subwatersheds (estimated to reduce the hypoxic zone to less than 3,000 km2 at a cost of $5.6 billion annually). PMID:25512489

  3. Cost-effective targeting of conservation investments to reduce the northern Gulf of Mexico hypoxic zone.

    PubMed

    Rabotyagov, Sergey S; Campbell, Todd D; White, Michael; Arnold, Jeffrey G; Atwood, Jay; Norfleet, M Lee; Kling, Catherine L; Gassman, Philip W; Valcu, Adriana; Richardson, Jeffrey; Turner, R Eugene; Rabalais, Nancy N

    2014-12-30

    A seasonally occurring summer hypoxic (low oxygen) zone in the northern Gulf of Mexico is the second largest in the world. Reductions in nutrients from agricultural cropland in its watershed are needed to reduce the hypoxic zone size to the national policy goal of 5,000 km(2) (as a 5-y running average) set by the national Gulf of Mexico Task Force's Action Plan. We develop an integrated assessment model linking the water quality effects of cropland conservation investment decisions on the more than 550 agricultural subwatersheds that deliver nutrients into the Gulf with a hypoxic zone model. We use this integrated assessment model to identify the most cost-effective subwatersheds to target for cropland conservation investments. We consider targeting of the location (which subwatersheds to treat) and the extent of conservation investment to undertake (how much cropland within a subwatershed to treat). We use process models to simulate the dynamics of the effects of cropland conservation investments on nutrient delivery to the Gulf and use an evolutionary algorithm to solve the optimization problem. Model results suggest that by targeting cropland conservation investments to the most cost-effective location and extent of coverage, the Action Plan goal of 5,000 km(2) can be achieved at a cost of $2.7 billion annually. A large set of cost-hypoxia tradeoffs is developed, ranging from the baseline to the nontargeted adoption of the most aggressive cropland conservation investments in all subwatersheds (estimated to reduce the hypoxic zone to less than 3,000 km(2) at a cost of $5.6 billion annually).

  4. Building Commissioning: A Golden Opportunity for Reducing Energy Costs and Greenhouse-gas Emissions

    SciTech Connect

    Mills, Evan

    2009-07-16

    available revealed over 10,000 energy-related problems, resulting in 16% median whole-building energy savings in existing buildings and 13% in new construction, with payback time of 1.1 years and 4.2 years, respectively. In terms of other cost-benefit indicators, median benefit-cost ratios of 4.5 and 1.1, and cash-on-cash returns of 91% and 23% were attained for existing and new buildings, respectively. High-tech buildings were particularly cost-effective, and saved higher amounts of energy due to their energy-intensiveness. Projects with a comprehensive approach to commissioning attained nearly twice the overall median level of savings and five-times the savings of the least-thorough projects. It is noteworthy that virtually all existing building projects were cost-effective by each metric (0.4 years for the upper quartile and 2.4 years for the lower quartile), as were the majority of new-construction projects (1.5 years and 10.8 years, respectively). We also found high cost-effectiveness for each specific measure for which we have data. Contrary to a common perception, cost-effectiveness is often achieved even in smaller buildings. Thanks to energy savings valued more than the cost of the commissioning process, associated reductions in greenhouse gas emissions come at 'negative' cost. In fact, the median cost of conserved carbon is negative - -$110 per tonne for existing buildings and -$25/tonne for new construction - as compared with market prices for carbon trading and offsets in the +$10 to +$30/tonne range. Further enhancing the value of commissioning, its non-energy benefits surpass those of most other energy-management practices. Significant first-cost savings (e.g., through right-sizing of heating and cooling equipment) routinely offset at least a portion of commissioning costs - fully in some cases. When accounting for these benefits, the net median commissioning project cost was reduced by 49% on average, while in many cases they exceeded the direct value of the

  5. Cost of reducing aromatics and sulfur levels in motor-vehicle fuels. Volume 3. Appendices. Final report

    SciTech Connect

    Felten, J.R.; McCarthy, K.M.

    1988-08-01

    Linear-programming (LP) models were developed for five refineries representative of the California refining industry and validated against historic operation. Process options to reduce gasoline and diesel contaminants were selected and represented in the LP models. Costs were estimated to separately reduce aromatics levels in automotive gasoline, aromatics in diesel, and sulfur in diesel for 1991 and 1995. Cost impacts were scaled up to obtain the overall cost impact in California. Estimates were made of total aromatics and benzene levels in gasoline and of sulfur, aromatics, and cetane levels in diesel. Estimates were made of the impact on refinery emissions, automotive emissions and automotive performance. The cost to reduce diesel sulfur level to .05% was 6.3 cents/gallon. The cost to reduce diesel aromatics level to 10% was 27.6 cents/gallon. The cost to reduce gasoline aromatics levels by 18% was 7.0 cents/gallon.

  6. [Reducing postoperative morbidity and mortality with preoperative risk evaluation and with refined perioperative medical care].

    PubMed

    Uchida, Kanji

    2012-05-01

    Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.

  7. Pediatric Medical Care System in China Has Significantly Reduced Abandonment of Acute Lymphoblastic Leukemia Treatment

    PubMed Central

    Zhou, Qi; Hong, Dan; Lu, Jun; Zheng, Defei; Ashwani, Neetica

    2015-01-01

    In this study, we have analyzed both administrative and clinical data from our hospital during 2002 to 2012 to evaluate the influence of government medical policies on reducing abandonment treatment in pediatric patients with acute lymphoblastic leukemia. Two policies funding for the catastrophic diseases and the new rural cooperative medical care system (NRCMS) were initiated in 2005 and 2011, respectively. About 1151 children diagnosed with acute lymphoblastic leukemia were enrolled in our study during this period and 316 cases abandoned treatment. Statistical differences in sex, age, number of children in the family, and family financial status were observed. Of most importance, the medical insurance coverage was critical for reducing abandonment treatment. However, 92 cases abandoning treatment after relapse did not show significant difference either in medical insurance coverage or in duration from first complete remission. In conclusion, financial crisis was the main reason for abandoning treatment. Government-funded health care expenditure programs reduced families’ economic burden and thereby reduced the abandonment rate with resultant increased overall survival. PMID:25393454

  8. [Medical training in Israel--can we realize the comments of Pazi's Committee and at what cost?].

    PubMed

    Lichtenberg, Dov

    2010-06-01

    In spite of the growth of Israel's population, the number of graduates from the four Israeli Schools of Medicine has changed very little in the last 30 years. Nevertheless, the annual number of new practitioners grew from about 300 to 900, due to Israeli graduates of European Schools and the large number of physicians among the new immigrants from the former USSR states in the early nineties. A committee, nominated by the National Board of Higher Education (MALAG), headed by the late Prof. Pazi, concluded that under steady state conditions we must train 800 medical students per year. MALAG adopted this recommendation. As a first step, MALAG approved two new programs: a special program for Academic Reserve candidates (Atudaim) and a new (5th) medical school in the Galilee. These two new programs, together with the new 4-year MD program in Tel Aviv, will add about 200 graduates to the list of medical students. Yet, the question of whether we can realize the recommendation of Pazi's Committee (to train 800 MDs annually) and at what cost, remains open. This preliminary review is devoted to the relevant factors that must be considered before the latter questions can be answered. First, we note that the limiting factor of the number of medical students is the ratio between the number of teaching departments in each of the medical disciplines and the number of weeks of Clerkships required in the given disciplines. Our main conclusion is that realization of the recommendation of Pazi's committee requires an increase in the number of teaching departments, preferably by upgrading the academic level of those departments that do not teach students, and increasing the teaching load of other departments. We may also have to reduce the number of weeks of 'bedside teaching' but should beware of reducing it to a minimum lower than about 70 weeks, as in North America. Regardless of the need to train more physicians, we must increase teaching in the community. Only a combination of

  9. 75 FR 24754 - Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... BUDGET Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Military Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third Persons AGENCY: Office... inpatient medical services furnished by military treatment facilities through the Department of Defense...

  10. 76 FR 15349 - Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... BUDGET Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable Third... furnished by military treatment facilities through the Department of Defense (DoD). The rates have...

  11. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in...

  12. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.160 Election of reasonable cost payment for direct medical and surgical services of physicians in...

  13. Reduced Metabolic Cost of Locomotion in Svalbard Rock Ptarmigan (Lagopus muta hyperborea) during Winter

    PubMed Central

    Lees, John; Nudds, Robert; Stokkan, Karl-Arne; Folkow, Lars; Codd, Jonathan

    2010-01-01

    The Svalbard rock ptarmigan, Lagopus muta hyperborea experiences extreme photoperiodic and climatic conditions on the Arctic archipelago of Svalbard. This species, however, is highly adapted to live in this harsh environment. One of the most striking adaptations found in these birds is the deposition, prior to onset of winter, of fat stores which may comprise up to 32% of body mass and are located primarily around the sternum and abdominal region. This fat, while crucial to the birds' survival, also presents a challenge in that the bird must maintain normal physiological function with this additional mass. In particular these stores are likely to constrain the respiratory system, as the sternum and pelvic region must be moved during ventilation and carrying this extra load may also impact upon the energetic cost of locomotion. Here we demonstrate that winter birds have a reduced cost of locomotion when compared to summer birds. A remarkable finding given that during winter these birds have almost twice the body mass of those in summer. These results suggest that Svalbard ptarmigan are able to carry the additional winter fat without incurring any energetic cost. As energy conservation is paramount to these birds, minimising the costs of moving around when resources are limited would appear to be a key adaptation crucial for their survival in the barren Arctic environment. PMID:21125015

  14. Reduced cost alternatives to premise wiring using ATM and microcellular technologies

    NASA Technical Reports Server (NTRS)

    Gejji, Raghvendra R.

    1993-01-01

    The cost of premises wiring keeps increasing due to personnel moves, new equipment, capacity upgrades etc. It would be desirable to have a wireless interface from the workstations to the fixed network, so as to minimize the wiring changes needed. New technologies such as microcellular personal communication systems are promising to bring down the cost of wireless communication. Another promising technology is Code Division Multiple Access (CDMA), which could dramatically increase the bandwidth available for wireless connections. In addition, Asynchronous Transfer Mode (ATM) technology is emerging as a technique for integrated management of voice, data, and video traffic on a single network. The focus of this investigation will be to assess the future utility of these new technologies for reducing the premise wiring cost at KSC. One of the issues to be studied is the cost comparison of 'old' versus 'new,' especially as time and technology progress. An additional issue for closer study is a feasible time-line for progress in technological capability.

  15. 76 FR 9329 - Efficiency Initiative Effort To Reduce Non-Value-Added Costs Imposed on Industry by Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... practices encourage industry to adopt processes and make investments that increase costs, especially overhead costs, but do not contribute to value added in systems and services delivered to the Department... Efficiency Initiative Effort To Reduce Non-Value-Added Costs Imposed on Industry by Department of...

  16. Validated Feasibility Study of Integrally Stiffened Metallic Fuselage Panels for Reducing Manufacturing Costs: Cost Assessment of Manufacturing/Design Concepts

    NASA Technical Reports Server (NTRS)

    Metschan, S.

    2000-01-01

    The objective of the Integral Airframe Structures (IAS) program was to demonstrate, for an integrally stiffened structural concept, performance and weight equal to "built-up" structure with lower manufacturing cost. This report presents results of the cost assessment for several design configuration/manufacturing method combinations. The attributes of various cost analysis models were evaluated and COSTRAN selected for this study. A process/design cost evaluation matrix was developed based on material, forming, machining, and assembly of structural sub-elements and assembled structure. A hybrid design, made from high-speed machined extruded frames that are mechanically fastened to high-speed machined plate skin/stringer panels, was identified as the most cost-effective manufacturing solution. Recurring labor and material costs of the hybrid design are up to 61 percent less than the current built-up technology baseline. This would correspond to a total cost reduction of $1.7 million per ship set for a 777-sized airplane. However, there are important outstanding issues with regard to the cost of capacity of high technology machinery, and the ability to cost-effectively provide surface finish acceptable to the commercial aircraft industry. The projected high raw material cost of large extrusions also played an important role in the trade-off between plate and extruded concepts.

  17. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Payment System for Inpatient Operating Costs § 412.105 Special treatment: Hospitals that incur indirect... 42 Public Health 2 2012-10-01 2012-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS...

  18. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Payment System for Inpatient Operating Costs § 412.105 Special treatment: Hospitals that incur indirect... 42 Public Health 2 2013-10-01 2013-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS...

  19. Cost-effectiveness of feeding strategies to reduce greenhouse gas emissions from dairy farming.

    PubMed

    Van Middelaar, C E; Dijkstra, J; Berentsen, P B M; De Boer, I J M

    2014-01-01

    The objective of this paper was to evaluate the cost-effectiveness of 3 feeding strategies to reduce enteric CH4 production in dairy cows by calculating the effect on labor income at the farm level and on greenhouse gas (GHG) emissions at the chain level (i.e., from production of farm inputs to the farm gate). Strategies included were (1) dietary supplementation of an extruded linseed product (56% linseed; 1kg/cow per day in summer and 2kg/cow per day in winter), (2) dietary supplementation of a nitrate source (75% nitrate; 1% of dry matter intake), and (3) reducing the maturity stage of grass and grass silage (grazing at 1,400 instead of 1,700kg of dry matter/ha and harvesting at 3,000 instead of 3,500kg of dry matter/ha). A dairy farm linear programing model was used to define an average Dutch dairy farm on sandy soil without a predefined feeding strategy (reference situation). Subsequently, 1 of the 3 feeding strategies was implemented and the model was optimized again to determine the new economically optimal farm situation. Enteric CH4 production in the reference situation and after implementing the strategies was calculated based on a mechanistic model for enteric CH4 and empirical formulas explaining the effect of fat and nitrate supplementation on enteric CH4 production. Other GHG emissions along the chain were calculated using life cycle assessment. Total GHG emissions in the reference situation added up to 840kg of CO2 equivalents (CO2e) per t of fat- and protein-corrected milk (FPCM) and yearly labor income of €42,605. Supplementation of the extruded linseed product reduced emissions by 9kg of CO2e/t of FPCM and labor income by €16,041; supplementation of the dietary nitrate source reduced emissions by 32kg of CO2e/t of FPCM and labor income by €5,463; reducing the maturity stage of grass and grass silage reduced emissions by 11kg of CO2e/t of FPCM and labor income by €463. Of the 3 strategies, reducing grass maturity was the most cost

  20. Cost of reducing carbon emissions in developing countries: Evidence from Columbia. Staff working paper No. 9

    SciTech Connect

    Linden, G.

    1993-06-01

    The author discusses the issue of the cost of reducing CO2 emissions related to the energy sector and the implications for the structure of the energy sector in Colombia. While there have been a number of attempts to estimate the costs of CO2 reduction in various developed countries such as the United States, there appears to be a lack of similar studies for developing countries. The analysis is based on optimizations using a comprehensive mathematical programming model of Colombia's energy sector in conjunction with an econometric model of the sector. Section one outlines the empirical methods used to analyze the energy/environmental linkages in Colombia. Section two summarizes the simulated results.

  1. RAPID HOME-BASED HIV TESTING TO REDUCE COSTS IN A LARGE TUBERCULOSIS COHORT STUDY.

    PubMed

    Galea, Jerome T; Contreras, Carmen; Lecca, Leonid; Shin, Sonya; Lobatón, Raúl; Zhang, Zibiao; Calderón, Roger; Murray, Megan; Becerra, Mercedes C

    2013-06-21

    To reduce costs in a large tuberculosis household contact cohort study in Lima, Peru, we replaced laboratory-based HIV testing with home-based rapid testing. We developed a protocol and training course to prepare staff for the new strategy; these included role playing for home-based deployment of the Determine® HIV 1/2 Ag/Ac Combo HIV test. Though the rapid HIV test produced more false-positives, the overall cost per participant tested, refusal rate and time to confirmatory HIV testing were lower with the home-based rapid testing strategy compared to the original approach. Rapid testing could be used in similar research or routine care settings.

  2. Great hammerhead sharks swim on their side to reduce transport costs

    PubMed Central

    Payne, Nicholas L.; Iosilevskii, Gil; Barnett, Adam; Fischer, Chris; Graham, Rachel T.; Gleiss, Adrian C.; Watanabe, Yuuki Y.

    2016-01-01

    Animals exhibit various physiological and behavioural strategies for minimizing travel costs. Fins of aquatic animals play key roles in efficient travel and, for sharks, the functions of dorsal and pectoral fins are considered well divided: the former assists propulsion and generates lateral hydrodynamic forces during turns and the latter generates vertical forces that offset sharks' negative buoyancy. Here we show that great hammerhead sharks drastically reconfigure the function of these structures, using an exaggerated dorsal fin to generate lift by swimming rolled on their side. Tagged wild sharks spend up to 90% of time swimming at roll angles between 50° and 75°, and hydrodynamic modelling shows that doing so reduces drag—and in turn, the cost of transport—by around 10% compared with traditional upright swimming. Employment of such a strongly selected feature for such a unique purpose raises interesting questions about evolutionary pathways to hydrodynamic adaptations, and our perception of form and function. PMID:27457414

  3. Crime and punishment. Can the NHIN reduce the cost of healthcare fraud?

    PubMed

    Parente, Stephen T; Mandelbaum, Karen; Hanson, Susan P; Cassidy, Bonnie S; Simborg, Donald W

    2008-01-01

    In his 2004 State of the Union Address, President Bush called for the adoption of the electronic health record (EHR) to increase efficiency and improve the quality of healthcare. This system could reduce healthcare costs by 20 percent or more per year. Some of those savings would be attributed to a dramatic reduction in losses due to fraud. Though IT by itself cannot solve the problem of healthcare fraud, developing an interoperable National Health Information Network (NHIN) can provide a platform to implement real-time anti-fraud controls. In this paper we inventory the costs and benefits of fraud detection from the NHIN and conclude that such an infrastructure investment has the potential to produce significant national savings.

  4. The role of technology in reducing health care costs. Final project report

    SciTech Connect

    Sill, A.E.; Warren, S.; Dillinger, J.D.; Cloer, B.K.

    1997-08-01

    Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. This study was conducted by implementing both top-down and bottom-up strategies. The top-down approach used prosperity gaming methodology to identify future health care delivery needs. This effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements. The bottom-up approach identified and ranked interventional therapies employed in existing care delivery systems for a host of health-related conditions. Economic analysis formed the basis for development of care pathway interaction models for two of the most pervasive, chronic disease/disability conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Societal cost-benefit relationships based on these analyses were used to evaluate the effect of emerging technology in these treatment areas. 17 figs., 48 tabs.

