Counterfeit Parts: DOD Needs to Improve Reporting and Oversight to Reduce Supply Chain Risk

DTIC Science & Technology

2016-02-01

the cost accounting standards board under 41 U.S.C. § 1502. 8DOD implemented its cost principle that costs are not allowable unless 1) the...February 2016 GAO-16-236 United States Government Accountability Office United States Government Accountability Office Highlights of GAO-16-236, a...apply to prime contractors subject to cost accounting standards on acquisitions other than small business set-asides. The cost accounting standards are

Cost-effectiveness of alternative changes to a national blood collection service.

PubMed

Willis, S; De Corte, K; Cairns, J A; Zia Sadique, M; Hawkins, N; Pennington, M; Cho, G; Roberts, D J; Miflin, G; Grieve, R

2018-05-16

To evaluate the cost-effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter-donation interval for donors attending static centres. Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. This study estimated the effect of changes to the blood collection service in England on the annual number of whole-blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost-effective. In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter-donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost-effective change is to extend opening hours for blood collection at static centres. © 2018 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.

Elements of Designing for Cost

NASA Technical Reports Server (NTRS)

Dean, Edwin B.; Unal, Resit

1992-01-01

During recent history in the United States, government systems development has been performance driven. As a result, systems within a class have experienced exponentially increasing cost over time in fixed year dollars. Moreover, little emphasis has been placed on reducing cost. This paper defines designing for cost and presents several tools which, if used in the engineering process, offer the promise of reducing cost. Although other potential tools exist for designing for cost, this paper focuses on rules of thumb, quality function deployment, Taguchi methods, concurrent engineering, and activity based costing. Each of these tools has been demonstrated to reduce cost if used within the engineering process.

Elements of designing for cost

NASA Technical Reports Server (NTRS)

Dean, Edwin B.; Unal, Resit

1992-01-01

During recent history in the United States, government systems development has been performance driven. As a result, systems within a class have experienced exponentially increasing cost over time in fixed year dollars. Moreover, little emphasis has been placed on reducing cost. This paper defines designing for cost and presents several tools which, if used in the engineering process, offer the promise of reducing cost. Although other potential tools exist for designing for cost, this paper focuses on rules of thumb, quality function deployment, Taguchi methods, concurrent engineering, and activity-based costing. Each of these tools has been demonstrated to reduce cost if used within the engineering process.

Statistical Power and Optimum Sample Allocation Ratio for Treatment and Control Having Unequal Costs Per Unit of Randomization

ERIC Educational Resources Information Center

Liu, Xiaofeng

2003-01-01

This article considers optimal sample allocation between the treatment and control condition in multilevel designs when the costs per sampling unit vary due to treatment assignment. Optimal unequal allocation may reduce the cost from that of a balanced design without sacrificing any power. The optimum sample allocation ratio depends only on the…

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

PubMed

Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Use Hardwoods for Building Components

Treesearch

Glenn A. Cooper; William W. Rice

1968-01-01

Describes a system for prefabricating structural units from hardwoods for use in floors, roofs, and walls of a-frame or post-and-beam type construction. The interior face of the unit is decorative paneling; the exterior face is sheathing. Use of the system could reduce prefabricated house construction costs compared to conventional construction costs.

The National Shipbuilding Research Program. Application of Industrial Engineering Techniques to Reduce Worker’s Compensation and Environmental Costs - Deliverable A

DTIC Science & Technology

1999-10-01

N8-96-3 Application of Industrial Engineering Techniques to Reduce Workers ’ Compensation and Environmental Costs - Deliverable A U.S. DEPARTMENT OF...disclosed in the report. As used in the above, “Persons acting on behalf of the United States Navy” includes any employee , contractor, or subcontractor to...the contractor of the United States Navy to the extent that such employee , contractor, or subcontractor to the contractor prepares, handles, or

Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital

PubMed Central

2013-01-01

Background A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a ‘reader’. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. Methods The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. Results Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). Conclusions Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits of the smartcard service, there is also scope to extend its use in a hospital setting to include the notification of patient arrival and use in other departments. PMID:23763904

Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital.

PubMed

Chu, Kuan-Yu; Huang, Chunmin

2013-06-13

A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a 'reader'. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits of the smartcard service, there is also scope to extend its use in a hospital setting to include the notification of patient arrival and use in other departments.

End-of-Life Care in the Intensive Care Unit

PubMed Central

Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

2012-01-01

The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

Reductions in U.S. Costs to Station Forces in the Federal Republic of Germany and the United Kingdom Are Unlikely.

DTIC Science & Technology

1984-07-31

AD-A144 501 REDUCTIONS IN US COSTS TO STATION FORCES IN THE FEDERAL i/’i REPUBLIC OF GERMA..(U) GENERAL ACCOUNTING OFFICE WASHINGTON DC RESOURCES...COMPTROLLER GENERAL Report To The Chairman Subcommittee On Defense, Senate p Committee On Appropriations OF THE UNITED STATES 0 lot Reductions In U.S. Costs To...reducing the costs of sta- tioning U.S. Forces in Europe through in- creased cost sharing by the European allies. The Federal Republic of Germany and

Can academic radiology departments become more efficient and cost less?

PubMed

Seltzer, S E; Saini, S; Bramson, R T; Kelly, P; Levine, L; Chiango, B F; Jordan, P; Seth, A; Elton, J; Elrick, J; Rosenthal, D; Holman, B L; Thrall, J H

1998-11-01

To determine how successful two large academic radiology departments have been in responding to market-driven pressures to reduce costs and improve productivity by downsizing their technical and support staffs while maintaining or increasing volume. A longitudinal study was performed in which benchmarking techniques were used to assess the changes in cost and productivity of the two departments for 5 years (fiscal years 1992-1996). Cost per relative value unit and relative value units per full-time equivalent employee were tracked. Substantial cost reduction and productivity enhancement were realized as linear improvements in two key metrics, namely, cost per relative value unit (decline of 19.0% [decline of $7.60 on a base year cost of $40.00] to 28.8% [$12.18 of $42.21]; P < or = .001) and relative value unit per full-time equivalent employee (increase of 46.0% [increase of 759.55 units over a base year productivity of 1,651.45 units] to 55.8% [968.28 of 1,733.97 units]; P < .001), during the 5 years of study. Academic radiology departments have proved that they can "do more with less" over a sustained period.

Technological development and medical productivity: the diffusion of angioplasty in New York state.

PubMed

Cutler, David M; Huckman, Robert S

2003-03-01

A puzzling feature of many medical innovations is that they simultaneously appear to reduce unit costs and increase total costs. We consider this phenomenon by examining the diffusion of percutaneous transluminal coronary angioplasty (PTCA)--a treatment for coronary artery disease--over the past two decades. We find that growth in the use of PTCA led to higher total costs despite its lower unit cost. Over the two decades following PTCA's introduction, however, we find that the magnitude of this increase was reduced by between 10 and 20% due to the substitution of PTCA for CABG. In addition, the increased use of PTCA appears to be a productivity improvement. PTCAs that substitute for CABG cost less and have the same or better outcomes, while PTCAs that replace medical management appear to improve health by enough to justify the cost. Copyright 2003 Elsevier Science B.V.

Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.

PubMed

Schutte, Carl; Tshimanga, M; Mugurungi, Owen; Come, Iotamo; Necochea, Edgar; Mahomed, Mehebub; Xaba, Sinokuthemba; Bossemeyer, Debora; Ferreira, Thais; Macaringue, Lucinda; Chatikobo, Pessanai; Gundididza, Patricia; Hatzold, Karin

2016-06-01

The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique. The studies calculated per male circumcision unit costs using a cost-analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated. The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique. PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

PubMed

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S.

PubMed

Long, Michael W; Gortmaker, Steven L; Ward, Zachary J; Resch, Stephen C; Moodie, Marj L; Sacks, Gary; Swinburn, Boyd A; Carter, Rob C; Claire Wang, Y

2015-07-01

Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years. A cohort model was used to simulate the impact of the tax on BMI. Assuming ongoing implementation and effect maintenance, quality-adjusted life-years gained and disability-adjusted life-years and healthcare costs averted were estimated over the 2015-2025 period for the 2015 U.S. Costs and health gains were discounted at 3% annually. Data were analyzed in 2014. Implementing the tax nationally would cost $51 million in the first year. The tax would reduce sugar-sweetened beverage consumption by 20% and mean BMI by 0.16 (95% uncertainty interval [UI]=0.06, 0.37) units among youth and 0.08 (95% UI=0.03, 0.20) units among adults in the second year for a cost of $3.16 (95% UI=$1.24, $8.14) per BMI unit reduced. From 2015 to 2025, the policy would avert 101,000 disability-adjusted life-years (95% UI=34,800, 249,000); gain 871,000 quality-adjusted life-years (95% UI=342,000, 2,030,000); and result in $23.6 billion (95% UI=$9.33 billion, $54.9 billion) in healthcare cost savings. The tax would generate $12.5 billion in annual revenue (95% UI=$8.92, billion, $14.1 billion). The proposed tax could substantially reduce BMI and healthcare expenditures and increase healthy life expectancy. Concerns regarding the potentially regressive tax may be addressed by reduced obesity disparities and progressive earmarking of tax revenue for health promotion. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Improving quality of life in multiple sclerosis: an unmet need.

PubMed

Zwibel, Howard L; Smrtka, Jennifer

2011-05-01

Multiple sclerosis (MS) affects approximately 400,000 people in the United States and 2.1 million people worldwide. It is the most common chronic, non-traumatic neurological disorder afflicting young people during their peak productive ages. MS can diminish quality of life (QOL) by interfering with the ability to work, pursue leisure activities, and carry on usual life roles. Symptoms that affect QOL may include impaired mobility, fatigue, depression, pain, spasticity, cognitive impairment, sexual dysfunction, bowel and bladder dysfunction, vision and hearing problems, seizures, and sDwallowing and breathing difficulties. Direct medical costs of MS in the United States are estimated in excess of $10 billion per year. Indirect costs of MS include costs of reduced employment or unemployment, assistive equipment, disability related home modifications, and paid and unpaid personal care. Although direct medical costs predominate in the earlier stages of MS, indirect costs of productivity loss are responsible for higher costs later. Disease-modifying therapies (DMTs) lessen symptoms, reduce relapses, and delay disability progression. Unfortunately, many DMTs might produce only modest improvements in QOL. Although symptom-specific therapies do not delay disease progression, they may delay unemployment and dependency, thereby reducing indirect costs.

Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit.

PubMed

Rabin, Joseph; Meyenburg, Timothy; Lowery, Ashleigh V; Rouse, Michael; Gammie, James S; Herr, Daniel

2017-07-01

Volume expansion is often necessary after cardiac surgery, and albumin is often administered. Albumin's high cost motivated an attempt to reduce its utilization. This study analyzes the impact limiting albumin infusion in a cardiac surgery intensive care unit. This retrospective study analyzed albumin use between April 2014 and April 2015 in patients admitted to a cardiac surgery intensive care unit. During the first 9 months, there were no restrictions. In January 2015, institutional guidelines limited albumin use to patients requiring more than 3 L crystalloid in the early postoperative period, hypoalbuminemic patients, and to patients considered fluid overloaded. Albumin utilization was obtained from pharmacy records and compared with outcome quality metrics. In all, 1,401 patients were admitted over 13 months. Albumin use, mortality, ventilator days, patients receiving transfusions, and length of stay were compared for 961 patients before and 440 patients after guidelines were initiated. After restrictive guidelines were instituted, albumin utilization was reduced from a mean of 280 monthly doses to a mean of 101 monthly doses (p < 0.001). There was also a trend toward reduced ventilator days. Mortality, length of stay, and transfusion requirements demonstrated no significant change. Based on an average wholesale price and an average monthly reduction of 180 albumin doses, the cardiac surgery intensive care unit demonstrated more than $45,000 of wholesale savings per month after restrictions were implemented. Albumin restriction in the cardiac surgery intensive care unit was feasible and safe. Significant reductions in utilization and cost with no changes in morbidity or mortality were demonstrated. These findings may provide a strategy for reducing cost while maintaining quality of care. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Healthcare "just around the corner": the role of geographic distribution strategies and healthcare costs.

PubMed

Keegan, Deborah Walker

2010-01-01

Proponents of the healthcare reform agenda continually compare per capita healthcare spending in the United States to other nations and cite this as one of the clear mandates for healthcare reform. The purpose of this article is to draw attention to the cost of geographic distribution strategies adopted by healthcare organizations and the impact this has on per capita healthcare costs. It is important to quantify the cost of such strategies and to weigh their merits, if the intent is to substantially reduce the cost of healthcare in the United States.

Learning and forgetting in the jet fighter aircraft industry.

PubMed

Bongers, Anelí

2017-01-01

A recent strategy carried out by the aircraft industry to reduce the total cost of the new generation fighters has consisted in the development of a single airframe with different technical and operational specifications. This strategy has been designed to reduce costs in the Research, Design and Development phase with the ultimate objective of reducing the final unit price per aircraft. This is the case of the F-35 Lightning II, where three versions, with significant differences among them, are produced simultaneously based on a single airframe. Whereas this strategy seems to be useful to cut down pre-production sunk costs, their effects on production costs remain to be studied. This paper shows that this strategy can imply larger costs in the production phase by reducing learning acquisition and hence, the total effect on the final unit price of the aircraft is indeterminate. Learning curves are estimated based on the flyaway cost for the latest three fighter aircraft models: The A/F-18E/F Super Hornet, the F-22A Raptor, and the F-35A Lightning II. We find that learning rates for the F-35A are significantly lower (an estimated learning rate of around 9%) than for the other two models (around 14%).

Learning and forgetting in the jet fighter aircraft industry

PubMed Central

2017-01-01

A recent strategy carried out by the aircraft industry to reduce the total cost of the new generation fighters has consisted in the development of a single airframe with different technical and operational specifications. This strategy has been designed to reduce costs in the Research, Design and Development phase with the ultimate objective of reducing the final unit price per aircraft. This is the case of the F-35 Lightning II, where three versions, with significant differences among them, are produced simultaneously based on a single airframe. Whereas this strategy seems to be useful to cut down pre-production sunk costs, their effects on production costs remain to be studied. This paper shows that this strategy can imply larger costs in the production phase by reducing learning acquisition and hence, the total effect on the final unit price of the aircraft is indeterminate. Learning curves are estimated based on the flyaway cost for the latest three fighter aircraft models: The A/F-18E/F Super Hornet, the F-22A Raptor, and the F-35A Lightning II. We find that learning rates for the F-35A are significantly lower (an estimated learning rate of around 9%) than for the other two models (around 14%). PMID:28957359

A cost management model for hospital food and nutrition in a public hospital.

PubMed

Neriz, Liliana; Núñez, Alicia; Ramis, Francisco

2014-11-13

In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

Fraction-storage unit for drug-identification system

NASA Technical Reports Server (NTRS)

Campen, C. F.; Stuart, J. L.

1976-01-01

Device, connecting outputs of all gas chromatographs to single, relatively inexpensive IR spectrometer, reduces costs of system. Storage unit provides buffer storage of samples until infrared spectrometer is ready to accept them. Storage unit can be used to separate overlapping peaks.

Reducing Operating Costs by Optimizing Space in Facilities

DTIC Science & Technology

2012-03-01

Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

Oxygen cost during exercise in simulated subgravity environments

NASA Technical Reports Server (NTRS)

Fox, E. L.; Bartels, R. L.; Chaloupka, E. C.; Klinzing, J. E.; Hoche, J.

1975-01-01

Oxygen cost (VO2) and heart rate (HR) were determined during treadmill walking in simulated subgravity environments. The long axis of the subject's body was suspended parallel to the floor in a slow rotation room with feet aligned on the surface of a treadmill mounted 90 deg on the wall. Without rotation, the subjects were virtually weightless against the treadmill; with centrifugation, environments of 0.25, 0.5 and 1 G were simulated. Oxygen cost (open circuit) and HR (ECG) were measured during the 5th minute of walking at 3.2, 4.7 and 6.1 km/h. Similar measurements were also determined during walking at 1/2-G using the inclined plane technique. Oxygen cost per unit mass and HR were significantly reduced in all subgravity environments. However, net oxygen cost per unit weight carried and, therefore, mechanical efficiency was found to be independent of gravity. This supports the idea that the most probable cause for the decreased oxygen cost with reduced gravity is less body weight carried.

Activity-based costing in radiology. Application in a pediatric radiological unit.

PubMed

Laurila, J; Suramo, I; Brommels, M; Tolppanen, E M; Koivukangas, P; Lanning, P; Standertskjöld-Nordenstam, G

2000-03-01

To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Using cost-effectiveness analysis to support research and development portfolio prioritization for product innovations in measles vaccination.

PubMed

Garrison, Louis P; Bauch, Chris T; Bresnahan, Brian W; Hazlet, Tom K; Kadiyala, Srikanth; Veenstra, David L

2011-07-01

Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions. This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children's Fund countries through 2049. Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million. Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

Cost-Benefit Analysis of Telemedicine Systems/Units in Greek Remote Areas.

PubMed

Kouskoukis, Marios-Nikolaos; Botsaris, Charalambos

2017-06-01

Telemedicine units and information technology systems provide special healthcare services to remote populations using telecommunication technology, in order to reduce or even remove the usual and typical face-to-face contact between doctor and patient. This innovative approach to medical care delivery has been expanding for several years and currently covers various medical specialties. To facilitate installation of telemedicine systems/units in Greek remote areas, this article presents results of a cost-benefit analysis for two Greek islands, Patmos and Leros, using specific economic criteria. Net present value (NPV), internal rate of return (IRR), and payback period were calculated, in order to monetize the economic benefits and the costs savings, estimate the depreciation of each project, and highlight the social benefits. Costs were reduced (through saved air medical transportations) by €19,005 for Patmos and €78,225 for Leros each year. NPV and IRR were positive; NPV was €29,608 for Patmos and €293,245 for Leros, and IRR was 21.5% for Patmos and 140.5% for Leros. Each project depreciated faster than the 5-year life-cycle period, and specifically in 3.13 years for Patmos and in 0.70 years for Leros. The establishment of telemedicine systems/units in Patmos and Leros was evaluated and assessed positively, with large savings, economical and social, gained by reducing or even removing the face-to-face contact between doctor and patient. Telemedicine systems/units seem to be a promising solution, especially in Greece, where the problem of primary healthcare services in remote/inaccessible areas is of great concern.

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:…

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

PubMed Central

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry.

PubMed

Manchanda, Ranjit; Patel, Shreeya; Antoniou, Antonis C; Levy-Lahad, Ephrat; Turnbull, Clare; Evans, D Gareth; Hopper, John L; Macinnis, Robert J; Menon, Usha; Jacobs, Ian; Legood, Rosa

2017-11-01

Population-based BRCA1/BRCA2 testing has been found to be cost-effective compared with family history-based testing in Ashkenazi-Jewish women were >30 years old with 4 Ashkenazi-Jewish grandparents. However, individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing for women with 1, 2, and 3 Ashkenazi-Jewish grandparents. Decision analysis model. Lifetime costs and effects of population and family history-based testing were compared with the use of a decision analysis model. 56% BRCA carriers are missed by family history criteria alone. Analyses were conducted for United Kingdom and United States populations. Model parameters were obtained from the Genetic Cancer Prediction through Population Screening trial and published literature. Model parameters and BRCA population prevalence for individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the relative frequency of BRCA mutations in the Ashkenazi-Jewish and general populations. Incremental cost-effectiveness ratios were calculated for all Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were discounted at 3.5%. The time horizon of the analysis is "life-time," and perspective is "payer." Probabilistic sensitivity analysis evaluated model uncertainty. Population testing for BRCA mutations is cost-saving in Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the United States populations, respectively. It is also extremely cost-effective in women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an incremental cost-effectiveness ratio of £863 per quality-adjusted life-years and 15 days life gained. Results show that population-testing remains cost-effective at the £20,000-30000 per quality-adjusted life-years and $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 Ashkenazi-Jewish grandparent scenarios, with ≥95% simulations found to be cost-effective on probabilistic sensitivity analysis. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower risk-reducing mastectomy (13%) or risk-reducing salpingo-oophorectomy (20%) rates. Population testing for BRCA mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in the United Kingdom and the United States. These results support population testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost and price estimate of Brayton and Stirling engines in selected production volumes

NASA Technical Reports Server (NTRS)

Fortgang, H. R.; Mayers, H. F.

1980-01-01

The methods used to determine the production costs and required selling price of Brayton and Stirling engines modified for use in solar power conversion units are presented. Each engine part, component and assembly was examined and evaluated to determine the costs of its material and the method of manufacture based on specific annual production volumes. Cost estimates are presented for both the Stirling and Brayton engines in annual production volumes of 1,000, 25,000, 100,000 and 400,000. At annual production volumes above 50,000 units, the costs of both engines are similar, although the Stirling engine costs are somewhat lower. It is concluded that modifications to both the Brayton and Stirling engine designs could reduce the estimated costs.

Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study

PubMed Central

Eichler, Klaus; Hess, Sascha; Chmiel, Corinne; Bögli, Karin; Sidler, Patrick; Senn, Oliver; Rosemann, Thomas; Brügger, Urs

2014-01-01

Background Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. Methods From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year. Results The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers. Conclusions From the health-economic point of view, our new service model shows ‘dominance’ over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase. PMID:23850883

The Idaho dedicated education unit model: cost-effective, high-quality education.

PubMed

Springer, Pamela J; Johnson, Patricia; Lind, Bonnie; Walker, Eldon; Clavelle, Joanne; Jensen, Nancy

2012-01-01

Faculty face many challenges in delivering clinical education, including faculty availability, the complexity of the faculty role, and limited clinical placements. Dedicated education units (DEUs) are being explored as alternatives to traditional clinical placement models. The authors describe the successful development of a DEU that resulted in positive student outcomes at reduced cost to both the school and the medical center.

Stabilization of gas turbine unit power

NASA Astrophysics Data System (ADS)

Dolotovskii, I.; Larin, E.

2017-11-01

We propose a new cycle air preparation unit which helps increasing energy power of gas turbine units (GTU) operating as a part of combined cycle gas turbine (CCGT) units of thermal power stations and energy and water supply systems of industrial enterprises as well as reducing power loss of gas turbine engines of process blowers resulting from variable ambient air temperatures. Installation of GTU power stabilizer at CCGT unit with electric and thermal power of 192 and 163 MW, respectively, has resulted in reduction of produced electrical energy production costs by 2.4% and thermal energy production costs by 1.6% while capital expenditures after installation of this equipment increased insignificantly.

The economics of dementia-care mapping in nursing homes: a cluster-randomised controlled trial.

PubMed

van de Ven, Geertje; Draskovic, Irena; van Herpen, Elke; Koopmans, Raymond T C M; Donders, Rogier; Zuidema, Sytse U; Adang, Eddy M M; Vernooij-Dassen, Myrra J F J

2014-01-01

Dementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes. Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units. 34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0.05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0.02). DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they adopt the DCM method. Dutch Trials Registry NTR2314.

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

PubMed

Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

2010-04-01

Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

Modeling fuel treatment costs on Forest Service Lands in the Western United States

Treesearch

David Calkin; Krista Gebert

2006-01-01

Years of successful fire suppression have led to high fuel loads on the nation's forests, and steps are being taken by the nation's land management agencies to reduce these fuel loads. However, to achieve desired outcomes in a fiscally responsible manner, the cost and effectiveness in reducing losses due to wildland fire of different fuel treatments in...

On the socioeconomic benefits of family planning work.

PubMed

Yang, D

1991-01-01

The focus of this article is on 1) the intended socioeconomic benefit of Chinese family planning (FP) versus the benefit of the maternal production sector, 2) the estimated costs of FP work, 3) and the principal ways to lower FP costs. Marxian population theory, which is ascribed to in socialist China, states that population and socioeconomic development are interconnected and must adapt to each other and that an excessively large or small population will upset the balance and retard development. Malthusians believe that large populations reduce income, and Adam Smith believed that more people meant a larger market and more income. It is believed that FP will bring socioeconomic benefits to China. The socioeconomic benefit of material production is the linkage between labor consumption and the amount of labor usage with the fruits and benefits of labor. FP invests in human, material, and financial resources to reduce the birth rate and the absolute number of births. The investment is recouped in population. The increased national income generated from a small outlay to produce an ideal population would be used to improve material and cultural lives. FP brings economic benefits and accelerates social development (ecological balances women's emancipation and improvement in the physical and mental health of women and children, improvement in cultural learning and employment, cultivation of socialist morality and new practices, and stability). In computing FP cost, consideration is given to total cost and unit cost. Cost is dependent on the state budget allocation, which was 445.76 million yuan in 1982 and was doubled by 1989. World Bank figures for 1984 affixed the FP budget in China at 979.6 million US dollars, of which 80% was provided by China. Per person, this means 21 cents for central, provincial, prefecture, and country spending, 34 cents for rural collective set-ups, 25 cents for child awards, and various subsidies, 15 cents for sterilization, and 5 cents for rural medical services, or 1 US dollar/person. Unit costs are the costs to reduce the population of one and include direct and indirect costs. The unit cost between 1970-82 was 35.5 yuan, but if outlays for families and industrial units are included, the cost was 70-100 yuan. Population growth, however, must be balanced so that aging does not cancel out the benefits from FP gains. Lower costs can be achieved by better FP administration.

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

Townsend, M.W.

The Monsanto Chemical Company operates a plastics and resins plant located in Addyston, Ohio. The process equipment requires routine rinsing with technical grade acetone between batches. Due to the volumes of spent acetone generated and the associated RCRA hazardous waste regulations, the plant sought to recycle and reuse the acetone to reduce the purchase cost of virgin acetone and the cost of spent acetone disposal. One of the first options explored was package unit distillation units. The cost of these units was in the $20--$30,000 range in 1989 dollars. Even though the cost of a package unit was not deemedmore » unreasonable, there were additional costs and concerns that led to elimination of this option. The unit would have required additional manpower to operate and maintain, i.e., at least a fraction of an operator and mechanic. For plant safety reasons, it was desired to operate this package unit outside the production building, thus construction of an outbuilding would have added to the expense of the project. Additionally, there were concerns of package unit reliability. During this evaluation, tractor-trailer mounted distillation units were discovered. The portable units were equipped with either thin-film evaporator technology capable of processing 240 to 480 gallons per hour, or pot still (batch) distillation technology capable of rates from 120 to 240 gallons per hour. Both units were constructed of stainless steel.« less

Optimal tracking and testing of U.S. and Canadian herds for BSE: a value-of-information (VOI) approach.