  5. Great hammerhead sharks swim on their side to reduce transport costs.

    PubMed

    Payne, Nicholas L; Iosilevskii, Gil; Barnett, Adam; Fischer, Chris; Graham, Rachel T; Gleiss, Adrian C; Watanabe, Yuuki Y

    2016-07-26

    Animals exhibit various physiological and behavioural strategies for minimizing travel costs. Fins of aquatic animals play key roles in efficient travel and, for sharks, the functions of dorsal and pectoral fins are considered well divided: the former assists propulsion and generates lateral hydrodynamic forces during turns and the latter generates vertical forces that offset sharks' negative buoyancy. Here we show that great hammerhead sharks drastically reconfigure the function of these structures, using an exaggerated dorsal fin to generate lift by swimming rolled on their side. Tagged wild sharks spend up to 90% of time swimming at roll angles between 50° and 75°, and hydrodynamic modelling shows that doing so reduces drag-and in turn, the cost of transport-by around 10% compared with traditional upright swimming. Employment of such a strongly selected feature for such a unique purpose raises interesting questions about evolutionary pathways to hydrodynamic adaptations, and our perception of form and function.

  6. Low-cost/high-efficiency lasers for medical applications in the 14XX-nm regime

    NASA Astrophysics Data System (ADS)

    Callahan, J. J.; McIntyre, E.; Rafferty, C.; Yanushefski, L.; Bean, D. M.

    2011-03-01

    Laser therapy is becoming an increasingly popular method of treating numerous dermatological conditions. The widespread use of these devices is often limited by the cost and size. Low cost, portable lasers would expand the laser market further into homes, general practitioners, dermatologists, plastic surgeons, and 3rd world countries. There are numerous light devices currently on the market for hair removal and growth, acne reduction, and wrinkles. These devices are varied, from LEDs to intense pulsed light (IPL) to lasers. One particular disease is leishmaniasis, caused by a parasite carried by sand flies, most often occurring in third world countries. While there are drug therapies available, they sometimes require hospitalization for several days and are very expensive. An RF device has been FDA approved for treatment of leishmaniasis, but costs about $20,000 which is too expensive for widespread use. Since the method is heating the lesion, the same affect could be achieved using an infrared laser. Diode lasers have the capability to be produced in mass quantity for low costs, as shown by the ubiquity of diode lasers in the telecom industry and household appliances. Unfortunately, many diode lasers suffer from poor efficiency, particularly in wavelengths for dermatology. Advances are being made to improve wall plug efficiency of lasers to reduce waste heat and increase output power. In this paper, those efforts being made to develop manufacturing partners to lower the cost while increasing the production volume of long wavelength lasers will be discussed along with performance data and clinical results.

  7. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.

    PubMed

    Hover, Alexander R; Sistrunk, William W; Cavagnol, Robert M; Scarrow, Alan; Finley, Phillip J; Kroencke, Audrey D; Walker, Judith L

    2014-01-01

    Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective.

  8. Reducing the cost of Ca-based direct air capture of CO2.

    PubMed

    Zeman, Frank

    2014-10-07

    Direct air capture, the chemical removal of CO2 directly from the atmosphere, may play a role in mitigating future climate risk or form the basis of a sustainable transportation infrastructure. The current discussion is centered on the estimated cost of the technology and its link to "overshoot" trajectories, where atmospheric CO2 levels are actively reduced later in the century. The American Physical Society (APS) published a report, later updated, estimating the cost of a one million tonne CO2 per year air capture facility constructed today that highlights several fundamental concepts of chemical air capture. These fundamentals are viewed through the lens of a chemical process that cycles between removing CO2 from the air and releasing the absorbed CO2 in concentrated form. This work builds on the APS report to investigate the effect of modifications to the air capture system based on suggestions in the report and subsequent publications. The work shows that reduced carbon electricity and plastic packing materials (for the contactor) may have significant effects on the overall price, reducing the APS estimate from $610 to $309/tCO2 avoided. Such a reduction does not challenge postcombustion capture from point sources, estimated at $80/tCO2, but does make air capture a feasible alternative for the transportation sector and a potential negative emissions technology. Furthermore, air capture represents atmospheric reductions rather than simply avoided emissions.

  9. Costs and Cost-Effectiveness of Training Traditional Birth Attendants to Reduce Neonatal Mortality in the Lufwanyama Neonatal Survival Study (LUNESP)

    PubMed Central

    Sabin, Lora L.; Knapp, Anna B.; MacLeod, William B.; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H.; Gill, Christopher J.

    2012-01-01

    Background The Lufwanyama Neonatal Survival Project (“LUNESP”) was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. Methods and Findings We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011–2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as ‘conservative’ and ‘optimistic’ scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Conclusions Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was ‘highly cost effective’. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care. PMID:22545117

  10. Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

    PubMed

    da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

    2005-01-01

    This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

  11. Application of COMPONT Medical Adhesive Glue for Tension-Reduced Duraplasty in Decompressive Craniotomy

    PubMed Central

    Zhou, Yujia; Wang, Gesheng; Liu, Jialin; Du, Yong; Wang, Lei; Wang, Xiaoyong

    2016-01-01

    Background The aim of this study was to evaluate the application of medical adhesive glue for tension-reduced duraplasty in decompressive craniotomy. Material/Methods A total of 56 cases were enrolled for this study from Jan 2013 to May 2015. All patients underwent decompressive craniotomy and the dura was repaired in all of them with tension-reduced duraplasty using the COMPONT medical adhesive to glue artificial dura together. The postoperative complications and the healing of dura mater were observed and recorded. Results No wound infection, epidural or subdural hematoma, cerebrospinal fluid leakage, or other complications associated with the procedure occurred, and there were no allergic reactions to the COMPONT medical adhesive glue. The second-phase surgery of cranioplasty was performed at 3 to 6 months after the decompressive craniotomy in 32 out of the 56 cases. During the cranioplasty we observed no adherence of the artificial dura mater patch to the skin flap, no residual COMPONT glue, or hydropic or contracture change of tissue at the surgical sites. Additionally, no defect or weakening of the adherence between the artificial dura mater patch and the self dura matter occurred. Conclusions COMPONT medical adhesive glue is a safe and reliable tool for tension-reduced duraplasty in decompressive craniotomy. PMID:27752035

  12. Application of COMPONT Medical Adhesive Glue for Tension-Reduced Duraplasty in Decompressive Craniotomy.

    PubMed

    Zhou, Yujia; Wang, Gesheng; Liu, Jialin; Du, Yong; Wang, Lei; Wang, Xiaoyong

    2016-10-14

    BACKGROUND The aim of this study was to evaluate the application of medical adhesive glue for tension-reduced duraplasty in decompressive craniotomy. MATERIAL AND METHODS A total of 56 cases were enrolled for this study from Jan 2013 to May 2015. All patients underwent decompressive craniotomy and the dura was repaired in all of them with tension-reduced duraplasty using the COMPONT medical adhesive to glue artificial dura together. The postoperative complications and the healing of dura mater were observed and recorded. RESULTS No wound infection, epidural or subdural hematoma, cerebrospinal fluid leakage, or other complications associated with the procedure occurred, and there were no allergic reactions to the COMPONT medical adhesive glue. The second-phase surgery of cranioplasty was performed at 3 to 6 months after the decompressive craniotomy in 32 out of the 56 cases. During the cranioplasty we observed no adherence of the artificial dura mater patch to the skin flap, no residual COMPONT glue, or hydropic or contracture change of tissue at the surgical sites. Additionally, no defect or weakening of the adherence between the artificial dura mater patch and the self dura matter occurred. CONCLUSIONS COMPONT medical adhesive glue is a safe and reliable tool for tension-reduced duraplasty in decompressive craniotomy.

  13. Waste Management Strategy for Dismantling Waste to Reduce Costs for Power Plant Decommissioning - 13543

    SciTech Connect

    Larsson, Arne; Lidar, Per; Bergh, Niklas; Hedin, Gunnar

    2013-07-01

    -necks in the process causes increased space requirements and will have negative impact on the project schedule, which increases not only the cost but also the dose exposure to personnel. For these reasons it is critical to create a process that transfers material into conditioned waste ready for disposal as quickly as possible. To a certain extent the decommissioning program should be led by the waste management process. With the objective to reduce time for handling of dismantled material at site and to efficiently and environmental-friendly use waste management methods (clearance for re-use followed by clearance for recycling), the costs for the plant decommissioning could be reduced as well as time needed for performing the decommissioning project. Also, risks for delays would be reduced with a well-defined handling scheme which limits surprises. Delays are a major cost driver for decommissioning projects. (authors)

  14. Reducing serious injury from falls in two veterans' hospital medical-surgical units.

    PubMed

    Quigley, Patricia A; Hahm, Bridget; Collazo, Sonia; Gibson, Wanda; Janzen, Sandra; Powell-Cope, Gail; Rice, Fanny; Sarduy, Innette; Tyndall, Kyna; White, Susan V

    2009-01-01

    A large veteran's hospital participated in a year-long collaborative project across 9 hospitals to reduce serious injury from falls in acute care, targeting medical-surgical units. The primary objective of this project was to develop and test a set of interventions (bundles) to prevent serious physical injury (fractures and hemorrhagic bleeds) from patient falls. The interventions were implemented using tests of change on 2 medical-surgical units focused on engaging unit-based staff and combining innovations for vulnerable populations at greatest risk for injury if they fall.

  15. Proven Innovations and New Initiatives in Ground System Development: Reducing Costs in the Ground System

    NASA Technical Reports Server (NTRS)

    Gunn, Jody M.

    2006-01-01

    The state-of-the-practice for engineering and development of Ground Systems has evolved significantly over the past half decade. Missions that challenge ground system developers with significantly reduced budgets in spite of requirements for greater and previously unimagined functionality are now the norm. Making the right trades early in the mission lifecycle is one of the key factors to minimizing ground system costs. The Mission Operations Strategic Leadership Team at the Jet Propulsion Laboratory has spent the last year collecting and working through successes and failures in ground systems for application to future missions.

  16. Integrating MEA Regeneration with CO2 Compression and Peaking to Reduce CO2 Capture Costs

    SciTech Connect

    Kevin S. Fisher; Carrie Beitler; Curtis Rueter; Katherine Searcy; Dr. Gary Rochelle; Dr. Majeed Jassim

    2005-06-09

    Capturing CO{sub 2} from coal-fired power plants is a necessary component of any large-scale effort to reduce anthropogenic CO{sub 2} emissions. Conventional absorption/stripping with monoethanolamine (MEA) or similar solvents is the most likely current process for capturing CO{sub 2} from the flue gas at these facilities. However, one of the largest problems with MEA absorption/stripping is that conventional process configurations have energy requirements that result in large reductions in the net power plant output. Several alternative process configurations for reducing these parasitic energy requirements were investigated in this research with the assistance of the Platte River Power Authority, based on recovering energy from the CO{sub 2} compression train and using that energy in the MEA regeneration step. In addition, the feasibility of selective operation of the amine system at a higher CO{sub 2} removal efficiency during non-peak electricity demand periods was also evaluated. Four process configurations were evaluated: A generic base case MEA system with no compression heat recovery, CO{sub 2} vapor recompression heat recovery, and multipressure stripping with and without vapor recompression heat recovery. These configurations were simulated using a rigorous rate-based model, and the results were used to prepare capital and operating cost estimates. CO{sub 2} capture economics are presented, and the cost of CO{sub 2} capture (cost per tonne avoided) is compared among the base case and the alternative process configurations. Cost savings per tonne of CO{sub 2} avoided ranged from 4.3 to 9.8 percent. Energy savings of the improved configurations (8-10%, freeing up 13 to 17 MW of power for sale to the grid based on 500 MW unit ) clearly outweighed the modest increases in capital cost to implement them; it is therefore likely that one of these improved configurations would be used whenever MEA-based (or similar) scrubbing technologies are implemented. In fact

  17. Stem transcriptome reveals mechanisms to reduce the energetic cost of shade-avoidance responses in tomato.

    PubMed

    Cagnola, Juan Ignacio; Ploschuk, Edmundo; Benech-Arnold, Tomás; Finlayson, Scott A; Casal, Jorge José

    2012-10-01

    While the most conspicuous response to low red/far-red ratios (R:FR) of shade light perceived by phytochrome is the promotion of stem growth, additional, less obvious effects may be discovered by studying changes in the stem transcriptome. Here, we report rapid and reversible stem transcriptome responses to R:FR in tomato (Solanum lycopersicum). As expected, low R:FR promoted the expression of growth-related genes, including those involved in the metabolism of cell wall carbohydrates and in auxin responses. In addition, genes involved in flavonoid synthesis, isoprenoid metabolism, and photosynthesis (dark reactions) were overrepresented in clusters showing reduced expression in the stem of low R:FR-treated plants. Consistent with these responses, low R:FR decreased the levels of flavonoids (anthocyanin, quercetin, kaempferol) and selected isoprenoid derivatives (chlorophyll, carotenoids) in the stem and severely reduced the photosynthetic capacity of this organ. However, lignin contents were unaffected. Low R:FR reduced the stem levels of jasmonate, which is a known inducer of flavonoid synthesis. The rate of stem respiration was also reduced in low R:FR-treated plants, indicating that by downsizing the stem photosynthetic apparatus and the levels of photoprotective pigments under low R:FR, tomato plants reduce the energetic cost of shade-avoidance responses.

  18. Medical and Indirect Costs Associated with a Rocky Mountain Spotted Fever Epidemic in Arizona, 2002-2011.

    PubMed

    Drexler, Naomi A; Traeger, Marc S; McQuiston, Jennifer H; Williams, Velda; Hamilton, Charlene; Regan, Joanna J

    2015-09-01

    Rocky Mountain spotted fever (RMSF) is an emerging public health issue on some American Indian reservations in Arizona. RMSF causes an acute febrile illness that, if untreated, can cause severe illness, permanent sequelae requiring lifelong medical support, and death. We describe costs associated with medical care, loss of productivity, and death among cases of RMSF on two American Indian reservations (estimated population 20,000) between 2002 and 2011. Acute medical costs totaled more than $1.3 million. This study further estimated $181,100 in acute productivity lost due to illness, and $11.6 million in lifetime productivity lost from premature death. Aggregate costs of RMSF cases in Arizona 2002-2011 amounted to $13.2 million. We believe this to be a significant underestimate of the cost of the epidemic, but it underlines the severity of the disease and need for a more comprehensive study.

  19. A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre's syndrome and peritonsillar abscesses.

    PubMed

    Bank, S; Christensen, K; Kristensen, L H; Prag, J

    2013-01-01

    The main purpose of this paper was to estimate the cost per quality-adjusted life year (QALY) saved by identifying Fusobacterium necrophorum in throat swabs followed by proper antibiotic treatment, to reduce the incidence of Lemierre's syndrome and peritonsillar abscesses (PTA) originating from a pharyngitis. The second purpose was to estimate the population size required to indicate that antibiotic treatment has an effect. Data from publications and our laboratory were collected. Monte Carlo simulation and one-way sensitivity analysis were used to analyse cost-effectiveness. The cost-effectiveness analysis shows that examining throat swabs from 15- to 24-year-olds for F. necrophorum followed by antibiotic treatment will probably be less costly than most other life-saving medical interventions, with a median cost of US$8,795 per QALY saved. To indicate a reduced incidence of Lemierre's syndrome and PTA in Denmark, the intervention probably has to be followed for up to 5 years. Identifying F. necrophorum in throat swabs from 15- to 24-year-olds followed by proper antibiotic treatment only requires a reduction of 20-25 % in the incidence of Lemierre's syndrome and PTA to be cost-effective. This study warrants further examination of the effect of antibiotic treatment on the outcome of F. necrophorum acute and recurrent pharyngitis, as well as the effect on Lemierre's syndrome and PTA.

  20. Re-Engineering of the Hubble Space Telescope (HST) to Reduce Operational Costs

    NASA Technical Reports Server (NTRS)

    Garvis, Michael; Dougherty, Andrew; Whittier, Wallace

    1996-01-01

    Satellite telemetry processing onboard the Hubble Space Telescope (HST) is carried out using dedicated software and hardware. The current ground system is expensive to operate and maintain. The mandate to reduce satellite ground system operations and maintenance costs by the year 2000 led NASA to upgrade the command and control systems in order to improve the data processing capabilities, reduce operator experience levels and increase system standardization. As a result, a command and control system product development team was formed to redesign and develop the HST ground system. The command and control system ground system development consists of six elements. The results of the prototyping phase carried out for the following of these elements are presented: the front end processor; middleware, and the graphical user interface.

  1. Reducing the cost of evaluating the committor by a fitting procedure

    NASA Astrophysics Data System (ADS)

    Li, Wenjin; Ma, Ao

    2015-11-01

    Correct identification of reaction coordinates in complex systems is essential for understanding the mechanisms of their reaction dynamics. Existing methods for identifying reaction coordinates typically require knowledge of the committor—the probability of a given configuration to reach the product basin. The high computational cost of evaluating committors has limited applications of methods for identifying reaction coordinates. We proposed a fitting procedure that can reduce the cost of evaluating committors by an order of magnitude or more. The method only requires evaluating the committors of a few configurations in a transition path by the standard and costly shooting procedure. The committors of the other configurations are then estimated with great accuracy by a sigmoid function derived from fitting the few numerically evaluated committors. The method has been systematically tested on a model system of a Brownian particle moving in a one-dimensional double-well potential, and a small biomolecular system—the isomerization of alanine dipeptide in vacuum and in explicit water.

  2. Do female Nicrophorus vespilloides reduce direct costs by choosing males that mate less frequently?

    PubMed Central

    Mazué, G. P. F.; Carter, M. J.; Head, M. L.; Moore, A. J.; Royle, N. J.

    2016-01-01

    Sexual conflict occurs when selection to maximize fitness in one sex does so at the expense of the other sex. In the burying beetle Nicrophorus vespilloides, repeated mating provides assurance of paternity at a direct cost to female reproductive productivity. To reduce this cost, females could choose males with low repeated mating rates or smaller, servile males. We tested this by offering females a dichotomous choice between males from lines selected for high or low mating rate. Each female was then allocated her preferred or non-preferred male to breed. Females showed no preference for males based on whether they came from lines selected for high or low mating rates. Pairs containing males from high mating rate lines copulated more often than those with low line males but there was a negative relationship between female size and number of times she mated with a non-preferred male. When females bred with their preferred male the number of offspring reared increased with female size but there was no such increase when breeding with non-preferred males. Females thus benefited from being choosy, but this was not directly attributable to avoidance of costly male repeated mating. PMID:26979560

  3. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care

    PubMed Central

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-01-01

    Abstract Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205) PMID:26348492

  4. Cost-benefit analysis of the Swiss national policy on reducing micropollutants in treated wastewater.

    PubMed

    Logar, Ivana; Brouwer, Roy; Maurer, Max; Ort, Christoph

    2014-11-04

    Contamination of freshwater with micropollutants (MPs) is a growing concern worldwide. Even at very low concentrations, MPs can have adverse effects on aquatic ecosystems and possibly also on human health. Switzerland is one of the first countries to start implementing a national policy to reduce MPs in the effluents of municipal sewage treatment plants (STPs). This paper estimates the benefits of upgrading STPs based on public's stated preferences. To assess public demand for the reduction of the environmental and health risks of MPs, we conducted a choice experiment in a national online survey. The results indicate that the average willingness to pay per household is CHF 100 (US$ 73) annually for reducing the potential environmental risk of MPs to a low level. These benefits, aggregated over households in the catchment of the STPs to be upgraded, generate a total annual economic value of CHF 155 million (US$ 113 million). This compares with estimated annual costs for upgrading 123 STPs of CHF 133 million (US$ 97 million) or CHF 86 (US$ 63) per household connected to these STPs. Hence, a cost-benefit analysis justifies the investment decision from an economic point of view and supports the implementation of the national policy in the ongoing political discussion.

  5. Effective information channels for reducing costs of environmentally- friendly technologies: evidence from residential PV markets

    NASA Astrophysics Data System (ADS)

    Rai, Varun; Robinson, Scott A.

    2013-03-01

    Realizing the environmental benefits of solar photovoltaics (PV) will require reducing costs associated with perception, informational gaps and technological uncertainties. To identify opportunities to decrease costs associated with residential PV adoption, in this letter we use multivariate regression models to analyze a unique, household-level dataset of PV adopters in Texas (USA) to systematically quantify the effect of different information channels on aspiring PV adopters’ decision-making. We find that the length of the decision period depends on the business model, such as whether the system was bought or leased, and on special opportunities to learn, such as the influence of other PV owners in the neighborhood. This influence accrues passively through merely witnessing PV systems in the neighborhood, increasing confidence and motivation, as well as actively through peer-to-peer communications. Using these insights we propose a new framework to provide public information on PV that could drastically reduce barriers to PV adoption, thereby accelerating its market penetration and environmental benefits. This framework could also serve as a model for other distributed generation technologies.

  6. Reducing monitoring costs in industrially contaminated rivers: cluster and regression analysis approach.

    PubMed

    Ruman, M; Olkowska, E; Kozioł, K; Absalon, D; Matysik, M; Polkowska, Ż

    2014-03-01

    Monitoring contamination in river water is an expensive procedure, particularly for developing countries where pollution is a significant problem. This study was conducted to provide a pollution monitoring strategy that reduces the cost of laboratory analysis. The new monitoring strategy was designed as a result of cluster and regression analysis on field data collected from an industrially influenced river. Pollution sources in the study site were coal mining, metallurgy, chemical industry, and metropolitan sewage. This river resembles those in other areas of the world, including developing countries where environmental monitoring is financially constrained. Data were collected on variability of contaminant concentrations during four seasons at the same points on tributaries of the river. The variables described in the study are pH, electrical conductivity, inorganic ions, trace elements, and selected organic pollutants. These variables were divided into groups using cluster analysis. These groups were then tested using regression models to identify how the behavior of one variable changes in relation to another. It was found that up to 86.8% of variability of one parameter could be determined by another in the dataset. We adopted 60, 65, and 70% determination levels () for accepting a regression model. As a result, monitoring could be reduced by 15 (60% level) and 10 variables (65 and 70%) out of 43, which comprises 35 and 23% of the monitored variable total. Cost reduction would be most effective if trace elements or organic pollutants were excluded from monitoring because these are the constituents most expensive to analyze.

  7. The Manuscript that We Finished: Structural Separation Reduces the Cost of Complement Coercion

    PubMed Central

    Lowder, Matthew W.; Gordon, Peter C.

    2014-01-01

    Two eye-tracking experiments examined the effects of sentence structure on the processing of complement coercion, in which an event-selecting verb combines with a complement that represents an entity (e.g., began the memo). Previous work has demonstrated that these expressions impose a processing cost, which has been attributed to the need to type-shift the entity into an event in order for the sentence to be interpretable (e.g., began writing the memo). Both experiments showed that the magnitude of the coercion cost was reduced when the verb and complement appeared in separate clauses (e.g., The memo that was begun by the secretary; What the secretary began was the memo) compared to when the constituents appeared together in the same clause. The moderating effect of sentence structure on coercion is similar to effects that have been reported for the processing of two other types of semantically complex expressions (inanimate subject-verb integration and metonymy). We propose that sentence structure influences the depth at which complex semantic relationships are computed. When the constituents that create the need for a complex semantic interpretation appear in a single clause, readers experience processing difficulty stemming from the need to detect and/or resolve the semantic mismatch. In contrast, the need to engage in additional processing is reduced when the expression is established across a clause boundary or other structure that deemphasizes the complex relationship. PMID:24999707

  8. Origin of how steam rockets can reduce space transport cost by orders of magnitude

    NASA Astrophysics Data System (ADS)

    Zuppero, Anthony; Larson, Thomas K.; Schnitzler, Bruce G.; Werner, James E.; Rice, John W.; Hill, Thomas J.; Richins, William D.; Parlier, Lynn

    1999-01-01

    A brief sketch shows the origin of why and how thermal rocket propulsion has the unique potential to dramatically reduce the cost of space transportation for most inner solar system missions of interest. Orders of magnitude reduction in cost are apparently possible when compared to all processes requiring electrolysis for the production of rocket fuels or propellants and to all electric propulsion systems. An order of magnitude advantage can be attributed to rocket propellant tank factors associated with storing water propellant, compared to cryogenic liquids. An order of magnitude can also be attributed to the simplicity of the extraction and processing of ice on the lunar surface, into an easily stored, non-cryogenic rocket propellant (water). A nuclear heated thermal rocket can deliver thousands of times its mass to Low Earth Orbit from the Lunar surface, providing the equivalent to orders of magnitude drop in launch cost for mass in Earth orbit. Mass includes water ice. These cost reductions depend (exponentially) on the mission delta-v requirements being less than about 6 km/s, or about 3 times the specific velocity of steam rockets (2 km/s, from Isp 200 sec). Such missions include: from the lunar surface to Low Lunar Orbit, (LLO), from LLO to lunar escape, from Low Earth Orbit (LEO) to Geosynchronous Orbit (GEO), from LEO to Earth Escape, from LEO to Mars Transfer Orbit, from LLO to GEO, missions returning payloads from about 10% of the periodic comets using propulsive capture to orbits around Earth itself, and fast, 100 day missions from Lunar Escape to Mars. All the assertions depend entirely and completely on the existence of abundant, nearly pure ice at the permanently dark North and South Poles of the Moon.

  9. Older adults learn less, but still reduce metabolic cost, during motor adaptation.

    PubMed

    Huang, Helen J; Ahmed, Alaa A

    2014-01-01

    The ability to learn new movements and dynamics is important for maintaining independence with advancing age. Age-related sensorimotor changes and increased muscle coactivation likely alter the trial-and-error-based process of adapting to new movement demands (motor adaptation). Here, we asked, to what extent is motor adaptation to novel dynamics maintained in older adults (≥65 yr)? We hypothesized that older adults would adapt to the novel dynamics less well than young adults. Because older adults often use muscle coactivation, we expected older adults to use greater muscle coactivation during motor adaptation than young adults. Nevertheless, we predicted that older adults would reduce muscle activity and metabolic cost with motor adaptation, similar to young adults. Seated older (n = 11, 73.8 ± 5.6 yr) and young (n = 15, 23.8 ± 4.7 yr) adults made targeted reaching movements while grasping a robotic arm. We measured their metabolic rate continuously via expired gas analysis. A force field was used to add novel dynamics. Older adults had greater movement deviations and compensated for just 65% of the novel dynamics compared with 84% in young adults. As expected, older adults used greater muscle coactivation than young adults. Last, older adults reduced muscle activity with motor adaptation and had consistent reductions in metabolic cost later during motor adaptation, similar to young adults. These results suggest that despite increased muscle coactivation, older adults can adapt to the novel dynamics, albeit less accurately. These results also suggest that reductions in metabolic cost may be a fundamental feature of motor adaptation.

  10. Report: landfill alternative daily cover: conserving air space and reducing landfill operating cost.

    PubMed

    Haughey, R D

    2001-02-01

    Title 40, Part 258 of the Code of Federal Regulations, Solid Waste Disposal Facility Criteria, commonly referred to as Subtitle D, became effective on October 9, 1993. It establishes minimum criteria for solid waste disposal facility siting, design, operations, groundwater monitoring and corrective action, and closure and postclosure maintenance, while providing EPA-approved state solid waste regulatory programs flexibility in implementing the criteria. Section 258.21(a) [40 CFR 258.21(a)] requires owners or operators of municipal solid waste landfill (MSWLF) units to cover disposed solid waste with 30cm of earthen material at the end of the operating day, or at more frequent intervals, if necessary, to control disease vectors, fires, odours, blowing litter, and scavenging. This requirement is consistent with already existing solid waste facility regulations in many states. For many MSWLFs, applying daily cover requires the importation of soil which increases landfill operating costs. Daily cover also uses valuable landfill air space, reducing potential operating revenue and the landfill's operating life. 40 CFR 258.21 (b) allows the director of an approved state to approve alternative materials of an alternative thickness if the owner or operator demonstrates that the alternative material and thickness will control disease vectors, fires, odours, blowing litter, and scavenging without presenting a threat to human health and the environment. Many different types of alternative daily cover (ADC) are currently being used, including geosynthetic tarps, foams, garden waste, and auto shredder fluff. These materials use less air space than soil and can reduce operating costs. This paper discusses the variety of ADCs currently being used around the country and their applicability to different climates and operating conditions, highlighting the more unusual types of ADC, the types of demonstrations necessary to obtain approval of ADC, and the impact on landfill air space

  11. Older adults learn less, but still reduce metabolic cost, during motor adaptation

    PubMed Central

    Huang, Helen J.

    2013-01-01

    The ability to learn new movements and dynamics is important for maintaining independence with advancing age. Age-related sensorimotor changes and increased muscle coactivation likely alter the trial-and-error-based process of adapting to new movement demands (motor adaptation). Here, we asked, to what extent is motor adaptation to novel dynamics maintained in older adults (≥65 yr)? We hypothesized that older adults would adapt to the novel dynamics less well than young adults. Because older adults often use muscle coactivation, we expected older adults to use greater muscle coactivation during motor adaptation than young adults. Nevertheless, we predicted that older adults would reduce muscle activity and metabolic cost with motor adaptation, similar to young adults. Seated older (n = 11, 73.8 ± 5.6 yr) and young (n = 15, 23.8 ± 4.7 yr) adults made targeted reaching movements while grasping a robotic arm. We measured their metabolic rate continuously via expired gas analysis. A force field was used to add novel dynamics. Older adults had greater movement deviations and compensated for just 65% of the novel dynamics compared with 84% in young adults. As expected, older adults used greater muscle coactivation than young adults. Last, older adults reduced muscle activity with motor adaptation and had consistent reductions in metabolic cost later during motor adaptation, similar to young adults. These results suggest that despite increased muscle coactivation, older adults can adapt to the novel dynamics, albeit less accurately. These results also suggest that reductions in metabolic cost may be a fundamental feature of motor adaptation. PMID:24133222

  12. Use of Biostratigraphy to Increase Production, Reduce Operating Costs and Risks and Reduce Environmental Concerns in Oil Well Drilling

    SciTech Connect

    Edward Marks

    2005-09-09

    out at the top of the late Miocene, early Mohnian: Bolivina aff hughesi, Rotalia becki, Suggrunda californica, Virgulina grandis, Virgulina ticensis, Bulimina ecuadorana, Denticula lauta and Nonion medio-costatum. Please see Appendix B, Fig. 1, Neogene Zones, p. 91 and Appendix C, chart 5, p. 99 By the use of Stratigraphy, employing both Paleontology and Lithology, we can increase hydrocarbon production, reduce operating costs and risks by the identification of the productive sections, and reduce environmental concerns by drilling less dry holes needlessly.

  13. The Effects of Health Information Technology on the Costs and Quality of Medical Care

    PubMed Central

    Agha, Leila

    2015-01-01

    Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998-2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3 percent increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates. PMID:24463141

  14. The effects of health information technology on the costs and quality of medical care.

    PubMed

    Agha, Leila

    2014-03-01

    Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.

  15. Dynamic Cost-Contingency Management: A Method for Reducing Project Costs While Increasing the Probability of Success

    DTIC Science & Technology

    2007-04-30

    simple Monte Carlo simulation tools such as @Risk® and Crystal Ball®. The premise of this paper is that a credible Probabilistic Cost Analysis...readily performed using commercially available Monte Carlo simulation Excel add-ins. The implementation of a project-wide cost contingency to ensure...deterministic to probabilistic approach is NOT silver bullet • Monte Carlo simulation is only a mathematical tool: GIGO Poor management practices Lack of

  16. A comparison of applicant and matriculant trends, and rising costs of medical education in United States medical schools and at the University of Kentucky College of Medicine.

    PubMed

    Elam, Carol L; Scott, Kimberly L; Gilbert, Linda A; Hartmann, Beth A

    2003-05-01

    This paper addresses fluctuations in the applicant and matriculant pools both across United States medical schools and at the University of Kentucky College of Medicine (UKCOM) for 1992-2002. It also presents data regarding the increasing costs of a medical education. Over the past decade, both nationally and at the UKCOM, there has been an over-all reduction in the number of applicants to medical school. In this changing applicant pool, the percentage of female matriculants has increased both nationally and at the UKCOM. However, the number of underrepresented minorities applying to and matriculating in the US and at the UKCOM has dropped since the mid-1990s. Although the applicant pool has decreased in size over the time period examined, the academic quality of applicants as measured by the undergraduate grade point average and Medical College Admission Test scores has increased both nationally and at UKCOM. Costs of a medical education have risen over time, as has the debt burden of medical school graduates due to increasing undergraduate debt, consumer debt, and medical school tuition. Potential causes for and implication of these changing trends are discussed.

  17. A conceptual framework for the evaluation of cost-effectiveness of projects to reduce GHG emissions and sequester carbon

    SciTech Connect

    Sathaye, J.; Norgaard, R.; Makundi, W.

    1993-07-01

    This paper proposes a conceptual framework for evaluating the cost of projects to reduce atmospheric greenhouse gases (GHGs). The evaluation of cost-effectiveness should account for both the timing of carbon emissions and the damage caused by the atmospheric stock of carbon. We develop a conceptual basis to estimate the cost-effectiveness of projects in terms of the cost of reducing atmospheric carbon (CRAC) and other GHGs. CRAC accounts for the economic discount rate, alternative functional forms of the shadow price, the residence period of carbon in the atmosphere, and the multiple monetary benefits of projects. The last item is of particular importance to the developing countries.

  18. Interest of a prescreening questionnaire to reduce the cost of bone densitometry.

    PubMed

    Ben Sedrine, W; Broers, P; Devogelaer, J P; Depresseux, G; Kaufman, J M; Goemaere, S; Reginster, J Y

    2002-05-01

    hip and up to 23% at one or more of the considered sites. On the other hand, of the subjects who would be recommended for a densitometry test, only a small fraction were identified correctly (the positive predictive values varied from 11.3% at the total hip to 34.8% at any site). In this first setting, the suggested criteria seem useful chiefly for excluding subjects who do not need a DXA scan rather than selecting osteoporotic patients. When applied only to patients aged 61 years or more, the positive predictive values rose to 15.1% (total hip) and 42.9% (any site), whereas the corresponding negative predictive values were set at 93% and 68.6%. In comparison, with a mass screening scenario the estimated diagnostic costs (costs associated with the DXA procedure) per osteoporotic patient detected at any of the considered sites would be reduced by more than 9% (59.4 instead of 65.3 Euros) if the suggested indications are taken into account for prescreening patients. And when the questionnaire is applied only to women over the age of 60 years these costs would be further reduced to 50.6 Euros, representing a 23% decrease. Then, a prescreening strategy based on these indications concomitantly with an age-selective criterion could represent a promising way toward a more rational use of BMD measurement.

  19. Trade in the US and Mexico helps reduce environmental costs of agriculture

    NASA Astrophysics Data System (ADS)

    Martinez-Melendez, Luz A.; Bennett, Elena M.

    2016-05-01

    Increasing international crop trade has enlarged global shares of cropland, water and fertilizers used to grow crops for export. Crop trade can reduce the environmental burden on importing countries, which benefit from embedded environmental resources in imported crops, and from avoided environmental impacts of production in their territory. International trade can also reduce the universal environmental impact of food production if crops are grown where they are produced in the most environmentally efficient way. We compared production efficiencies for the same crops in the US and Mexico to determine whether current crop trade between these two countries provides an overall benefit to the environment. Our economic and environmental accounting for the key traded crops from 2010 to 2014 shows that exports to Mexico are just 3% (∼16 thousand Gg) of the total production of these crops in the US, and exports to US represent roughly 0.13% (∼46 Gg) of Mexican total production of the same crops. Yields were higher in US than Mexico for all crops except wheat. Use of nitrogen fertilizer was higher in US than in Mexico for all crops except corn. Current trade reduces some, but not all, environmental costs of agriculture. A counterfactual trade scenario showed that an overall annual reduction in cultivated land (∼371 thousand ha), water use (∼923 million m3), fertilizer use (∼122 Gg; ∼68 Gg nitrogen) and pollution (∼681 tonnes of N2O emissions to the atmosphere and ∼511 tonnes of leached nitrogen) can be achieved by changing the composition of food products traded. In this case, corn, soybeans and rice should be grown in the US, while wheat, sorghum and barley should be grown in Mexico. Assigning greater economic weight to the environmental costs of agriculture might improve the balance of trade to be more universally beneficial, environmentally.

  20. Antioxidant supplementation can reduce the survival costs of excess amino acid intake in honeybees.

    PubMed

    Archer, C Ruth; Köhler, Angela; Pirk, Christian W W; Oosthuizen, Vinette; Apostolides, Zeno; Nicolson, Susan W

    2014-12-01

    Over-consuming amino acids is associated with reduced survival in many species, including honeybees. The mechanisms responsible for this are unclear but one possibility is that excessive intake of amino acids increases oxidative damage. If this is the case, antioxidant supplementation may help reduce the survival costs of high amino acid intake. We tested this hypothesis in African honeybees (Apis mellifera scutellata) using the major antioxidant in green tea, epigallocatechin-3-gallate (EGCG). We first determined the dose-range of EGCG that improved survival of caged honeybees fed sucrose solution. We then provided bees with eight diets that differed in their ratio of essential amino acids (EAA) to carbohydrate (C) (0:1, 1:250, 1:100, 1:75, 1:50, 1:25, 1:10, 1:5 EAA:C) and also in their EGCG dose (0.0 or 0.4 mM). We found that bees fed sucrose only solution survived better than bees fed EAA diets. Despite this, bees preferred a diet that contained intermediate ratios of EAA:C (ca. 1:25), which may represent the high demands for nitrogen of developing nurse bees. EGCG supplementation improved honeybee survival but only at an intermediate dose (0.3-0.5 mM) and in bees fed low EAA diets (1:250, 1:100 EAA:C). That EGCG counteracted the lifespan reducing effects of eating low EAA diets suggests that oxidative damage may be involved in the association between EAAs and lifespan in honeybees. However, that EGCG had no effect on survival in bees fed high EAA diets suggests that there are other physiological costs of over-consuming EAAs in honeybees.