PubMed

Cox, Louis Anthony; Popken, Douglas A; VanSickle, John J; Sahu, Ranajit

2005-08-01

The U.S. Department of Agriculture (USDA) tests a subset of cattle slaughtered in the United States for bovine spongiform encephalitis (BSE). Knowing the origin of cattle (U.S. vs. Canadian) at testing could enable new testing or surveillance policies based on the origin of cattle testing positive. For example, if a Canadian cow tests positive for BSE, while no U.S. origin cattle do, the United States could subject Canadian cattle to more stringent testing. This article illustrates the application of a value-of-information (VOI) framework to quantify and compare potential economic costs to the United States of implementing tracking cattle origins to the costs of not doing so. The potential economic value of information from a tracking program is estimated to exceed its costs by more than five-fold if such information can reduce future losses in export and domestic markets and reduce future testing costs required to reassure or win back customers. Sensitivity analyses indicate that this conclusion is somewhat robust to many technical, scientific, and market uncertainties, including the current prevalence of BSE in the United States and/or Canada and the likely reactions of consumers to possible future discoveries of BSE in the United States and/or Canada. Indeed, the potential value of tracking information is great enough to justify locating and tracking Canadian cattle already in the United States when this can be done for a reasonable cost. If aggressive tracking and testing can win back lost exports, then the VOI of a tracking program may increase to over half a billion dollars per year.

26 CFR 1.42-16 - Eligible basis reduced by federal grants.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the owner has agreed to maintain as public housing units (PH-units) in the building; (2) Are made with... difference between the rents received from a building's PH-unit tenants and a pro rata portion of the building's actual operating costs that are reasonably allocable to the PH-units (based on square footage...

26 CFR 1.42-16 - Eligible basis reduced by federal grants.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the owner has agreed to maintain as public housing units (PH-units) in the building; (2) Are made with... difference between the rents received from a building's PH-unit tenants and a pro rata portion of the building's actual operating costs that are reasonably allocable to the PH-units (based on square footage...

26 CFR 1.42-16 - Eligible basis reduced by federal grants.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the owner has agreed to maintain as public housing units (PH-units) in the building; (2) Are made with... difference between the rents received from a building's PH-unit tenants and a pro rata portion of the building's actual operating costs that are reasonably allocable to the PH-units (based on square footage...

26 CFR 1.42-16 - Eligible basis reduced by federal grants.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the owner has agreed to maintain as public housing units (PH-units) in the building; (2) Are made with... difference between the rents received from a building's PH-unit tenants and a pro rata portion of the building's actual operating costs that are reasonably allocable to the PH-units (based on square footage...

26 CFR 1.42-16 - Eligible basis reduced by federal grants.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the owner has agreed to maintain as public housing units (PH-units) in the building; (2) Are made with... difference between the rents received from a building's PH-unit tenants and a pro rata portion of the building's actual operating costs that are reasonably allocable to the PH-units (based on square footage...

Statin cost-effectiveness in the United States for people at different vascular risk levels.

PubMed

2009-03-01

Statins reduce the rates of heart attacks, strokes, and revascularization procedures (ie, major vascular events) in a wide range of circumstances. Randomized controlled trial data from 20,536 adults have been used to estimate the cost-effectiveness of prescribing statin therapy in the United States for people at different levels of vascular disease risk and to explore whether wider use of generic statins beyond the populations currently recommended for treatment in clinical guidelines is indicated. Randomized controlled trial data, an internally validated vascular disease model, and US costs of statin therapy and other medical care were used to project lifetime risks of vascular events and evaluate the cost-effectiveness of 40 mg simvastatin daily. For an average of 5 years, allocation to simvastatin reduced the estimated US costs of hospitalizations for vascular events by approximately 20% (95% CI, 15 to 24) in the different subcategories of participants studied. At a daily cost of $1 for 40 mg generic simvastatin, the estimated costs of preventing a vascular death within the 5-year study period ranged from a net saving of $1300 (95% CI, $15,600 saving to $13,200 cost) among participants with a 42% 5-year major vascular event risk to a net cost of $216,500 ($123,700 to $460,000 cost) among those with a 12% 5-year risk. The costs per life year gained with lifetime simvastatin treatment ranged from $2500 (-$40 to $3820) in people aged 40 to 49 years with a 42% 5-year major vascular event risk to $10,990 ($9430 to $14,700) in people aged 70 years and older with a 12% 5-year risk. Treatment with generic simvastatin appears to be cost-effective for a much wider population in the United States than that recommended by current guidelines.

Relation of weather forecasts to the prediction of dangerous forest fire conditions

Treesearch

R. H. Weidman

1923-01-01

The purpose of predicting dangerous forest-fire conditions, of course, is to reduce the great cost and damage caused by forest fires. In the region of Montana and northern Idaho alone the average cost to the United States Forest Service of fire protection and suppression is over $1,000,000 a year. Although the causes of forest fires will gradually be reduced by...

Miniature rotary actuator

NASA Technical Reports Server (NTRS)

Fink, R. A.; Ellis, R. C.

1996-01-01

The trend toward smaller satellites has challenged component manufacturers to reduce the size, weight, and cost of their products while maintaining high performance. Both a new stepper motor and a new harmonic drive were developed to meet this need. The resulting actuator embodies small angle stepper technology usually reserved for larger units and incorporates an integral approach to harmonic drive design. By product simplifications, costs were significantly reduced over prior designs.

Minnesota urban partnership agreement national evaluation : cost benefit analysis test plan.

DOT National Transportation Integrated Search

2009-11-17

This report presents the cost benefit analysis test plan for the Minnesota Urban Partnership Agreement (UPA) under the United States Department of Transportation (U.S. DOT) UPA Program. The Minnesota UPA projects focus on reducing congestion by emplo...

Economic evaluation of the DiAMOND randomized trial: cost and outcomes of 2 decision aids for mode of delivery among women with a previous cesarean section.

PubMed

Hollinghurst, Sandra; Emmett, Clare; Peters, Tim J; Watson, Helen; Fahey, Tom; Murphy, Deirdre J; Montgomery, Alan

2010-01-01

Maternal preferences should be considered in decisions about mode of delivery following a previous cesarean, but risks and benefits are unclear. Decision aids can help decision making, although few studies have assessed costs in conjunction with effectiveness. Economic evaluation of 2 decision aids for women with 1 previous cesarean. Cost-consequences analysis. Data sources were self-reported resource use and outcome and published national unit costs. The target population was women with 1 previous cesarean. The time horizon was 37 weeks' gestation and 6 weeks postnatal. The perspective was health care delivery system. The interventions were usual care, usual care plus an information program, and usual care plus a decision analysis program. The outcome measures were costs to the National Health Service (NHS) in the United Kingdom (UK), score on the Decisional Conflict Scale, and mode of delivery. RESULTS OF MAIN ANALYSIS: Cost of delivery represented 84% of the total cost; mode of delivery was the most important determinant of cost differences across the groups. Mean (SD) total cost per mother and baby: 2033 (677) for usual care, 2069 (738) for information program, and 2019 (741) for decision analysis program. Decision aids reduced decisional conflict. Women using the decision analysis program had fewest cesarean deliveries. Applying a cost premium to emergency cesareans over electives had little effect on group comparisons. Conclusions were unaffected. Disparity in timing of outcomes and costs, data completeness, and quality. Decision aids can reduce decisional conflict in women with a previous cesarean section when deciding on mode of delivery. The information program could be implemented at no extra cost to the NHS. The decision analysis program might reduce the rate of cesarean sections without any increase in costs.

Automated drug dispensing systems in the intensive care unit: a financial analysis.

PubMed

Chapuis, Claire; Bedouch, Pierrick; Detavernier, Maxime; Durand, Michel; Francony, Gilles; Lavagne, Pierre; Foroni, Luc; Albaladejo, Pierre; Allenet, Benoit; Payen, Jean-Francois

2015-09-09

To evaluate the economic impact of automated-drug dispensing systems (ADS) in surgical intensive care units (ICUs). A financial analysis was conducted in three adult ICUs of one university hospital, where ADS were implemented, one in each unit, to replace the traditional floor stock system. Costs were estimated before and after implementation of the ADS on the basis of floor stock inventories, expired drugs, and time spent by nurses and pharmacy technicians on medication-related work activities. A financial analysis was conducted that included operating cash flows, investment cash flows, global cash flow and net present value. After ADS implementation, nurses spent less time on medication-related activities with an average of 14.7 hours saved per day/33 beds. Pharmacy technicians spent more time on floor-stock activities with an average of 3.5 additional hours per day across the three ICUs. The cost of drug storage was reduced by €44,298 and the cost of expired drugs was reduced by €14,772 per year across the three ICUs. Five years after the initial investment, the global cash flow was €148,229 and the net present value of the project was positive by €510,404. The financial modeling of the ADS implementation in three ICUs showed a high return on investment for the hospital. Medication-related costs and nursing time dedicated to medications are reduced with ADS.

Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States

PubMed Central

Atkins, Katherine E.; Fitzpatrick, Meagan C.; Galvani, Alison P.; Townsend, Jeffrey P.

2016-01-01

Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible. PMID:27188951

Domestic returns from investment in the control of tuberculosis in other countries.

PubMed

Schwartzman, Kevin; Oxlade, Olivia; Barr, R Graham; Grimard, Franque; Acosta, Ivelisse; Baez, Jeannette; Ferreira, Elizabeth; Melgen, Ricardo Elías; Morose, Willy; Salgado, Arturo Cruz; Jacquet, Vary; Maloney, Susan; Laserson, Kayla; Mendez, Ariel Pablos; Menzies, Dick

2005-09-08

We hypothesized that investments to improve the control of tuberculosis in selected high-incidence countries would prove to be cost saving for the United States by reducing the incidence of the disease among migrants. Using decision analysis, we estimated tuberculosis-related morbidity, mortality, and costs among legal immigrants and refugees, undocumented migrants, and temporary visitors from Mexico after their entry into the United States. We assessed the current strategy of radiographic screening of legal immigrants plus current tuberculosis-control programs alone and with the addition of either U.S.-funded expansion of the strategy of directly observed treatment, short course (DOTS), in Mexico or tuberculin skin testing to screen legal immigrants from Mexico. We also examined tuberculosis-related outcomes among migrants from Haiti and the Dominican Republic using the same three strategies. As compared with the current strategy, expanding the DOTS program in Mexico at a cost to the United States of 34.9 million dollars would result in 2591 fewer cases of tuberculosis in the United States, with 349 fewer deaths from the disease and net discounted savings of 108 million dollars over a 20-year period. Adding tuberculin skin testing to radiographic screening of legal immigrants from Mexico would result in 401 fewer cases of tuberculosis in the United States but would cost an additional 329 million dollars. Expansion of the DOTS program would remain cost saving even if the initial investment were doubled, if the United States paid for all antituberculosis drugs in Mexico, or if the decline in the incidence of tuberculosis in Mexico was less than projected. A 9.4 million dollars investment to expand the DOTS program in Haiti and the Dominican Republic would result in net U.S. savings of 20 million dollars over a 20-year period. U.S.-funded efforts to expand the DOTS program in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality among migrants to the United States, producing net cost savings for the United States. Copyright 2005 Massachusetts Medical Society.

[Mobile single-pass batch hemodialysis system in intensive care medicine. Reduction of costs and workload in renal replacement therapy].

PubMed

Hopf, H-B; Hochscherf, M; Jehmlich, M; Leischik, M; Ritter, J

2007-07-01

This paper describes the introduction of a single-pass batch hemodialysis system for renal replacement therapy in a 14 bed intensive care unit. The goals were to reduce the workload of intensive care unit physicians using an alternative and simpler method compared to continuous veno-venous hemodiafiltration (CVVHDF) and to reduce the costs of hemofiltrate solutions (80,650 EUR per year in our clinic in 2005). We describe and evaluate the process of implementation of the system as well as the achieved and prospective savings. We conclude that a close cooperation of all participants (physicians, nurses, economists, technicians) of a hospital can achieve substantial benefits for patients and employees as well as reduce the economic burden of a hospital.

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

Edmans, Judi; Bradshaw, Lucy; Gladman, John R F; Franklin, Matthew; Berdunov, Vladislav; Elliott, Rachel; Conroy, Simon P

2013-11-01

tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them. 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. 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. two acute medical units in the East Midlands, UK. a total of 667 patients aged ≥70 discharged from acute medical units. 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). 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.

76 FR 13209 - United States and State of Texas v. United Regional Health Care System; Proposed Final Judgment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

...-sensitive patients, likely leading to higher health-care costs for those patients; and (3) reducing quality... lines that it has considered opening, including obstetrics, pediatrics, oncology, industrial medicine... combined account for less than 5% of the commercially insured lives in Wichita Falls, United Regional...

SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

ERIC Educational Resources Information Center

Jelinek, Richard C.; And Others

To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

User delay costs due to work zone operations Near Echo Junction.

DOT National Transportation Integrated Search

2010-11-01

With the increasing number of road rehabilitation projects across the United States, the need to reduce user costs due to congestion is more important than ever. The Utah Department of Transportation (UDOT) has proposed replacing two I-80 bridges ove...

Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.

PubMed

Shepard, Donald S; Gurewich, Deborah; Lwin, Aung K; Reed, Gerald A; Silverman, Morton M

2016-06-01

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under-reporting increased the total cost to $93.5 billion or $298 per capita, 2.1-2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit-cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients. © 2015 The Authors. Suicide and LifeThreatening Behavior published by Wiley Periodicals, Inc. on behalf of American Association of Suicidology.

High Performance Residential Housing Units at U.S. Coast Guard Base Kodiak: Preprint

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

Romero, R.; Hickey, J.

2013-10-01

The United States Coast Guard (USCG) constructs residential housing throughout the country using a basic template that must meet the minimum Leadership in Energy and Environmental Design (LEED) Silver criteria or better for the units. In Kodiak, Alaska, USCG is procuring between 24 and 100 residential multi-family housing units. Priorities for the Kodiak project were to reduce overall energyconsumption by at least 20% over existing units, improve envelope construction, and evaluate space heating options. USCG is challenged with maintaining similar existing units that have complicated residential diesel boilers. Additionally, fuel and material costs are high in Kodiak. While USCG hasmore » worked to optimize the performance of the housing units with principles of improved buildingenvelope, the engineers realize there are still opportunities for improvement, especially within the heating, ventilation, and air conditioning (HVAC) system and different envelope measures. USCG staff also desires to balance higher upfront project costs for significantly reduced life-cycle costs of the residential units that have an expected lifetime of 50 or more years. To answer thesequestions, this analysis used the residential modeling tool BEoptE+ to examine potential energy- saving opportunities for the climate. The results suggest criteria for achieving optimized housing performance at the lowest cost. USCG will integrate the criteria into their procurement process. To achieve greater than 50% energy savings, USCG will need to specify full 2x 6 wood stud R-21 insulationwith two 2 inches of exterior foam, R-38 ceiling insulation or even wall insulation in the crawl space, and R-49 fiberglass batts in a the vented attic. The air barrier should be improved to ensure a tight envelope with minimal infiltration to the goal of 2.0 ACH50. With the implementation of an air source heat pump for space heating requirements, the combination of HVAC and envelope savings inthe residential unit can save up to 58% in source energy over existing residential units.« less

The Effects of Operational Parameters on a Mono-wire Cutting System: Efficiency in Marble Processing

NASA Astrophysics Data System (ADS)

Yilmazkaya, Emre; Ozcelik, Yilmaz

2016-02-01

Mono-wire block cutting machines that cut with a diamond wire can be used for squaring natural stone blocks and the slab-cutting process. The efficient use of these machines reduces operating costs by ensuring less diamond wire wear and longer wire life at high speeds. The high investment costs of these machines will lead to their efficient use and reduce production costs by increasing plant efficiency. Therefore, there is a need to investigate the cutting performance parameters of mono-wire cutting machines in terms of rock properties and operating parameters. This study aims to investigate the effects of the wire rotational speed (peripheral speed) and wire descending speed (cutting speed), which are the operating parameters of a mono-wire cutting machine, on unit wear and unit energy, which are the performance parameters in mono-wire cutting. By using the obtained results, cuttability charts for each natural stone were created on the basis of unit wear and unit energy values, cutting optimizations were performed, and the relationships between some physical and mechanical properties of rocks and the optimum cutting parameters obtained as a result of the optimization were investigated.

Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study.

PubMed

Eichler, Klaus; Hess, Sascha; Chmiel, Corinne; Bögli, Karin; Sidler, Patrick; Senn, Oliver; Rosemann, Thomas; Brügger, Urs

2014-10-01

Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year. The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers. From the health-economic point of view, our new service model shows 'dominance' over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Hospital economics of the hospitalist.

PubMed

Gregory, Douglas; Baigelman, Walter; Wilson, Ira B

2003-06-01

To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to 1,775 dollars from 2,332 dollars (p<.001); costs per day increased to 811 dollars from 679 dollars (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was -1.44 dollars per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of 1.3 million dollars. Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program.

Coordinated EV adoption: double-digit reductions in emissions and fuel use for $40/vehicle-year.

PubMed

Choi, Dong Gu; Kreikebaum, Frank; Thomas, Valerie M; Divan, Deepak

2013-09-17

Adoption of electric vehicles (EVs) would affect the costs and sources of electricity and the United States efficiency requirements for conventional vehicles (CVs). We model EV adoption scenarios in each of six regions of the Eastern Interconnection, containing 70% of the United States population. We develop electricity system optimization models at the multidecade, day-ahead, and hour-ahead time scales, incorporating spatial wind energy modeling, endogenous modeling of CV efficiencies, projections for EV efficiencies, and projected CV and EV costs. We find two means to reduce total consumer expenditure (TCE): (i) controlling charge timing and (ii) unlinking the fuel economy regulations for CVs from EVs. Although EVs provide minimal direct GHG reductions, controlled charging provides load flexibility, lowering the cost of renewable electricity. Without EVs, a 33% renewable electricity standard (RES) would cost $193/vehicle-year more than the reference case (10% RES). Combining a 33% RES, EVs with controlled charging and unlinking would reduce combined electric- and vehicle-sector CO2 emissions by 27% and reduce gasoline consumption by 59% for $40/vehicle-year more than the reference case. Coordinating EV adoption with adoption of controlled charging, unlinked fuel economy regulations, and renewable electricity standards would provide low-cost reductions in emissions and fuel usage.

24 CFR 905.200 - Eligible activities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... reduction. Physical improvements to reduce the number of units that are vacant. Not included are costs for... physical improvement costs associated with: (i) Correcting violations of local building code or the Uniform...) Management improvements. Noncapital activities that are project-specific or PHA-wide improvements needed to...

Design Approach and Implementation of Application Specific Instruction Set Processor for SHA-3 BLAKE Algorithm

NASA Astrophysics Data System (ADS)

Zhang, Yuli; Han, Jun; Weng, Xinqian; He, Zhongzhu; Zeng, Xiaoyang

This paper presents an Application Specific Instruction-set Processor (ASIP) for the SHA-3 BLAKE algorithm family by instruction set extensions (ISE) from an RISC (reduced instruction set computer) processor. With a design space exploration for this ASIP to increase the performance and reduce the area cost, we accomplish an efficient hardware and software implementation of BLAKE algorithm. The special instructions and their well-matched hardware function unit improve the calculation of the key section of the algorithm, namely G-functions. Also, relaxing the time constraint of the special function unit can decrease its hardware cost, while keeping the high data throughput of the processor. Evaluation results reveal the ASIP achieves 335Mbps and 176Mbps for BLAKE-256 and BLAKE-512. The extra area cost is only 8.06k equivalent gates. The proposed ASIP outperforms several software approaches on various platforms in cycle per byte. In fact, both high throughput and low hardware cost achieved by this programmable processor are comparable to that of ASIC implementations.

Measuring treatment costs of typical waste electrical and electronic equipment: A pre-research for Chinese policy making.

PubMed

Li, Jinhui; Dong, Qingyin; Liu, Lili; Song, Qingbin

2016-11-01

Waste Electrical and Electronic Equipment (WEEE) volume is increasing, worldwide. In 2011, the Chinese government issued new regulations on WEEE recycling and disposal, establishing a WEEE treatment subsidy funded by a levy on producers of electrical and electronic equipment. In order to evaluate WEEE recycling treatment costs and revenue possibilities under the new regulations, and to propose suggestions for cost-effective WEEE management, a comprehensive revenue-expenditure model (REM), were established for this study, including 7 types of costs, 4 types of fees, and one type of revenue. Since TV sets dominated the volume of WEEE treated from 2013 to 2014, with a contribution rate of 87.3%, TV sets were taken as a representative case. Results showed that the treatment cost varied from 46.4RMB/unit to 82.5RMB/unit, with a treatment quantity of 130,000 units to 1,200,000 units per year in China. Collection cost accounted for the largest portion (about 70.0%), while taxes and fees (about 11.0 %) and labor cost (about 7.0 %) contributed less. The average costs for disposal, sales, and taxes had no influence on treatment quantity (TQ). TQ might have an adverse effect on average labor and management costs; while average collection and purchase fees, and financing costs, would vary with purchase price, and the average sales fees and taxes would vary with the sales of dismantled materials and other recycled products. Recycling enterprises could reduce their costs by setting up online and offline collection platforms, cooperating with individual collectors, creating door-to-door collection channels, improving production efficiency and reducing administrative expenditures. The government could provide economic incentives-such as subsidies, low-cost loans, tax cuts and credits-and could also raise public awareness of waste management and environmental protection, in order to capture some of the WEEE currently discarded into the general waste stream. Foreign companies with advanced WEEE utilization technology could invest or participate in this area, producing profits for themselves while helping to develop and implement environmentally friendly and energy-saving technologies applicable to the Chinese market. Copyright © 2016 Elsevier Ltd. All rights reserved.

How Cool Is Your Roof?

ERIC Educational Resources Information Center

Fickes, Michael

2001-01-01

Explains a concept called cool roof that is used to reduce electricity costs for air conditioning, and also reduce the price of air conditioning units. Discusses the light reflecting capabilities of metal roofing as well as coatings that can stop leaks. (GR)

Is Job Sharing Worthwhile? A Cost-Benefit Analysis in UK Universities.

ERIC Educational Resources Information Center

Harris, Geoff

1997-01-01

Data from a survey of personnel directors in United Kingdom universities were used to conduct a cost-benefit analysis of job sharing from the institutions' perspective. Results show a 5% rise in productivity would raise the ratio of benefits to cost to 14.3 to 1. Retention of staff, reduction of stress, and reduced unemployment are also benefits.…

On intra-supply chain system with an improved distribution plan, multiple sales locations and quality assurance.

PubMed

Chiu, Singa Wang; Huang, Chao-Chih; Chiang, Kuo-Wei; Wu, Mei-Fang

2015-01-01

Transnational companies, operating in extremely competitive global markets, always seek to lower different operating costs, such as inventory holding costs in their intra- supply chain system. This paper incorporates a cost reducing product distribution policy into an intra-supply chain system with multiple sales locations and quality assurance studied by [Chiu et al., Expert Syst Appl, 40:2669-2676, (2013)]. Under the proposed cost reducing distribution policy, an added initial delivery of end items is distributed to multiple sales locations to meet their demand during the production unit's uptime and rework time. After rework when the remaining production lot goes through quality assurance, n fixed quantity installments of finished items are then transported to sales locations at a fixed time interval. Mathematical modeling and optimization techniques are used to derive closed-form optimal operating policies for the proposed system. Furthermore, the study demonstrates significant savings in stock holding costs for both the production unit and sales locations. Alternative of outsourcing product delivery task to an external distributor is analyzed to assist managerial decision making in potential outsourcing issues in order to facilitate further reduction in operating costs.

Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs.

PubMed

Mehra, Tarun; Seifert, Burkhardt; Bravo-Reiter, Silvina; Wanner, Guido; Dutkowski, Philipp; Holubec, Tomas; Moos, Rudolf M; Volbracht, Jörk; Manz, Markus G; Spahn, Donat R

2015-12-01

Patient blood management (PBM) measures have been shown to be effective in reducing transfusions while maintaining patient outcome. The issuance of transfusion guidelines is seen as being key to the success of PBM programs. As the introduction of guidelines alone did not visibly reduce transfusions in our center, a monitoring and feedback program was established. The aim of our study was to show the effectiveness of such measures in reducing transfusions and cost. We designed a prospective, interventional cohort study with a 3-year time frame (January 1, 2012 to December 31, 2014). In total, 101,794 patients aged 18 years or older were included. The PBM monitoring and feedback program was introduced on January 1, 2014, with the subsequent issuance of quarterly reporting. Within the first year of introduction, transfusion of all allogeneic blood products per 1000 patients was reduced by 27% (red blood cell units, -24%; platelet units, -25%; and fresh-frozen plasma units, -37%; all p < 0.001) leading to direct allogeneic blood product related savings of more than 2 million USD. The number of blood products transfused per case was significantly reduced from 9 ± 19 to 7 ± 14 (p < 0.001). With an odds ratio of 0.86 (95% confidence interval, 0.82-0.91), the introduction of our PBM monitoring and feedback program was a significant independent factor in the reduction of transfusion probability (p < 0.001). Our PBM monitoring and feedback program was highly efficacious in reducing the transfusion of allogeneic blood products and transfusion-related costs. © 2015 AABB.

Cost effectiveness of universal umbilical cord blood gas and lactate analysis in a tertiary level maternity unit.

PubMed

White, Christopher R H; Doherty, Dorota A; Cannon, Jeffrey W; Kohan, Rolland; Newnham, John P; Pennell, Craig E

2016-07-01

There is an increasing body of literature supporting universal umbilical cord blood gas analysis (UCBGA) into all maternity units. A significant impediment to UCBGA's introduction is the perceived expense of the introduction and associated ongoing costs. Consequently, this study set out to conduct the first cost-effectiveness analysis of introducing universal UCBGA. Analysis was based on 42,100 consecutive deliveries ≥23 weeks of gestation at a single tertiary obstetric unit. Within 4 years of UCBGA's introduction there was a 45% reduction in term special care nursery (SCN) admissions >2499 g. Incurred costs included initial and ongoing costs associated with universal UCBGA. Averted costs were based on local diagnosis-related grouping costs for reduction in term SCN admissions. Incremental cost-effectiveness ratio (ICER) and sensitivity analysis results were reported. Under the base-case scenario, the adoption of universal UCBGA was less costly and more effective than selective UCBGA over 4 years and resulted in saving of AU$641,532 while adverting 376 SCN admissions. Sensitivity analysis showed that UCBGA was cost-effective in 51.8%, 83.3%, 99.6% and 100% of simulations in years 1, 2, 3 and 4. These conclusions were not sensitive to wide, clinically possible variations in parameter values for neonatal intensive care unit and SCN admissions, magnitude of averted SCN admissions, cumulative delivery numbers, and SCN admission costs. Universal UCBGA is associated with significant initial and ongoing costs; however, potential averted costs (due to reduced SCN admissions) exceed incurred costs in most scenarios.

Cost-effectiveness of a new short-stay unit to "rule out" acute myocardial infarction in low risk patients.

PubMed

Gaspoz, J M; Lee, T H; Weinstein, M C; Cook, E F; Goldman, P; Komaroff, A L; Goldman, L

1994-11-01

This study attempted to determine the safety and costs of a new short-stay unit for low risk patients who may be admitted to a hospital to rule out myocardial infarction or ischemia. One strategy to reduce the costs of ruling out acute myocardial infarction in low risk patients is to develop alternatives to coronary care units. The short-term and 6-month clinical outcomes and costs for 592 patients admitted to a short-stay coronary observation unit at Brigham and Women's Hospital with a low (< or = 10%) probability of acute myocardial infarction were compared with those for 924 consecutive comparison patients who were eligible for the same unit but were admitted to other hospital settings or discharged home. Actual costs were calculated using detailed cost-accounting methods that incorporated nursing intensity weights. The rate of major complications, recurrent myocardial infarction or cardiac death during 6 months after the initial presentation of the 592 patients admitted to the coronary observation unit was similar to that of the 924 comparison patients before and after adjustment for clinical factors influencing triage and initial diagnoses (adjusted relative risk 0.86, 95% confidence interval 0.49 to 1.53). Their median total costs (25th, 75th percentile) at 6 months ($1,927; 1,455, 3,650) were significantly lower than for comparison patients admitted to the wards $4,712; 1,868, 11,187), to stepdown or intermediate care units ($4,031; 2,069, 9,169) or to the coronary care unit ($9,201; 3,171, 20,011) but were higher than for comparison patients discharged home from the emergency department ($403; 403,927) before and after the same adjustments (all adjusted p < 0.0001). These data suggest that the coronary observation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarction admitted from the emergency department. Its replication in other hospitals should be tested.

Surgical vampires and rising health care expenditure: reducing the cost of daily phlebotomy.

PubMed

Stuebing, Elizabeth A; Miner, Thomas J

2011-05-01

To determine whether simply being made continually aware of the hospital costs of daily phlebotomy would reduce the amount of phlebotomy ordered for nonintensive care unit surgical patients. Prospective observational study. Tertiary care hospital in an urban setting. All nonintensive care unit patients on 3 general surgical services. A weekly announcement to surgical house staff and attending physicians of the dollar amount charged to nonintensive care unit patients for laboratory services during the previous week. Dollars charged per patient per day for routine blood work. At baseline, the charges for daily phlebotomy were $147.73/patient/d. After 11 weeks of residents being made aware of the daily charges for phlebotomy, the charges dropped as low as $108.11/patient/d. This had a correlation coefficient of -0.76 and significance of P = .002. Over 11 weeks of intervention, the dollar amount saved was $54,967. Health care providers being made aware of the cost of phlebotomy can decrease the amount of these tests ordered and result in significant savings for the hospital.

Designing a critical care nurse-led rapid response team using only available resources: 6 years later.

PubMed

Mitchell, Anne; Schatz, Marilyn; Francis, Heather

2014-06-01

Rapid response teams have been introduced to intervene in the care of patients whose condition deteriorates unexpectedly by bringing clinical experts quickly to the patient's bedside. Evidence supporting the need to overcome failure to deliver optimal care in hospitals is robust; whether rapid response teams demonstrate benefit by improving patient safety and reducing the occurrence of adverse events remains controversial. Despite inconsistent evidence regarding the effectiveness of rapid response teams, concerns regarding care and costly consequences of unaddressed deterioration in patients' condition have prompted many hospitals to implement rapid response teams as a patient safety strategy. A cost-neutral structure for a rapid response team led by a nurse from the intensive care unit was implemented with the goal of reducing cardiopulmonary arrests occurring outside the intensive care unit. The results of 6 years' experience indicate that a sustainable and effective rapid response team response can be put into practice without increasing costs or adding positions and can decrease the percentage of cardiopulmonary arrests occurring outside the intensive care unit. ©2014 American Association of Critical-Care Nurses.

Inventory of federal data systems in the United states for injury surveillance, research and prevention activities

DOT National Transportation Integrated Search

1996-05-01

The mission of the National Center for Injury Prevention and Control (NCIPC) : is to reduce morbidity, disability, death, and costs associated with injuries : outside the workplace in the United States. NCIPC works closely with other : federal agenci...

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations

PubMed Central

Hommel, Kevin A.

2016-01-01

Objective Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. Methods A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. Results All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Conclusions Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. PMID:26359311

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

PubMed

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases in the United States was not considered in the model.

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

PubMed

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

2003-09-01

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

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

PubMed

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

2012-01-01

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

Enhanced methods for operating refueling station tube-trailers to reduce refueling cost

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

Elgowainy, Amgad; Reddi, Krishna

A method and apparatus are provided for operating a refueling station including source tube-trailers and at least one compressor to reduce refueling cost. The refueling station includes a gaseous fuel supply source including a plurality of tanks on a tube trailer coupled to a first control unit, and high pressure buffer storage having predefined capacity coupled to a second control unit and the first tanks by a pressure control valve and the first control unit, and at least one compressor. The refueling station is operated at different modes depending on a state of the refueling station at the beginning ofmore » each operational mode. The refueling system is assessed at the end of each operational mode to identify the state of the system and select a next mode of operation. The operational modes include consolidating hydrogen, or any gaseous fuel, within the tubes mounted on the trailer.« less

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

19 CFR 10.877 - Direct costs of processing operations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Direct costs of processing operations. 10.877 Section 10.877 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Oman...

Carvedilol reduces the costs of medical care in severe heart failure: an economic analysis of the COPERNICUS study applied to the United Kingdom.

PubMed

Stewart, Simon; McMurray, John J V; Hebborn, Ansgar; Coats, Andrew J S; Packer, Milton

2005-04-08

The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per diem (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was pound530,771 ( pound44.89 per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was pound3.49 million in the carvedilol group compared with pound4.24 million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group ( pound479,200 vs. pound548,300). Overall, the cost per patient treated in the carvedilol group was pound3948 compared to pound4279 in the placebo group. This equated to a cost of pound385.98 vs. pound434.18, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

PubMed

Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

2016-09-01

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov model calculated that sacubitril/valsartan would increase life expectancy at an ICER consistent with other high-value accepted cardiovascular interventions. Sensitivity analyses demonstrated sacubitril/valsartan would remain cost-effective vs enalapril.

Ten ways for provider units to weather this economic downturn.

PubMed

Bernard, Amy

2009-05-01

The current economic recession challenges all continuing nursing education provider units to review operational practices and explore ways to maintain and ensure financial viability. Adjustments in programs are likely, as nurses seek more cost-effective ways of meeting their continuing education requirements. Further, employers are reducing staff and budgets. As a result, provider units need to reassess operations and refocus outcomes.

36 CFR 223.64 - Appraisal on a lump-sum value or rate per unit of measure basis.

Code of Federal Regulations, 2010 CFR

2010-07-01

... costs or selling values subsequent to the rate redetermination which reduce conversion value to less... or rate per unit of measure basis. 223.64 Section 223.64 Parks, Forests, and Public Property FOREST... Contracts Appraisal and Pricing § 223.64 Appraisal on a lump-sum value or rate per unit of measure basis...

The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

ERIC Educational Resources Information Center

Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

2011-01-01

The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

Optimized 4-bit Quantum Reversible Arithmetic Logic Unit

NASA Astrophysics Data System (ADS)

Ayyoub, Slimani; Achour, Benslama

2017-08-01

Reversible logic has received a great attention in the recent years due to its ability to reduce the power dissipation. The main purposes of designing reversible logic are to decrease quantum cost, depth of the circuits and the number of garbage outputs. The arithmetic logic unit (ALU) is an important part of central processing unit (CPU) as the execution unit. This paper presents a complete design of a new reversible arithmetic logic unit (ALU) that can be part of a programmable reversible computing device such as a quantum computer. The proposed ALU based on a reversible low power control unit and small performance parameters full adder named double Peres gates. The presented ALU can produce the largest number (28) of arithmetic and logic functions and have the smallest number of quantum cost and delay compared with existing designs.

Analysis of digester design concepts

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

Ashare, E.; Wilson, E. H.

1979-01-29

Engineering economic analyses were performed on various digester design concepts to determine the relative performance for various biomass feedstocks. A comprehensive literature survey describing the state-of-the-art of the various digestion designs is included. The digester designs included in the analyses are CSTR, plug flow, batch, CSTR in series, multi-stage digestion and biomethanation. Other process options investigated included pretreatment processes such as shredding, degritting, and chemical pretreatment, and post-digestion processes, such as dewatering and gas purification. The biomass sources considered include feedlot manure, rice straw, and bagasse. The results of the analysis indicate that the most economical (on a unit gasmore » cost basis) digester design concept is the plug flow reactor. This conclusion results from this system providing a high gas production rate combined with a low capital hole-in-the-ground digester design concept. The costs determined in this analysis do not include any credits or penalties for feedstock or by-products, but present the costs only for conversion of biomass to methane. The batch land-fill type digester design was shown to have a unit gas cost comparable to that for a conventional stirred tank digester, with the potential of reducing the cost if a land-fill site were available for a lower cost per unit volume. The use of chemical pretreatment resulted in a higher unit gas cost, primarily due to the cost of pretreatment chemical. A sensitivity analysis indicated that the use of chemical pretreatment could improve the economics provided a process could be developed which utilized either less pretreatment chemical or a less costly chemical. The use of other process options resulted in higher unit gas costs. These options should only be used when necessary for proper process performance, or to result in production of a valuable by-product.« less

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.

Financing Strategies For A Nuclear Fuel Cycle Facility

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

David Shropshire; Sharon Chandler

2006-07-01

To help meet the nation’s energy needs, recycling of partially used nuclear fuel is required to close the nuclear fuel cycle, but implementing this step will require considerable investment. This report evaluates financing scenarios for integrating recycling facilities into the nuclear fuel cycle. A range of options from fully government owned to fully private owned were evaluated using DPL (Decision Programming Language 6.0), which can systematically optimize outcomes based on user-defined criteria (e.g., lowest lifecycle cost, lowest unit cost). This evaluation concludes that the lowest unit costs and lifetime costs are found for a fully government-owned financing strategy, due tomore » government forgiveness of debt as sunk costs. However, this does not mean that the facilities should necessarily be constructed and operated by the government. The costs for hybrid combinations of public and private (commercial) financed options can compete under some circumstances with the costs of the government option. This analysis shows that commercial operations have potential to be economical, but there is presently no incentive for private industry involvement. The Nuclear Waste Policy Act (NWPA) currently establishes government ownership of partially used commercial nuclear fuel. In addition, the recently announced Global Nuclear Energy Partnership (GNEP) suggests fuels from several countries will be recycled in the United States as part of an international governmental agreement; this also assumes government ownership. Overwhelmingly, uncertainty in annual facility capacity led to the greatest variations in unit costs necessary for recovery of operating and capital expenditures; the ability to determine annual capacity will be a driving factor in setting unit costs. For private ventures, the costs of capital, especially equity interest rates, dominate the balance sheet; and the annual operating costs, forgiveness of debt, and overnight costs dominate the costs computed for the government case. The uncertainty in operations, leading to lower than optimal processing rates (or annual plant throughput), is the most detrimental issue to achieving low unit costs. Conversely, lowering debt interest rates and the required return on investments can reduce costs for private industry.« less

40 CFR 20.8 - Requirements for certification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the useful life, or (C) reduce the total operating costs of the operating unit (of the plant or other... policies of the United States and the States in the prevention and abatement of air pollution, the Regional... directed; (3) Local government requirements for control of air pollution, including emission standards; (4...

40 CFR 20.8 - Requirements for certification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the useful life, or (C) reduce the total operating costs of the operating unit (of the plant or other... policies of the United States and the States in the prevention and abatement of air pollution, the Regional... directed; (3) Local government requirements for control of air pollution, including emission standards; (4...

40 CFR 20.8 - Requirements for certification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the useful life, or (C) reduce the total operating costs of the operating unit (of the plant or other... policies of the United States and the States in the prevention and abatement of air pollution, the Regional... directed; (3) Local government requirements for control of air pollution, including emission standards; (4...

40 CFR 20.8 - Requirements for certification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the useful life, or (C) reduce the total operating costs of the operating unit (of the plant or other... policies of the United States and the States in the prevention and abatement of air pollution, the Regional... directed; (3) Local government requirements for control of air pollution, including emission standards; (4...

40 CFR 20.8 - Requirements for certification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the useful life, or (C) reduce the total operating costs of the operating unit (of the plant or other... policies of the United States and the States in the prevention and abatement of air pollution, the Regional... directed; (3) Local government requirements for control of air pollution, including emission standards; (4...

77 FR 40324 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-09

... compromising RUS loan security, and to reduce the cost to borrowers, in terms of time, expenses and paperwork... make loans in the several United States and Territories of the United States for rural electrification... subordinating loans made by the national Rural Utilities Cooperative Finance Corporation, the Federal Financing...

Reducing Nitrogen Oxide Emissions: 1996 Compliance with Title IV Limits

EIA Publications

1998-01-01

The purpose of this article is to summarize the existing federal nitrogen oxide (Nox) regulations and the 1996 performance of the 239 Title IV generating units. It also reviews the basics of low-Nox burner technology and presents cost and performance data for retrofits at Title IV units.

Low-cost boring mill

NASA Technical Reports Server (NTRS)

Hibdon, R. A.

1979-01-01

Portable unit and special fixture serve as boring mill. Machine, fabricated primarily from scrap metal, was designed and set up in about 12 working days. It has reduced setup and boring time by 66 percent as compared with existing boring miles, thereby making latter available for other jobs. Unit can be operated by one man.

Assessing antibacterial pharmacoeconomics in the intensive care unit.

PubMed

Birmingham, M C; Hassett, J M; Schentag, J J; Paladino, J A

1997-12-01

Intensive care units (ICUs) represent areas of high use of antibacterials and other pharmacy goods and services. Many institutions view their ICUs as a target for drug-use surveillance and cost-containment programmes. Economic assessment of antibacterial interventions in the ICU should include all direct costs and patient outcomes. Nonetheless, many of these institutions focus their efforts at reducing antibacterial costs without considering the consequences of these actions. It is possible that devoting more resources to antibacterials can have an overall positive economic impact if more appropriate antibacterial use reduces length of stay, decreases bacterial resistance or lowers frequency of adverse complications. Two consequences of antibacterial use which can result in substantial economic burdens to institutions are drug-induced complications (toxicities and adverse events) and the development of antibacterial-resistant organisms. These events are logical targets for performing pharmacoeconomic studies to evaluate appropriate and inappropriate antibacterial use. Either of these problems can increase length of stay, which is the single most important variable influencing the overall cost of patient care. The primary goal of patient care is to hasten patients' clinical improvement. This will result in decreased antibacterial acquisition costs, decreased lengths of ICU and hospital stays, and ultimately decreased consumption of hospital resources. These can be accomplished by using strategies to guide antibacterial use in order to reduce failures, adverse events, toxicity and antimicrobial resistance.

Economic analysis of biomass gasification for generating electricity in rural areas in Indonesia

NASA Astrophysics Data System (ADS)

Susanto, H.; Suria, T.; Pranolo, S. H.

2018-03-01

The gaseous fuel from biomass gasification might reduce the consumption of diesel fuel by 70%. The investment cost of the whole unit with a capacity of 45 kWe was about IDR 220 million in 2008 comprised of 24% for gasification unit, 54% for diesel engine and electric generator, 22% for transportation of the whole unit from Bandung to the site in South Borneo. The gasification unit was made in local workshop in Bandung, while the diesel-generator was purchased also in a local market. To anticipate the development of biomass based electricity in remote areas, an economic analysis has been made for implementations in 2019. A specific investment cost of 600 USD/kW has been estimated taking account to the escalation and capacity factors. Using a discounted factor of 11% and biomass cost in the range of 0.03-0.07 USD/kg, the production cost of electricity would be in the range of 0.09-0.16 USD/kWh. This production cost was lower than that of diesel engine fueled with full oil commonly implemented in many remote areas in Indonesia at this moment. This production cost was also lower than the Feed in Tariff in some regions established by Indonesian government in 2017.

[Relationship between cost systems and hospital expenditure].

PubMed

García-Cornejo, Beatriz; Pérez-Méndez, José A

To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The large-scale removal of mammalian invasive alien species in Northern Europe.

PubMed

Robertson, Peter A; Adriaens, Tim; Lambin, Xavier; Mill, Aileen; Roy, Sugoto; Shuttleworth, Craig M; Sutton-Croft, Mike

2017-02-01

Numerous examples exist of successful mammalian invasive alien species (IAS) eradications from small islands (<10 km 2 ), but few from more extensive areas. We review 15 large-scale removals (mean area 2627 km 2 ) from Northern Europe since 1900, including edible dormouse, muskrat, coypu, Himalayan porcupine, Pallas' and grey squirrels and American mink, each primarily based on daily checking of static traps. Objectives included true eradication or complete removal to a buffer zone, as distinct from other programmes that involved local control to limit damage or spread. Twelve eradication/removal programmes (80%) were successful. Cost increased with and was best predicted by area, while the cost per unit area decreased; the number of individual animals removed did not add significantly to the model. Doubling the area controlled reduced cost per unit area by 10%, but there was no evidence that cost effectiveness had increased through time. Compared with small islands, larger-scale programmes followed similar patterns of effort in relation to area. However, they brought challenges when defining boundaries and consequent uncertainties around costs, the definition of their objectives, confirmation of success and different considerations for managing recolonisation. Novel technologies or increased use of volunteers may reduce costs. Rapid response to new incursions is recommended as best practice rather than large-scale control to reduce the environmental, financial and welfare costs. © 2016 Crown copyright. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. © 2016 Crown copyright. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth.

PubMed

Sonneville, Kendrin R; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Wang, Y Claire; Pomeranz, Jennifer L; Moodie, Marj L; Carter, Rob; Sacks, Gary; Swinburn, Boyd A; Gortmaker, Steven L

2015-07-01

Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

$1.8 Million and counting: how volatile agent education has decreased our spending $1000 per day.

PubMed

Miller, Scott A; Aschenbrenner, Carol A; Traunero, Justin R; Bauman, Loren A; Lobell, Samuel S; Kelly, Jeffrey S; Reynolds, John E

2016-12-01

Volatile anesthetic agents comprise a substantial portion of every hospital's pharmacy budget. Challenged with an initiative to lower anesthetic drug expenditures, we developed an education-based intervention focused on reducing volatile anesthetic costs while preserving access to all available volatile anesthetics. When postintervention evaluation demonstrated a dramatic year-over-year reduction in volatile agent acquisition costs, we undertook a retrospective analysis of volatile anesthetic purchasing data using time series analysis to determine the impact of our educational initiative. We obtained detailed volatile anesthetic purchasing data from the Central Supply of Wake Forest Baptist Health from 2007 to 2014 and integrated these data with the time course of our educational intervention. Aggregate volatile anesthetic purchasing data were analyzed for 7 consecutive fiscal years. The educational initiative emphasized tissue partition coefficients of volatile anesthetics in adipose tissue and muscle and their impact on case management. We used an interrupted time series analysis of monthly cost per unit data using autoregressive integrated moving average modeling, with the monthly cost per unit being the amount spent per bottle of anesthetic agent per month. The cost per unit decreased significantly after the intervention (t=-6.73, P<.001). The autoregressive integrated moving average model predicted that the average cost per unit decreased $48 after the intervention, with 95% confidence interval of $34 to $62. As evident from the data, the purchasing of desflurane and sevoflurane decreased, whereas that of isoflurane increased. An educational initiative focused solely on the selection of volatile anesthetic agent per case significantly reduced volatile anesthetic expense at a tertiary medical center. This approach appears promising for application in other hospitals in the rapidly evolving, value-added health care environment. We were able to accomplish this with instruction on tissue partition coefficients and each agent's individual cost per MAC-hour delivered. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty.

PubMed

Churchill, Jessica L; Puca, Kathleen E; Meyer, Elizabeth S; Carleton, Matthew C; Truchan, Susan L; Anderson, Michael J

2016-12-01

Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network. In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery. Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Adherence to infection control guidelines in surgery on MRSA positive patients : A cost analysis.

PubMed

Saegeman, V; Schuermans, A

2016-09-01

In surgical units, similar to other healthcare departments, guidelines are used to curb transmission of methicillin resistant Staphylococcus aureus (MRSA). The aim of this study was to calculate the extra costs for material and extra working hours for compliance to MRSA infection control guidelines in the operating rooms of a University Hospital. The study was based on observations of surgeries on MRSA positive patients. The average cost per surgery was calculated utilizing local information on unit costs. Robustness of the calculations was evaluated with a sensitivity analysis. The total extra costs of adherence to MRSA infection control guidelines averaged € 340.46 per surgical procedure (range € 207.76- € 473.15). A sensitivity analysis based on a standardized operating room hourly rate reached a cost of € 366.22. The extra costs of adherence to infection control guidelines are considerable. To reduce costs, the logistical planning of surgeries could be improved by for instance a dedicated room.

SMART: The Future of Spaceflight Avionics

NASA Technical Reports Server (NTRS)

Alhorn, Dean C.; Howard, David E.

2010-01-01

A novel avionics approach is necessary to meet the future needs of low cost space and lunar missions that require low mass and low power electronics. The current state of the art for avionics systems are centralized electronic units that perform the required spacecraft functions. These electronic units are usually custom-designed for each application and the approach compels avionics designers to have in-depth system knowledge before design can commence. The overall design, development, test and evaluation (DDT&E) cycle for this conventional approach requires long delivery times for space flight electronics and is very expensive. The Small Multi-purpose Advanced Reconfigurable Technology (SMART) concept is currently being developed to overcome the limitations of traditional avionics design. The SMART concept is based upon two multi-functional modules that can be reconfigured to drive and sense a variety of mechanical and electrical components. The SMART units are key to a distributed avionics architecture whereby the modules are located close to or right at the desired application point. The drive module, SMART-D, receives commands from the main computer and controls the spacecraft mechanisms and devices with localized feedback. The sensor module, SMART-S, is used to sense the environmental sensors and offload local limit checking from the main computer. There are numerous benefits that are realized by implementing the SMART system. Localized sensor signal conditioning electronics reduces signal loss and overall wiring mass. Localized drive electronics increase control bandwidth and minimize time lags for critical functions. These benefits in-turn reduce the main processor overhead functions. Since SMART units are standard flight qualified units, DDT&E is reduced and system design can commence much earlier in the design cycle. Increased production scale lowers individual piece part cost and using standard modules also reduces non-recurring costs. The benefit list continues, but the overall message is already evident: the SMART concept is an evolution in spacecraft avionics. SMART devices have the potential to change the design paradigm for future satellites, spacecraft and even commercial applications.

Fabricating a Microcomputer on a Single Silicon Wafer

NASA Technical Reports Server (NTRS)

Evanchuk, V. L.

1983-01-01

Concept for "microcomputer on a slice" reduces microcomputer costs by eliminating scribing, wiring, and packaging of individual circuit chips. Low-cost microcomputer on silicon slice contains redundant components. All components-central processing unit, input/output circuitry, read-only memory, and random-access memory (CPU, I/O, ROM, and RAM) on placed on single silicon wafer.

Electronic Mail: Defining a Role for the U.S. Postal Service.

ERIC Educational Resources Information Center

McLaughlin, John F.

Threatened by competitive diversification and by increasing costs, the United States Postal Service has investigated two potential cost reducing systems: (1) a microsystem which would provide electronic facsimile transmission between major markets and (2) a macrosystem which could take digital input such as utility bills and deliver a hardcopy to…

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

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

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. 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. 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. 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). The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on designing effective and cost-effective specialist service for frail older people discharged from acute medical units is needed. ISRCTN registry ISRCTN21800480 http://www.isrctn.com/ISRCTN21800480.

Vortex tube can increase liquid hydrocarbon recovery at plant inlet

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

Hajdik, B.; Lorey, M.; Steinle, J.

1997-09-08

Use of a vortex-tube device yields improved inlet gas-liquid separation, when compared with a Joule-Thomson system, but is less costly and complex than a true isentropic system, such as a turboexpander. Because the vortex-tube unit provides separation as well as pressure reduction, the capital cost of a Joule-Thomson system with valve and separator will be similar to that of the vortex-tube system. Future applications of vortex-tube units will be concentrated where performance improvements over Joule-Thomson units, at low capital cost, are required. The operating characteristics of a vortex tube permit gas, in part, to be reduced in temperature to lessmore » than that normally achievable through isenthalpic expansion. The following three examples show how vortex technology can be applied to achieve these aims.« less

Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

PubMed

Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

2014-03-01

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants — United States, 2012

PubMed Central

Bergen, Gwen; Peterson, Cora; Ederer, David; Florence, Curtis; Haileyesus, Tadesse; Kresnow, Marcie-jo; Xu, Likang

2014-01-01

Background Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States. Methods CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs. Results In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012. Conclusions Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED. Implications for Public Health Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs. PMID:25299606

The impact of urban spatial structure on travel demand in the United States

DOT National Transportation Integrated Search

2003-03-20

Attempts to limit urban growth or to change its form are motivated by three concerns-to preserve open space and foster urban development that is more aesthetically appealing, to reduce the cost of providing public services, and to reduce dependence o...