  1. Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials

    PubMed Central

    Hallsworth, Michael; Berry, Dan; Sanders, Michael; Sallis, Anna; King, Dominic; Vlaev, Ivo; Darzi, Ara

    2015-01-01

    Background Missed hospital appointments are a major cause of inefficiency worldwide. Healthcare providers are increasingly using Short Message Service reminders to reduce ‘Did Not Attend’ (DNA) rates. Systematic reviews show that sending such reminders is effective, but there is no evidence on whether their impact is affected by their content. Accordingly, we undertook two randomised controlled trials that tested the impact of rephrasing appointment reminders on DNA rates in the United Kingdom. Trial Methods Participants were outpatients with a valid mobile telephone number and an outpatient appointment between November 2013 and January 2014 (Trial One, 10,111 participants) or March and May 2014 (Trial Two, 9,848 participants). Appointments were randomly allocated to one of four reminder messages, which were issued five days in advance. Message assignment was then compared against appointment outcomes (appointment attendance, DNA, cancellation by patient). Results In Trial One, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4%, compared to 11.1% for the existing message (OR 0.74, 95% CI 0.61–0.89, P<0.01). Trial Two replicated this effect (DNA rate 8.2%), but also found that expressing the same concept in general terms was significantly less effective (DNA rate 9.9%, OR 1.22, 95% CI 1.00–1.48, P<0.05). Moving from the existing reminder to the more effective costs message would result in 5,800 fewer missed appointments per year in the National Health Service Trust in question, at no additional cost. The study’s main limitations are that it took place in a single location in England, and that it required accurate phone records, which were only obtained for 20% of eligible patients. We conclude that missed appointments can be reduced, for no additional cost, by introducing persuasive messages to appointment reminders. Future studies could examine the impact of varying reminder messages in other health

  2. The impact of disease stage on direct medical costs of HIV management: a review of the international literature.

    PubMed

    Levy, Adrian; Johnston, Karissa; Annemans, Lieven; Tramarin, Andrea; Montaner, Julio

    2010-01-01

    The global prevalence of HIV infection continues to grow, as a result of increasing incidence in some countries and improved survival where highly active antiretroviral therapy (HAART) is available. Growing healthcare expenditure and shifts in the types of medical resources used have created a greater need for accurate information on the costs of treatment. The objectives of this review were to compare published estimates of direct medical costs for treating HIV and to determine the impact of disease stage on such costs, based on CD4 cell count and plasma viral load. A literature review was conducted to identify studies meeting prespecified criteria for information content, including an original estimate of the direct medical costs of treating an HIV-infected individual, stratified based on markers of disease progression. Three unpublished cost-of-care studies were also included, which were applied in the economic analyses published in this supplement. A two-step procedure was used to convert costs into a common price year (2004) using country-specific health expenditure inflators and, to account for differences in currency, using health-specific purchasing power parities to express all cost estimates in US dollars. In all nine studies meeting the eligibility criteria, infected individuals were followed longitudinally and a 'bottom-up' approach was used to estimate costs. The same patterns were observed in all studies: the lowest CD4 categories had the highest cost; there was a sharp decrease in costs as CD4 cell counts rose towards 100 cells/mm³; and there was a more gradual decline in costs as CD4 cell counts rose above 100 cells/mm³. In the single study reporting cost according to viral load, it was shown that higher plasma viral load level (> 100,000 HIV-RNA copies/mL) was associated with higher costs of care. The results demonstrate that the cost of treating HIV disease increases with disease progression, particularly at CD4 cell counts below 100 cells

  3. Impact of Alternative Medical Device Approval Processes on Costs and Health

    PubMed Central

    George, Benjamin P.; Venkataraman, Vinayak; Dorsey, E. Ray; Johnston, S. Claiborne

    2014-01-01

    Background Medical devices are often introduced prior to randomized-trial evidence of efficacy and this slows completion of trials. Alternative regulatory approaches include restricting device use outside of trials prior to trial evidence of efficacy (like the drug approval process) or restricting out-of-trial use but permitting coverage within trials such as Medicare’s Coverage with Study Participation (CSP). Methods We compared the financial impact to manufacturers and insurers of three regulatory alternatives: (1) limited regulation (current approach), (2) CSP, and (3) restrictive regulation (like the current drug approval process). Using data for patent foramen ovale closure devices, we modeled key parameters including recruitment time, probability of device efficacy, market adoption, and device cost/price to calculate profits to manufacturers, costs to insurers, and overall societal impact on health. Results For manufacturers, profits were greatest under CSP—driven by faster market adoption of effective devices—followed by restrictive regulation. Societal health benefit in total quality-adjusted life years was greatest under CSP. Insurers’ expenditures for ineffective devices were greatest with limited regulation. Findings were robust over a reasonable range of probabilities of trial success. Conclusions Regulation restricting out-of-trial device use and extending limited insurance coverage to clinical trial participants may balance manufacturer and societal interests. PMID:25185975

  4. Promoting emergency medical care systems in the developing world: weighing the costs.

    PubMed

    Anthony, David R

    2011-01-01

    Despite the global health community's historical focus on providing basic, cost-effective primary health care delivered at the community level, recent trends in the developing world show increasing demand for the implementation of emergency care infrastructures, such as prehospital care systems and emergency departments, as well as specialised training programmes. However, the question remains whether, in a setting of limited global health care resources, it is logical to divert these already-sparse resources into the development of emergency care frameworks. The existing literature overwhelmingly supports the idea that emergency care systems, both community-based and within medical institutions, improve important outcomes, including significant morbidity and mortality. Crucial to the success of any public health or policy intervention, emergency care systems also seem to be strongly desired at the community and governmental levels. Integrating emergency care into existing health care systems will ideally rely on modest, low-cost steps to augment current models of primary health care delivery, focusing on adapting the lessons learned in the developed world to the unique needs and local variability of the rest of the globe.

  5. Community-Based Health Education Programs Designed to Improve Clinical Measures Are Unlikely to Reduce Short-Term Costs or Utilization Without Additional Features Targeting These Outcomes.

    PubMed

    Burton, Joe; Eggleston, Barry; Brenner, Jeffrey; Truchil, Aaron; Zulkiewicz, Brittany A; Lewis, Megan A

    2016-06-07

    Stakeholders often expect programs for persons with chronic conditions to "bend the cost curve." This study assessed whether a diabetes self-management education (DSME) program offered as part of a multicomponent initiative could affect emergency department (ED) visits, hospital stays, and the associated costs for an underserved population in addition to the clinical indicators that DSME programs attempt to improve. The program was implemented in Camden, New Jersey, by the Camden Coalition of Healthcare Providers to address disparities in diabetes care. Data used are from medical records and from patient-level information about hospital services from Camden's hospitals. Using multivariate regression models to control for individual characteristics, changes in utilization over time and changes relative to 2 comparison groups were assessed. No reductions in ED visits, inpatient stays, or costs for participants were found over time or relative to the comparison groups. High utilization rates and costs for diabetes are associated with longer term disease progression and its sequelae; thus, DSME or peer support may not affect these in the near term. Some clinical indicators improved among participants, and these might lead to fewer costly adverse health events in the future. DSME deployed at the community level, without explicit segmentation and targeting of high health care utilizers or without components designed to affect costs and utilization, should not be expected to reduce short-term medical needs for participating individuals or care-seeking behaviors such that utilization is reduced. Stakeholders must include financial outcomes in a program's design if those outcomes are to improve. (Population Health Management 20XX;XX:XXX-XXX).

  6. Pre-Stage Acute Kidney Injury Can Predict Mortality and Medical Costs in Hospitalized Patients

    PubMed Central

    Ahn, Shin Young; Chin, Ho Jun; Na, Ki Young; Chae, Dong-Wan; Kim, Sejoong

    2016-01-01

    The significance of minimal increases in serum creatinine below the levels indicative of the acute kidney injury (AKI) stage is not well established. We aimed to investigate the influence of pre-stage AKI (pre-AKI) on clinical outcomes. We enrolled a total of 21,261 patients who were admitted to the Seoul National University Bundang Hospital from January 1, 2013 to December 31, 2013. Pre-AKI was defined as a 25–50% increase in peak serum creatinine levels from baseline levels during the hospital stay. In total, 5.4% of the patients had pre-AKI during admission. The patients with pre-AKI were predominantly female (55.0%) and had a lower body weight and lower baseline levels of serum creatinine (0.63 ± 0.18 mg/dl) than the patients with AKI and the patients without AKI (P < 0.001). The patients with pre-AKI had a higher prevalence of diabetes mellitus (25.1%) and malignancy (32.6%). The adjusted hazard ratio of in-hospital mortality for pre-AKI was 2.112 [95% confidence interval (CI), 1.143 to 3.903]. In addition, patients with pre-AKI had an increased length of stay (7.7 ± 9.7 days in patients without AKI, 11.4 ± 11.4 days in patients with pre-AKI, P < 0.001) and increased medical costs (4,061 ± 4,318 USD in patients without AKI, 4,966 ± 5,099 USD in patients with pre-AKI, P < 0.001) during admission. The adjusted hazard ratio of all-cause mortality for pre-AKI during the follow-up period of 2.0 ± 0.6 years was 1.473 (95% CI, 1.228 to 1.684). Although the adjusted hazard ratio of pre-AKI for overall mortality was not significant among the patients admitted to the surgery department or who underwent surgery, pre-AKI was significantly associated with mortality among the non-surgical patients (adjusted HR 1.542 [95% CI, 1.330 to 1.787]) and the patients admitted to the medical department (adjusted HR 1.384 [95% CI, 1.153 to 1.662]). Pre-AKI is associated with increased mortality, longer hospital stay, and increased medical costs during admission. More attention

  7. The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units

    PubMed Central

    Edmans, Judi; Bradshaw, Lucy; Gladman, John R. F.; Franklin, Matthew; Berdunov, Vladislav; Elliott, Rachel; Conroy, Simon P.

    2013-01-01

    Background: tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them. Objective: to evaluate whether the Identification of Seniors At Risk (ISAR) predicts the clinical outcomes and health and social services costs of older people discharged from acute medical units. Design: an observational cohort study using receiver–operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days (where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living (decrease of 2 or more points on the Barthel ADL Index), reduced mental well-being (increase of 2 or more points on the 12-point General Health Questionnaire) or reduced quality of life (reduction in the EuroQol-5D) and high health and social services costs over 90 days estimated from routine electronic service records. Setting: two acute medical units in the East Midlands, UK. Participants: a total of 667 patients aged ≥70 discharged from acute medical units. Results: an adverse outcome at 90 days was observed in 76% of participants. The ISAR was poor at predicting adverse outcomes (AUC: 0.60, 95% CI: 0.54–0.65) and fair for health and social care costs (AUC: 0.70, 95% CI: 0.59–0.81). Conclusions: adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making. PMID:23666405

  8. Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence

    PubMed Central

    Herzog, Dominik; Poellinger, Alexander; Doellinger, Felix; Schuermann, Dirk; Temmesfeld-Wollbrueck, Bettina; Froeling, Vera; Schreiter, Nils F.; Neumann, Konrad; Hippenstiel, Stefan; Suttorp, Norbert; Hubner, Ralf-Harto

    2015-01-01

    Objective Endoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax. Methods Seventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)). Results The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts. Conclusions In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data. PMID:26010886

  9. Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan

    PubMed Central

    Salahuddin, Naseem; Gohar, M. Aftab; Baig-Ansari, Naila

    2016-01-01

    Background Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP). Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG), assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED) health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV) per patient, whereas Thai Red Cross intradermal (TRC-id) regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen. Methodology/Principal Findings This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded. Conclusions/Significance Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique. PMID:26919606

  10. Domain Analysis of Integrated Data to Reduce Cost Associated with Liver Disease.

    PubMed

    Motiwala, Tasneem; Kite, Bobbie; Regan, Kelly; Gascon, Gregg M; Payne, Philip R O

    2015-01-01

    Liver cancer, the fifth most common cancer and second leading cause of cancer-related death among men worldwide, is plagued by not only lack of clinical research, but informatics tools for early detection. Consequently, it presents a major health and cost burden. Among the different types of liver cancer, hepatocellular carcinoma (HCC) is the most common and deadly form, arising from underlying liver disease. Current models for predicting risk of HCC and liver disease are limited to clinical data. A domain analysis of existing research related to screening for HCC and liver disease suggests that metabolic syndrome (MetS) may present oppportunites to detect early signs of liver disease. The purpose of this paper is to (i) provide a domain analysis of the relationship between HCC, liver disease, and metabolic syndrome, (ii) a review of the current disparate sources of data available for MetS diagnosis, and (iii) recommend informatics solutions for the diagnosis of MetS from available administrative (Biometrics, PHA, claims) and laboratory data, towards early prediction of liver disease. Our domain analysis and recommendations incorporate best practices to make meaningful use of available data with the goal of reducing cost associated with liver disease.

  11. Complementarity in the provision of ecosystem services reduces the cost of mitigating amplified natural disturbance events.

    PubMed

    Sims, Charles; Aadland, David; Powell, James; Finnoff, David C; Crabb, Ben

    2014-11-25

    Climate change has been implicated as a root cause of the recent surge in natural disturbance events such as storms, wildfires, and insect outbreaks. This climate-based surge has led to a greater focus on disturbance-mitigating benefits of ecosystem management. Quantifying these benefits requires knowledge of the relationship between natural and anthropogenic disturbances, which is lacking at the temporal and spatial scales needed to inform ecosystem-based management. This study investigates a specific relationship between timber harvesting and climate-amplified outbreaks of mountain pine beetle. If harvesting is located to mitigate long-distance insect dispersal, there is potential for a win-win outcome in which both timber production and forest conservation can be increased. This spatially targeted harvesting strategy lowers the cost of providing disturbance-mitigating ecosystem services, because valuable timber products are also produced. Mitigating long-distance dispersal also produces net gains in forest conservation across various stakeholder groups. These results speak to ongoing federal efforts to encourage forest vegetation removal on public forestlands to improve forest health. These efforts will lower the cost of responding to climate-amplified natural disturbance events but only if vegetation removal efforts are spatially located to reduce disturbance risk. Otherwise, efforts to improve forest health may be converting forest conservation services to timber services.

  12. A New User-Friendly Model to Reduce Cost for Headwater Benefits Assessment

    SciTech Connect

    Bao, Y.S.; Cover, C.K.; Perlack, R.D.; Sale, M.J.; Sarma, V.

    1999-07-07

    Headwater benefits at a downstream hydropower project are energy gains that are derived from the installation of upstream reservoirs. The Federal Energy Regulatory Commission is required by law to assess charges of such energy gains to downstream owners of non-federal hydropower projects. The high costs of determining headwater benefits prohibit the use of a complicated model in basins where the magnitude of the benefits is expected to be small. This paper presents a new user-friendly computer model, EFDAM (Enhanced Flow Duration Analysis Method), that not only improves the accuracy of the standard flow duration method but also reduces costs for determining headwater benefits. The EFDAM model includes a MS Windows-based interface module to provide tools for automating input data file preparation, linking and executing of a generic program, editing/viewing of input/output files, and application guidance. The EDFAM was applied to various river basins. An example was given to illustrate the main features of EFDAM application for creating input files and assessing headwater benefits at the Tulloch Hydropower Plant on the Stanislaus River Basin, California.

  13. Complementarity in the provision of ecosystem services reduces the cost of mitigating amplified natural disturbance events

    PubMed Central

    Sims, Charles; Aadland, David; Powell, James; Finnoff, David C.; Crabb, Ben

    2014-01-01

    Climate change has been implicated as a root cause of the recent surge in natural disturbance events such as storms, wildfires, and insect outbreaks. This climate-based surge has led to a greater focus on disturbance-mitigating benefits of ecosystem management. Quantifying these benefits requires knowledge of the relationship between natural and anthropogenic disturbances, which is lacking at the temporal and spatial scales needed to inform ecosystem-based management. This study investigates a specific relationship between timber harvesting and climate-amplified outbreaks of mountain pine beetle. If harvesting is located to mitigate long-distance insect dispersal, there is potential for a win–win outcome in which both timber production and forest conservation can be increased. This spatially targeted harvesting strategy lowers the cost of providing disturbance-mitigating ecosystem services, because valuable timber products are also produced. Mitigating long-distance dispersal also produces net gains in forest conservation across various stakeholder groups. These results speak to ongoing federal efforts to encourage forest vegetation removal on public forestlands to improve forest health. These efforts will lower the cost of responding to climate-amplified natural disturbance events but only if vegetation removal efforts are spatially located to reduce disturbance risk. Otherwise, efforts to improve forest health may be converting forest conservation services to timber services. PMID:25385604

  14. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    SciTech Connect

    Sullivan, Kevin; Anasti, William; Fang, Yichuan; Subramanyan, Karthik; Leininger, Tom; Zemsky, Christine

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

  15. An evaluation of the US Department of Energy`s reducing swimming pool energy costs initiative

    SciTech Connect

    Jones, R.W.; Irwin, R.

    1997-06-01

    The US Department of Energy`s Reduce Swimming Pool Energy Costs (RSPEC) initiative developed and distributed a set of consumer-oriented fact sheets and the Energy Smart Pools software package to over 1300 pool owners, builders, and product manufacturers and retailers since the fall of 1994. The purpose was to promote the adoption of cost-effective energy efficiency and renewable energy measures in swimming pools. An evaluation request for feedback was recently sent to all who had received the materials to determine the impact of the program. With a minimal government investment, the RSPEC program has generated significant sales of pool energy efficiency and renewable energy technologies resulting in significant energy savings. These are very conservative numbers since they are based only on the fourteen percent of RSPEC program participants who returned the evaluations. Results are also from only one year of use. Results will continue to multiply as savings accumulate over the years, more pool industry people receive the RSPEC materials, and more energy efficiency and renewable energy products are sold.

  16. Innovative, High-Pressure, Cryogenic Control Valve: Short Face-to-Face, Reduced Cost

    NASA Technical Reports Server (NTRS)

    Wilkes, Karlin; Larsen, Ed; McCourt, Jackson

    2004-01-01

    A control valve that can throttle high pressure cryogenic fluid embodies several design features that distinguish it over conventional valves designed for similar applications. Field and design engineers worked together to create a valve that would simplify installation, trim changes, and maintenance, thus reducing overall cost. The seals and plug stem packing were designed to perform optimally in cryogenic temperature ranges. Unlike conventional high-pressure cryogenic valves, the trim size can be changed independent of the body. The design feature that provides flexibility for changing the trim is a split body. The body is divided into an upper and a lower section with the seat ring sandwiched in between. In order to maintain the plug stem packing at an acceptable sealing temperature during cryogenic service, heat-exchanging fins were added to the upper body section (see figure). The body is made of stainless steel.