Cost-Effectiveness of Pertussis Vaccination During Pregnancy in the United States.

PubMed

Atkins, Katherine E; Fitzpatrick, Meagan C; Galvani, Alison P; Townsend, Jeffrey P

2016-06-15

Vaccination against pertussis has reduced the disease burden dramatically, but the most severe cases and almost all fatalities occur in infants too young to be vaccinated. Recent epidemiologic evidence suggests that targeted vaccination of mothers during pregnancy can reduce pertussis incidence in their infants. To evaluate the cost-effectiveness of antepartum maternal vaccination in the United States, we created an age-stratified transmission model, incorporating empirical data on US contact patterns and explicitly modeling parent-infant exposure. Antepartum maternal vaccination incurs costs of $114,000 (95% prediction interval: 82,000, 183,000) per quality-adjusted life-year, in comparison with the strategy of no adult vaccination, and is cost-effective in the United States according to World Health Organization criteria. By contrast, vaccinating a second parent is not cost-effective, and vaccination of either parent postpartum is strongly dominated by antepartum maternal vaccination. Nonetheless, postpartum vaccination of mothers who were not vaccinated antepartum improves upon the current recommendation of untargeted adult vaccination. Additionally, the temporary direct protection of the infant due to maternal antibody transfer has efficacy for infants comparable to that conferred to toddlers by the full primary vaccination series. Efficient protection against pertussis for infants begins before birth. We highly recommend antepartum vaccination for as many US mothers as possible. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations.

PubMed

McGrady, Meghan E; Hommel, Kevin A

2016-09-01

Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Low-Cost Composite Materials and Structures for Aircraft Applications

NASA Technical Reports Server (NTRS)

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

2003-01-01

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

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

PubMed

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Ben Romdhane, Habiba; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

PubMed Central

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

Cost of standard indoor ultra-low-volume space spraying as a method to control adult dengue vectors.

PubMed

Ditsuwan, Thanittha; Liabsuetrakul, Tippawan; Ditsuwan, Vallop; Thammapalo, Suwich

2012-06-01

To access the costs of standard indoor ultra-low-volume (SID-ULV) space spraying for controlling dengue vectors in Thailand. Resources related to SID-ULV space spraying as a method to control dengue vectors between July and December 2009 were identified, measured and valued taking a societal perspective into consideration. Information on costs was collected from direct observations, interviews and bookkeeping records. Uncertainty of unit costs was investigated using a bootstrap technique. Costs of SID-ULV were calculated from 18 new dengue cases that covered 1492 surrounding houses. The average coverage of the SID-ULV was 64.4%. In the first round of spraying, 53% of target houses were sprayed and 44.6% in the second round, of which 69.2% and 54.7% received entire indoor space spraying. Unit costs per case, per 10 houses and per 100 m(2) were USD 705 (95% Confidence Interval CI, 539-888), 180 (95% CI, 150-212) and USD 23 (95% CI, 17-30). The majority of SID-ULV unit cost per case was attributed to productivity loss (83.9%) and recurrent costs (15.2%). The unit cost of the SID-ULV per case and per house in rural was 2.8 and 1.6 times lower than municipal area. The estimated annual cost of SID-ULV space spraying from 2005 to 2009 using healthcare perspective ranged from USD 5.3 to 10.3 million. The majority of the cost of SID-ULV space spraying was attributed to productivity loss. Potential productivity loss influences the achievement of high coverage, so well-planned SID-ULV space spraying strategies are needed to reduce costs. © 2012 Blackwell Publishing Ltd.

Orthogeriatric care: improving patient outcomes

PubMed Central

Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

2016-01-01

Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

Performance and cost evaluation of constructed wetland for domestic waste water treatment.

PubMed

Deeptha, V T; Sudarsan, J S; Baskar, G

2015-09-01

Root zone treatment through constructed wetlands is an engineered method of purifying wastewater. The aim of the present research was to study the potential of wetland plants Phragmites and Typha in treatment of wastewater and to compare the cost of constructed wetlands with that of conventional treatment systems. A pilot wetland unit of size 2x1x0.9 m was constructed in the campus. 3x3 rows of plants were transplanted into the pilot unit and subjected to wastewater from the hostels and other campus buildings. The raw wastewater and treated wastewater were collected periodically and tested for Total nitrogen (TN),Total Phosphorous (TP), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD). It was observed that this pilot unit reduced the concentrations of TN, TP, BOD and COD by 76, 73, 83 and 86%, respectively, on an average. Root zone system achieved standards for tertiary treatment with low operating costs, low maintenance costs, enhance the landscape, provide a natural habitat for birds, and did not emit any odour.

Natural Hazards - A National Threat

USGS Publications Warehouse

Geological Survey, U.S.

2007-01-01

The USGS Role in Reducing Disaster Losses -- In the United States each year, natural hazards cause hundreds of deaths and cost billions of dollars in disaster aid, disruption of commerce, and destruction of homes and critical infrastructure. Although the number of lives lost to natural hazards each year generally has declined, the economic cost of major disaster response and recovery continues to rise. Each decade, property damage from natural hazards events doubles or triples. The United States is second only to Japan in economic damages resulting from natural disasters. A major goal of the U.S. Geological Survey (USGS) is to reduce the vulnerability of the people and areas most at risk from natural hazards. Working with partners throughout all sectors of society, the USGS provides information, products, and knowledge to help build more resilient communities.

An evaluation of the clinical and cost-effectiveness of alternative care locations for critically ill adult patients with acute traumatic brain injury.

PubMed

Grieve, R; Sadique, Z; Gomes, M; Smith, M; Lecky, F E; Hutchinson, P J A; Menon, D K; Rowan, K M; Harrison, D A

2016-08-01

For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) 'Early' transfer to a neuroscience centre versus 'no or late' transfer for those who present at a non-neuroscience centre. The Risk Adjustment In Neurocritical care (RAIN) Study included prospective admissions following acute TBI to 67 UK adult critical care units during 2009-11. Data were collected on baseline case-mix, mortality, resource use, and at six months, Glasgow Outcome Scale Extended (GOSE), and quality of life (QOL) (EuroQol 5D-3L). We report incremental effectiveness, costs and cost per Quality-Adjusted Life Year (QALY) of the alternative care locations, adjusting for baseline differences with validated risk prediction models. We tested the robustness of results in sensitivity analyses. Dedicated neurocritical care unit patients (N = 1324) had similar six-month mortality, higher QOL (mean gain 0.048, 95% CI -0.002 to 0.099) and increased average costs compared with those managed in combined neuro/general units (N = 1341), with a lifetime cost per QALY gained of £14,000. 'Early' transfer to a neuroscience centre (N = 584) was associated with lower mortality (odds ratio 0.52, 0.34-0.80), higher QOL for survivors (mean gain 0.13, 0.032-0.225), but positive incremental costs (£15,001, £11,123 to £18,880) compared with 'late or no transfer' (N = 263). The lifetime cost per QALY gained for 'early' transfer was £11,000. For critically ill adult patients with acute TBI, within neuroscience centres management in dedicated neurocritical care units versus combined neuro/general units led to improved QoL and higher costs, on average, but these differences were not statistically significant. This study finds that 'early' transfer to a neuroscience centre is associated with reduced mortality, improvement in QOL and is cost-effective.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study.

PubMed

Brennan, Alan; Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-09-30

To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Modelling study using the Sheffield Alcohol Policy Model version 2.5. England 2014-15. Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45 p, and 50 p per unit (7.9 g/10 mL) of pure alcohol. Changes in mean consumption in terms of units of alcohol, drinkers' expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45 p minimum unit price. Below cost selling is estimated to reduce harmful drinkers' mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45 p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health-saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45 p minimum unit price is estimated to save 624 deaths and 23,700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40 p and 50 p per unit, is estimated to have an approximately 40-50 times greater effect. © Brennan et al 2014.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study

PubMed Central

Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-01-01

Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40p and 50p per unit, is estimated to have an approximately 40-50 times greater effect. PMID:25270743

Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

PubMed

Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

2009-01-01

More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.

Thermal control of power supplies with electronic packaging techniques

NASA Technical Reports Server (NTRS)

1975-01-01

The analysis, design, and development work to reduce the weight and size of a standard modular power supply with a 350 watt output was summarized. By integrating low cost commercial heat pipes in the redesign of this power supply, weight was reduced by 30% from that of the previous design. The temperature was also appreciably reduced, increasing the environmental capability of the unit. A demonstration unit with a 100 watt output and a 15 volt regulator module, plus simulated output modules, was built and tested to evaluate the thermal performance of the redesigned power supply.

Costing improvement of remanufacturing crankshaft by integrating Mahalanobis-Taguchi System and Activity based Costing

NASA Astrophysics Data System (ADS)

Abu, M. Y.; Nor, E. E. Mohd; Rahman, M. S. Abd

2018-04-01

Integration between quality and costing system is very crucial in order to achieve an accurate product cost and profit. Current practice by most of remanufacturers, there are still lacking on optimization during the remanufacturing process which contributed to incorrect variables consideration to the costing system. Meanwhile, traditional costing accounting being practice has distortion in the cost unit which lead to inaccurate cost of product. The aim of this work is to identify the critical and non-critical variables during remanufacturing process using Mahalanobis-Taguchi System and simultaneously estimate the cost using Activity Based Costing method. The orthogonal array was applied to indicate the contribution of variables in the factorial effect graph and the critical variables were considered with overhead costs that are actually demanding the activities. This work improved the quality inspection together with costing system to produce an accurate profitability information. As a result, the cost per unit of remanufactured crankshaft of MAN engine model with 5 critical crankpins is MYR609.50 while Detroit engine model with 4 critical crankpins is MYR1254.80. The significant of output demonstrated through promoting green by reducing re-melting process of damaged parts to ensure consistent benefit of return cores.

Cost-effectiveness analysis of microscopic observation drug susceptibility test versus Xpert MTB/Rif test for diagnosis of pulmonary tuberculosis in HIV patients in Uganda.

PubMed

Walusimbi, Simon; Kwesiga, Brendan; Rodrigues, Rashmi; Haile, Melles; de Costa, Ayesha; Bogg, Lennart; Katamba, Achilles

2016-10-10

Microscopic Observation Drug Susceptibility (MODS) and Xpert MTB/Rif (Xpert) are highly sensitive tests for diagnosis of pulmonary tuberculosis (PTB). This study evaluated the cost effectiveness of utilizing MODS versus Xpert for diagnosis of active pulmonary TB in HIV infected patients in Uganda. A decision analysis model comparing MODS versus Xpert for TB diagnosis was used. Costs were estimated by measuring and valuing relevant resources required to perform the MODS and Xpert tests. Diagnostic accuracy data of the tests were obtained from systematic reviews involving HIV infected patients. We calculated base values for unit costs and varied several assumptions to obtain the range estimates. Cost effectiveness was expressed as costs per TB patient diagnosed for each of the two diagnostic strategies. Base case analysis was performed using the base estimates for unit cost and diagnostic accuracy of the tests. Sensitivity analysis was performed using a range of value estimates for resources, prevalence, number of tests and diagnostic accuracy. The unit cost of MODS was US$ 6.53 versus US$ 12.41 of Xpert. Consumables accounted for 59 % (US$ 3.84 of 6.53) of the unit cost for MODS and 84 % (US$10.37 of 12.41) of the unit cost for Xpert. The cost effectiveness ratio of the algorithm using MODS was US$ 34 per TB patient diagnosed compared to US$ 71 of the algorithm using Xpert. The algorithm using MODS was more cost-effective compared to the algorithm using Xpert for a wide range of different values of accuracy, cost and TB prevalence. The cost (threshold value), where the algorithm using Xpert was optimal over the algorithm using MODS was US$ 5.92. MODS versus Xpert was more cost-effective for the diagnosis of PTB among HIV patients in our setting. Efforts to scale-up MODS therefore need to be explored. However, since other non-economic factors may still favour the use of Xpert, the current cost of the Xpert cartridge still needs to be reduced further by more than half, in order to make it economically competitive with MODS.

Charge-Control Unit for Testing Lithium-Ion Cells

NASA Technical Reports Server (NTRS)

Reid, Concha M.; Mazo, Michelle A.; Button, Robert M.

2008-01-01

A charge-control unit was developed as part of a program to validate Li-ion cells packaged together in batteries for aerospace use. The lithium-ion cell charge-control unit will be useful to anyone who performs testing of battery cells for aerospace and non-aerospace uses and to anyone who manufacturers battery test equipment. This technology reduces the quantity of costly power supplies and independent channels that are needed for test programs in which multiple cells are tested. Battery test equipment manufacturers can integrate the technology into their battery test equipment as a method to manage charging of multiple cells in series. The unit manages a complex scheme that is required for charging Li-ion cells electrically connected in series. The unit makes it possible to evaluate cells together as a pack using a single primary test channel, while also making it possible to charge each cell individually. Hence, inherent cell-to-cell variations in a series string of cells can be addressed, and yet the cost of testing is reduced substantially below the cost of testing each cell as a separate entity. The unit consists of electronic circuits and thermal-management devices housed in a common package. It also includes isolated annunciators to signal when the cells are being actively bypassed. These annunciators can be used by external charge managers or can be connected in series to signal that all cells have reached maximum charge. The charge-control circuitry for each cell amounts to regulator circuitry and is powered by that cell, eliminating the need for an external power source or controller. A 110-VAC source of electricity is required to power the thermal-management portion of the unit. A small direct-current source can be used to supply power for an annunciator signal, if desired.

Cost projections for implementation of safety interventions to prevent transfusion-transmitted Zika virus infection in the United States

PubMed Central

Ellingson, Katherine D.; Sapiano, Mathew R.P.; Haass, Kathryn A.; Savinkina, Alexandra A.; Baker, Misha L.; Henry, Richard A.; Berger, James J.; Kuehnert, Matthew J.; Basavaraju, Sridhar V.

2017-01-01

BACKGROUND In August 2016, the Food and Drug Administration advised US blood centers to screen all whole blood and apheresis donations for Zika virus (ZIKV) with an individual-donor nucleic acid test (ID-NAT) or to use approved pathogen reduction technology (PRT). The cost of implementing this guidance nationally has not been assessed. STUDY DESIGN AND METHODS Scenarios were constructed to characterize approaches to ZIKV screening, including universal ID-NAT, risk-based seasonal allowance of minipool (MP) NAT by state, and universal MP-NAT. Data from the 2015 National Blood Collection and Utilization Survey (NBCUS) were used to characterize the number of donations nationally and by state. For each scenario, the estimated cost per donor ($3–$9 for MP-NAT, $7–$13 for ID-NAT) was multiplied by the estimated number of relevant donations from the NBCUS. Cost of PRT was calculated by multiplying the cost per unit ($50–$125) by the number of units approved for PRT. Prediction intervals for costs were generated using Monte Carlo simulation methods. RESULTS Screening all donations in the 50 states and DC for ZIKV by ID-NAT would cost $137 million (95% confidence interval [CI], $109–$167) annually. Allowing seasonal MP-NAT in states with lower ZIKV risk could reduce NAT screening costs by 18% to 25%. Application of PRT to all platelet (PLT) and plasma units would cost $213 million (95% CI, $156–$304). CONCLUSION Universal ID-NAT screening for ZIKV will cost US blood centers more than $100 million annually. The high cost of PRT for apheresis PLTs and plasma could be mitigated if, once validated, testing for transfusion transmissible pathogens could be eliminated. PMID:28591470

FPGA Implementation of Generalized Hebbian Algorithm for Texture Classification

PubMed Central

Lin, Shiow-Jyu; Hwang, Wen-Jyi; Lee, Wei-Hao

2012-01-01

This paper presents a novel hardware architecture for principal component analysis. The architecture is based on the Generalized Hebbian Algorithm (GHA) because of its simplicity and effectiveness. The architecture is separated into three portions: the weight vector updating unit, the principal computation unit and the memory unit. In the weight vector updating unit, the computation of different synaptic weight vectors shares the same circuit for reducing the area costs. To show the effectiveness of the circuit, a texture classification system based on the proposed architecture is physically implemented by Field Programmable Gate Array (FPGA). It is embedded in a System-On-Programmable-Chip (SOPC) platform for performance measurement. Experimental results show that the proposed architecture is an efficient design for attaining both high speed performance and low area costs. PMID:22778640

49 CFR 7.44 - Services performed without charge or at a reduced charge.

Code of Federal Regulations, 2013 CFR

2013-10-01

... charged to any requestor making a request under subpart C of this part for the first two hours of search... search is required two hours of search time will be considered spent when the hourly costs of operating the central processing unit used to perform the search added to the computer operator's salary cost...

49 CFR 7.44 - Services performed without charge or at a reduced charge.

Code of Federal Regulations, 2011 CFR

2011-10-01

... charged to any requestor making a request under subpart C of this part for the first two hours of search... search is required two hours of search time will be considered spent when the hourly costs of operating the central processing unit used to perform the search added to the computer operator's salary cost...

49 CFR 7.44 - Services performed without charge or at a reduced charge.

Code of Federal Regulations, 2012 CFR

2012-10-01

... charged to any requestor making a request under subpart C of this part for the first two hours of search... search is required two hours of search time will be considered spent when the hourly costs of operating the central processing unit used to perform the search added to the computer operator's salary cost...

Drug Prohibition in the United States: Costs, Consequences, and Alternatives

NASA Astrophysics Data System (ADS)

Nadelmann, Ethan A.

1989-09-01

``Drug legalization'' increasingly merits serious consideration as both an analytical model and a policy option for addressing the ``drug problem.'' Criminal justice approaches to the drug problem have proven limited in their capacity to curtail drug abuse. They also have proven increasingly costly and counterproductive. Drug legalization policies that are wisely implemented can minimize the risks of legalization, dramatically reduce the costs of current policies, and directly address the problems of drug abuse.

46 CFR 393.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Act, as set forth in Chapter 551 of Title 46, United States Code. (d) Corridor Sponsor. An entity that... emissions, energy savings, improved safety, system resiliency, and/or reduced infrastructure costs. Routes...

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda.

PubMed

Greco, Giulia; Knight, Louise; Ssekadde, Willington; Namy, Sophie; Naker, Dipak; Devries, Karen

2018-01-01

This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider's perspective to estimate total and unit costs. The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region.

Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement.

PubMed

Nevin, Rick; Jacobs, David E; Berg, Michael; Cohen, Jonathan

2008-03-01

Previous estimates of childhood lead poisoning prevention benefits have quantified the present value of some health benefits, but not the costs of lead paint hazard control or the benefits associated with housing and energy markets. Because older housing with lead paint constitutes the main exposure source today in the US, we quantify health benefits, costs, market value benefits, energy savings, and net economic benefits of lead-safe window replacement (which includes paint stabilization and other measures). The benefit per resident child from improved lifetime earnings alone is $21,195 in pre-1940 housing and $8685 in 1940-59 housing (in 2005 dollars). Annual energy savings are $130-486 per housing unit, with or without young resident children, with an associated increase in housing market value of $5900-14,300 per housing unit, depending on home size and number of windows replaced. Net benefits are $4490-5,629 for each housing unit built before 1940, and $491-1629 for each unit built from 1940-1959, depending on home size and number of windows replaced. Lead-safe window replacement in all pre-1960 US housing would yield net benefits of at least $67 billion, which does not include many other benefits. These other benefits, which are shown in this paper, include avoided Attention Deficit Hyperactivity Disorder, other medical costs of childhood lead exposure, avoided special education, and reduced crime and juvenile delinquency in later life. In addition, such a window replacement effort would reduce peak demand for electricity, carbon emissions from power plants, and associated long-term costs of climate change.

Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis.

PubMed

You, Joyce H S; Li, Hong-Kiu; Ip, Margaret

2018-03-01

Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results. Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold. Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

PubMed Central

2012-01-01

Introduction Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is a cornerstone of successful MRSA control policies. Implementation of such strategies is hampered when using conventional cultures with diagnostic delays of three to five days, as many non-carriers remain unnecessarily isolated. Rapid diagnostic testing (RDT) reduces the amount of unnecessary isolation days, but costs and benefits have not been accurately determined in intensive care units (ICUs). Methods Embedded in a multi-center hospital-wide study in 12 Dutch hospitals we quantified cost per isolation day avoided using RDT for MRSA, added to conventional cultures, in ICUs. BD GeneOhm™ MRSA PCR (IDI) and Xpert MRSA (GeneXpert) were subsequently used during 17 and 14 months, and their test characteristics were calculated with conventional culture results as reference. We calculated the number of pre-emptive isolation days avoided and incremental costs of adding RDT. Results A total of 163 patients at risk for MRSA carriage were screened and MRSA prevalence was 3.1% (n = 5). Duration of isolation was 27.6 and 21.4 hours with IDI and GeneXpert, respectively, and would have been 96.0 hours when based on conventional cultures. The negative predictive value was 100% for both tests. Numbers of isolation days were reduced by 44.3% with PCR-based screening at the additional costs of €327.84 (IDI) and €252.14 (GeneXpert) per patient screened. Costs per isolation day avoided were €136.04 (IDI) and €121.76 (GeneXpert). Conclusions In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of €121.76 to €136.04 per isolation day avoided. PMID:22314204

Wastewater reclamation using discarded reverse osmosis membranes for reuse in irrigation in Djibouti, an arid country.

PubMed

Awaleh, Mohamed Osman; Ahmed, Moussa Mahdi; Soubaneh, Youssouf Djibril; Hoch, Farhan Bouraleh; Bouh, Samatar Mohamed; Dirieh, Elias Said

2013-01-01

The purpose of this paper is to establish the feasibility of recovering discarded reverse osmosis (RO) membranes in order to reduce the salinity of domestic treated wastewater. This study shows that the reuse of RO membranes is of particular interest for arid countries having naturally high mineralized water such as Djibouti. The pilot desalination unit reduces the electrical conductivity, the turbidity and the total dissolved salt respectively at 75-85, 96.7 and 95.4%. The water produced with this desalination unit contains an average of 254 cfu/100 mL total coliforms and 87 cfu/100 mL fecal coliforms. This effluent meets the World Health Organization standards for treated wastewater reuse for agricultural purposes. The annual cost of the desalination unit was evaluated as US $/m(3) 0.82, indicating the relatively high cost of this process. Nevertheless, such processes are required to produce an effluent, with a high reuse potential.

Reconciling quality and cost: A case study in interventional radiology.

PubMed

Zhang, Li; Domröse, Sascha; Mahnken, Andreas

2015-10-01

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

Cost-effectiveness of Phacoemulsification Versus Combined Phacotrabeculectomy for Treating Primary Angle Closure Glaucoma.

PubMed

Chan, Poemen P; Li, Emmy Y; Tsoi, Kelvin K F; Kwong, Yolanda Y; Tham, Clement C

2017-10-01

The purpose of this study is to compare the cost effectiveness of phacoemulsification and combined phacotrabeculectomy for lowering intraocular pressure (IOP) in primary angle closure glaucoma (PACG) eyes with coexisting cataract. Real-life data of 2 previous randomized control trials that involved 51 medically uncontrolled PACG eyes and 72 medically controlled PACG eyes were utilized to calculate the direct cost of treatment. They were followed-up for 2 years. Cost of preoperative assessments, surgical interventions, additional procedures for managing complications and maintenance of filtration, postoperative follow-up, and cost of medications were considered. Cost data of 3 different regions (The United States, People's Republic of China, and Hong Kong) were used for comparison. The corresponding average costs for treating 1 eye with newly diagnosed PACG by phacoemulsification alone and combined phacotrabeculectomy were US$3479 and US$2439 in the United States, US$1051 and US$861 in China, and US$6856 and US$12087 in Hong Kong. Surgical and medications costs were the 2 key contributors. Combined phacotrabeculectomy was more cost-effective for IOP reduction when calculating with the United States and China cost data, but was less cost-effective when calculating with the Hong Kong cost data. The cost-effectiveness was insensitive to the costs of follow-up visit and investigations, the cost of surgical operations, and the cost of postoperative procedures, but sensitive to the cost fluctuation of medications. Furthermore, for the medically uncontrolled PACG group, phacoemulsification alone became more cost-effective when the cost of medication was reduced by >75%. Combined phacotrabeculectomy is a more cost-effective option for lowering IOP in PACG eyes with coexisting cataract, over a 2-year follow-up period.

Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low-Birth-Weight Infants123

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Bigger, Harold R.; Engstrom, Janet L.; Meier, Paula P.

2014-01-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities. PMID:24618763

Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants.

PubMed

Johnson, Tricia J; Patel, Aloka L; Bigger, Harold R; Engstrom, Janet L; Meier, Paula P

2014-03-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities.

Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Study

PubMed Central

2010-01-01

Introduction Severe acute kidney injury (AKI) can be treated with either continuous renal replacement therapy (CRRT) or intermittent renal replacement therapy (IRRT). Limited evidence from existing studies does not support an outcome advantage of one modality versus the other, and most centers around the word use both modalities according to patient needs. However, cost estimates involve multiple factors that may not be generalizable to other sites, and, to date, only single-center cost studies have been performed. The aim of this study was to estimate the cost difference between CRRT and IRRT in the intensive care unit (ICU). Methods We performed a post hoc analysis of a prospective observational study among 53 centers from 23 countries, from September 2000 to December 2001. We estimated costs based on staffing, as well as dialysate and replacement fluid, anticoagulation and extracorporeal circuit. Results We found that the theoretic range of costs were from $3,629.80/day more with CRRT to $378.60/day more with IRRT. The median difference in cost between CRRT and IRRT was $289.60 (IQR 830.8-116.8) per day (greater with CRRT). Costs also varied greatly by region. Reducing replacement fluid volumes in CRRT to ≤ 25 ml/min (approximately 25 ml/kg/hr) would result in $67.20/day (23.2%) mean savings. Conclusions Cost considerations with RRT are important and vary substantially among centers. We identified the relative impact of four cost domains (nurse staffing, fluid, anticoagulation, and extracorporeal circuit) on overall cost differences, and hospitals can look to these areas to reduce costs associated with RRT. PMID:20346163

Feasibility of Floating Platform Systems for Wind Turbines: Preprint

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

Musial, W.; Butterfield, S.; Boone, A.

This paper provides a general technical description of several types of floating platforms for wind turbines. Platform topologies are classified into multiple- or single-turbine floaters and by mooring method. Platforms using catenary mooring systems are contrasted to vertical mooring systems and the advantages and disadvantages are discussed. Specific anchor types are described in detail. A rough cost comparison is performed for two different platform architectures using a generic 5-MW wind turbine. One platform is a Dutch study of a tri-floater platform using a catenary mooring system, and the other is a mono-column tension-leg platform developed at the National Renewable Energymore » Laboratory. Cost estimates showed that single unit production cost is $7.1 M for the Dutch tri-floater, and $6.5 M for the NREL TLP concept. However, value engineering, multiple unit series production, and platform/turbine system optimization can lower the unit platform costs to $4.26 M and $2.88 M, respectively, with significant potential to reduce cost further with system optimization. These foundation costs are within the range necessary to bring the cost of energy down to the DOE target range of $0.05/kWh for large-scale deployment of offshore floating wind turbines.« less

Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care

PubMed Central

Williams, Kristine N.; Ayyagari, Padmaja; Perkhounkova, Yelena; Bott, Marjorie J.; Herman, Ruth; Bossen, Ann

2017-01-01

CONTEXT Persons with Alzheimer’s disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC). OBJECTIVE This analysis evaluates the cost-effectiveness of the CHAT intervention to reduce elderspeak communication by staff and RTC behaviors of NH residents with dementia. DESIGN Costs to provide the intervention were determined in eleven NHs that participated in the CHAT study during 2011–2013 using process-based costing. Each NH provided data on staff wages for the quarter before and for two quarters after the CHAT intervention. An incremental cost-effectiveness analysis was completed. ANALYSIS An average cost per participant was calculated based on the number and type of staff attending the CHAT training, plus materials and interventionist time. Regression estimates from the parent study then were applied to determine costs per unit reduction in staff elderspeak communication and resident RTC. RESULTS A one percentage point reduction in elderspeak costs $6.75 per staff member with average baseline elderspeak usage. Assuming that each staff cares for 2 residents with RTC, a one percentage point reduction in RTC costs $4.31 per resident using average baseline RTC. CONCLUSIONS Costs to reduce elderspeak and RTC depend on baseline levels of elderspeak and RTC, as well as the number of staff participating in CHAT training and numbers of residents with dementia-related behaviors. Overall, the 3-session CHAT training program is a cost-effective intervention for reducing RTC behaviors in dementia care. PMID:28503675

Who Purchases Low-Cost Alcohol in Australia?

PubMed

Callinan, Sarah; Room, Robin; Livingston, Michael; Jiang, Heng

2015-11-01

Debates surrounding potential price-based polices aimed at reducing alcohol-related harms tend to focus on the debate concerning who would be most affected-harmful or low-income drinkers. This study will investigate the characteristics of people who purchase low-cost alcohol using data from the Australian arm of the International Alcohol Control study. 1681 Australians aged 16 and over who had consumed alcohol and purchased it in off-licence premises were asked detailed questions about both practices. Low-cost alcohol was defined using cut-points of 80¢, $1.00 or $1.25 per Australian standard drink. With a $1.00 cut-off low income (OR = 2.1) and heavy drinkers (OR = 1.7) were more likely to purchase any low-cost alcohol. Harmful drinkers purchased more, and low-income drinkers less, alcohol priced at less than $1.00 per drink than high income and moderate drinkers respectively. The relationship between the proportion of units purchased at low cost and both drinker category and income is less clear, with hazardous, but not harmful, drinkers purchasing a lower proportion of units at low cost than moderate drinkers. The impact of minimum pricing on low income and harmful drinkers will depend on whether the proportion or total quantity of all alcohol purchased at low cost is considered. Based on absolute units of alcohol, minimum unit pricing could be differentially effective for heavier drinkers compared to other drinkers, particularly for young males. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Establishing Common Cost Measures to Evaluate the Economic Value of Patient Navigation Programs

PubMed Central

Whitley, Elizabeth; Valverde, Patricia; Wells, Kristen; Williams, Loretta; Teschner, Taylor; Shih, Ya-Chen Tina

2011-01-01

Background Patient navigation is an intervention aimed at reducing barriers to healthcare for underserved populations as a means to reduce cancer health disparities. Despite the proliferation of patient navigation programs across the United States, information related to the economic impact and sustainability of these programs is lacking. Method Following a review of the relevant literature, the Health Services Research (HSR) cost workgroup of the American Cancer Society National Patient Navigator Leadership Summit met to examine cost data relevant to assessing the economic impact of patient navigation and to propose common cost metrics. Results Recognizing that resources available for data collection, management and analysis vary, five categories of core and optional cost measures were identified related to patient navigator programs, including, program costs, human capital costs, direct medical costs, direct non-medical costs and indirect costs. Conclusion(s) Information demonstrating economic as well as clinical value is necessary to make decisions about sustainability of patient navigation programs. Adoption of these common cost metrics are recommended to promote understanding of the economic impact of patient navigation and comparability across diverse patient navigation programs. PMID:21780096

Internal Logistics System Selection with Total Cost of Ownership Analysis

NASA Astrophysics Data System (ADS)

Araújo, Inês; Pimentel, Carina; Godina, Radu; Matias, João C. O.

2017-06-01

In this paper a methodology was followed in order to support the decision-making of one industrial unit regarding its internal logistics system. The addressed factory was facing issues with their internal logistics approach. Some alternatives were pointed out and a proper total cost of ownership (TCO) analysis was developed. This analysis was taken in order to demonstrate the more cost-effective solution for the internal logistics system. This tool is more and more valued by the companies, due to their willing to reduce the costs that are associated with the way of doing business. Despite the proposal of the best choice for the internal logistics system of the enterprise, this study also intends to present some conclusions about the match between the nature of the industrial unit and the logistics systems that best fit the requirements of those.

Health economics in the United States: cost implications.

PubMed

Whitelaw, G N

1993-01-01

World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light.

Cost-benefit of a clinical services integrated with a decentralized unit dose system.

PubMed

Warrian, K; Irvine-Meek, J

1988-06-01

Clinical pharmacy services are believed to be beneficial to patient care and to have the potential to reduce drug costs. This study was designed to apply cost-benefit analysis techniques to selected clinical pharmacy services provided by staff pharmacists assigned to a mobile decentralized unit-dose drug distribution system. Pharmacists' interventions were identified and recorded by the pharmacists and the investigator over an eight-week period. Interventions, to which a monetary value could be assigned, included non-formulary drug use, drug regimen adjustments, and the duration of drug therapy. A total of 543 interventions were recorded or observed. Of these, 174 (32 percent) fit the criteria for inclusion in the study. Those interventions accepted by physicians (87 percent) were assigned a dollar value and tabulated. Costs to provide the service were the pharmacists' salaries. Benefit to cost ratios of 1.08 and 1.59 demonstrated that the benefits accrued from selected clinical pharmacy services exceeded the costs to the hospital.

Solar Energy Technologies Office FY 2017 Budget At-A-Glance

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

None, None

2016-03-01

The Solar Energy Technologies Office supports the SunShot Initiative goal to make solar energy technologies cost competitive with conventional energy sources by 2020. Reducing the total installed cost for utility-scale solar electricity by approximately 75% (2010 baseline) to roughly $0.06 per kWh without subsidies will enable rapid, large-scale adoption of solar electricity across the United States. This investment will help re-establish American technological and market leadership in solar energy, reduce environmental impacts of electricity generation, and strengthen U.S. economic competitiveness.

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

PubMed

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

2016-06-01

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

A Reduced Form Model for Ozone Based on Two Decades of CMAQ Simulations for the Continental United States

EPA Science Inventory

A Reduced Form Model (RFM) is a mathematical relationship between the inputs and outputs of an air quality model, permitting estimation of additional modeling without costly new regional-scale simulations. A 21-year Community Multiscale Air Quality (CMAQ) simulation for the con...

Cost and efficacy comparison of integrated pest management strategies with monthly spray insecticide applications for German cockroach (Dictyoptera: Blattellidae) control in public housing.

PubMed

Miller, D M; Meek, F

2004-04-01

The long-term costs and efficacy of two treatment methodologies for German cockroach, Blattella germanica (L.), control were compared in the public housing environment. The "traditional" treatment for German cockroaches consisted of monthly baseboard and crack and crevice treatment (TBCC) by using spray and dust formulation insecticides. The integrated pest management treatment (IPM) involved initial vacuuming of apartments followed by monthly or quarterly applications of baits and insect growth regulator (IGR) devices. Cockroach populations in the IPM treatment were also monitored with sticky traps. Technician time and the amount of product applied were used to measure cost in both treatments. Twenty-four hour sticky trap catch was used as an indicator of treatment efficacy. The cost of the IPM treatment was found to be significantly greater than the traditional treatment, particularly at the initiation of the test. In the first month (clean-out), the average cost per apartment unit was dollar 14.60, whereas the average cost of a TBCC unit was dollar 2.75. In the second month of treatment, the average cost of IPM was still significantly greater than the TBCC cost. However, after month 4 the cost of the two treatments was no longer significantly different because many of the IPM apartments were moved to a quarterly treatment schedule. To evaluate the long-term costs of the two treatments over the entire year, technician time and product quantities were averaged over all units treated within the 12-mo test period (total 600 U per treatment). The average per unit cost of the IPM treatment was (dollar 4.06). The average IPM cost was significantly greater than that of the TBCC treatment at dollar 1.50 per unit. Although the TBCC was significantly less expensive than the IPM treatment, it was also less effective. Trap catch data indicated that the TBCC treatment had little, if any, effect on the cockroach populations over the course of the year. Cockroach populations in the TBCC treatment remained steady for the first 5 mo of the test and then had a threefold increase during the summer. Cockroach populations in the IPM treatment were significantly reduced from an average of 24.7 cockroaches per unit before treatment to an average 3.9 cockroaches per unit in month 4. The suppressed cockroach populations (< 5 per unit) in the IPM treatment remained constant for the remaining 8 mo of the test.

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation

PubMed Central

Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Mumba, Grace Tembo; Gill, Michelle M.; Strasser, Susan; Peeling, Rosanna W.; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider’s perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up. PMID:25970443

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

PubMed

Shelley, Katharine D; Ansbro, Éimhín M; Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Tembo Mumba, Grace; Gill, Michelle M; Strasser, Susan; Peeling, Rosanna W; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider's perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up.

The cost-effectiveness of predonation screening for transfusion transmissible infections using rapid test kits in a hospital-based blood transfusion centre.

PubMed

Dosunmu, Adedoyin Owolabi; Akinbami, Akinsegun Abduljaleel; Ismail, Ayobami Kamal; Olaiya, Modupe Adebimpe; Uche, Ebele Ifeyinwa; Aile, Igbinoba Kingsley

2017-01-01

Blood transfusion practice emphasises safety, efficacy and appropriate use. These require cost-effective programme management. This study focused on the cost of screening for transfusion transmissible infections (TTI). This was a 1 year (2016) analysis of screening in a hospital-based transfusion centre. The cost of screening all blood donors by ELISA was compared to the cost of serial screening starting from rapid kit, taking into account, the estimated cost of blood bags prevented from discard after ELISA screening (attributable cost). The cost of voluntary donor drive plus cost of ELISA screening was compared with the present cost of screening. A total of 5591 donors were screened for HIV, hepatitis B and C using the rapid kit, 291 donors were deferred (5.2%). A total of 5300 units were further screened by ELISA. A total of 435 blood units (8.2%) were discarded due to TTI positivity. TTI positivity rate was 12.98%. Only 2.36% were voluntary donors and among these 9.1% were TTI positive. The attributable cost of serial screening was 55,653.5 USD while that of screening by ELISA only was 55,910 USD. The attributable cost of rapid screening for only hepatitis B and then ELISA was 53,313.9 USD taking into consideration that 187 blood units would be prevented from undue discard. This analysis demonstrated that with proper donor selection, rapid screening for hepatitis B virus only before ELISA screening is more cost-effective. This will also reduce the waiting time for donors and counselling if HIV positive.

Costs of novel tuberculosis diagnostics--will countries be able to afford it?

PubMed

Pantoja, Andrea; Kik, Sandra V; Denkinger, Claudia M

2015-04-01

Four priority target product profiles for the development of diagnostic tests for tuberculosis were identified: 1) Rapid sputum-based (RSP), 2) non-sputum Biomarker-based (BMT), 3) triage test followed by confirmatory test (TT), and 4) drug-susceptibility testing (DST). We assessed the cost of the new tests in suitable strategies and of the conventional diagnosis of tuberculosis as per World Health Organization guidelines, in 36 high tuberculosis and MDR burden countries. Costs were then compared to the available funding for tuberculosis at country level. Costs of diagnosing tuberculosis using RSP ranged US$93-187 million/year; if RSP unit cost is of US$2-4 it would be lower/similar cost than conventional strategy with sputum smear microscopy (US$ 119 million/year). Using BMT (with unit cost of US$2-4) would cost US$70-121 million/year and be lower/comparable cost than conventional diagnostics. Using TT with TPP characteristics (unit cost of US$1-2) followed by Xpert would reduce diagnostic costs up to US$36 million/year. Costs of using different novel DST strategies for the diagnosis of drug resistance would be higher compared with conventional diagnosis. Introducing a TT or a biomarker test with optimal characteristics would be affordable from a cost and affordability perspective at the current available funding for tuberculosis. Additional domestic or donor funding would be needed in most countries to achieve affordability for other new diagnostic tests. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Low-cost forest operation systems that minimize environmental impacts of harvesting

Treesearch

Thomas F. Lloyd; Thomas A. Waldrop

1995-01-01

Forest operation systems have been developed for mixed pine and hardwood stands in the Piedmont region of the southeastern United States that reduce the cost and environmental impacts of forest operations. This has been done by studying the interrelations of forest operations with site edaphic properties and the biology of plant communities that reside on each site. In...

Felling and skidding cost estimates for thinnings to reduce gypsy moth impacts

Treesearch

Michael D. Erickson; Curt C. Hassler; Chris B. LeDoux

1991-01-01

The gypsy moth is a serious threat to the hardwood forests of the eastern United States. Although chemical treatments currently exist which can be used to help control the impacts of the moth, silvicultural control measures are just now being proposed and tested. Felling and skidding cost estimates for harvesting merchantable timber under two such proposed...

A comparison of efficacy of endovascular versus surgical repair for the treatment of arteriovenous fistula stenosis in Taiwan.

PubMed

Fan, Szu-Shan; Chen, Chien-Wen; Lu, Kuo-Cheng; Mao, Hung-Chung; Chen, Miao-Pei; Chou, Chu-Lin

2017-05-15

Percutaneous transluminal angioplasty (PTA) and fistula reconstruction surgery are therapeutic options for vascular access occlusion in hemodialysis patients. However, owing to its convenience, PTA has gradually become the preferred therapeutic option for fistula stenosis or occlusion. This study investigated the effects of the two therapeutic methods on the vascular access maintenance duration (number of days) and maintenance costs of fistula in dialysis patients from different dialysis units. In this study, 544 hemodialysis patients from 2 dialysis units in a teaching hospital in the southern area of Taiwan were included in the analysis of the frequency of PTA or revascularization surgery and the use of related medical resources by conducting a retrospective chart review. The frequency of PTA in the patients undergoing long-term hemodialysis was not significantly associated with their demographic characteristics. The efficacy of PTA has declined with shorter maintenance duration with increasing PTA frequency. The cost profile of PTA was more expensive than that of fistula revascularization surgery. In this study, PTA was found to be just a temporary solution for fistula thrombosis, whereas fistula reconstruction surgery is inexpensive and improves survival time. Therefore, dialysis units should establish an appropriate standard of care to avoid over-reliance on PTA in order to reduce the fistula failure rate, improve the dialysis efficacy, and reduce the psychological stress in patients, as well as to reduce the maintenance costs and rationalize the medical expenses.

Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States?

PubMed

Cohen, Deborah A; Wu, Shin-Yi; Farley, Thomas A

2006-07-01

Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population. We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States. All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections. Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.

Ion propulsion cost effectivity

NASA Technical Reports Server (NTRS)

Zafran, S.; Biess, J. J.

1978-01-01

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

Development of a practical costing method for hospitals.

PubMed

Cao, Pengyu; Toyabe, Shin-Ichi; Akazawa, Kouhei

2006-03-01

To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.

Procalcitonin Biomarker Algorithm Reduces Antibiotic Prescriptions, Duration of Therapy, and Costs in Chronic Obstructive Pulmonary Disease: A Comparison in the Netherlands, Germany, and the United Kingdom.

PubMed

van der Maas, Marloes E; Mantjes, Gertjan; Steuten, Lotte M G

2017-04-01

Antibiotics are often recommended as treatment for patients with chronic obstructive pulmonary disease (COPD) exacerbations. However, not all COPD exacerbations are caused by bacterial infections and there is consequently considerable misuse and overuse of antibiotics among patients with COPD. This poses a severe burden on healthcare resources such as increased risk of developing antibiotic resistance. The biomarker procalcitonin (PCT) displays specificity to distinguish bacterial inflammations from nonbacterial inflammations and may therefore help to rationalize antibiotic prescriptions. We report in this study, a three-country comparison of the health and economic consequences of a PCT biomarker-guided prescription and clinical decision-making strategy compared to current practice in hospitalized patients with COPD exacerbations. A decision tree was developed, comparing the expected costs and effects of the PCT algorithm to current practice in the Netherlands, Germany, and the United Kingdom. The time horizon of the model captured the length of hospital stay and a societal perspective was also adopted. The primary health outcome was the duration of antibiotic therapy. The incremental cost-effectiveness ratio was defined as the incremental costs per antibiotic day avoided. The incremental cost savings per day on antibiotic therapy avoided were (in Euros) €90 in the Netherlands, €125 in Germany, and €52 in the United Kingdom. Probabilistic sensitivity analyses showed that in the majority of simulations, the PCT biomarker strategy was superior to current practice (the Netherlands: 58%, Germany: 58%, and the United Kingdom: 57%). In conclusion, the PCT biomarker algorithm to optimize antibiotic prescriptions in COPD is likely to be cost-effective compared to current practice. Both the percentage of patients who start with antibiotic treatment as well as the duration of antibiotic therapy are reduced with the PCT decision algorithm, leading to a decrease in total costs per patient. Economic analysis based on real-life data is recommended for further research. Biomarker-driven prescription algorithms are important instruments for personalized medicine in COPD. This also attests to the emerging convergence of biomarker innovations and the broader field of Health Technology Assessment (HTA).

Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty.

PubMed

Churchill, Jessica L; Puca, Kathleen E; Meyer, Elizabeth; Carleton, Matthew; Anderson, Michael J

2017-06-01

Multiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TXA, has been less frequently used. This study evaluated whether EACA is as efficacious as TXA in reducing postoperative blood transfusion rates and compared the cost per surgery between agents. A multicenter retrospective chart review of elective unilateral TKA from April 2012 through December 2014 was performed. Five hospitals within a health care system participated. Data collected included age, gender, severity of illness score, use of antifibrinolytic and dose, red blood cell (RBC) transfusions and the number of units, and preadmission and discharge hemoglobin (Hb). Dosing of the antifibrinolytic differed based on the agent used, 5 or 10 g (based on weight) for EACA versus 1 g for TXA. The institutional acquisition cost of each antifibrinolytic was obtained and averaged over the study period. Of 2,922 primary unilateral TKA cases, 820 patients received EACA, 610 patients received TXA, and 1,492 patients received no antifibrinolytic (control group). Compared with the control group both EACA and TXA groups had significantly fewer patients transfused (EACA 2.8% [ p  < 0.0001], TXA 3.2% [ p  < 0.0001] vs. control 10.8%) and lower mean RBC units transfused per patient (EACA 0.05 units/patient [pt] [ p  < 0.0001], TXA 0.05 units/pt [ p  < 0.0001] vs. control 0.19 units/pt]. There was no difference in mean RBC units transfused per patient, percentage of patients transfused, and discharge Hb levels between the EACA and TXA groups ( p  = 0.822, 0.236, and 0.322, respectively). Medication acquisition cost for EACA averaged $2.23 per surgery compared with TXA at $39.58 per surgery. Administration of EACA or TXA significantly decreased postoperative transfusion rates compared with no antifibrinolytic therapy. Utilization of EACA for unilateral TKA proved to be comparable to TXA in all studied aspects at a lower cost. The level of evidence for the study is Level 3. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Cost-Effectiveness of Independent Housing for the Chronically Mentally Ill: Do Housing and Neighborhood Features Matter?

PubMed Central

Harkness, Joseph; Newman, Sandra J; Salkever, David

2004-01-01

Objective To determine the effects of housing and neighborhood features on residential instability and the costs of mental health services for individuals with chronic mental illness (CMI). Data Sources Medicaid and service provider data on the mental health service utilization of 670 individuals with CMI between 1988 and 1993 were combined with primary data on housing attributes and costs, as well as census data on neighborhood characteristics. Study participants were living in independent housing units developed under the Robert Wood Johnson Foundation Program on Chronic Mental Illness in four of nine demonstration cities between 1988 and 1993. Study Design Participants were assigned on a first-come, first-served basis to housing units as they became available for occupancy after renovation by the housing providers. Multivariate statistical models are used to examine the relationship between features of the residential environment and three outcomes that were measured during the participant's occupancy in a study property: residential instability, community-based service costs, and hospital-based service costs. To assess cost-effectiveness, the mental health care cost savings associated with some residential features are compared with the cost of providing housing with these features. Data Collection/Extraction Methods Health service utilization data were obtained from Medicaid and from state and local departments of mental health. Non-mental-health services, substance abuse services, and pharmaceuticals were screened out. Principal Findings Study participants living in newer and properly maintained buildings had lower mental health care costs and residential instability. Buildings with a richer set of amenity features, neighborhoods with no outward signs of physical deterioration, and neighborhoods with newer housing stock were also associated with reduced mental health care costs. Study participants were more residentially stable in buildings with fewer units and where a greater proportion of tenants were other individuals with CMI. Mental health care costs and residential instability tend to be reduced in neighborhoods with many nonresidential land uses and a higher proportion of renters. Mixed-race neighborhoods are associated with reduced probability of mental health hospitalization, but they also are associated with much higher hospitalization costs if hospitalized. The degree of income mixing in the neighborhood has no effect. Conclusions Several of the key findings are consistent with theoretical expectations that higher-quality housing and neighborhoods lead to better mental health outcomes among individuals with CMI. The mental health care cost savings associated with these favorable features far outweigh the costs of developing and operating properties with them. Support for the hypothesis that “diverse-disorganized” neighborhoods are more accepting of individuals with CMI and, hence, associated with better mental health outcomes, is mixed. PMID:15333112

Using Simulation to Compare 4 Categories of Intervention for Reducing Cardiovascular Disease Risks

PubMed Central

Homer, Jack; Trogdon, Justin; Wile, Kristina; Orenstein, Diane

2014-01-01

The Prevention Impacts Simulation Model (PRISM) projects the multiyear impacts of 22 different interventions aimed at reducing risk of cardiovascular disease. We grouped these into 4 categories: clinical, behavioral support, health promotion and access, and taxes and regulation. We simulated impacts for the United States overall and also for a less-advantaged county with a higher death rate. Of the 4 categories of intervention, taxes and regulation reduce costs the most in the short term (through 2020) and long term (through 2040) and reduce deaths the most in the long term; they are second to clinical interventions in reducing deaths in the short term. All 4 categories combined were required to bring costs and deaths in the less-advantaged county down to the national level. PMID:24832142

Cost analysis of colorectal cancer screening with CT colonography in Italy.

PubMed

Mantellini, Paola; Lippi, Giuseppe; Sali, Lapo; Grazzini, Grazia; Delsanto, Silvia; Mallardi, Beatrice; Falchini, Massimo; Castiglione, Guido; Carozzi, Francesca Maria; Mascalchi, Mario; Milani, Stefano; Ventura, Leonardo; Zappa, Marco

2018-06-01

Unit costs of screening CT colonography (CTC) can be useful for cost-effectiveness analyses and for health care decision-making. We evaluated the unit costs of CTC as a primary screening test for colorectal cancer in the setting of a randomized trial in Italy. Data were collected within the randomized SAVE trial. Subjects were invited to screening CTC by mail and requested to have a pre-examination consultation. CTCs were performed with 64- and 128-slice CT scanners after reduced or full bowel preparation. Activity-based costing was used to determine unit costs per-process, per-participant to screening CTC, and per-subject with advanced neoplasia. Among 5242 subjects invited to undergo screening CTC, 1312 had pre-examination consultation and 1286 ultimately underwent CTC. Among 129 subjects with a positive CTC, 126 underwent assessment colonoscopy and 67 were ultimately diagnosed with advanced neoplasia (i.e., cancer or advanced adenoma). Cost per-participant of the entire screening CTC pathway was €196.80. Average cost per-participant for the screening invitation process was €17.04 and €9.45 for the pre-examination consultation process. Average cost per-participant of the CTC execution and reading process was €146.08 and of the diagnostic assessment colonoscopy process was €24.23. Average cost per-subject with advanced neoplasia was €3777.30. Cost of screening CTC was €196.80 per-participant. Our data suggest that the more relevant cost of screening CTC, amenable of intervention, is related to CTC execution and reading process.