  17. Synthesis of medicinally relevant terpenes: reducing the cost and time of drug discovery.

    PubMed

    Jansen, Daniel J; Shenvi, Ryan A

    2014-06-01

    Terpenoids constitute a significant fraction of molecules produced by living organisms that have found use in medicine and other industries. Problems associated with their procurement and adaptation for human use can be solved using chemical synthesis, which is an increasingly economical option in the modern era of chemistry. This article documents, by way of individual case studies, strategies for reducing the time and cost of terpene synthesis for drug discovery. A major trend evident in recent syntheses is that complex terpenes are increasingly realistic starting points for both medicinal chemistry campaigns and large-scale syntheses, at least in the context of the academic laboratory, and this trend will likely penetrate the commercial sector in the near future.

  18. Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

    PubMed Central

    Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

    2013-01-01

    Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

  19. Synthesis of medicinally relevant terpenes: reducing the cost and time of drug discovery

    PubMed Central

    Jansen, Daniel J; Shenvi, Ryan A

    2014-01-01

    Terpenoids constitute a significant fraction of molecules produced by living organisms that have found use in medicine and other industries. Problems associated with their procurement and adaptation for human use can be solved using chemical synthesis, which is an increasingly economical option in the modern era of chemistry. This article documents, by way of individual case studies, strategies for reducing the time and cost of terpene synthesis for drug discovery. A major trend evident in recent syntheses is that complex terpenes are increasingly realistic starting points for both medicinal chemistry campaigns and large-scale syntheses, at least in the context of the academic laboratory, and this trend will likely penetrate the commercial sector in the near future. PMID:25078134

  20. Recycling Flight Hardware Components and Systems to Reduce Next Generation Research Costs

    NASA Technical Reports Server (NTRS)

    Turner, Wlat

    2011-01-01

    With the recent 'new direction' put forth by President Obama identifying NASA's new focus in research rather than continuing on a path to return to the Moon and Mars, the focus of work at Kennedy Space Center (KSC) may be changing dramatically. Research opportunities within the micro-gravity community potentially stands at the threshold of resurgence when the new direction of the agency takes hold for the next generation of experimenters. This presentation defines a strategy for recycling flight experiment components or part numbers, in order to reduce research project costs, not just in component selection and fabrication, but in expediting qualification of hardware for flight. A key component of the strategy is effective communication of relevant flight hardware information and available flight hardware components to researchers, with the goal of 'short circuiting' the design process for flight experiments

  1. Reducing Nitrogen Pollution while Decreasing Farmers' Costs and Increasing Fertilizer Industry Profits.

    PubMed

    Kanter, David R; Zhang, Xin; Mauzerall, Denise L

    2015-03-01

    Nitrogen (N) pollution is emerging as one of the most important environmental issues of the 21st Century, contributing to air and water pollution, climate change, and stratospheric ozone depletion. With agriculture being the dominant source, we tested whether it is possible to reduce agricultural N pollution in a way that benefits the environment, reduces farmers' costs, and increases fertilizer industry profitability, thereby creating a "sweet spot" for decision-makers that could significantly increase the viability of improved N management initiatives. Although studies of the economic impacts of improved N management have begun to take into account farmers and the environment, this is the first study to consider the fertilizer industry. Our "sweet spot" hypothesis is evaluated via a cost-benefit analysis of moderate and ambitious N use efficiency targets in U.S. and China corn sectors over the period 2015-2035. We use a blend of publicly available crop and energy price projections, original time-series modeling, and expert elicitation. The results present a mixed picture: although the potential for a "sweet spot" exists in both countries, it is more likely that one occurs in China due to the currently extensive overapplication of fertilizer, which creates a greater potential for farmers and the fertilizer industry to gain economically from improved N management. Nevertheless, the environmental benefits of improving N management consistently dwarf the economic impacts on farmers and the fertilizer industry in both countries, suggesting that viable policy options could include incentives to farmers and the fertilizer industry to increase their support for N management policies.

  2. Autonomous exoskeleton reduces metabolic cost of human walking during load carriage

    PubMed Central

    2014-01-01

    Background Many soldiers are expected to carry heavy loads over extended distances, often resulting in physical and mental fatigue. In this study, the design and testing of an autonomous leg exoskeleton is presented. The aim of the device is to reduce the energetic cost of loaded walking. In addition, we present the Augmentation Factor, a general framework of exoskeletal performance that unifies our results with the varying abilities of previously developed exoskeletons. Methods We developed an autonomous battery powered exoskeleton that is capable of providing substantial levels of positive mechanical power to the ankle during the push-off region of stance phase. We measured the metabolic energy consumption of seven subjects walking on a level treadmill at 1.5 m/s, while wearing a 23 kg vest. Results During the push-off portion of the stance phase, the exoskeleton applied positive mechanical power with an average across the gait cycle equal to 23 ± 2 W (11.5 W per ankle). Use of the autonomous leg exoskeleton significantly reduced the metabolic cost of walking by 36 ± 12 W, which was an improvement of 8 ± 3% (p = 0.025) relative to the control condition of not wearing the exoskeleton. Conclusions In the design of leg exoskeletons, the results of this study highlight the importance of minimizing exoskeletal power dissipation and added limb mass, while providing substantial positive power during the walking gait cycle. PMID:24885527

  3. 76 FR 40749 - Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-11

    ... BUDGET DEPARTMENT OF VETERANS AFFAIRS Cost-Based and Inter-Agency Billing Rates for Medical Care or... updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the....) ] SUPPLEMENTARY INFORMATION: VA's methodology for computing Cost-Based and Inter-Agency billing rates for...

  4. Reduced medication in organic farming with emphasis on organic dairy production.

    PubMed

    Vaarst, M; Bennedsgaard, T W

    2001-01-01

    Medication is an important focus area in organic animal husbandry. The combination of goals relating to improved animal welfare and reduced use of chemicals in general creates a common wish to reduce medication. Based on data from current Danish research projects in organic dairy farming, one specific organic medication pattern or policy cannot be described. The disease treatment pattern is influenced by many factors, e.g. the interaction with colleagues, veterinarians and agricultural advisors. No significant difference could be found with regard to incidence of mastitis treatments or somatic cell counts in 27 organic and 57 conventional herds. A marked tendency to shorter treatment periods in relation to mastitis treatments was described for organic farms in comparison with conventional farms (1.9 days versus 3.2 days (5 organic and 7 conventional herds)). In a study of development of health advisory service in organic herds, the dialogue between farmer, veterinarian and agricultural cattle advisor changed the treatment pattern markedly during a period of 6 months. Among important future challenges for veterinarians in organic farming is pointed at the constructive, open, and critical interaction with the single organic farmer as well as the organic animal husbandry system in general.

  5. Defense Health Care Reform: Actions Needed to Help Realize Potential Cost Savings from Medical Education and Training

    DTIC Science & Technology

    2014-07-01

    that the creation of the Directorate serves more as a functional realignment than a cost savings endeavor. Without a fully developed business case...responsibility for numerous functions of its medical health care system, support the services in carrying out their medical missions, manage the...oversight functions , including management of online courses and modeling and simulation programs; and (3) management of academic and administrative

  6. SOAP-V: Introducing a method to empower medical students to be change agents in bending the cost curve.

    PubMed

    Moser, Eileen M; Huang, Grace C; Packer, Clifford D; Glod, Susan; Smith, Cynthia D; Alguire, Patrick C; Fazio, Sara B

    2016-03-01

    Medical students must learn how to practice high-value, cost-conscious care. By modifying the traditional SOAP (Subjective-Objective-Assessment-Plan) presentation to include a discussion of value (SOAP-V), we developed a cognitive forcing function designed to promote discussion of high-value, cost-conscious care during patient delivery. The SOAP-V model prompts the student to consider (1) the evidence that supports a test or treatment, (2) the patient's preferences and values, and (3) the financial cost of a test or treatment compared to alternatives. Students report their findings to their teams during patient care rounds. This tool has been successfully used at 3 medical schools. Preliminary results find that students who have been trained in SOAP-V feel more empowered to address the economic healthcare crisis, are more comfortable in initiating discussions about value, and are more likely to consider potential costs to the healthcare system.

  7. Reducing the energy cost of human walking using an unpowered exoskeleton.

    PubMed

    Collins, Steven H; Wiggin, M Bruce; Sawicki, Gregory S

    2015-06-11

    With efficiencies derived from evolution, growth and learning, humans are very well-tuned for locomotion. Metabolic energy used during walking can be partly replaced by power input from an exoskeleton, but is it possible to reduce metabolic rate without providing an additional energy source? This would require an improvement in the efficiency of the human-machine system as a whole, and would be remarkable given the apparent optimality of human gait. Here we show that the metabolic rate of human walking can be reduced by an unpowered ankle exoskeleton. We built a lightweight elastic device that acts in parallel with the user's calf muscles, off-loading muscle force and thereby reducing the metabolic energy consumed in contractions. The device uses a mechanical clutch to hold a spring as it is stretched and relaxed by ankle movements when the foot is on the ground, helping to fulfil one function of the calf muscles and Achilles tendon. Unlike muscles, however, the clutch sustains force passively. The exoskeleton consumes no chemical or electrical energy and delivers no net positive mechanical work, yet reduces the metabolic cost of walking by 7.2 ± 2.6% for healthy human users under natural conditions, comparable to savings with powered devices. Improving upon walking economy in this way is analogous to altering the structure of the body such that it is more energy-effective at walking. While strong natural pressures have already shaped human locomotion, improvements in efficiency are still possible. Much remains to be learned about this seemingly simple behaviour.

  8. Basking hamsters reduce resting metabolism, body temperature and energy costs during rewarming from torpor.

    PubMed

    Geiser, Fritz; Gasch, Kristina; Bieber, Claudia; Stalder, Gabrielle L; Gerritsmann, Hanno; Ruf, Thomas

    2016-07-15

    Basking can substantially reduce thermoregulatory energy expenditure of mammals. We tested the hypothesis that the largely white winter fur of hamsters (Phodopus sungorus), originating from Asian steppes, may be related to camouflage to permit sun basking on or near snow. Winter-acclimated hamsters in our study were largely white and had a high proclivity to bask when resting and torpid. Resting hamsters reduced metabolic rate (MR) significantly (>30%) when basking at ambient temperatures (Ta) of ∼15 and 0°C. Interestingly, body temperature (Tb) also was significantly reduced from 34.7±0.6°C (Ta 15°C, not basking) to 30.4±2.0°C (Ta 0°C, basking), which resulted in an extremely low (<50% of predicted) apparent thermal conductance. Induced torpor (food withheld) during respirometry at Ta 15°C occurred on 83.3±36.0% of days and the minimum torpor MR was 36% of basal MR at an average Tb of 22.0±2.6°C; movement to the basking lamp occurred at Tb<20.0°C. Energy expenditure for rewarming was significantly reduced (by >50%) during radiant heat-assisted rewarming; however, radiant heat per se without an endogenous contribution by animals did not strongly affect metabolism and Tb during torpor. Our data show that basking substantially modifies thermal energetics in hamsters, with a drop of resting Tb and MR not previously observed and a reduction of rewarming costs. The energy savings afforded by basking in hamsters suggest that this behaviour is of energetic significance not only for mammals living in deserts, where basking is common, but also for P. sungorus and probably other cold-climate mammals.

  9. Human Responding on Random-Interval Schedules of Response-Cost Punishment: The Role of Reduced Reinforcement Density

    ERIC Educational Resources Information Center

    Pietras, Cynthia J.; Brandt, Andrew E.; Searcy, Gabriel D.

    2010-01-01

    An experiment with adult humans investigated the effects of response-contingent money loss (response-cost punishment) on monetary-reinforced responding. A yoked-control procedure was used to separate the effects on responding of the response-cost contingency from the effects of reduced reinforcement density. Eight adults pressed buttons for money…

  10. Reducing medication errors and increasing patient safety: case studies in clinical pharmacology.

    PubMed

    Benjamin, David M

    2003-07-01

    Today, reducing medication errors and improving patient safety have become common topics of discussion for the president of the United States, federal and state legislators, the insurance industry, pharmaceutical companies, health care professionals, and patients. But this is not news to clinical pharmacologists. Improving the judicious use of medications and minimizing adverse drug reactions have always been key areas of research and study for those working in clinical pharmacology. However, added to the older terms of adverse drug reactions and rational therapeutics, the now politically correct expression of medication error has emerged. Focusing on the word error has drawn attention to "prevention" and what can be done to minimize mistakes and improve patient safety. Webster's New Collegiate Dictionary has several definitions of error, but the one that seems to be most appropriate in the context of medication errors is "an act that through ingnorance, deficiency, or accident departs from or fails to achieve what should be done." What should be done is generally known as "the five rights": the right drug, right dose, right route, right time, and right patient. One can make an error of omission (failure to act correctly) or an error of commission (acted incorrectly). This article now summarizes what is currently known about medication errors and translates the information into case studies illustrating common scenarios leading to medication errors. Each case is analyzed to provide insight into how the medication error could have been prevented. "System errors" are described, and the application of failure mode effect analysis (FMEA) is presented to determine the part of the "safety net" that failed. Examples of reengineering the system to make it more "error proof" are presented. An error can be prevented. However, the practice of medicine, pharmacy, and nursing in the hospital setting is very complicated, and so many steps occur from "pen to patient" that there

  11. Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients

    PubMed Central

    Cubro, Hajrunisa; Somun-Kapetanovic, Rabija; Thiery, Guillaume; Talmor, Daniel; Gajic, Ognjen

    2016-01-01

    AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed. RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria. CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services. PMID:27152258

  12. The nosocomial component of medical care. A prospective study on the amount, spectrum and costs of medical disturbances in a department of infectious diseases.

    PubMed

    Jorup-Rönström, C; Britton, S

    1982-01-01

    During a nine month period all patients admitted to a department of infectious diseases were prospectively studied regarding nosocomial reactions defined as any unwanted or unexpected negative effect of medical treatment or care. Eleven percent of 1271 patients were admitted because of complications to previous medical treatment. Twenty-seven percent of the patients developed adverse reactions during the hospital stay. Only four percent of these resulted in a prolonged hospital stay. Six patients (0.5%) died from complications to medical care. We deduce that medical complications are not a major factor in prolonging hospital stay, but rather that the longer the hospital stay the greater the risk for developing nosocomial symptoms. The estimated cost for the whole of the nosocomial matter was seventeen percent of the budget of the department.

  13. An economic toolkit for identifying the cost of emergency medical services (EMS) systems: detailed methodology of the EMS Cost Analysis Project (EMSCAP).

    PubMed

    Lerner, E Brooke; Garrison, Herbert G; Nichol, Graham; Maio, Ronald F; Lookman, Hunaid A; Sheahan, William D; Franz, Timothy R; Austad, James D; Ginster, Aaron M; Spaite, Daniel W

    2012-02-01

    Calculating the cost of an emergency medical services (EMS) system using a standardized method is important for determining the value of EMS. This article describes the development of a methodology for calculating the cost of an EMS system to its community. This includes a tool for calculating the cost of EMS (the "cost workbook") and detailed directions for determining cost (the "cost guide"). The 12-step process that was developed is consistent with current theories of health economics, applicable to prehospital care, flexible enough to be used in varying sizes and types of EMS systems, and comprehensive enough to provide meaningful conclusions. It was developed by an expert panel (the EMS Cost Analysis Project [EMSCAP] investigator team) in an iterative process that included pilot testing the process in three diverse communities. The iterative process allowed ongoing modification of the toolkit during the development phase, based upon direct, practical, ongoing interaction with the EMS systems that were using the toolkit. The resulting methodology estimates EMS system costs within a user-defined community, allowing either the number of patients treated or the estimated number of lives saved by EMS to be assessed in light of the cost of those efforts. Much controversy exists about the cost of EMS and whether the resources spent for this purpose are justified. However, the existence of a validated toolkit that provides a standardized process will allow meaningful assessments and comparisons to be made and will supply objective information to inform EMS and community officials who are tasked with determining the utilization of scarce societal resources.

  14. The rising cost of health care: can demand be reduced through more effective health promotion?

    PubMed

    Phillips, Peter

    2002-11-01

    The cost of health care continues to rise in the face of an apparently insatiable demand. Unless the actual need for health care can be reduced to manageable levels, the financial burden will probably become economically unacceptable. Although some illnesses are unavoidable, others that are largely due to unhealthy lifestyles are preventable. Circulatory diseases, diabetes and some cancers, which are major causes of morbidity and mortality in western societies, are strongly linked to physical inactivity, psychological stress, unhealthy eating, obesity and smoking. There is ample evidence that promotion of healthy lifestyles, including physical activity, healthy eating and non-smoking, are effective for the primary and secondary prevention of these diseases. Although there are examples of successful public health programmes that have encouraged more healthy lifestyles and reduced the burden of disease, we need to be much more effective in putting theory into practice. In order to improve the health of the nation and to prevent the economy being overwhelmed by the increasing demand for health care, we need a change of mindset from a consumerist approach to an acceptance of personal and corporate responsibility for more healthy lifestyles. Widespread collaboration among health care agencies, private and public utilities, the entertainment industry and the communications media will be necessary in order to provide the necessary incentives for lifestyle changes.

  15. Pointed wings, low wingloading and calm air reduce migratory flight costs in songbirds.

    PubMed

    Bowlin, Melissa S; Wikelski, Martin

    2008-05-14

    Migratory bird, bat and insect species tend to have more pointed wings than non-migrants. Pointed wings and low wingloading, or body mass divided by wing area, are thought to reduce energy consumption during long-distance flight, but these hypotheses have never been directly tested. Furthermore, it is not clear how the atmospheric conditions migrants encounter while aloft affect their energy use; without such information, we cannot accurately predict migratory species' response(s) to climate change. Here, we measured the heart rates of 15 free-flying Swainson's Thrushes (Catharus ustulatus) during migratory flight. Heart rate, and therefore rate of energy expenditure, was positively associated with individual variation in wingtip roundedness and wingloading throughout the flights. During the cruise phase of the flights, heart rate was also positively associated with wind speed but not wind direction, and negatively but not significantly associated with large-scale atmospheric stability. High winds and low atmospheric stability are both indicative of the presence of turbulent eddies, suggesting that birds may be using more energy when atmospheric turbulence is high. We therefore suggest that pointed wingtips, low wingloading and avoidance of high winds and turbulence reduce flight costs for small birds during migration, and that climate change may have the strongest effects on migrants' in-flight energy use if it affects the frequency and/or severity of high winds and atmospheric instability.

  16. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs.