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda

PubMed Central

Knight, Louise; Ssekadde, Willington; Namy, Sophie; Naker, Dipak; Devries, Karen

2018-01-01

Introduction This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. Methods The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider’s perspective to estimate total and unit costs. Results The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. Conclusions The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region. PMID:29707243

Interpreting Financial Results. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

ERIC Educational Resources Information Center

Adamson, Jan; And Others

One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following an introduction and a paragraph on how to use the unit, section 1 covers how to use management information. The section includes these trainee…

Making Financial Decisions. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

ERIC Educational Resources Information Center

Adamson, Jan; And Others

One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following a paragraph on how to use the unit and an introduction, section 1 covers control levels as the framework for making decisions. The section…

An Examination of Information Technology and Its Perceived Quality Issues in Single System Hospitals in the United States

ERIC Educational Resources Information Center

Byrd, Linda W.

2009-01-01

The safety and quality of healthcare is of great concern in the United States. The positive effects of information technology reported in past research, especially case studies, has encouraged expectations that information technology may increase the quality of healthcare while reducing costs of healthcare. The goals of this study was to examine…

Are wildfire management resources in the United States efficiently allocated to protect resources at risk? A case study from Montana

Treesearch

Derek T. O' Donnell; Tyron J. Venna; David E. Calkin

2014-01-01

Federal wildfire management agencies in the United States are under substantial pressure to reduce and economically justify their expenditures. To support economically efficient management of wildfires, managers need better estimates of the resource benefits and avoided damage costs associated with alternative wildfire management strategies. This paper reports findings...

Application of CFB technology for large power generating units and CO{sub 2} capture

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

Ryabov, G. A., E-mail: georgy.ryabov@gmail.com; Folomeev, O. M.; Sankin, D. A.

2010-07-15

Data on the development of the circulating fluidized bed (CFB) technology for combustion of fuels in large power generating units are examined. The problems with raising the steam parameters and unit power of boilers with a circulating fluidized bed are examined. With the boiler system at the 460 MW unit at Lagisza (Poland) as an example, the feasibility of raising the efficiency of units with CFB boilers through deep recovery of the heat of the effluent gases and reducing expenditure for in-house needs is demonstrated. Comparative estimates of the capital and operating costs of 225 and 330 MW units aremore » used to determine the conditions for optimum use of CFB boilers in the engineering renovation of thermal power plants in Russia. New areas for the application of CFB technology in CO{sub 2} capture are analyzed in connection with the problem of reducing greenhouse gas emissions.« less

Namibia’s transition from whole blood–derived pooled platelets to single-donor apheresis platelet collections

PubMed Central

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

2015-01-01

BACKGROUND Few African countries separate blood donations into components; however, demand for platelets (PLTs) is increasing as regional capacity to treat causes of thrombocytopenia, including chemotherapy, increases. Namibia introduced single-donor apheresis PLT collections in 2007 to increase PLT availability while reducing exposure to multiple donors via pooling. This study describes the impact this transition had on PLT availability and safety in Namibia. STUDY DESIGN AND METHODS Annual national blood collections and PLT units issued data were extracted from a database maintained by the Blood Transfusion Service of Namibia (NAMBTS). Production costs and unit prices were analyzed. RESULTS In 2006, NAMBTS issued 771 single and pooled PLT doses from 3054 whole blood (WB) donations (drawn from 18,422 WB donations). In 2007, NAMBTS issued 486 single and pooled PLT doses from 1477 WB donations (drawn from 18,309 WB donations) and 131 single-donor PLT doses. By 2011, NAMBTS issued 837 single-donor PLT doses per year, 99.1% of all PLT units. Of 5761 WB donations from which PLTs were made in 2006 to 2011, a total of 20 (0.35%) were from donors with confirmed test results for human immunodeficiency virus or other transfusion-transmissible infections (TTIs). Of 2315 single-donor apheresis donations between 2007 and 2011, none of the 663 donors had a confirmed positive result for any pathogen. As apheresis replaced WB-derived PLTs, apheresis production costs dropped by a mean of 8.2% per year, while pooled PLT costs increased by an annual mean of 21.5%. Unit prices paid for apheresis- and WB-derived PLTs increased by 9 and 7.4% per year on average, respectively. CONCLUSION Namibia’s PLT transition shows that collections from repeat apheresis donors can reduce TTI risk and production costs. PMID:25727921

Socio-economic and Engineering Assessments of Renewable Energy Cost Reduction Potential

NASA Astrophysics Data System (ADS)

Seel, Joachim

This dissertation combines three perspectives on the potential of cost reductions of renewable energy--a relevant topic, as high energy costs have traditionally been cited as major reason to vindicate developments of fossil fuel and nuclear power plants, and to justify financial support mechanisms and special incentives for renewable energy generators. First, I highlight the role of market and policy drivers in an international comparison of upfront capital expenses of residential photovoltaic systems in Germany and the United States that result in price differences of a factor of two and suggest cost reduction opportunities. In a second article I examine engineering approaches and siting considerations of large-scale photovoltaic projects in the United States that enable substantial system performance increases and allow thus for lower energy costs on a levelized basis. Finally, I investigate future cost reduction options of wind energy, ranging from capital expenses, operating expenses, and performance over a project's lifetime to financing costs. The assessment shows both substantial further cost decline potential for mature technologies like land-based turbines, nascent technologies like fixed-bottom offshore turbines, and experimental technologies like floating offshore turbines. The following paragraphs summarize each analysis: International upfront capital cost comparison of residential solar systems: Residential photovoltaic (PV) systems were twice as expensive in the United States as in Germany in 2012. This price discrepancy stems primarily from differences in non-hardware or "soft" costs between the two countries, of which only 35% be explained by differences in cumulative market size and associated learning. A survey of German PV installers was deployed to collect granular data on PV soft costs in Germany, and the results are compared to those of a similar survey of U.S. PV installers. Non-module hardware costs and all analyzed soft costs are lower in Germany, especially for customer acquisition, installation labor, and profit/overhead costs, but also for expenses related to permitting, interconnection, and inspection procedures. Additional costs occur in the United States due to state and local sales taxes, smaller average system sizes, and longer project-development times. To reduce the identified additional costs of residential PV systems, the United States could introduce policies that enable a robust and lasting market while minimizing market fragmentation. Regularly declining incentives offering a transparent and certain value proposition might help accelerate PV cost reductions in the United States. Performance analysis of large-scale solar installations in the United States: This paper presents the first known use of multi-variate regression techniques to statistically explore empirical variation in utility-scale PV project performance across the United States. Among a sample of 128 utility-scale PV projects totaling 3,201 MWAC, net capacity factors in 2014 varied by more than a factor of two. Regression models developed for this analysis find that just three highly significant independent variables can explain 92% of this project-level variation. Adding the commercial operation year as a fourth independent variable and three interactive variables improves the model further and reveals interesting relationships. Taken together, the empirical data and statistical modeling results presented in this paper can provide a useful indication of the level of performance that solar project developers and investors can expect from various project configurations in different regions of the United States. Moreover, the tight relationship between fitted and actual capacity factors should instill confidence among investors that the utility-scale projects in this sample have largely performed as predicted by our models, with no significant outliers to date. Holistic assessment of future cost reduction opportunities of wind energy applications: Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends on the future costs of both onshore and offshore wind. Here, I summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. The main identified drivers for near term cost reductions are rotor-related advancements and taller towers for onshore installations, fixed-bottom offshore turbines can benefit from an upscaling in generator capacity, streamlined foundation design and reduced financing costs, while floating offshore turbines require further progress in buoyant support structure design and installation process efficiencies. Insights gained through this expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy, planning, R&D, and industry strategy. (Abstract shortened by ProQuest.).

[Economic impact of an automated dispensing system in an intensive care unit].

PubMed

Kheniene, F; Bedouch, P; Durand, M; Marie, F; Brudieu, E; Tourlonnias, M-M; Bongi, P; Allenet, B; Calop, J

2008-03-01

Automated dispensing systems (ADS) allow a reduction of medication errors and an improvement of drug distribution in clinical ward. The objective of this study was to evaluate the economic impact of ADS in an intensive care unit. A cost-benefit model was constructed based on the hospital perspective. The system was evaluated before-after implementation of an ADS in a 12-bed cardiovascular intensive care unit of a French teaching hospital: (a) by a measuring nurse and pharmacy technician working time required for various tasks; (b) by measuring the cost of drug storage and the cost of expired drug; (c) by measuring the nurses' acceptability. After ADS was installed, nursing personnel spent less time on medication-related activities (mean of 1.9 hour/day of nursing time). Pharmacy technicians spent more time on floor-stock activities (mean of 0.7 hour/day of technician time). Implementation reduced the cost of drug storage by 56% (14,742 euros) and cost of expired drug by 9,086 euros per year. Finally, cost-benefit analysis including potential savings in terms of working time showed a net benefit of 71,586 euros (14,317 euros/year). The ADS was given high marks by the nurses; 77% wanted to keep it on their unit. Implementation of ADS is expected to generate direct savings for the hospital and working time reallocation, for nurses to interact with patients and for pharmacy technicians to get involved on the ward.

Hospital economics of primary total knee arthroplasty at a teaching hospital.

PubMed

Healy, William L; Rana, Adam J; Iorio, Richard

2011-01-01

The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

Reducing the financial impact of pathogen inactivation technology for platelet components: our experience.

PubMed

Girona-Llobera, Enrique; Jimenez-Marco, Teresa; Galmes-Trueba, Ana; Muncunill, Josep; Serret, Carmen; Serra, Neus; Sedeño, Matilde

2014-01-01

Pathogen inactivation (PI) technology for blood components enhances blood safety by inactivating viruses, bacteria, parasites, and white blood cells. Additionally, PI for platelet (PLT) components has the potential to extend PLT storage time from 5 to 7 days. A retrospective analysis was conducted into the percentage of outdated PLT components during the 3 years before and after the adoption of PLT PI technology in our institution. The PLT transfusion dose for both pre-PI and post-PI periods was similar. A retrospective analysis to study clinical safety and component utilization was also performed in the Balearic Islands University Hospital. As a result of PI implementation in our institution, the PLT production cost increased by 85.5%. However, due to the extension of PLT storage time, the percentage of outdated PLT units substantially decreased (-83.9%) and, consequently, the cost associated with outdated units (-69.8%). This decrease represented a 13.7% reduction of the initial cost increase which, together with the saving in blood transportation (0.1%), led to a saving of 13.8% over the initial cost. Therefore, the initial 85.5% increase in the cost of PLT production was markedly reduced to 71.7%. The mean number of PLT concentrates per patient was similar during both periods. The extension of PLT storage time can substantially contribute to reducing the financial impact of PI by decreasing the percentage of outdated PLTs while improving blood safety. Since the adoption of PI, there have been no documented cases of PLT transfusion-related sepsis in our region. © 2013 American Association of Blood Banks.

Hospital costs and specialization: benefits of limiting the number of product lines.

PubMed

Eastaugh, Steven R

2009-01-01

Trends in hospital specialization are studied using multiple regression analysis for the period 1999-2008. The observed 31.3 percent rise in specialization was associated with a 9.5 percent decline in unit cost per admission. The number of specialized hospitals has grown by 149 percent in the past decade. Other hospitals are getting more specialized by reducing their product lines. Specialization has been highest in competitive West Coast markets and lowest in the rate-regulated states (New York and Massachusetts). Hospitals have less incentive to contain costs by decreasing the array of services offered in stringent rate-setting states. The term "underspecialization" is advanced to capture the inability of some hospitals to selectively prune out product lines in order to specialize. Such hospitals spread resources so thin that many good departments suffer. Unit cost per case (DRG-adjusted) is higher in the less specialized hospitals.

Designing and Testing of Self-Cleaning Recirculating Zebrafish Tanks.

PubMed

Nema, Shubham; Bhargava, Yogesh

2016-08-01

Maintenance of large number of zebrafish in captive conditions is a daunting task. This can be eased by the use of recirculating racks with self-cleaning zebrafish tanks. Commercially available systems are costly, and compatibility of intercompany products has never been investigated. Although various cost-effective designs and methods of construction of custom-made recirculating zebrafish racks are available in literature, the design of self-cleaning zebrafish tanks is still not available. In this study, we report the design and method of construction of the self-cleaning unit, which can be fitted in any zebrafish tank. We validated the design by investigating sediment cleaning process in rectangular and cylindrical tank geometries using time lapse imaging. Our results suggest that for both tank geometries, the tanks fitted with self-cleaning unit provided superior sediment cleaning than the tanks fitted with overflow-drain unit. Although the self-cleaning unit could clean the sediment completely from both geometries over prolonged period, the cleaning of sediments was faster in the cylindrical tank than the rectangular tank. In conclusion, cost and efforts of zebrafish maintenance could be significantly reduced through the installation of our self-cleaning unit in any custom-made zebrafish tank.

Aggregation and the Measurement of Health Care Costs

PubMed Central

Getzen, Thomas E

2006-01-01

Objective This study evaluated the extent to which the causes of variation in health care costs differ by the level at which observations are made. Methods More than 40 U.S. and international studies providing empirical estimates of the sources of variation in health care costs were reviewed and arrayed by size of observational units. A simplified graphical analysis demonstrating how estimated correlation coefficients change with the level and type of aggregation is presented. Results As the unit of observation becomes larger, association between health care costs and health status/morbidity becomes weaker and smaller in magnitude, while correlation with income (per capita GDP) becomes stronger and larger. Individual expenditure variation within a particular health care system is largely due to differences in health status, but across systems, morbidity has almost no effect on costs. For nations, differences in per capita income explain over 90 percent of the variation in both time series and cross section. Conclusions Units of observation used for analysis of health care costs must be matched to the units at which decision making occurs. The observed pattern of empirical results is consistent with a multilevel allocative model incorporating aggregate capacity constraints. To the extent that macro constraints determine total budgets at the national level, policy interventions at the micro level (substitution of generic pharmaceuticals, use of CEA for allocation of treatments, controls on construction and technology, etc.) can act to improve efficiency, equity and average health status, but will not usually reduce aggregate average per capita costs of medical care. PMID:16987309

Implementation of Total Employee Involvement as Part of a Continuous Improvement Program at a Fortune 500 Company

ERIC Educational Resources Information Center

Carlson, Kathy Lynn

2012-01-01

Over the last several decades, Continuous Improvement (CI) type initiatives have been implemented in companies across the United States to improve quality, reduce process variation, eliminate waste and ultimately reduce costs. Approximately five years ago, one particular Fortune 500 company implemented CI in its manufacturing facilities. A key…

A Study of United States Army Product Support Manager (PSM) Training

DTIC Science & Technology

2016-03-25

relevant policy and data associated with Product Support Manager (PSM) responsibilities, measure the current status of PSM training and selection, and...Year (FY) 16 (U.S. Department of Defense, 2015) which encompasses a need for processes, procedures, policies and regulations by which to accomplish...availability rates , and reduce operation and sustainment costs (C) Conduct appropriate cost analyses to validate the product support strategy

The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States.

PubMed

Shah, Maunank; Risher, Kathryn; Berry, Stephen A; Dowdy, David W

2016-01-15

Recent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States. We constructed a dynamic transmission model of HIV among US adults (aged 15-65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum : We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs). Despite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91-2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199-298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%-26%) at a cost of $65 700 per QALY gained ($44 500-111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%-68%) and mortality rate by 64% (46%-78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800-72 300). Failure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States

PubMed Central

Shah, Maunank; Risher, Kathryn; Berry, Stephen A.; Dowdy, David W.

2016-01-01

Background. Recent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States. Methods. We constructed a dynamic transmission model of HIV among US adults (aged 15–65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum. We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs). Results. Despite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91–2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199–298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%–26%) at a cost of $65 700 per QALY gained ($44 500–111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%–68%) and mortality rate by 64% (46%–78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800–72 300). Conclusions. Failure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness. PMID:26362321

Air Distribution Retrofit Strategies for Affordable Housing

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

Dentz, Jordan; Conlin, Francis; Holloway, Parker

2014-03-01

In multifamily and attached buildings, traditional duct sealing methods are often impractical or costly and disruptive because of the difficulty in accessing leakage sites. In this project, two retrofit duct sealing techniques -- manually-applied sealants and injecting a spray sealant, were implemented in several low-rise multi-unit buildings. An analysis on the cost and performance of the two methods are presented. Each method was used in twenty housing units: approximately half of each group of units are single story and the remainder two-story. Results show that duct leakage to the outside was reduced by an average of 59% through the usemore » of manual methods, and by 90% in the units where the injected spray sealant was used. It was found that 73% of the leakage reduction in homes that were treated with injected spray sealant was attributable to the manual sealing done at boots, returns and the air handler. The cost of manually-applying sealant ranged from $275 to $511 per unit and for the injected spray sealant the cost was $700 per unit. Modeling suggests a simple payback of 2.2 years for manual sealing and 4.7 years for the injected spray sealant system. Utility bills were collected for one year before and after the retrofits. Utility bill analysis shows 14% and 16% energy savings using injected spray sealant system and hand sealing procedure respectively in heating season whereas in cooling season, energy savings using injected spray sealant system and hand sealing were both 16%.« less

High Temperature Irradiation Resistant Thermocouple (HTIR-TC)

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

Rempe, Joy; Condie, Keith; Knudson, Darrell

2011-01-01

INL researchers have created a new thermocouple that can resist high temperature and radiation. This device will improve safety and reduce costs associated with unit failures. Learn more about INL research at http://www.facebook.com/idahonationallaboratory

High Temperature Irradiation Resistant Thermocouple (HTIR-TC)

ScienceCinema

Rempe, Joy; Condie, Keith; Knudson, Darrell

2018-05-16

INL researchers have created a new thermocouple that can resist high temperature and radiation. This device will improve safety and reduce costs associated with unit failures. Learn more about INL research at http://www.facebook.com/idahonationallaboratory

How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010–2014

PubMed Central

Brantley, Erin; Bysshe, Tyler; Steinmetz, Erika; Bruen, Brian K.

2016-01-01

Introduction State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers. Methods We used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014. Results Medicaid policies that require patients to obtain counseling to get medications reduced the use of cessation medications by approximately one-quarter to one-third; states that cover all types of cessation medications increased usage by approximately one-quarter to one-third. Non-Medicaid policies did not have significant effects on use levels. Conclusions States could increase efforts to quit by developing more comprehensive coverage and reducing barriers to coverage. Reductions in barriers could bolster smoking cessation rates, and the costs would be small compared with the costs of treating smoking-related diseases. Innovative initiatives to help smokers quit could improve health and reduce health care costs. PMID:27788063

Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States.

PubMed

Subramanian, Kritika; Midha, Inuka; Chellapilla, Vijaya

2017-01-01

Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management - Innovations and Opportunities.

PubMed

Neiman, Andrea B; Ruppar, Todd; Ho, Michael; Garber, Larry; Weidle, Paul J; Hong, Yuling; George, Mary G; Thorpe, Phoebe G

2017-11-17

Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions (1). Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs (2). In the United States, 3.8 billion prescriptions are written annually (3). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (4). Whereas rates of nonadherence across the United States have remained relatively stable, direct health care costs associated with nonadherence have grown to approximately $100-$300 billion of U.S. health care dollars spent annually (5,6). Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions (7).

Necrotizing Enterocolitis Risk

PubMed Central

Gephart, Sheila M.; McGrath, Jacqueline M.; Effken, Judith A.; Halpern, Melissa D.

2012-01-01

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research. PMID:22469959

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. © 2014 Society for Risk Analysis.

Flooded Underground Coal Mines: A Significant Source of Inexpensive Geothermal Energy

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

Watzlaf, G.R.; Ackman, T.E.

2007-04-01

Many mining regions in the United States contain extensive areas of flooded underground mines. The water within these mines represents a significant and widespread opportunity for extracting low-grade, geothermal energy. Based on current energy prices, geothermal heat pump systems using mine water could reduce the annual costs for heating to over 70 percent compared to conventional heating methods (natural gas or heating oil). These same systems could reduce annual cooling costs by up to 50 percent over standard air conditioning in many areas of the country. (Formatted full-text version is released by permission of publisher)

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. Project HOPE—The People-to-People Health Foundation, Inc.

Optimal policies for aggregate recycling from decommissioned forest roads.

PubMed

Thompson, Matthew; Sessions, John

2008-08-01

To mitigate the adverse environmental impact of forest roads, especially degradation of endangered salmonid habitat, many public and private land managers in the western United States are actively decommissioning roads where practical and affordable. Road decommissioning is associated with reduced long-term environmental impact. When decommissioning a road, it may be possible to recover some aggregate (crushed rock) from the road surface. Aggregate is used on many low volume forest roads to reduce wheel stresses transferred to the subgrade, reduce erosion, reduce maintenance costs, and improve driver comfort. Previous studies have demonstrated the potential for aggregate to be recovered and used elsewhere on the road network, at a reduced cost compared to purchasing aggregate from a quarry. This article investigates the potential for aggregate recycling to provide an economic incentive to decommission additional roads by reducing transport distance and aggregate procurement costs for other actively used roads. Decommissioning additional roads may, in turn, result in improved aquatic habitat. We present real-world examples of aggregate recycling and discuss the advantages of doing so. Further, we present mixed integer formulations to determine optimal levels of aggregate recycling under economic and environmental objectives. Tested on an example road network, incorporation of aggregate recycling demonstrates substantial cost-savings relative to a baseline scenario without recycling, increasing the likelihood of road decommissioning and reduced habitat degradation. We find that aggregate recycling can result in up to 24% in cost savings (economic objective) and up to 890% in additional length of roads decommissioned (environmental objective).

Economic costs of the foot and mouth disease outbreak in the United Kingdom in 2001.

PubMed

Thompson, D; Muriel, P; Russell, D; Osborne, P; Bromley, A; Rowland, M; Creigh-Tyte, S; Brown, C

2002-12-01

The authors present estimates of the economic costs to agriculture and industries affected by tourism of the outbreak of foot and mouth disease (FMD) in the United Kingdom (UK) in 2001. The losses to agriculture and the food chain amount to about Pound Sterling3.1 billion. The majority of the costs to agriculture have been met by the Government through compensation for slaughter and disposal as well as clean-up costs. Nonetheless, agricultural producers will have suffered losses, estimated at Pound Sterling355 million, which represents about 20% of the estimated total income from farming in 2001. Based on data from surveys of tourism, businesses directly affected by tourist expenditure are estimated to have lost a similar total amount (between Pound Sterling2.7 and Pound Sterling3.2 billion) as a result of reduced numbers of people visiting the countryside. The industries which supply agriculture, the food industries and tourist-related businesses will also have suffered losses. However, the overall costs to the UK economy are substantially less than the sum of these components, as much of the expenditure by tourists was not lost, but merely displaced to other sectors of the economy. Overall, the net effect of FMD is estimated to have reduced the gross domestic product in the UK by less than 0.2% in 2001.

A retrospective quasi-experimental study of a community crisis house for patients with severe and persistent mental illness.

PubMed

Siskind, Dan; Harris, Meredith; Kisely, Steve; Brogan, James; Pirkis, Jane; Crompton, David; Whiteford, Harvey

2013-07-01

There is increasing international evidence that crisis houses can reduce the time spent in acute psychiatric inpatient units for patients with severe and persistent mental illness, at a lower cost and in an environment preferable to patients. We evaluated the Alternatives to Hospitalisation (AtH) program, a crisis house operating in outer suburban Brisbane. One hundred and ninety-three AtH patients were compared to 371 matched controls admitted to a peer hospital district acute psychiatric unit. Hospitalisations, demographics and illness acuity were compared one year before and after an acute index episode of residential care involving hospital and/or AtH. Hospital bed-days during the index episode were compared between AtH participants and controls. The cost of bed-days averted was compared to the cost of providing the AtH program. AtH participants spent 5.35 fewer days in hospital during the index episode than controls, after adjustment for illness acuity, living conditions, marital status and emergency department (ED) presentations. Per patient cost of averted psychiatric inpatient bed-days, $5948.22, was higher than the per patient cost of providing AtH, $3071.44. AtH participants had higher levels of illness acuity, ED presentations and acute psychiatric admissions than controls in the year after the index episode. For acutely unwell, stably housed patients, able to be managed outside of a secure facility, a crisis house program can reduce acute psychiatric bed-days, providing a cost saving for mental health services.

Considerations for diabetes: treatment with insulin pen devices.

PubMed

Cuddihy, Robert M; Borgman, Sarah K

2013-01-01

Insulin is essential for the treatment of type 1 diabetes, and most patients with type 2 diabetes will eventually require insulin for glycemic control. Several barriers contribute to delays in initiating insulin therapy in type 2 diabetes. Furthermore, insulin-treated patients often miss doses or otherwise fail to self-administer their insulin as prescribed, placing themselves at the risk of developing complications. Insulin pens can help overcome barriers to initiating insulin therapy and can facilitate the self-management of diabetes. Compared with the vial and syringe, insulin pens are more accurate, associated with greater adherence, and preferred by patients because of their convenience and ease of use. Large database analyses suggest that insulin pens may reduce the rate of occurrence of hypoglycemic events in patients with type 2 diabetes. Despite higher costs of insulin pens vs vials and syringes, studies suggest little or no increase in total health care costs and decreases in diabetes-related costs associated with reduced health care utilization with pens. Interestingly, the use of insulin pens within the United States lags far behind the use of pens in Europe and Japan. Insulin pens may be disposable or refillable, and some pens have special features [eg, audible clicks, large-dose selector and dial, memory function, half-unit dosing, high dosing (ie, 80 U)] that offer the opportunity to individualize treatment by meeting patients' needs. This review compares available insulin pens, describes strategies to facilitate their usage, and discusses how insulin pens can improve self-management of diabetes while reducing cost.

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

PubMed

Bratt, John H; Torpey, Kwasi; Kabaso, Mushota; Gondwe, Yebo

2011-01-01

To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia. Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT. Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening. © 2010 Blackwell Publishing Ltd.

Incorporating nurse absenteeism into staffing with demand uncertainty.

PubMed

Maass, Kayse Lee; Liu, Boying; Daskin, Mark S; Duck, Mary; Wang, Zhehui; Mwenesi, Rama; Schapiro, Hannah

2017-03-01

Increased nurse-to-patient ratios are associated negatively with increased costs and positively with improved patient care and reduced nurse burnout rates. Thus, it is critical from a cost, patient safety, and nurse satisfaction perspective that nurses be utilized efficiently and effectively. To address this, we propose a stochastic programming formulation for nurse staffing that accounts for variability in the patient census and nurse absenteeism, day-to-day correlations among the patient census levels, and costs associated with three different classes of nursing personnel: unit, pool, and temporary nurses. The decisions to be made include: how many unit nurses to employ, how large a pool of cross-trained nurses to maintain, how to allocate the pool nurses on a daily basis, and how many temporary nurses to utilize daily. A genetic algorithm is developed to solve the resulting model. Preliminary results using data from a large university hospital suggest that the proposed model can save a four-unit pool hundreds of thousands of dollars annually as opposed to the crude heuristics the hospital currently employs.

A cost effective method of meeting emission requirements from a 50 MMscfd glycol dehydrator

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

Gearhart, L.E.

1998-12-31

The removal of volatile organic compounds (VOC) and benzene, toluene, ethylbenzene, xylene (BTEX) from glycol dehydration systems does not require costly equipment or elaborate controls. This paper will describe the design and installation of a 10 equivalent try glycol dehydration unit for field gas dehydration. The absorber design minimizes the absorption of VOC and BTEX by requiring 1.0 to 1.5 gallons of glycol per pound of water removed. Glycol unit VOC emissions are effectively controlled without installing vent gas condensers which require disposal of the waste condensate. The emission control system on this unit is simple to operate, meets emissionmore » standards and the dehydrator design achieves pipeline sales gas specifications at a reasonable cost. The system reduces the VOC and BTEX by adding a stripper on the glycol going to the reboiler. A 50 MMscfd dehydrator was installed in December 1995 and the results of an emission test done in April 1997 are presented in this paper.« less

Dual-use micromechanical inertial sensors

NASA Astrophysics Data System (ADS)

Elwell, John M., Jr.

1995-03-01

A new industry, which will provide low-cost silicon-based inertial sensors to the commercial and military markets. is being created. Inertial measurement units are used extensively in military systems, and new versions are expected to find their way into commercial products, such as automobiles, as production costs fall as technology advances. An automotive inertial measurement unit can be expected to perform a complete range of control, diagnostic, and navigation functions. These functions are expected to provide significant active safety, performance, comfort, convenience, and fuel economy advantages to the automotive consumer. An inertial measurement unit applicable to the automobile industry would meet many of the performance requirements for the military in important areas, such as antenna and image stabilization, autopilot control, and the guidance of smart weapons. Such a new industrial base will significantly reduce the acquisition cost of many future tactical weapons systems. An alliance, consisting of the Charles Stark Draper Laboratory and Rockwell International, has been created to develop inertial products for this new industry.

Key cost drivers of pharmaceutical clinical trials in the United States.

PubMed

Sertkaya, Aylin; Wong, Hui-Hsing; Jessup, Amber; Beleche, Trinidad

2016-04-01

The increasing cost of clinical research has significant implications for public health, as it affects drug companies' willingness to undertake clinical trials, which in turn limits patient access to novel treatments. Thus, gaining a better understanding of the key cost drivers of clinical research in the United States is important. The study which is based on a report prepared by Eastern Research Group, Inc., for the US Department of Health and Human Services, examined different factors, such as therapeutic area, patient recruitment, administrative staff, and clinical procedure expenditures, and their contribution to pharmaceutical clinical trial costs in the United States by clinical trial phase. The study used aggregate data from three proprietary databases on clinical trial costs provided by Medidata Solutions. We evaluated per-study costs across therapeutic areas by aggregating detailed (per patient and per site) cost information. We also compared average expenditures on cost drivers with the use of weighted mean and standard deviation statistics. Therapeutic area was an important determinant of clinical trial costs by phase. The average cost of a Phase 1 study conducted at a US site ranged from US$1.4 million (pain and anesthesia) to US$6.6 million (immunomodulation), including estimated site overhead and monitoring costs of the sponsoring organization. A Phase 2 study cost from US$7.0 million (cardiovascular) to US$19.6 million (hematology), whereas a Phase 3 study cost ranged from US$11.5 million (dermatology) to US$52.9 (pain and anesthesia) on average. Across all study phases and excluding estimated site overhead costs and costs for sponsors to monitor the study, the top three cost drivers of clinical trial expenditures were clinical procedure costs (15%-22% of total), administrative staff costs (11%-29% of total), and site monitoring costs (9%-14% of total). The data were from 2004 through 2012 and were not adjusted for inflation. Additionally, the databases used represented a convenience, that is, non-probability, sample and did not allow for statistically valid estimates of cost drivers. Finally, the data were from trials funded by the global pharmaceutical and biotechnology industry only. Hence, our study findings are limited to that segment. Therapeutic area being studied as well as number and types of clinical procedures involved were the key drivers of direct costs in Phase 1 through Phase 3 studies. Research shows that strategies exist for reducing the price tag of some of these major direct cost components. Therefore, to increase clinical trial efficiency and reduce costs, gaining a better understanding of the key direct cost drivers is an important step. © The Author(s) 2016.

Operational response to malaria epidemics: are rapid diagnostic tests cost-effective?

PubMed

Rolland, Estelle; Checchi, Francesco; Pinoges, Loretxu; Balkan, Suna; Guthmann, Jean-Paul; Guerin, Philippe J

2006-04-01

To compare the cost-effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs). We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over-treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether-lumefantrine (ART-LUM) in a Plasmodium falciparum epidemic. Our main cost-effectiveness measure was the incremental cost per false positive treatment averted by RDTs. As malaria prevalence increases, the difference in cost between presumptive and RDT-based treatment rises. The threshold prevalence above which the RDT-based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART-LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 euro per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT-based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART-LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non-biomedical costs. If their unit price were halved, RDTs would be more cost-effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART-LUM treatment. In most epidemic prevalence scenarios, RDTs would considerably reduce over-treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost-effectiveness, and should thus be advocated. A tolerated incremental cost of 1 euro is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow.

Preoperative Interventions and Charges Before Total Knee Arthroplasty.

PubMed

Cohen, Jeremiah R; Bradley, Alexander T; Lieberman, Jay R

2016-12-01

The cost effectiveness of total knee arthroplasty (TKA) has been well established, but little data exist regarding preoperative interventions and their costs. The purpose of this study was to examine preoperative interventions and their associated charges within the 2-year period before TKA. A retrospective cohort analysis of patients undergoing TKA between 2007 and 2011 was conducted using the PearlDiver Patient Record Database. Patients' inpatient and outpatient billing records were tracked over the 2-year period before receiving a TKA. A total of 35,596 patients from Medicare and 47,064 from United Healthcare underwent TKA from 2009 to 2011. In the 2-year period before TKA, the per patient average charge was $3545.82 for Medicare and $3281.57 for United Healthcare. In the 2-year period before TKA, 21.4% (Medicare) and 23.3% (United Healthcare) of all patients received a magnetic resonance imaging, with between 31.9% (Medicare) and 45.6% (United Healthcare) of these occurring within 3 months of surgery (P < .05). During this same period, 49.4% (Medicare) and 63.2% (United Healthcare) of all patients received an intra-articular injection, with between 29.4% (Medicare) and 44.8% (United Healthcare) of these occurring within 3 months of surgery (P < .05). Interventions and costs before TKA occur largely within 6 months preoperatively, with a substantial portion occurring within 3 months. These interventions may not be clinically or cost effective for certain patients, such as those with moderate-to-severe osteoarthritis. Foregoing these interventions and opting to perform TKA earlier may reduce costs and prevent unnecessary tests and procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Economies of scale and trends in the size of southern forest industries

Treesearch

James E. Granskog

1978-01-01

In each of the major southern forest industries, the trend has been toward achieving economies of scale, that is, to build larger production units to reduce unit costs. Current minimum efficient plant size estimated by survivor analysis is 1,000 tons per day capacity for sulfate pulping, 100 million square feet (3/8- inch basis) annual capacity for softwood plywood,...

Health care administration in the United States and Canada: micromanagement, macro costs.

PubMed

Woolhandler, Steffie; Campbell, Terry; Himmelstein, David U

2004-01-01

A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.

Lithium-Ion Cell Charge-Control Unit Developed

NASA Technical Reports Server (NTRS)

Reid, Concha M.; Manzo, Michelle A.; Buton, Robert M.; Gemeiner, Russel

2005-01-01

A lithium-ion (Li-ion) cell charge-control unit was developed as part of a Li-ion cell verification program. This unit manages the complex charging scheme that is required when Li-ion cells are charged in series. It enables researchers to test cells together as a pack, while allowing each cell to charge individually. This allows the inherent cell-to-cell variations to be addressed on a series string of cells and reduces test costs substantially in comparison to individual cell testing.

Thirty-five units of botulinum toxin type A for treatment of axillary hyperhidrosis in female patients.

PubMed

Marcella, Stefanie; Goodman, Greg; Cumming, Simon; Foley, Peter; Morgan, Vanessa

2011-05-01

We present a retrospective audit on efficacy and impact of 35 units of botulinum toxin type A per axilla on quality of life in female patients with axillary hyperhidrosis. This audit shows that 35 units of botulinum toxin type A is a reasonable starting dose and could significantly improve patients' quality of life and reduce the cost of treatment. © 2011 The Authors. Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists.

Design of automated oil sludge treatment unit

NASA Astrophysics Data System (ADS)

Chukhareva, N.; Korotchenko, T.; Yurkin, A.

2015-11-01

The article provides the feasibility study of contemporary oil sludge treatment methods. The basic parameters of a new resource-efficient oil sludge treatment unit that allows extracting as much oil as possible and disposing other components in efficient way have been outlined. Based on the calculation results, it has been revealed that in order to reduce the cost of the treatment unit and the expenses related to sludge disposal, it is essential to apply various combinations of the existing treatment methods.

Consumer preferences for reduced packaging under economic instruments and recycling policy.

PubMed

Yamaguchi, Keiko; Takeuchi, Kenji

2016-02-01

This study was conducted using a web-based survey and bidding game in contingent valuation method to evaluate consumer preferences for packaging with less material. Results revealed that people who live in a municipality implementing unit-based pricing of waste have a higher willingness-to-pay (WTP) for a product. Economic instruments can affect the purchase of products with reduced packaging because a higher disposal cost increases the attractiveness of source reduction. However, unit-based pricing combined with plastic separation for recycling reduces WTP. This result suggests that recycling policy weakens the effect of economic instruments on source reduction of waste. Copyright © 2015 Elsevier Ltd. All rights reserved.

A toolkit of measures for reducing animal-vehicle collisions.

DOT National Transportation Integrated Search

2006-01-01

Animal-vehicle collisions are a growing concern in terms of human safety; costs related to injury, property damage, and disposal; and the viability of wildlife populations. These collisions are rapidly increasing throughout the United States, and Vir...

Regional implementation of warm mix asphalt.

DOT National Transportation Integrated Search

2014-09-01

Asphalt is used in over 94 percent of all paved roadways in the United States. The ability to reduce its cost and emissions : while improving its performance has benefits that could potentially change the direction the asphalt industry moves toward i...

Pell Grant Validation Imposes Some Costs and Does Not Greatly Reduce Award Errors: New Strategies Are Needed. Report to the Honorable Paul Simon, United States Senate.

ERIC Educational Resources Information Center

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

Efforts of the U.S. Department of Education to verify data submitted by applicants to the Pell Grant program were analyzed by the General Accounting Office. The effects of carrying out the Department's policy or methodology, called "validation," on financial aid applicants and colleges were assessed. Costs of 1982-1983 validation on…

Thermal control of power supplies with electronic packaging techniques. [using low cost heat pipes

NASA Technical Reports Server (NTRS)

1977-01-01

The integration of low-cost commercial heat pipes in the design of a NASA candidate standard modular power supply with a 350 watt output resulted in a 44% weight reduction. Part temperatures were also appreciably reduced, increasing the environmental capability of the unit. A complete 350- watt modular power converter was built and tested to evaluate thermal performance of the redesigned supply.

Impact and cost-effectiveness of a second tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine dose to prevent pertussis in the United States.

PubMed

Kamiya, Hajime; Cho, Bo-Hyun; Messonnier, Mark L; Clark, Thomas A; Liang, Jennifer L

2016-04-04

The United States experienced a substantial increase in reported pertussis cases over the last decade. Since 2005, persons 11 years and older have been routinely recommended to receive a single dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine. The objective of this analysis was to evaluate the potential impact and cost-effectiveness of recommending a second dose of Tdap. A static cohort model was used to calculate the epidemiologic and economic impact of adding a second dose of Tdap at age 16 or 21 years. Projected costs and outcomes were examined from a societal perspective over a 20-year period. Quality-adjusted Life Years (QALY) saved were calculated. Using baseline pertussis incidence from the National Notifiable Diseases Surveillance System, Tdap revaccination at either age 16 or 21 years would reduce outpatient visits by 433 (5%) and 285 (4%), and hospitalization cases by 7 (7%) and 5 (5%), respectively. The costs per QALY saved with a second dose of Tdap were approximately US $19.7 million (16 years) and $26.2 million (21 years). In sensitivity analyses, incidence most influenced the model; as incidence increased, the costs per QALY decreased. To a lesser degree, initial vaccine effectiveness and waning of effectiveness also affected cost outcomes. Multivariate sensitivity analyses showed that under a set of optimistic assumptions, the cost per QALY saved would be approximately $163,361 (16 years) and $204,556 (21 years). A second dose of Tdap resulted in a slight decrease in the number of cases and other outcomes, and that trend is more apparent when revaccinating at age 16 years than at age 21 years. Both revaccination strategies had high dollar per QALY saved even under optimistic assumptions in a multivariate sensitivity analysis. Published by Elsevier Ltd.

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

PubMed

Leahy, Michael F; Hofmann, Axel; Towler, Simon; Trentino, Kevin M; Burrows, Sally A; Swain, Stuart G; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C; Farmer, Shannon L

2017-06-01

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001). Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Fission Surface Power for the Exploration and Colonization of Mars

NASA Technical Reports Server (NTRS)

Houts, Mike; Porter, Ron; Gaddis, Steve; Van Dyke, Melissa; Martin, Jim; Godfroy, Tom; Bragg-Sitton, Shannon; Garber, Anne; Pearson, Boise

2006-01-01

The colonization of Mars will require abundant energy. One potential energy source is nuclear fission. Terrestrial fission systems are highly developed and have the demonstrated ability to safely produce tremendous amounts of energy. In space, fission systems not only have the potential to safely generate tremendous amounts of energy, but could also potentially be used on missions where alternatives are not practical. Programmatic risks such as cost and schedule are potential concerns with fission surface power (FSP) systems. To be mission enabling, FSP systems must be affordable and programmatic risk must be kept acceptably low to avoid jeopardizing exploration efforts that may rely on FSP. Initial FSP systems on Mars could be "workhorse" units sized to enable the establishment of a Mars base and the early growth of a colony. These systems could be nearly identical to FSP systems used on the moon. The systems could be designed to be safe, reliable, and have low development and recurring costs. Systems could also be designed to fit on relatively small landers. One potential option for an early Mars FSP system would be a 100 kWt class, NaK cooled system analogous to space reactors developed and flown under the U.S. "SNAP" program or those developed and flown by the former Soviet Union ("BUK" reactor). The systems could use highly developed fuel and materials. Water and Martian soil could be used to provide shielding. A modern, high-efficiency power conversion subsystem could be used to reduce required reactor thermal power. This, in turn, would reduce fuel burnup and radiation damage .effects by reducing "nuclear" fuels and materials development costs. A realistic, non-nuclear heated and fully integrated technology demonstration unit (TDU) could be used to reduce cost and programmatic uncertainties prior to initiating a flight program.

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

PubMed

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

2015-11-01

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. 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. 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. 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. © 2015 AABB.

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

Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

PubMed

Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M

2017-11-01

To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.

Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator.

PubMed

Khandelwal, Nita; Benkeser, David; Coe, Norma B; Engelberg, Ruth A; Curtis, J Randall

2016-12-01

In the intensive care unit (ICU), complex decision making by clinicians and families requires good communication to ensure that care is consistent with the patients' values and goals. To assess the economic feasibility of staffing ICUs with a communication facilitator. Data were from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n = 135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker. Adjusted regression analyses assessed differences in ICU total and direct variable costs between intervention and control patients. A bootstrap-based simulation assessed the cost efficiency of a facilitator while varying the full-time equivalent of the facilitator and the ICU mortality risk. Total ICU costs (mean 22.8k; 95% CI, -42.0k to -3.6k; P = 0.02) and average daily ICU costs (mean, -0.38k; 95% CI, -0.65k to -0.11k; P = 0.006)] were reduced significantly with the intervention. Despite more contacts, families of survivors spent less time per encounter with facilitators than did families of decedents (mean, 25 [SD, 11] min vs. 36 [SD, 14] min). Simulation demonstrated maximal weekly savings with a 1.0 full-time equivalent facilitator and a predicted ICU mortality of 15% (total weekly ICU cost savings, $58.4k [95% CI, $57.7k-59.2k]; weekly direct variable savings, $5.7k [95% CI, $5.5k-5.8k]) after incorporating facilitator costs. Adding a full-time trained communication facilitator in the ICU may improve the quality of care while simultaneously reducing short-term (direct variable) and long-term (total) health care costs. This intervention is likely to be more cost effective in a lower-mortality population.

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

PubMed

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of pneumococcal conjugate vaccine: evidence from the first 5 years of use in the United States incorporating herd effects.

PubMed

Ray, G Thomas; Whitney, Cynthia G; Fireman, Bruce H; Ciuryla, Vincent; Black, Steven B

2006-06-01

Pneumococcal conjugate vaccine (PCV) has been in routine use in the United States for 5 years. Prior U.S. cost-effectiveness analyses have not taken into account the effect of the vaccine on nonvaccinated persons. We revised a previously published model to simulate the effects of PCV on children vaccinated between 2000 and 2004, and to incorporate the effect of the vaccine in reducing invasive pneumococcal disease (IPD) in nonvaccinated persons during those years. Data from the Active Bacterial Core Surveillance of the Centers for Disease Control and Prevention (2000-2004) were used to estimate changes in the burden of IPD in nonvaccinated adults since the introduction of PCV (compared with the baseline years 1997-1999). Results combined the simulated effects of the vaccine on the vaccinated and nonvaccinated populations. Before incorporating herd effects in the model, the PCV was estimated to have averted 38,000 cases of IPD during its first 5 years of use at a cost of dollar 112,000 per life-year saved. After incorporating the reductions in IPD for nonvaccinated individuals, the vaccine averted 109,000 cases of IPD at a cost of dollar 7500 per life-year saved. When the herd effect was assumed to be half that of the base case, the cost per life-year saved was dollar 18,000. IPD herd effects in the nonvaccinated population substantially reduce the cost, and substantially improve the cost-effectiveness, of PCV. The cost-effectiveness of PCV in actual use has been more favorable than predicted by estimates created before the vaccine was licensed.

Low temperature air with high IAQ for dry climates

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

Scofield, C.M.; Des Champs, N.H.

1995-01-01

This article describes how low temperature supply air and air-to-air heat exchangers can furnish 100% outdoor air with reduced peak energy demands. The use of low temperature supply air systems in arid climates greatly simplifies the air-conditioning design. Risks associated with moisture migration and sweating of duct and terminal equipment are reduced. Insulation and vapor barrier design requirements are not nearly as critical as they are in the humid, ambient conditions that exist in the eastern United States. The introduction of outdoor air to meet ASHRAE Standard 62-1989 becomes far less taxing on the mechanical cooling equipment because of themore » lower enthalpy levels of the dry western climate. Energy costs to assure indoor air quality (IAQ) are lower than for more tropical climates. In arid regions, maintaining acceptable indoor relative humidity (RH) levels becomes a major IAQ concern. For the western United States, coupling an air-to-air heat exchanger to direct (adiabatic) evaporative coolers can greatly reduce low temperature supply air refrigeration energy requirements and winter humidification costs while ensuring proper ventilation.« less

Natural gas-assisted steam electrolyzer

DOEpatents

Pham, Ai-Quoc; Wallman, P. Henrik; Glass, Robert S.

2000-01-01

An efficient method of producing hydrogen by high temperature steam electrolysis that will lower the electricity consumption to an estimated 65 percent lower than has been achievable with previous steam electrolyzer systems. This is accomplished with a natural gas-assisted steam electrolyzer, which significantly reduces the electricity consumption. Since this natural gas-assisted steam electrolyzer replaces one unit of electrical energy by one unit of energy content in natural gas at one-quarter the cost, the hydrogen production cost will be significantly reduced. Also, it is possible to vary the ratio between the electricity and the natural gas supplied to the system in response to fluctuations in relative prices for these two energy sources. In one approach an appropriate catalyst on the anode side of the electrolyzer will promote the partial oxidation of natural gas to CO and hydrogen, called Syn-Gas, and the CO can also be shifted to CO.sub.2 to give additional hydrogen. In another approach the natural gas is used in the anode side of the electrolyzer to burn out the oxygen resulting from electrolysis, thus reducing or eliminating the potential difference across the electrolyzer membrane.

Economic Analysis of the Reduction of Blood Transfusions during Surgical Procedures While Continuous Hemoglobin Monitoring Is Used

PubMed Central

Ribed-Sánchez, Borja; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Pérez-Oteyza, Jaime; Belda-Iniesta, Cristóbal

2018-01-01

Background: Two million transfusions are performed in Spain every year. These come at a high economic price for the health system, increasing the morbidity and mortality rates. The way of obtaining the hemoglobin concentration value is via invasive and intermittent methods, the results of which take time to obtain. The drawbacks of this method mean that some transfusions are unnecessary. New continuous noninvasive hemoglobin measurement technology can save unnecessary transfusions. Methods: A prospective study was carried out with a historical control of two homogeneous groups. The control group used the traditional hemoglobin measurement methodology. The experimental group used the new continuous hemoglobin measurement technology. The difference was analyzed by comparing the transfused units of the groups. The economic savings was calculated by multiplying the cost of a transfusion by the difference in units, taking into account measurement costs. Results: The percentage of patients needing a transfusion decreased by 7.4%, and the number of transfused units per patient by 12.56%. Economic savings per patient were €20.59. At the national level, savings were estimated to be 13,500 transfusions (€1.736 million). Conclusions: Constant monitoring of the hemoglobin level significantly reduces the need for blood transfusions. By using this new measurement technology, health care facilities can significantly reduce costs and improve care quality. PMID:29702617

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.

PubMed

Hornberger, John; Robertus, Katherine

2006-09-05

The Shingles Prevention Study showed that a varicella-zoster virus (VZV) vaccine administered to adults 60 years of age or older reduced the incidence of herpes zoster from 11.12 to 5.42 cases per 1000 person-years. Median follow-up was 3.1 years, and relative risk reduction was 51.3% (95% CI, 44.2% to 57.6%). To assess the extent to which clinical and cost variables influence the cost-effectiveness of VZV vaccination for preventing herpes zoster in immunocompetent older adults. Decision theoretical model. English-language data published to March 2006 identified from MEDLINE on herpes zoster rates, vaccine effectiveness, quality of life, medical resource use, and unit costs. Immunocompetent adults 60 years of age or older with a history of VZV infection. Lifetime. U.S. societal. Varicella-zoster virus vaccination versus no vaccination. Incremental quality-adjusted survival and cost per quality-adjusted life-year (QALY) gained. By reducing incidence and severity of herpes zoster, vaccination can increase quality-adjusted survival by 0.6 day compared with no vaccination. One scenario in which vaccination costs less than 100,000 dollars per QALY gained is when 1) the unit cost of vaccination is less than 200 dollars, 2) the age at vaccination is less than 70 years, and 3) the duration of vaccine efficacy is more than 30 years. Vaccination would be more cost-effective in "younger" older adults (age 60 to 64 years) than in "older" older adults (age > or =80 years). Longer life expectancy and a higher level of vaccine efficacy offset a lower risk for herpes zoster in the younger group. Other factors influencing cost-effectiveness include quality-of-life adjustments for acute zoster, unit cost of the vaccine, risk for herpes zoster, and duration of vaccine efficacy. The effectiveness of VZV vaccination remains uncertain beyond the median 3.1-year duration of follow-up in the Shingles Prevention Study. Varicella-zoster virus vaccination to prevent herpes zoster in older adults would increase QALYs compared with no vaccination. Resolution of uncertainties about the average quality-of-life effects of acute zoster and the duration of vaccine efficacy is needed to better determine the cost-effectiveness of zoster vaccination in older adults.

Evaluating the Use of Tissue Oximetry to Decrease Intensive Unit Monitoring for Free Flap Breast Reconstruction.

PubMed

Ricci, Joseph A; Vargas, Christina R; Ho, Olivia A; Lin, Samuel J; Tobias, Adam M; Lee, Bernard T

2017-07-01

Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008-2014) and cases requiring return to the operating room were identified. Data evaluated included patient demographics, the take back time course, and complications of flap loss and salvage. A cost-benefit analysis was performed to analyse the utility of a postoperative intensive monitoring setting. There were 900 flaps performed and 32 required an unplanned return to the operating room. There were 16 flaps that required a reexploration within the first 24 hours; the standard length of intensive unit monitoring. After 4 hours, there were 7 flaps (44%) detected by tissue oximetry for reexploration. After 15 hours of intensive monitoring postoperatively, cost analysis revealed that the majority (15/16; 94%) of failing flaps had been identified and the cost of identifying each subsequent failing flap exceeded the cost of another hour of intensive monitoring. The postoperative paradigm for microsurgical flaps has historically required intensive unit monitoring. Using tissue oximetry, a fast-track pathway can reduce time spent in an intensive monitoring setting from 24 to 15 hours with significant cost savings and minimal risk of missing a failing free flap.

Implementation of Advanced Warehouses in a Hospital Environment - Case study

NASA Astrophysics Data System (ADS)

Costa, J.; Sameiro Carvalho, M.; Nobre, A.