    PubMed

    Cummings, K Michael; Fix, Brian; Celestino, Paula; Carlin-Menter, Shannon; O'Connor, Richard; Hyland, Andrew

    2006-01-01

    In an effort to increase access to evidence-based smoking cessation therapies, regional tobacco control programs in New York State implemented different interventions to make free nicotine patches and gum available to smokers wishing to quit. In one region, eligible smokers were sent a voucher redeemable at a local pharmacy for a 2-week supply of either nicotine patches or gum. In other regions, smokers received either a 1-week supply or a 2-week supply of nicotine patches sent to their home. In New York City, eligible smokers received a 6-week supply of nicotine patches and a follow-up phone call. All of the programs utilized the state's Smokers' Quitline to screen and register eligible smokers for the free medication. The reach of the different programs was evaluated by computing the proportion of eligible smokers within a given area enrolled in the program and tracking call volume to the Quitline before, during, and after the free giveaway promotions. Efficacy was evaluated by a telephone follow-up survey of program participants conducted 4 months after enrollment to measure use of the medications and smoking behavior. The quit rate of program participants was contrasted with the quit rate computed from an earlier follow-up survey of Quitline callers who were not provided nicotine replacement therapy (NRT). Free nicotine patches or gum was sent to 40,090 smokers representing about 2.9 percent of eligible heavy smokers (10+ cigarettes per day) in the state. In each time period and location where free NRT was offered, call volume to the Quitline increased dramatically. Quit rates varied in relationship to the supply of NRT sent to participants, but in all cases was higher than the quit rate observed among smokers not sent NRT (21%-35% vs 12%). The offer of free NRT appears to be a cost-effective method to induce large numbers of smokers to make a quit attempt.

  17. An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network.

    PubMed

    Tannenbaum, Cara; Farrell, Barbara; Shaw, James; Morgan, Steve; Trimble, Johanna; Currie, Jane; Turner, Justin; Rochon, Paula; Silvius, James

    2017-03-01

    Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.

  18. [Medication in a physicians network: modern treatment with no increase in costs?].

    PubMed

    Wunder, S; Brune, K

    2005-04-07

    Practice networks are intended to improve drug treatment and render it more economical. To check whether these aims can be realized, two groups of physicians were observed over a period of two years. The first group stemmed from the Practice Network Nuremberg North (PNN), the other comprised a group of physicians in Augsburg similarly structured in terms of prescriptions, specialties and patients. A comparison was made of the application and costs of drugs for the following four different indications: bronchial asthma, diabetes mellitus, hypertension and osteoporosis. Within the practice network a mild increase in costswas observed forall four indications. This was in part explained by the increased used of modern, more expensive drugs, although savings were also achieved by a more liberal use of more economical, patent-free medications. No improvement in treatment outcome was seen, since prescription in accordance with recommended guidelines would have required the use of other drugs. Evaluation of treatment qualitywas not an aim of this study. Overall, the potentials in terms of improved and simultaneously more economical chemotherapy expected from the establishment of a practice network were not fully utilized. Perhaps the conclusion of a modified agreement Quality and Efficiency (QaE, 2003) might result in improved prescribing through evidence-based medicine, and greater savings.

  19. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Executive Summary.

    ERIC Educational Resources Information Center

    Musgrave, Gerald L.

    A study that forecast the consequences of the projected growth in the number of practicing U.S. physicians during the 1980s and beyond is summarized. Attention was directed to the potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services. Econometric modeling and analysis of…

  20. Potential Impact of Increased Numbers of Physicians upon Physician Behavior, Access to, and Cost of, Medical Care. Final Report.

    ERIC Educational Resources Information Center

    Musgrave, Gerald L.

    The potential impact of the increasing supply of physicians on physician behavior, the cost of medical services, and access to services is addressed in detail in this final research report. Econometric modeling and analyses of economic activity within the health sector were undertaken. An eight equation model of the hospital and physician sectors…

  1. The Relationship between National Heart, Lung, and Blood Institute Weight Guidelines and Concurrent Medical Costs in a Manufacturing Population.

    ERIC Educational Resources Information Center

    Wang, Feifei; Schultz, Alyssa B.; Musich, Shirley; McDonald, Tim; Hirschland, David; Edington, Dee W.

    2003-01-01

    Explored the relationship between the 1998 National Heart, Lung, and Blood Institute (NHLBI) weight guidelines and concurrent medical costs among 177,971 employees, retirees, and adult dependents from a nationwide manufacturing corporation. Results indicated that the six weight groups defined by the NHLBI guidelines were consistent with concurrent…

  2. The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

    NASA Technical Reports Server (NTRS)

    Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

  3. Report on audit of fire and emergency medical services cost sharing between the Department of Energy and Los Alamos County

    SciTech Connect

    1995-10-02

    Los Alamos County was created in 1964 as a response to a Congressional mandate, promulgated in the Atomic Energy Act of 1954. Because the county came into existence via the Atomic Energy Act, the Department provided fire and emergency medical services. In the intervening years, however, the Department and the county have worked toward making the county self-sufficient. The contract for fire and emergency medical services represented a step in the direction of self-sufficiency by requiring the county to begin paying for its share of the related costs. The purpose of the audit was to determine if the costs for fire and emergency medical services were shared appropriately commensurate with the use of the services.

  4. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... investigation? Yes. Reclamation may reduce the non-Federal cost-share for appraisal investigations below 50... Federal interest in conducting the appraisal investigation, and you demonstrate financial hardship... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Can Reclamation reduce the non-Federal...

  5. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... appraisal investigation? Yes. Reclamation may reduce the non-Federal cost-share for appraisal investigations... overwhelming Federal interest in conducting the appraisal investigation, and you demonstrate financial hardship... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Can Reclamation reduce the...

  6. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... appraisal investigation? Yes. Reclamation may reduce the non-Federal cost-share for appraisal investigations... overwhelming Federal interest in conducting the appraisal investigation, and you demonstrate financial hardship... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Can Reclamation reduce the...

  7. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... appraisal investigation? Yes. Reclamation may reduce the non-Federal cost-share for appraisal investigations... overwhelming Federal interest in conducting the appraisal investigation, and you demonstrate financial hardship... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Can Reclamation reduce the...

  8. 43 CFR 404.32 - Can Reclamation reduce the non-Federal cost-share required for an appraisal investigation?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... appraisal investigation? Yes. Reclamation may reduce the non-Federal cost-share for appraisal investigations... overwhelming Federal interest in conducting the appraisal investigation, and you demonstrate financial hardship... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Can Reclamation reduce the...

  9. A Comparison of Response Cost and Differential Reinforcement of Other Behavior to Reduce Disruptive Behavior in a Preschool Classroom

    ERIC Educational Resources Information Center

    Conyers, Carole; Miltenberger, Raymond; Maki, Amber; Barenz, Rebecca; Jurgens, Mandy; Sailer, Angela; Haugen, Meredith; Kopp, Brandon

    2004-01-01

    This study investigated the effectiveness of response cost and differential reinforcement of other behavior (DRO) in reducing the disruptive behaviors of 25 children in a preschool classroom. Using an alternating treatments design, disruptive behavior was reduced when the participants earned tokens for the absence of disruptive behavior (DRO) or…

  10. Capsiate supplementation reduces oxidative cost of contraction in exercising mouse skeletal muscle in vivo.

    PubMed

    Yashiro, Kazuya; Tonson, Anne; Pecchi, Émilie; Vilmen, Christophe; Le Fur, Yann; Bernard, Monique; Bendahan, David; Giannesini, Benoît

    2015-01-01

    Chronic administration of capsiate is known to accelerate whole-body basal energy metabolism, but the consequences in exercising skeletal muscle remain very poorly documented. In order to clarify this issue, the effect of 2-week daily administration of either vehicle (control) or purified capsiate (at 10- or 100-mg/kg body weight) on skeletal muscle function and energetics were investigated throughout a multidisciplinary approach combining in vivo and in vitro measurements in mice. Mechanical performance and energy metabolism were assessed strictly non-invasively in contracting gastrocnemius muscle using magnetic resonance (MR) imaging and 31-phosphorus MR spectroscopy (31P-MRS). Regardless of the dose, capsiate treatments markedly disturbed basal bioenergetics in vivo including intracellular pH alkalosis and decreased phosphocreatine content. Besides, capsiate administration did affect neither mitochondrial uncoupling protein-3 gene expression nor both basal and maximal oxygen consumption in isolated saponin-permeabilized fibers, but decreased by about twofold the Km of mitochondrial respiration for ADP. During a standardized in vivo fatiguing protocol (6-min of repeated maximal isometric contractions electrically induced at a frequency of 1.7 Hz), both capsiate treatments reduced oxidative cost of contraction by 30-40%, whereas force-generating capacity and fatigability were not changed. Moreover, the rate of phosphocreatine resynthesis during the post-electrostimulation recovery period remained unaffected by capsiate. Both capsiate treatments further promoted muscle mass gain, and the higher dose also reduced body weight gain and abdominal fat content. These findings demonstrate that, in addition to its anti-obesity effect, capsiate supplementation improves oxidative metabolism in exercising muscle, which strengthen this compound as a natural compound for improving health.

  11. Assessment of xylanase activity in dry storage as a potential method of reducing feedstock cost.

    PubMed

    Smith, William A; Thompson, David N; Thompson, Vicki S; Radtke, Corey W; Carter, Brady

    2009-05-01

    Enzymatic preprocessing of lignocellulosic biomass in dry storage systems has the potential to improve feedstock characteristics and lower ethanol production costs. To assess the potential for endoxylanase activity at low water contents, endoxylanase activity was tested using a refined wheat arabinoxylan substrate and three commercial endoxylanases over the water activity range 0.21-1.0, corresponding to water contents of 5% to >60% (dry basis). Homogeneously mixed dry samples were prepared at a fixed enzyme to substrate ratio and incubated in chambers at a variety of fixed water activities. Replicates were sacrificed periodically, and endoxylanase activity was quantified as an increase in reducing sugar relative to desiccant-stored controls. Endoxylanase activity was observed at water activities over 0.91 in all enzyme preparations in less than 4 days and at a water activity of 0.59 in less than 1 week in two preparations. Endoxylanase activity after storage was confirmed for selected desiccant-stored controls by incubation at 100% relative humidity. Water content to water activity relationships were determined for three lignocellulosic substrates, and results indicate that two endoxylanase preparations retained limited activity as low as 7% to 13% water content (dry basis), which is well within the range of water contents representative of dry biomass storage. Future work will examine the effects of endoxylanase activity toward substrates such as corn stover, wheat straw, and switchgrass in low water content environments.

  12. Mechanism and capacities of reducing ecological cost through rice–duck cultivation

    PubMed Central

    Long, Pan; Huang, Huang; Liao, Xiaolan; Fu, Zhiqiang; Zheng, Huabin; Chen, Aiwu; Chen, Can

    2013-01-01

    BACKGROUND: Rice–duck cultivation is the essence of Chinese traditional agriculture. A scientific assessment of the mechanism and its capacity is of theoretical significance and practical value in improving modern agricultural technology. RESULTS: The duck’s secretions, excreta and their treading, pecking and predation decrease the occurrence of plant diseases, pests and weeds, enrich species diversity and improve the field environment. The rice–duck intergrowth system effectively prevents rice planthoppers and rice leafhoppers. The control effects can be up to 98.47% and 100% respectively; it also has effects on the control of Chilo suppressalis, Tryporyza incertulas and the rice leafrollers. Notable control results are found on sheath blight, while the effects on other diseases are about 50%. Harm from weeds is placed under primary control; prevention of weeds is sequenced by broadleaf weeds > sedge weeds > Gramineae weeds. Contents of soil organic matter, N, P and K are improved by the system; nutrient utilization is accelerated, resulting in decreased fertilizer application. Greenhouse gas emissions are reduced by 1–2% and duck fodder is saved in this system. There is also an obvious economic benefit. CONCLUSION: Compared to conventional rice cultivation, rice–duck cultivation shows great benefits to ecologic cost and economic income. © 2013 The Authors. Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:23703299

  13. Patient engagement: four case studies that highlight the potential for improved health outcomes and reduced costs.

    PubMed

    Laurance, Jeremy; Henderson, Sarah; Howitt, Peter J; Matar, Mariam; Al Kuwari, Hanan; Edgman-Levitan, Susan; Darzi, Ara

    2014-09-01

    The energy of patients and members of the public worldwide who care about improving health is a huge, but still largely unrecognized and untapped, resource. The aim of patient engagement is to shift the clinical paradigm from determining "what is the matter?" to discovering "what matters to you?" This article presents four case studies from around the world that highlight the proven and potential abilities of increased patient engagement to improve health outcomes and reduce costs, while extending the reach of treatment and diagnostic programs into the community. The cases are an online mental health community in the United Kingdom, a genetic screening program in the United Arab Emirates, a World Health Organization checklist for new mothers, and a hospital-based patient engagement initiative in the United States. Evidence from these and similar endeavors suggests that closer collaboration on the part of patients, families, health care providers, health care systems, and policy makers at multiple levels could help diverse nations provide more effective and population-appropriate health care with fewer resources.

  14. The role of photoperiods on photobioreactors - A potential strategy to reduce costs.

    PubMed

    Maroneze, Mariana Manzoni; Siqueira, Stefania Fortes; Vendruscolo, Raquel Guidetti; Wagner, Roger; de Menezes, Cristiano Ragagnin; Zepka, Leila Queiroz; Jacob-Lopes, Eduardo

    2016-11-01

    The aim of this work was evaluate the role of photoperiods (long-term, frequencies and short) on the growth and lipid content of microalgae Scenedesmus obliquus CPCC05. The results showed that Scenedesmus obliquus can store sufficient energy to sustain cell growth for continuous periods of up to 2h in the dark, without affecting the photosynthetic rate. The values for maximum biomass (9.58mg/Lh) and lipid productivities (2.56mg/Lh) were obtained at photoperiod of 0.91:0.09s (light:dark) and 48 t/d, respectively. Moreover, the best trade-offs between biomass productivity and light energy economy occurred in photoperiods of 0.5:0.5s and 0.91:0.09s (light:dark), and those between lipid productivity and light energy economy occurred in the frequency photoperiod of 24 and 48 t/d. Thus, the use of the photoperiods are an effective strategy for reducing costs of microalgal biomass production.

  15. Cost Effective Measures to Reduce CO2 Emissions in the Air Freight Sector

    NASA Technical Reports Server (NTRS)

    Blinge, Magnus

    2003-01-01

    This paper presents cost effective measures to reduce CO2 emissions in the air freight sector. One door-to-door transport chain is studied in detail from a Scandinavian city to a city in southern Europe. The transport chain was selected by a group of representatives from the air freight sector in order to encompass general characteristics within the sector. Three different ways of shipping air cargo are studied, i.e., by air freighter, as belly freight (in passenger aircrafts) and trucking. CO2 emissions are calculated for each part of the transport chain and its relative importance towards the total amount CO2 emitted during the whole transport chain is shown. It is confirmed that the most CO2 emitting part of the transport chain is the actual flight and that it is in the take-off and climbing phases that most fuel are burned. It is also known that the technical development of aircraft implies a reduction in fuel consumption for each new generation of aircraft. Thus, the aircraft manufacturers have an important role in this development. Having confirmed these observations, this paper focuses on other factors that significantly affects the fuel consumption. Analyzed factors are, e.g., optimization of speed and altitude, traffic management, congestion on and around the airfields, tankering, "latest acceptance time" for goods and improving the load factor. The different factors relative contribution to the total emission levels for the transport chain has been estimated.

  16. Selection for reduced translation costs at the intronic 5′ end in fungi

    PubMed Central

    Zafrir, Zohar; Zur, Hadas; Tuller, Tamir

    2016-01-01

    It is generally believed that introns are not translated; therefore, the potential intronic features that may be related to the translation step (occurring after splicing) have yet to be thoroughly studied. Here, focusing on four fungi, we performed for the first time a comprehensive study aimed at characterizing how translation efficiency is encoded in introns and affects their evolution. By analysing their intronome we provide evidence of selection for STOP codons close to the intronic 5′ end, and show that the beginning of introns are selected for significantly high translation, presumably to reduce translation and metabolic costs in cases of non-spliced introns. Ribosomal profiling data analysis in Saccharomyces cerevisiae supports the conjecture that in this organism intron retention frequently occurs, introns are partially translated, and their translation efficiency affects organismal fitness. We show that the reported results are more significant in highly translated and highly spliced genes, but are not associated only with genes with a specific function. We also discuss the potential relation of the reported signals to efficient nonsense-mediated decay due to splicing errors. These new discoveries are supported by population-genetics considerations. In addition, they are contributory steps towards a broader understanding of intron evolution and the effect of silent mutations on gene expression and organismal fitness. PMID:27260512

  17. The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

    SciTech Connect

    Ashcraft, Phillip Lynn; Fogle, Blythe G.; Cummings, Susan M.; Lopez, Leon

    2016-07-29

    This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

  18. A rural cancer outreach program lowers patient care costs and benefits both the rural hospitals and sponsoring academic medical center.

    PubMed

    Desch, C E; Grasso, M A; McCue, M J; Buonaiuto, D; Grasso, K; Johantgen, M K; Shaw, J E; Smith, T J

    1999-01-01

    The Rural Cancer Outreach Program (RCOP) between two rural hospitals and the Medical College of Virginia's Massey Cancer Center (MCC) was developed to bring state-of-the-art cancer care to medically underserved rural patients. The financial impact of the RCOP on both the rural hospitals and the MCC was analyzed. Pre- and post-RCOP financial data were collected on 1,745 cancer patients treated at the participating centers, two rural community hospitals and the MCC. The main outcome measures were costs (estimated reimbursement from all sources), revenues, contribution margins and profit (or loss) of the program. The RCOP may have enhanced access to cancer care for rural patients at less cost to society. The net annual cost per patient fell from $10,233 to $3,862 associated with more use of outpatient services, more efficient use of resources, and the shift to a less expensive locus of care. The cost for each rural patient admitted to the Medical College of Virginia fell by more than 40 percent compared with only an 8 percent decrease for all other cancer patients. The rural hospitals experienced rapid growth of their programs to more than 200 new patients yearly, and the RCOP generated significant profits for them. MCC benefited from increased referrals from RCOP service areas by 330 percent for cancer patients and by 9 percent for non-cancer patients during the same time period. While it did not generate a major profit for the MCC, the RCOP generated enough revenue to cover costs of the program. The RCOP had a positive financial impact on the rural and academic medical center hospitals, provided state-of-the-art care near home for rural patients and was associated with lower overall cancer treatment costs.

  19. Reducing the manufacturing cost of tubular solid oxide fuel cell technology

    NASA Astrophysics Data System (ADS)

    George, Raymond A.; F. Bessette, Norman

    In recent years, Westinghouse Electric Corporation has made great strides in advancing tubular solid oxide fuel cell (SOFC) technology towards commercialization by the year 2001. In 1993, Westinghouse initiated a program to develop a `MWe-Class' (1-3 MWe) pressurized SOFC (PSOFC)/gas turbine (GT) combined cycle power system for distributed power applications because of its (1) ultra-high efficiency (˜63% net AC/LHV CH4), (2) its compatibility with a factory packaged, minimum site work philosophy, and (3) its cost effectiveness. Since then two cost studies on this market entry product performed by consultants to the US Department of Energy have confirmed Westinghouse cost studies that fully installed costs of under $1300/kWe can be achieved in the early commercialization years for such small PSOFC/GT power systems. The paper will present the results of these cost studies in the areas of cell manufacturing cost, PSOFC generator manufacturing cost, balance-of-plant (BOP) cost, and system installation cost. In addition, cost of electricity calculations will be presented.

  20. Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

    PubMed Central

    Shreffler, Jack; Schoster, Britta; Callahan, Leigh F.

    2012-01-01

    Background Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ. Purpose The purposes of this study are (1) to identify characteristics of individuals with arthritis who self-report prescription medication cost-coping strategies and (2) to examine the association between medication cost-coping strategies and health status. Methods Seven hundred twenty-nine people self-reporting arthritis and prescription medication use completed a telephone survey. Adjusted regression models examined medication cost-coping strategies and five health status outcomes. Results Participants reported engaging in cost-coping strategies due to medication costs. Those borrowing money had worse psychosocial health and greater disability; those with increasing credit card debt reported worse physical functioning, self-rated health, and greater helplessness. Medication underuse was associated with worse psychosocial health, greater disability, and depressive symptoms. Conclusion Individuals with arthritis use multiple strategies to cope with medication costs, and these strategies are associated with adverse physical and psychosocial health status. PMID:22740363

  1. Needs Assessment and Telecommunications Cost Benefit Analysis for Army Medical Department Continuing Clinical Education Requirements.

    DTIC Science & Technology

    1985-04-01

    collected in several ways which include computerized and manual literature searches of professional medical journals , telephonic 0 contacts with national...Spring, MD: CCEU. Davis, D. & Feldman, E. (1982, June). The McMaster CME Society. Journal of Medical E’ucation, 57(6), 476-480. Derbyshire, R.C...Continuing Medical Education. The Journal of the American Medical Association, 250(12), 1557-1559. Manning, P. R. (1983, February). Continuing

  2. Cost-Effectiveness of Preventive Interventions to Reduce Alcohol Consumption in Denmark

    PubMed Central

    Holm, Astrid Ledgaard; Veerman, Lennert; Cobiac, Linda; Ekholm, Ola; Diderichsen, Finn

    2014-01-01

    Introduction Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. Methods We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. Results Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. Conclusion Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus

  3. Logistics Planning for the M1 Tank: Implications for Reduced Readiness and Increased Support Costs

    DTIC Science & Technology

    1981-07-01

    comments and our evaluation LIFE-CYCLE COSTING: STILL TIME TO BENEFIT THE Ml Different wiring harnesses could save millions of dollars Use of...future Ml support costs. DIFFERENT WIRING HARNESSES COULD SAVE MILLIONS OF DOLLARS Because of high acquisition costs, the Army and Chrysler have...been a major problem with the wiring harnesses on Army tanks and other combat vehicles. The Army Armament Research and Develop- ment Command’s May

  4. The green operating room: simple changes to reduce cost and our carbon footprint.

    PubMed

    Wormer, Blair A; Augenstein, Vedra A; Carpenter, Christin L; Burton, Patrick V; Yokeley, William T; Prabhu, Ajita S; Harris, Beth; Norton, Sujatha; Klima, David A; Lincourt, Amy E; Heniford, B Todd

    2013-07-01

    Generating over four billion pounds of waste each year, the healthcare system in the United States is the second largest contributor of trash with one-third produced by operating rooms. Our objective is to assess improvement in waste reduction and recycling after implementation of a Green Operating Room Committee (GORC) at our institution. A surgeon and nurse-initiated GORC was formed with members from corporate leadership, nursing, anesthesia, and OR staff. Initiatives for recycling opportunities, reduction of energy and water use as well as solid waste were implemented and the results were recorded. Since formation of GORC in 2008, our OR has diverted 6.5 tons of medical waste. An effort to recycle all single-use devices was implemented with annual solid waste reduction of approximately 12,860 lbs. Disposable OR foam padding was replaced with reusable gel pads at greater than $50,000 per year savings. Over 500 lbs of previously discarded batteries were salvaged from the OR and donated to charity or redistributed in the hospital ($9,000 annual savings). A "Power Down" initiative to turn off all anesthesia and OR lights and equipment not in use resulted in saving $33,000 and 234.3 metric tons of CO2 emissions reduced per year. Converting from soap to alcohol-based waterless scrub demonstrated a potential saving of 2.7 million liters of water annually. Formation of an OR committee dedicated to ecological initiatives can provide a significant opportunity to improve health care's impact on the environment and save money.

  5. Potential Cost-Effectiveness of Schistosomiasis Treatment for Reducing HIV Transmission in Africa – The Case of Zimbabwean Women

    PubMed Central

    Ndeffo Mbah, Martial L.; Poolman, Eric M.; Atkins, Katherine E.; Orenstein, Evan W.; Meyers, Lauren Ancel; Townsend, Jeffrey P.; Galvani, Alison P.

    2013-01-01

    Background Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection. Methods We developed a mathematical model of female genital schistosomiasis (FGS) and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa. Findings We showed that for a variation of efficacy between 30–70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16–101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30–70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36−92 million over a ten-year period. Conclusions In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel

  6. Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence

    PubMed Central

    Chen, Mingsheng; Si, Lei; Winzenberg, Tania M; Gu, Jieruo; Jiang, Qicheng; Palmer, Andrew J

    2016-01-01

    Aims Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods We used a previously developed and validated osteoporosis state-transition microsimulation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medication persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness-to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost-effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost-effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion Given the willingness-to-pay threshold

  7. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions.

    PubMed

    Veroff, David; Marr, Amy; Wennberg, David E

    2013-02-01

    Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a year-long randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a "remote" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members.

  8. Medical care utilization and costs on end-of-life cancer patients: The role of hospice care.

    PubMed

    Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Chen, Tzeng-Ji; Tsai, Shu-Lin; Cheng, Shao-Yi; Chiu, Tai-Yuan; Tsai, Shih-Tzu; Hwang, Shinn-Jang

    2016-11-01

    Although there are 3 hospice care programs for terminal cancer patients in Taiwan, the medical utilization and expenses for these patients by programs have not been well-explored. The aim of this study was to examine the medical utilization and expenses of terminal cancer patients under different programs of hospice care in the last 90, 30, and 14 days of life.This was a retrospective observational study by secondary data analysis. By using the National Health Insurance claim database and Hospice Shared Care Databases. We identified cancer descents from these databases and classified them into nonhospice care and hospice care groups based on different combination of hospice care received. We then analyzed medical utilization including inpatient care, outpatient care, emergency room visits, and medical expenses by patient groups in the last 90, 30, and 14 days of life.Among 118,376 cancer descents, 46.9% ever received hospice care. Patients had ever received hospice care had significantly lower average medical utilization and expenses in their last 90, 30, and 14 days of life (all P < 0.001) compared to nonhospice care group. Each hospice care group had significantly less medical utilization and expenses in the last 90, 30, and 14 days of life (all P < 0.01).Different kinds of hospice care program have different effects on medical care utilization reduction and cost-saving at different stage of the end of life of terminal cancer patients.

  9. Walking with a Backpack using Load Distribution and Dynamic Load Compensation Reduces Metabolic Cost and Adaptations to Loads.

    PubMed

    Park, Joon-Hyuk; Stegall, Paul; Zhang, Haohan; Agrawal, Sunil

    2016-11-09

    In this study, we showed a way of reducing the metabolic cost of walking with a backpack using load distribution and dynamic load compensation, provided by a wearable upper body device. This device distributes the backpack load between the shoulders and the pelvis, senses the vertical motion of the pelvis, and provides gait synchronized compensatory forces to reduce the dynamic loads from a backpack. It was hypothesized that by reducing dynamic loads from a backpack during load carriage, the users gait and postural adaptation, muscular effort and metabolic cost would be reduced. This hypothesis was supported by biomechanical and physiological measurements on a group of young healthy subjects, as they walked on a treadmill under 4 different conditions: unloaded; with a backpack, loaded with 25% of their body weight, supported on the shoulders; with the same load distributed between the shoulders and the pelvis; and with dynamic load compensation in addition to load distribution. The results showed reductions in gait and postural adaptations, muscle activity, vertical and braking ground reaction forces, and metabolic cost while carrying the same backpack load with the device. We conclude that the device can potentially reduce the risk of musculoskeletal injuries and muscle fatigue associated with carrying heavy backpack loads while reducing the metabolic cost of loaded walking.

  10. Barefoot Running Reduces the Submaximal Oxygen Cost in Female Distance Runners.

    PubMed

    Berrones, Adam J; Kurti, Stephanie P; Kilsdonk, Korey M; Cortez, Delonyx J; Melo, Flavia F; Whitehurst, Michael

    2016-08-01

    Berrones, AJ, Kurti, SP, Kilsdonk, KM, Cortez, DJ, Melo, FF, and Whitehurst, M. Barefoot running reduces the submaximal oxygen cost in female distance runners. J Strength Cond Res 30(8): 2348-2353, 2016-Being a competitive distance runner is, in part, attributable to a high V[Combining Dot Above]O2max. However, running economy (RE) is a more robust indicator of distance running performance among endurance athletes of similar V[Combining Dot Above]O2max levels. The purpose of this study was to examine the influence of unshod (barefoot) vs. shod (wearing shoes) running on RE (expressed as ml·kg·min) during three 5-minute submaximal running trials representing 65, 75, and 85% of V[Combining Dot Above]O2max. Other physiologic and perceptual variables such as respiratory exchange ratio, lactate, heart rate, and ratings of perceived exertion were also chosen as dependent variables. We measured V[Combining Dot Above]O2max in 14 recreationally active trained distance female runners (age = 27.6 ± 1.6 years; height = 163.3 ± 1.7 cm; weight = 57.8 ± 1.9 kg) who were completely inexperienced with unshod running. After initial testing, each subject was randomized to either unshod or shod for days 2 and 3. We analyzed the data with a 2-way (condition by intensity) repeated-measures analysis of variance. Submaximal oxygen consumption was significantly reduced at 85% of V[Combining Dot Above]O2max (p = 0.018), indicating an improvement in RE, but not during the 65% or 75% trials (p > 0.05, both). No other dependent measure was different between unshod and shod conditions. Our results indicate that the immediate improvement to RE while barefoot occurs at a relatively high fraction of maximal oxygen consumption. For the recreational or competitive distance runner, training or competing while barefoot may be a useful strategy to improve endurance performance.

  11. The price of information: Increased inspection costs reduce the confirmation bias in visual search.

    PubMed

    Rajsic, Jason; Wilson, Daryl E; Pratt, Jay

    2017-01-31

    In visual search, there is a confirmation bias such that attention is biased towards stimuli that match a target template, which has been attributed to covert costs of updating the templates that guide search [Rajsic, Wilson, & Pratt, 2015. Confirmation bias in visual search. Journal of Experimental Psychology: Human Perception and Performance. Advance online publication. doi: 10.1037/xhp0000090 ]. In order to provide direct evidence for this speculation, the present study increased the cost of inspections in search by using gaze- and mouse-contingent searches, which restrict the manner in which information in search displays can be accrued, and incur additional motor costs (in the case of mouse-contingent searches). In a fourth experiment, we rhythmically mask elements in the search display to induce temporal inspection costs. Our results indicated that confirmation bias is indeed attenuated when inspection costs are increased. We conclude that confirmation bias results from the low-cost strategy of matching information to a single, concrete visual template, and that more sophisticated guidance strategies will be used when sufficiently beneficial. This demonstrates that search guidance itself comes at a cost, and that the form of guidance adopted in a given search depends on a comparison between guidance costs and the expected benefits of their implementation.

  12. A Cost Analysis of Web-Enhanced Training to Reduce Alcohol Sales to Intoxicated Bar Patrons

    ERIC Educational Resources Information Center

    Page, Timothy F.; Nederhoff, Dawn M.; Ecklund, Alexandra M.; Horvath, Keith J.; Nelson, Toben F.; Erickson, Darin J.; Toomey, Traci L.

    2015-01-01

    Objective: The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a "real world", non-research setting. Methods: Data for this…

  13. Costs of solar and wind power variability for reducing CO2 emissions.

    PubMed

    Lueken, Colleen; Cohen, Gilbert E; Apt, Jay

    2012-09-04

    We compare the power output from a year of electricity generation data from one solar thermal plant, two solar photovoltaic (PV) arrays, and twenty Electric Reliability Council of Texas (ERCOT) wind farms. The analysis shows that solar PV electricity generation is approximately one hundred times more variable at frequencies on the order of 10(-3) Hz than solar thermal electricity generation, and the variability of wind generation lies between that of solar PV and solar thermal. We calculate the cost of variability of the different solar power sources and wind by using the costs of ancillary services and the energy required to compensate for its variability and intermittency, and the cost of variability per unit of displaced CO(2) emissions. We show the costs of variability are highly dependent on both technology type and capacity factor. California emissions data were used to calculate the cost of variability per unit of displaced CO(2) emissions. Variability cost is greatest for solar PV generation at $8-11 per MWh. The cost of variability for solar thermal generation is $5 per MWh, while that of wind generation in ERCOT was found to be on average $4 per MWh. Variability adds ~$15/tonne CO(2) to the cost of abatement for solar thermal power, $25 for wind, and $33-$40 for PV.

  14. Planning Fireworks Trajectories for Steerable Medical Needles to Reduce Patient Trauma.

    PubMed

    Xu, Jijie; Duindam, Vincent; Alterovitz, Ron; Pouliot, Jean; Cunha, J Adam M; Hsu, I-Chow; Goldberg, Ken

    Accurate insertion of needles to targets in 3D anatomy is required for numerous medical procedures. To reduce patient trauma, a "fireworks" needle insertion approach can be used in which multiple needles are inserted from a single small region on the patient's skin to multiple targets in the tissue. In this paper, we explore motion planning for "fireworks" needle insertion in 3D environments by developing an algorithm based on Rapidly-exploring Random Trees (RRTs). Given a set of targets, we propose an algorithm to quickly explore the configuration space by building a forest of RRTs and to find feasible plans for multiple steerable needles from a single entry region. We present two path selection algorithms with different optimality considerations to optimize the final plan among all feasible outputs. Finally, we demonstrate the performance of the proposed algorithm with a simulation based on a prostate cancer treatment environment.

  15. Planning Fireworks Trajectories for Steerable Medical Needles to Reduce Patient Trauma

    PubMed Central

    Xu, Jijie; Duindam, Vincent; Alterovitz, Ron; Pouliot, Jean; Cunha, J. Adam M.; Hsu, I-Chow; Goldberg, Ken

    2012-01-01

    Accurate insertion of needles to targets in 3D anatomy is required for numerous medical procedures. To reduce patient trauma, a “fireworks” needle insertion approach can be used in which multiple needles are inserted from a single small region on the patient’s skin to multiple targets in the tissue. In this paper, we explore motion planning for “fireworks” needle insertion in 3D environments by developing an algorithm based on Rapidly-exploring Random Trees (RRTs). Given a set of targets, we propose an algorithm to quickly explore the configuration space by building a forest of RRTs and to find feasible plans for multiple steerable needles from a single entry region. We present two path selection algorithms with different optimality considerations to optimize the final plan among all feasible outputs. Finally, we demonstrate the performance of the proposed algorithm with a simulation based on a prostate cancer treatment environment. PMID:25946259

  16. A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia

    PubMed Central

    Rowell, David; Gordon, Louisa G; Olsen, Catherine M; Whiteman, David C

    2016-01-01

    Objectives: The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers. Methods: We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers. Results: Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis. Conclusion: Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference. PMID:27231550

  17. Reduced Costs for Staphylococcus aureus Carriers Treated Prophylactically with Mupirocin and Chlorhexidine in Cardiothoracic and Orthopaedic Surgery

    PubMed Central

    Baak, Diane A.; Kluytmans, Jan A. J. W.; Vos, Margreet C.

    2012-01-01

    Background A multi centre double-blind randomised-controlled trial (M-RCT), carried out in the Netherlands in 2005–2007, showed that hospitalised patients with S. aureus nasal carriage who were treated prophylactically with mupirocin nasal ointment and chlorhexidine gluconate medicated soap (MUP-CHX), had a significantly lower risk of health-care associated S. aureus infections than patients receiving placebo (3.4% vs. 7.7%, RR 0.42, 95% CI 0.23–0.75). The objective of the present study was to determine whether treatment of patients undergoing elective cardiothoracic or orthopaedic surgery with MUP-CHX (screen-and-treat strategy) affected the costs of patient care. Methods We compared hospital costs of patients undergoing cardiothoracic or orthopaedic surgery (n = 415) in one of the participating centres of the M-RCT. Data from the ‘Planning and Control’ department were used to calculate total hospital costs of the patients. Total costs were calculated including nursing days, costs of surgery, costs for laboratory and radiological tests, functional assessments and other costs. Costs for personnel, materials and overhead were also included. Mean costs in the two treatment arms were compared using the t-test for equality of means (two-tailed). Subgroup analysis was performed for cardiothoracic and orthopaedic patients. Results An investigator-blinded analysis revealed that costs of care in the treatment arm (MUP-CHX, n = 210) were on average €1911 lower per patient than costs of care in the placebo arm (n = 205) (€8602 vs. €10513, p = 0.01). Subgroup analysis showed that MUP-CHX treated cardiothoracic patients cost €2841 less (n = 280, €9628 vs €12469, p = 0.006) and orthopaedic patients €955 less than non-treated patients (n = 135, €6097 vs €7052, p = 0.05). Conclusions In conclusion, in patients undergoing cardiothoracic or orthopaedic surgery, screening for S. aureus nasal carriage and treating carriers

  18. Intraocular pressure with rebound tonometry and effects of topical intraocular pressure reducing medications in guinea pigs

    PubMed Central

    Di, Yue; Luo, Xiu-Mei; Qiao, Tong; Lu, Na

    2017-01-01

    AIM To investigate the intraocular pressure (IOP) of adult guinea pig eyes with rebound tonometry (RBT), and assess the effects of four distinctive topical IOP reducing medications including Carteolol, Brimonidine, Brinzolamide and Latanoprost. METHODS The IOPs of twenty-four 12-week-old guinea pigs (48 eyes) were measured every two hours in one day with RBT as baselines. All the animals were then divided into four groups (Carteolol, Brimonidine, Brinzolamide and Latanaprost groups, n=6). The IOPs were measured and compared to the baseline 1, 2, 3, 5, 7, 9, 15 and 24h after treatment. RESULTS The mean baseline IOP of 24 guinea pigs (48 eyes) was 10.3±0.36 mm Hg (6-13 mm Hg) and no binocular significant differences of IOPs were observed (t=1.76, P>0.05). No significant difference of IOP in Carteolol group at each time point was observed before and after treatment (t=1.48, P>0.05). In Brimonidine group, IOP was 2.2±1.9 mm Hg lower than the baseline after one hour (t=3.856, P=0.003) and lasted for one hour. In Brinzolamide group, IOP was 1.4±1.1 mm Hg lower than the baseline after one hour (t=4.53, P=0.001) and lasted for 7h and the IOP declined most at 3h. In Latanaprost group, IOP was 2.1±1.3 mm Hg lower than the baseline after one hour (t=6.11, P=0.001) and lasted for one hour. CONCLUSION The IOP of guinea pig eyes is relatively stable compared to human eyes. In four reducing IOP medications, no significant effect of Carteolol is observed. Brinzolamide has the longest duration, while the Brimonidine has the shortest duration and the maximum level of treatment. PMID:28251075

  19. Prospective comparative study on cost-effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson's disease.

    PubMed

    Valldeoriola, Francesc; Morsi, Ossama; Tolosa, Eduardo; Rumià, Jordi; Martí, Maria José; Martínez-Martín, Pablo

    2007-11-15

    This is an open, prospective, longitudinal study designed to compare two cohorts of patients with advanced Parkinson's disease during 1 year, one undergoing bilateral subthalamic stimulation (STN-DBS) and the other receiving the best medical treatment (BMT), with respect to the clinical effects observed and the medical expenses produced. Assessments were done by using clinical measures and a generic health related quality of life scale. A questionnaire was used to collect direct healthcare resources. As a measure of cost-effectiveness, we calculated life years gained adjusted by health-related quality of life (QALY) and the incremental cost-effectiveness ratio (ICER). Clinical and demographic variables of both groups were comparable at baseline. Total UPDRS scores improved from 50.5 +/- 3.6 to 28.5 +/- 3.8 in STN-DBS patients and worsened from 44.3 +/- 3.3 to 54.2 +/- 4 in the control group. Pharmacological costs in the operated patients were 3,799 +/- 940 euro, while in the BMT group the costs were 13,208 +/- 4,966 euro. Other medical costs were 1,280 +/- 720 euro in the STN-DBS group and 4,017 +/- 2,962 euro in BMT patients. Nondirect medical costs were 4,079 +/- 1,289 in operated patients and 2,787 +/- 1,209 euro in the BMT group. Mean QALYs were 0.7611 +/- 0.03 in STN-DBS and 0.5401 +/- 0.06 in BMT patients. In STN-DBS patients, the ICER needed to obtain an improvement of one point in the total UPDRS score was of 239.8 euro and the ICER/QALY was of 34,389 euro. Cost-effectiveness parameters were mostly related to the degree of clinical improvement and the reduction of pharmacological costs after STN-DBS. An ICER of 34,389 euro/QALY is within appropriate limits to consider subthalamic stimulation as an efficient therapy.

  20. Compressed Air System Retrofit Reduces Energy Costs at a Newspaper Printing Facility

    SciTech Connect

    2002-05-01

    In 2000, a compressed air system optimization project was implemented at The Bakersfield Californian's printing facility in Bakersfield, California. The compressed air system was evaluated for potential energy efficiency improvement opportunities in response to rising energy costs.

  1. Architecture Synthesis and Reduced-Cost Architectures for Human Exploration Missions

    NASA Technical Reports Server (NTRS)

    Woodcock, Gordon

    2004-01-01

    Development of architectures for human exploration missions has been pursued in the international aerospace community for a long time. This paper attempts a different approach and way of looking at architectures. Most of the emphasis is on lunar architectures with a brief look at Mars. The first step is to set forth overarching gods in order to understand origins of requirements. Then, principles and guidelines are developed for architecture formulation. It is argued that safety and cost are the primary factors. Alternative mission profiles are examined for adherence to the principles, and specific architectures formulated according to the guidelines. The guidelines themselves indicate preferred evolution paths from lunar to Mars architectures. Results of example calculations are given to illustrate the process, and an evolution path is recommended. Safety and cost criteria tend to conflict, but it is shown that cost-efficient architectures can be enhanced for good safety ratings at modest cost.

  2. Low-cost flexible thin-film detector for medical dosimetry applications.

    PubMed

    Zygmanski, P; Abkai, C; Han, Z; Shulevich, Y; Menichelli, D; Hesser, J

    2014-03-06

    The purpose of this study is to characterize dosimetric properties of thin film photovoltaic sensors as a platform for development of prototype dose verification equipment in radiotherapy. Towards this goal, flexible thin-film sensors of dose with embedded data acquisition electronics and wireless data transmission are prototyped and tested in kV and MV photon beams. Fundamental dosimetric properties are determined in view of a specific application to dose verification in multiple planes or curved surfaces inside a phantom. Uniqueness of the new thin-film sensors consists in their mechanical properties, low-power operation, and low-cost. They are thinner and more flexible than dosimetric films. In principle, each thin-film sensor can be fabricated in any size (mm² - cm² areas) and shape. Individual sensors can be put together in an array of sensors spreading over large areas and yet being light. Photovoltaic mode of charge collection (of electrons and holes) does not require external electric field applied to the sensor, and this implies simplicity of data acquisition electronics and low power operation. The prototype device used for testing consists of several thin film dose sensors, each of about 1.5 cm × 5 cm area, connected to simple readout electronics. Sensitivity of the sensors is determined per unit area and compared to EPID sensitivity, as well as other standard photodiodes. Each sensor independently measures dose and is based on commercially available flexible thin-film aSi photodiodes. Readout electronics consists of an ultra low-power microcontroller, radio frequency transmitter, and a low-noise amplification circuit implemented on a flexible printed circuit board. Detector output is digitized and transmitted wirelessly to an external host computer where it is integrated and processed. A megavoltage medical linear accelerator (Varian Tx) equipped with kilovoltage online imaging system and a Cobalt source are used to irradiate different thin

  3. Medical-device risk management and public safety: using cost-benefit as a measurement of effectiveness

    NASA Astrophysics Data System (ADS)

    Hughes, Allen A.

    1994-12-01

    Public safety can be enhanced through the development of a comprehensive medical device risk management. This can be accomplished through case studies using a framework that incorporates cost-benefit analysis in the evaluation of risk management attributes. This paper presents a framework for evaluating the risk management system for regulatory Class III medical devices. The framework consists of the following sixteen attributes of a comprehensive medical device risk management system: fault/failure analysis, premarket testing/clinical trials, post-approval studies, manufacturer sponsored hospital studies, product labeling, establishment inspections, problem reporting program, mandatory hospital reporting, medical literature surveillance, device/patient registries, device performance monitoring, returned product analysis, autopsy program, emergency treatment funds/interim compensation, product liability, and alternative compensation mechanisms. Review of performance histories for several medical devices can reveal the value of information for many attributes, and also the inter-dependencies of the attributes in generating risk information flow. Such an information flow network is presented as a starting point for enhancing medical device risk management by focusing on attributes with high net benefit values and potential to spur information dissemination.

  4. Reduced-form approach for evaluating hospital cost-containment program in paired experiment

    SciTech Connect

    Liu, B.C.

    1980-01-01

    The paper investigates the feasibility, analyzes the project benefit, and establishes the cost-1 effectiveness of the Cooperative Utilization Review Program (CURP), the action plan for cost containment proposed by the Blue Cross and Blue Shield Company. A statistical evaluation framework is developed for analyzing the effects of the CURP through control and participating hospital selection, impatient discharge data collection, and the average length of stay delineation and explanation by diagnosis. (ACR)

  5. Acquisition Reform: Contractors Can Use Technologies and Management Techniques to Reduce Costs

    DTIC Science & Technology

    1993-07-01

    industry downsizing , the Department of Defense (DOD) is planning to expand the potential of the defense industrial base by encouraging contraetors to...identified in the financial and technical literature as having used innovative technologies and techniques.2 We identified those that had achieved cost...DOD is looking at alternative means to motivate defense companies to achieve significant cost reductions, which will include a review of procurement

  6. A Preliminary Study of Reducing the Cost of Blast Shelter for Critical Workers

    DTIC Science & Technology

    1983-08-01

    23 2.1.6 Luscher Study ..... ................. .... 28 2.1.7 Krupka Study ..... ................. .... 29 2.1.9 Haaland Study...a more reasonable cost/space number had been reported. 2.1.6 Ulrich Luscher - Behavior of Flexible Underground Cylinders, 1965 This study ( Luscher ...information about the utilization of corrugated culverts as blast shelters and modes of hardening. No cost analyses were discussed by Luscher . 2.1.7 R. A

  7. Innovative, High-Pressure, Cryogenic Control Valve: Short Face-to-Face, Reduced Cost

    NASA Technical Reports Server (NTRS)

    2002-01-01

    A control valve that can throttle high-pressure cryogenic fluid embodies several design features that distinguish it over conventional valves designed for similar applications. Field and design engineers worked together to create a valve that would simplify installation, trim changes, and maintenance, thus reducing overall cost. The seals and plug stem packing were designed to perform optimally in cryogenic temperature ranges. Unlike conventional high-pressure cryogenic valves, the trim size can be changed independent of the body. The design feature that provides flexibility for changing the trim is a split body. The body is divided into an upper and a lower section with the seat ring sandwiched in between. In order to maintain the plug stem packing at an acceptable sealing temperature during cryogenic service, heat-exchanging fins were added to the upper body section. The body is made of stainless steel. The seat ring is made of a nickel-based alloy having a coefficient of thermal expansion less than that of the body material. Consequently, when the interior of the valve is cooled cryogenically, the body surrounding the seat ring contracts more than the seat ring. This feature prevents external leakage at the body-seat joint. The seat ring has been machined to have small, raised-face sealing surfaces on both sides of the seal groove. These sealing surfaces concentrate the body bolt load over a small area, thereby preventing external leakage. The design of the body bolt circle is different from that of conventional highpressure control valves. Half of the bolts clamp the split body together from the top, and half from the bottom side. This bolt-circle design allows a short, clean flow path, which minimizes frictional flow losses. This bolt-circle design also makes it possible to shorten the face-toface length of the valve, which is 25.5 in. (65 cm). In contrast, a conventional, high-pressure control valve face-to-face dimension may be greater than 40 in. (>1 m

  8. Improving efficiency and reducing costs: Design of an adaptive, seamless, and enriched pragmatic efficacy trial of an online asthma management program.

    PubMed

    Lu, Mei; Ownby, Dennis R; Zoratti, Edward; Roblin, Douglas; Johnson, Dayna; Johnson, Christine Cole; Joseph, Christine L M

    2014-05-01

    Clinical trials are critical for medical decision-making, however, under the current paradigm, clinical trials are fraught with problems including low enrollment and high cost. Promising alternatives to increase trial efficiency and reduce costs include the use of (1) electronic initiatives that permit electronic remote data capture (EDC) for direct data collection at a site (2), electronic medical records (EMR) for patient identification and data collection, and (3) adaptive, enrichment designs with pragmatic approaches. We describe the design of a seamless, multi-site randomized Phase II/III trial to evaluate an asthma management intervention in urban adolescents with asthma. Patients are randomized, asked to access four online sessions of the intervention or control asthma management program, and are then followed for one year. The primary efficacy endpoint is self-reported asthma control as measured by the Asthma Control Test (ACT). Comparative effectiveness parametric approaches are utilized to conduct the trial in a real world setting with reduced costs. Escalated electronic initiatives are implemented for patient identification, assent, enrollment and tracking. Patient enrollment takes place during primary care visits. A centralized database with EDC is used for CRF data collection with integration of EMR data. This Phase II/III trial plans to have a total sample size of 500 patients with an interim look at the completion of Phase II (n=250), The interim analyses include an assessment of the intervention effect, marker(s) identification and the feasibility study of EMR data as the trial CRF data collection. Patient enrollment has begun and is ongoing.

  9. Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them

    PubMed Central

    Read, Simon; McGale, Paul; Darby, Sarah

    2009-01-01

    Objective To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality. Design Cost effectiveness analysis. Setting United Kingdom. Data sources Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation. Main outcome measures Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality. Results The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m3). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m3 and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of £11 400 ( €12 200; $16 913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained £36 800) nor effective in reducing lung cancer mortality. Conclusions Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure

  10. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... residents spend in non-hospital provider settings such as freestanding clinics, nursing homes, and... medical education payments if all of the following conditions are met: (1) The resident spends his or her... the total number of individuals enrolled in the MA organization. (e) Direct graduate medical...

  11. Toward a treaty on safety and cost-effectiveness of pharmaceuticals and medical devices: enhancing an endangered global public good

    PubMed Central

    Faunce, Thomas Alured

    2006-01-01

    • Expert evaluations of the safety, efficacy and cost-effectiveness of pharmaceutical and medical devices, prior to marketing approval or reimbursement listing, collectively represent a globally important public good. The scientific processes involved play a major role in protecting the public from product risks such as unintended or adverse events, sub-standard production and unnecessary burdens on individual and governmental healthcare budgets. • Most States now have an increasing policy interest in this area, though institutional arrangements, particularly in the area of cost-effectiveness analysis of medical devices, are not uniformly advanced and are fragile in the face of opposing multinational industry pressure to recoup investment and maintain profit margins. • This paper examines the possibility, in this context, of States commencing negotiations toward bilateral trade agreement provisions, and ultimately perhaps a multilateral Treaty, on safety, efficacy and cost-effectiveness analysis of pharmaceuticals and medical devices. Such obligations may robustly facilitate a conceptually interlinked, but endangered, global public good, without compromising the capacity of intellectual property laws to facilitate local product innovations. PMID:16569240

  12. Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis

    PubMed Central

    Carvalho, Natalie; Gutiérrez-Delgado, Cristina; Orozco, Ricardo; Mancuso, Anna; Hogan, Daniel R; Lee, Diana; Murakami, Yuki; Sridharan, Lakshmi; Medina-Mora, María Elena; González-Pier, Eduardo

    2012-01-01

    Objective To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform. Design Cost effectiveness analysis based on epidemiological modelling. Interventions 101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes. Data sources Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature. Main outcome measures Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY. Results Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300 000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying

  13. Estimated Lifetime Medical and Work-Loss Costs of Emergency Department-Treated Nonfatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Haegerich, Tamara; Simon, Thomas; Zhou, Chao; Luo, Feijun

    2015-10-02

    A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies.

  14. Medication Management in Schools: A Systems Approach to Reducing Risk and Strengthening Quality in School Medication Management

    ERIC Educational Resources Information Center

    Center for Health and Health Care in Schools, 2004

    2004-01-01

    This paper and the invitational meeting for which it has been prepared make certain assumptions about the challenge of strengthening the quality of medication management in school. The participants believe that recent research on improving the safety and quality of patient care has relevance for health services in school, particularly the safety…

  15. Solution of resource allocation problem for identification of cost-effective measures to reduce nuclear proliferation risks

    SciTech Connect

    Andrianov, A.; Kuptsov, I.

    2013-07-01

    This report presents a methodology of selection of cost-effective measures to reduce nuclear proliferation risks. The methodology relies on a graded security model used in practice in different applications. The method is based on the controlled finite Markov chain approach set in combination with discrete dynamic programming and MCDM (Multi Criteria Decision Making) techniques that enables the expert to select the cost-effective measures to reduce nuclear proliferation risks depending on availability of resources. The analysis performed with different number of possible measures confirms the conclusions that the implementation of extra-large costs may not produce the required effect, and the increase in resources above a certain level does not appear sensitive. Diversification in improving the effectiveness of other measures seems more rational and efficient for the whole system than the unlimited improvement of the effectiveness of only one measure.

  16. 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.

  17. A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

    PubMed

    Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

    2017-01-20

    Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

  18. ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.

    PubMed

    Paradis, Pierre Emmanuel; Nemis-White, Joanna; Meilleur, Marie-Claude; Ginn, Marissa; Cox, Jafna; Montague, Terrence

    2010-01-01

    Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure. Over the five-year course of ICONS, one-year readmissions and readmission rates fell continuously for both index disease states. Despite a general inflationary rise in real hospital costs, the per-event cost of readmissions expressed in constant 2002 dollars also decreased: from $10,377 in 1997 to $9,022 in 2002 for the heart attack patient population; and from $9,020 to $8,697 for patients with heart failure. Total real yearly costs for heart attack readmissions fell from $7.4 million in 1997 to $6.4 million in 2002, a 14% decrease; for heart failure, yearly costs decreased by 26%, from $9.2 million to $6.8 million. These microeconomic data supplement the previously reported improvements in patient care and the positive macroeconomic impact of ICONS. Overall, ICONS demonstrated that quality and cost of healthcare could be simultaneously and successfully managed over a sustained period of time for whole patient populations in a real-world setting. ICONS offers strong evidence of the value of the partnership-measurement model of disease management and prevention as a reproducible and desirable template for next-generation healthcare in Canada.

  19. Reducing the risk of injury from table saw use: the potential benefits and costs of automatic protection.

    PubMed

    Graham, John D; Chang, Joice

    2015-02-01

    The use of table saws in the United States is associated with approximately 28,000 emergency department (ED) visits and 2,000 cases of finger amputation per year. This article provides a quantitative estimate of the economic benefits of automatic protection systems that could be designed into new table saw products. Benefits are defined as reduced health-care costs, enhanced production at work, and diminished pain and suffering. The present value of the benefits of automatic protection over the life of the table saw are interpreted as the switch-point cost value, the maximum investment in automatic protection that can be justified by benefit-cost comparison. Using two alternative methods for monetizing pain and suffering, the study finds switch-point cost values of $753 and $561 per saw. These point estimates are sensitive to the values of inputs, especially the average cost of injury. The various switch-point cost values are substantially higher than rough estimates of the incremental cost of automatic protection systems. Uncertainties and future research needs are discussed.

  20. Cost-effectiveness of a community-based intervention for reducing the transmission of Schistosoma haematobium and HIV in Africa

    PubMed Central

    Ndeffo Mbah, Martial L.; Kjetland, Eyrun F.; Atkins, Katherine E.; Poolman, Eric M.; Orenstein, Evan W.; Meyers, Lauren Ancel; Townsend, Jeffrey P.; Galvani, Alison P.

    2013-01-01

    Epidemiological studies from sub-Saharan Africa show that genital infection with Schistosoma haematobium may increase the risk for HIV infection in young women. Therefore, preventing schistosomiasis has the potential to reduce HIV transmission in sub-Saharan Africa. We developed a transmission model of female genital schistosomiasis and HIV infections that we fit to epidemiological data of HIV and female genital schistosomiasis prevalence and coinfection in rural Zimbabwe. We used the model to evaluate the cost-effectiveness of a multifaceted community-based intervention for preventing schistosomiasis and, consequently, HIV infections in rural Zimbabwe, from the perspective of a health payer. The community-based intervention combined provision of clean water, sanitation, and health education (WSH) with administration of praziquantel to school-aged children. Considering variation in efficacy between 10% and 70% of WSH for reducing S. haematobium transmission, our model predicted that community-based intervention is likely to be cost-effective in Zimbabwe at an aggregated WSH cost corresponding to US $725–$1,000 per individual over a 20-y intervention period. These costs compare favorably with empirical measures of WSH provision in developing countries, indicating that integrated community-based intervention for reducing the transmission of S. haematobium is an economically attractive strategy for reducing schistosomiasis and HIV transmission in sub-Saharan Africa that would have a powerful impact on averting infections and saving lives. PMID:23589884