2015-05-01

In Portugal, there is an increase of costs in the healthcare sector due to several factors such as the aging of the population, the increased demand for health care services and the increasing investment in new technologies. Thus, there is a need to reduce costs, by presenting the effective and efficient management of logistics supply systems with enormous potential to achieve savings in health care organizations without compromising the quality of the provided service, which is a critical factor, in this type of sector. In this research project the implementation of Advanced Warehouses has been studied, in the Hospital de Braga patient care units, based in a mix of replenishment systems approaches: the par level system, the two bin system and the consignment model. The logistics supply process is supported by information technology (IT), allowing a proactive replacement of products, based on the hospital services consumption records. The case study was developed in two patient care units, in order to study the impact of the operation of the three replenishment systems. Results showed that an important inventory holding costs reduction can be achieved in the patient care unit warehouses while increasing the service level and increasing control of incoming and stored materials with less human resources. The main conclusion of this work illustrates the possibility of operating multiple replenishment models, according to the types of materials that healthcare organizations deal with, so that they are able to provide quality health care services at a reduced cost and economically sustainable. The adoption of adequate IT has been shown critical for the success of the project.

A Cost-Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States.

PubMed

Werner, Erika F; Hauspurg, Alisse K; Rouse, Dwight J

2015-12-01

To develop a decision model to evaluate the risks, benefits, and costs of different approaches to aspirin prophylaxis for the approximately 4 million pregnant women in the United States annually. We created a decision model to evaluate four approaches to aspirin prophylaxis in the United States: no prophylaxis, prophylaxis per American College of Obstetricians and Gynecologists (the College) recommendations, prophylaxis per U.S. Preventive Services Task Force recommendations, and universal prophylaxis. We included the costs associated with aspirin, preeclampsia, preterm birth, and potential aspirin-associated adverse effects. TreeAge Pro 2011 was used to perform the analysis. The estimated rate of preeclampsia would be 4.18% without prophylaxis compared with 4.17% with the College approach in which 0.35% (n=14,000) of women receive aspirin, 3.83% with the U.S. Preventive Services Task Force approach in which 23.5% (n=940,800) receive aspirin, and 3.81% with universal prophylaxis. Compared with no prophylaxis, the U.S. Preventive Services Task Force approach would save $377.4 million in direct medical care costs annually, and universal prophylaxis would save $365 million assuming 4 million births each year. The U.S. Preventive Services Task Force approach is the most cost-beneficial in 79% of probabilistic simulations. Assuming a willingness to pay of $100,000 per neonatal quality-adjusted life-year gained, the universal approach is the most cost-effective in more than 99% of simulations. Both the U.S. Preventive Services Task Force approach and universal prophylaxis would reduce morbidity, save lives, and lower health care costs in the United States to a much greater degree than the approach currently recommended by the College.

Applying activity-based costing to the nuclear medicine unit.

PubMed

Suthummanon, Sakesun; Omachonu, Vincent K; Akcin, Mehmet

2005-08-01

Previous studies have shown the feasibility of using activity-based costing (ABC) in hospital environments. However, many of these studies discuss the general applications of ABC in health-care organizations. This research explores the potential application of ABC to the nuclear medicine unit (NMU) at a teaching hospital. The finding indicates that the current cost averages 236.11 US dollars for all procedures, which is quite different from the costs computed by using ABC. The difference is most significant with positron emission tomography scan, 463 US dollars (an increase of 96%), as well as bone scan and thyroid scan, 114 US dollars (a decrease of 52%). The result of ABC analysis demonstrates that the operational time (machine time and direct labour time) and the cost of drugs have the most influence on cost per procedure. Clearly, to reduce the cost per procedure for the NMU, the reduction in operational time and cost of drugs should be analysed. The result also indicates that ABC can be used to improve resource allocation and management. It can be an important aid in making management decisions, particularly for improving pricing practices by making costing more accurate. It also facilitates the identification of underutilized resources and related costs, leading to cost reduction. The ABC system will also help hospitals control costs, improve the quality and efficiency of the care they provide, and manage their resources better.

Rationale for cost-effective laboratory medicine.

PubMed Central

Robinson, A

1994-01-01

There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States. PMID:8055467

19 CFR 10.3013 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Colombia Trade Promotion... value. “Adjusted value” means the value determined in accordancewith Articles 1 through 8, Article 15... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

The new car assessment program suggested approaches for future program enhancements

DOT National Transportation Integrated Search

2007-01-01

The National Highway Traffic Safety Administration (NHTSA) is an integral part of the United States Department of Transportation (DOT) and its mission is to save lives, prevent injuries, and reduce traffic-related health care and other economic costs...

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.

A short-stay unit for thyroidectomy patients increases discharge efficiency.

PubMed

Vrabec, Sara; Oltmann, Sarah C; Clark, Nicholas; Chen, Herbert; Sippel, Rebecca S

2013-09-01

Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow. Copyright © 2013 Elsevier Inc. All rights reserved.

Ducts Sealing Using Injected Spray Sealant, Raleigh, North Carolina (Fact Sheet)

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

None, None

2014-03-01

In multifamily and attached buildings, traditional duct sealing methods are often impractical or costly and disruptive because of the difficulty in accessing leakage sites. In this project, two retrofit duct sealing techniques - manually-applied sealants and injecting a spray sealant, were implemented in several low-rise multi-unit buildings. An analysis on the cost and performance of the two methods are presented. Each method was used in twenty housing units: approximately half of each group of units are single story and the remainder two-story. Results show that duct leakage to the outside was reduced by an average of 59% through the usemore » of manual methods, and by 90% in the units where the injected spray sealant was used. It was found that 73% of the leakage reduction in homes that were treated with injected spray sealant was attributable to the manual sealing done at boots, returns and the air handler. The cost of manually-applying sealant ranged from $275 to $511 per unit and for the injected spray sealant the cost was $700 per unit. Modeling suggests a simple payback of 2.2 years for manual sealing and 4.7 years for the injected spray sealant system. Utility bills were collected for one year before and after the retrofits. Utility bill analysis shows 14% and 16% energy savings using injected spray sealant system and hand sealing procedure respectively in heating season whereas in cooling season, energy savings using injected spray sealant system and hand sealing were both 16%.« less

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

PubMed

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

2015-06-05

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

Public Housing: A Tailored Approach to Energy Retrofits

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

Dentz, J.; Conlin, F.; Podorson, D.

2014-06-01

Over one million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 PHAs across the country indicated that there is a high level of interest in developing low cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with two public housing authorities (PHAs) to develop packages of energy efficiency retrofit measures the PHAs can cost effectively implement with their own staffs in the normal course of housing operations at themore » time when units are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing and measures that improve equipment efficiency. ARIES documented implementation in ten housing units. Reductions in average air leakage were 16-20% and duct leakage reductions averaged 38%. Total source energy consumption savings was estimated at 6-10% based on BEopt modeling with a simple payback of 1.7 to 2.2 years. Implementation challenges were encountered mainly related to required operational changes and budgetary constraints. Nevertheless, simple measures can feasibly be accomplished by PHA staff at low or no cost. At typical housing unit turnover rates, these measures could impact hundreds of thousands of unit per year nationally.« less

Development of Protection and Control Unit for Distribution Substation

NASA Astrophysics Data System (ADS)

Iguchi, Fumiaki; Hayashi, Hideyuki; Takeuchi, Motohiro; Kido, Mitsuyasu; Kobayashi, Takashi; Yanaoka, Atsushi

The Recently, electronics and IT technologies have been rapidly innovated and have been introduced to power system protection & control system to achieve high reliability, maintainability and more functionality. Concerning the distribution substation application, digital relays have been applied for more than 10 years. Because of a number of electronic devices used for it, product cost becomes higher. Also, products installed during the past high-growth period will be at the end of lifetime and will be replaced. Therefore, replacing market is expected to grow and the reduction of cost is demanded. Considering above mentioned background, second generation digital protection and control unit as a successor is designed to have following concepts. Functional integration based on advanced digital technologies, Ethernet LAN based indoor communication network, cost reduction and downsizing. Pondering above concepts, integration of protection and control function is adopted in contrary to the functional segregation applied to the previous system in order to achieve one-unit concept. Also the adoption of Ethernet LAN for inter-unit communication is objective. This report shows the development of second-generation digital relay for distribution substation, which is equipped with control function and Ethernet LAN by reducing the size of auxiliary transformer unit and the same size as previous product is realized.

Identification of Flights for Cost-Efficient Climate Impact Reduction

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Kirschen, Philippe G.; Sridhar, Banavar; Ng, Hok K.

2014-01-01

The aircraft-induced climate impact has drawn attention in recent years. Aviation operations affect the environment mainly through the release of carbon-dioxide, nitrogen-oxides, and by the formation of contrails. Recent research has shown that altering trajectories can reduce aviation environmental cost by reducing Absolute Global Temperature Change Potential, a climate assessment metric that adapts a linear system for modeling the global temperature response to aviation emissions and contrails. However, these methods will increase fuel consumption that leads to higher fuel costs imposed on airlines. The goal of this work is to identify ights for which the environmental cost of climate impact reduction outweighs the increase in operational cost on an individual aircraft basis. Environmental cost is quanti ed using the monetary social cost of carbon. The increase in operational cost is considering cost of additional fuel usage only. For this paper, an algorithm has been developed that modi es the trajectories of ights to evaluate the e ect of environ- mental cost and operational cost of ights in the United States National Airspace System. The algorithm identi es ights for which the environmental cost of climate impact can be reduced and modi es their trajectories to achieve maximum environmental net bene t, which is the di erence between reduction in environmental cost and additional operational cost. The result shows on a selected day, 16% of the ights among eight major airlines, or 2,043 ights, can achieve environmental net bene t using weather forecast data, resulting in net bene t of around $500,000. The result also suggests that the long-haul ights would be better candidates for cost-ecient climate impact reduction than the short haul ights. The algorithm will help to identify the characteristics of ights that are capable of applying cost-ecient climate impact reduction strategy.

Air Distribution Retrofit Strategies for Affordable Housing

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

Dentz, J.; Conlin, F.; Holloway, Parker

2014-03-01

In multifamily and attached buildings, traditional duct sealing methods are often impractical or costly and disruptive because of the difficulty in accessing leakage sites. In this project, two retrofit duct sealing techniques, manually-applied sealants and injecting a spray sealant, were implemented in several low-rise multiunit buildings. An analysis on the cost and performance of the two methods are presented. Each method was used in twenty housing units: approximately half of each group of units are single story and the remainder are two story. Results show that duct leakage to the outside was reduced by an average of 59% through themore » use of manual methods, and by 90% in the units where the injected spray sealant was used. It was found that 73% of the leakage reduction in homes that were treated with injected spray sealant was attributable to the manual sealing done at boots, returns and the air handler. The cost of manually-applying sealant ranged from $275 to $511 per unit and for the injected spray sealant the cost was $700 per unit. Modeling suggests a simple payback of 2.2 years for manual sealing and 4.7 years for the injected spray sealant system. Utility bills were collected for one year before and after the retrofits. Utility bill analysis shows 14% and 16% energy savings using injected spray sealant system and hand sealing procedure respectively in heating season whereas in cooling season, energy savings using injected spray sealant system and hand sealing were both 16%.« less

The clinical case for proton beam therapy

PubMed Central

2012-01-01

Abstract Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. Summary sentence Proton beam therapy is a technically advanced and promising form of radiation therapy. PMID:23083010

Facility Management as a Way of Reducing Costs in Transport Companies

NASA Astrophysics Data System (ADS)

Matusova, Dominika; Gogolova, Martina

2017-10-01

For facility management exists a several interpretations. These interpretations emerged progressively. At the time of the notion of facility management was designed to manage an administrative building, in the United States (US). They can ensure their operation and maintenance. From the US, this trend is further moved to Europe and now it start becoming a current and actual topic also in Slovakia. Facility management is contractually agreed scheme of services, semantically recalls traditional building management. There by finally pushed for activities related to real estates. For facility management is fundamental - certification and certification systems. Therefore, is essential to know, the cost structure of certification. The most commonly occurring austerity measures include: heat pumps, use of renewable energy, solar panels and water savings. These measures can reduce the cost.

Distribution Grid Integration Unit Cost Database | Solar Research | NREL

Science.gov Websites

Unit Cost Database Distribution Grid Integration Unit Cost Database NREL's Distribution Grid Integration Unit Cost Database contains unit cost information for different components that may be used to associated with PV. It includes information from the California utility unit cost guides on traditional

USE OF COAL DRYING TO REDUCE WATER CONSUMED IN PULVERIZED COAL POWER PLANTS

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

Edward K. Levy; Nenad Sarunac; Harun Bilirgen

2006-03-01

U.S. low rank coals contain relatively large amounts of moisture, with the moisture content of subbituminous coals typically ranging from 15 to 30 percent and that for lignites from 25 and 40 percent. High fuel moisture has several adverse impacts on the operation of a pulverized coal generating unit, for it can result in fuel handling problems and it affects heat rate, stack emissions and maintenance costs. Theoretical analyses and coal test burns performed at a lignite fired power plant show that by reducing the fuel moisture, it is possible to improve boiler performance and unit heat rate, reduce emissionsmore » and reduce water consumption by the evaporative cooling tower. The economic viability of the approach and the actual impact of the drying system on water consumption, unit heat rate and stack emissions will depend critically on the design and operating conditions of the drying system. The present project evaluated the low temperature drying of high moisture coals using power plant waste heat to provide the energy required for drying. Coal drying studies were performed in a laboratory scale fluidized bed dryer to gather data and develop models on drying kinetics. In addition, analyses were carried out to determine the relative costs and performance impacts (in terms of heat rate, cooling tower water consumption and emissions) of drying along with the development of optimized drying system designs and recommended operating conditions.« less

Improvements in SMR Modular Construction through Supply Chain Optimization and Lessons Learned

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

White III, Chelsea C.; Petrovic, Bojan

Affordable energy is a critical societal need. Capital construction cost is a significant portion of nuclear energy cost. By controlling and reducing cost, companies can build more competitive nuclear power plants and hence provide access to more affordable energy. Modular construction provides an opportunity to reduce the cost of construction, and as projects scale up in number, the cost of each unit can be further reduced. The objective of this project was to advance design and construction methods for manufacturing Small Modular Reactors (SMRs), and in particular to improve modular construction techniques and develop best practices for designing and operatingmore » supply chains that take advantage of these techniques. The overarching objectives were to accelerate the construction schedule and reduce its variability, reduce the cost of construction, reduce interest costs accrued during construction (IDC), and thus enhance the economic attractiveness of SMRs. Our fundamental measure of merit was total capital investment cost (TCIC). To achieve these objectives, this project developed a decision support system, EVAL, to support identifying, addressing, and resolving or ameliorating challenges and deficiencies in the current modular construction approach. The results of this effort were consistent with the facts that the cost of a construction activity is often smallest when accomplished in the factory, greatest when accomplished at the construction site, and at an intermediate level when accomplished at an assembly area close to the construction site. Further, EVAL can aid in providing insight into ways to reduce waste, improve quality, efficiency, and throughput and reflects the fact that the more done early in the construction process, i.e., in the factory, the more upfront funding is required and hence the more IDC will be accrued. The analysis has lead to a better understanding of circumstances under which modular construction performed mainly in the factory will result in lower expected total cost, relative to more traditional, on-site construction procedures. Further, we anticipate that EVAL can be used to gain insight regarding what role standardization can play in order for modularization to be most effectively defined. Such results would ultimately benefit all (small and large) new nuclear construction.« less

Corruption in the Middle East: Challenges Posed for the United States

DTIC Science & Technology

2004-11-01

American exporters allegedly lost out on foreign deals because they are not allowed, under U.S. law, to pay bribes to foreign officials. For...American companies, the payment of bribes to foreign officials is a criminal act and, of course, the bribes paid cannot be deducted as costs for tax...Cost-reducing (to the briber) or benefit enhancing; • Briber-initiated or bribee -initiated; • Coercive or collusive; centralized or

Ferrite Research Aimed at Improving Induction Linac Driven FEL performance. Phase 2

DTIC Science & Technology

1992-10-01

energy costs and decrease our dependence on foreign energy sources. SO 2 control has used flue gas desulfurization scrubbers after combustion, coal...minimizing operating costs. . Dry Mode of Operation Conventional flue - gas treatment processes are generally wet systems which generate waste water and wet ...energy source in the United States. So reducing the SO 2 and NOx emission from flue gas will allow use of abundant, high-sulphur coal resources, lower

The Effect of Weld Penetration on Blast Performance of Welded Panels

DTIC Science & Technology

2014-08-01

requirements of blast and ballistic protection, structural strength, fatigue resistance, unit mass and production cost. The testing described in this report...UNCLASSIFIED 7 TETRA S 20 9 3-G is an austenitic filler material often selected for welding high strength armour steels to control hydrogen induced...repeatability, lower cost, faster test turnaround and a reduced number of variables to control . Figure 30 is an illustration of the simplifications made

Cost-effectiveness of Ward Closure to Control Outbreaks of Norovirus Infection in United Kingdom National Health Service Hospitals.

PubMed

Sadique, Zia; Lopman, Ben; Cooper, Ben S; Edmunds, W John

2016-02-01

Norovirus is the most common cause of outbreaks of acute gastroenteritis in National Health Service hospitals in the United Kingdom. Wards (units) are often closed to new admissions to stop the spread of the virus, but there is limited evidence describing the cost-effectiveness of ward closure. An economic analysis based on the results from a large, prospective, active-surveillance study of gastroenteritis outbreaks in hospitals and from an epidemic simulation study compared alternative ward closure options evaluated at different time points since first infection, assuming different efficacies of ward closure. A total of 232 gastroenteritis outbreaks occurring in 14 hospitals over a 1-year period were analyzed. The risk of a new outbreak in a hospital is significantly associated with the number of admission, general medical, and long-stay wards that are concurrently affected but is less affected by the level of community transmission. Ward closure leads to higher costs but reduces the number of new outbreaks by 6%-56% and the number of clinical cases by 1%-55%, depending on the efficacy of the intervention. The incremental cost per outbreak averted varies from £10 000 ($14 000) to £306 000 ($428 000), and the cost per case averted varies from £500 ($700) to £61 000 ($85 000). The cost-effectiveness of ward closure decreases as the efficacy of the intervention increases, and the cost-effectiveness increases with the timing of the intervention. The efficacy of ward closure is critical from a cost-effectiveness perspective. Ward closure may be cost-effective, particularly if targeted to high-throughput units. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Wind Power Technologies FY 2017 Budget At-A-Glance

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

None, None

2016-03-01

The Wind Program accelerates U.S. deployment of clean, affordable, and reliable domestic wind power through research, development, and demonstration activities. These advanced technology investments directly contribute to the goals for the United States to generate 80% of the nation’s electricity from clean, carbon-free energy sources by 2035; reduce carbon emissions 26%-28% below 2005 levels by 2025; and reduce carbon emissions 80% by 2050 by reducing costs and increasing performance of wind energy systems.

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

PubMed

Skeem, Jennifer L; Montoya, Lina; Manchak, Sarah M

2018-05-15

Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation. A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies. Compared with traditional officers, specialty officers supervised smaller caseloads, established better relationships with supervisees, and participated more in treatment. Participants and officers were interviewed, and administrative databases were integrated to capture service use and criminal justice contacts. Unit costs were attached to these data to estimate costs incurred by each participant over two years. Cost differences were estimated by using machine-learning algorithms combined with targeted maximum-likelihood estimation (TMLE), a double-robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Specialty probation cost $11,826 (p<.001) less per participant than traditional probation, with overall savings of about 51%. Specialty and traditional probation did not differ in criminal justice costs because the additional costs for supervision of specialty caseloads were offset by reduced recidivism. However, for behavioral health care, specialty probation cost an estimated $14,049 (p<.001) less per client than traditional probation. Greater outpatient costs were more than offset by reduced emergency, inpatient, and residential costs. Well-implemented specialty probation yielded substantial savings-and should be considered in justice reform efforts for people with mental illness.

Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement.

PubMed

Harris, D C

1994-01-01

Decisions about epoetin (recombinant human erythropoetin) dosage and target haematocrit in dialysis patients have been determined largely by the high acquisition cost of epoetin, but are made with incomplete knowledge about which target haematocrit gives the optimum clinical benefit. Haematopoietic response to epoetin may be determined by pharmacodynamic factors such as rate and frequency of administration, as well as by individual patient characteristics such as ethnicity. Resistance to epoetin may be due to iron or vitamin deficiency, natural or exogenous inhibitors of erythropoiesis and bone marrow fibrosis. The high acquisition cost of epoetin must be considered along with a number of other factors that can influence the true cost of epoetin treatment. Hidden costs of epoetin treatment include administration costs, changes in other treatments, extra laboratory tests and adverse events. Administration costs and extra laboratory surveillance add little to overall cost. Depletion of iron stores, hypertension, increased blood coagulability and reduced dialyser efficiency resulting from epoetin treatment may all add a small additional component to the true cost. Severe complications with significant cost implications are rare. Amongst the various components of true cost, only the acquisition cost can definitely be reduced by low dosage treatment. Balanced against the true and potential costs of epoetin are a number of benefits which can result in potential savings. The need for blood transfusion is all but abolished, avoiding the cost of transfusion and its complications. Sensitisation against histocompatibility antigens is reduced by avoiding transfusion, and so the waiting time for cadaveric transplantation may be reduced. Rates of hospitalisation for all causes, especially those associated with anaemia, may be reduced by epoetin treatment. By improving well-being, epoetin may allow patients to be transferred to minimal-care units or home where dialysis can be performed much more cheaply. Amongst the various potential benefits of epoetin, the one with the greatest potential to save money for society is improved productivity. To date, productivity improvements with epoetin have been demonstrated only in small studies. If the acquisition costs of epoetin are reduced by low dosage therapy, these potential benefits can cover a large proportion of the total cost of epoetin. Epoetin undoubtedly improves quality of life and activity, but it is not clear which level of haematocrit gives optimum improvement.(ABSTRACT TRUNCATED AT 400 WORDS)

Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol

PubMed Central

Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

2015-01-01

Introduction Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease—a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32 201±$23 059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. Methods and analysis We use time-driven activity-based costing (TDABC) to quantify the hospitals’ costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. Ethics and dissemination All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. PMID:26307621

Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease: study TELEPOC.

PubMed

Mirón Rubio, Manuel; Ceballos Fernández, Rocío; Parras Pastor, Inmaculada; Palomo Iloro, Amaya; Fernández Félix, Borja Manuel; Medina Miralles, Jenifer; Zamudio López, Esther; González Pastor, Javier; Amador Lorente, Caridad; Mena Hortelano, Nazaret; Domínguez Sánchez, Alejandro; Alonso-Viteri, Soledad

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD. Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients' home if an alarm signal was detected. The outcomes were compared to historical data from the same patients. The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by €1,860.80 per patient per year. Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.

[Unit cost variation in a social security company in Querétaro, México].

PubMed

Villarreal-Ríos, Enrique; Campos-Esparza, Maribel; Garza-Elizondo, María E; Martínez-González, Lidia; Núñez-Rocha, Georgina M; Romero-Islas, Nestor R

2006-01-01

Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. Unit cost variation was more important in the emergency room and the dental service.

Nicotine reduction as an increase in the unit price of cigarettes: A behavioral economics approach

PubMed Central

Smith, Tracy T.; Sved, Alan F.; Hatsukami, Dorothy K.; Donny, Eric C.

2015-01-01

Urgent action is needed to reduce the harm caused by smoking. Product standards that reduce the addictiveness of cigarettes are now possible both in the U.S. and in countries party to the Framework Convention on Tobacco Control. Specifically, standards that required substantially reduced nicotine content in cigarettes could enable cessation in smokers and prevent future smoking among current non-smokers. Behavioral economics uses principles from the field of microeconomics to characterize how consumption of a reinforcer changes as a function of the unit price of that reinforcer (unit price = cost / reinforcer magnitude). A nicotine reduction policy might be considered an increase in the unit price of nicotine because smokers are paying more per unit of nicotine. This perspective allows principles from behavioral economics to be applied to nicotine reduction research questions, including how nicotine consumption, smoking behavior, use of other tobacco products, and use of other drugs of abuse are likely to be affected. This paper reviews the utility of this approach and evaluates the notion that a reduction in nicotine content is equivalent to a reduction in the reinforcement value of smoking—an assumption made by the unit price approach. PMID:25025523

Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach.

PubMed

Smith, Tracy T; Sved, Alan F; Hatsukami, Dorothy K; Donny, Eric C

2014-11-01

Urgent action is needed to reduce the harm caused by smoking. Product standards that reduce the addictiveness of cigarettes are now possible both in the U.S. and in countries party to the Framework Convention on Tobacco Control. Specifically, standards that required substantially reduced nicotine content in cigarettes could enable cessation in smokers and prevent future smoking among current non-smokers. Behavioral economics uses principles from the field of microeconomics to characterize how consumption of a reinforcer changes as a function of the unit price of that reinforcer (unit price=cost/reinforcer magnitude). A nicotine reduction policy might be considered an increase in the unit price of nicotine because smokers are paying more per unit of nicotine. This perspective allows principles from behavioral economics to be applied to nicotine reduction research questions, including how nicotine consumption, smoking behavior, use of other tobacco products, and use of other drugs of abuse are likely to be affected. This paper reviews the utility of this approach and evaluates the notion that a reduction in nicotine content is equivalent to a reduction in the reinforcement value of smoking-an assumption made by the unit price approach. Copyright © 2014 Elsevier Inc. All rights reserved.

Development works on nickel/hydrogen cells. [for satellite energy storage

NASA Technical Reports Server (NTRS)

Gutmann, G.

1982-01-01

Experiments were performed to reduce the costs for NI/H2 cells by using nickel oxide electrodes with high capacity per unit area. No maintenance requirements, long cycle life, insensitivity to overcharge and cell reversal, and high power capability were revealed.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-28

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

Regional implementation of warm mix asphalt : [tech summary].

DOT National Transportation Integrated Search

2014-09-01

Asphalt is used in over 94 percent of all paved roadways in the United States. The ability to reduce its cost and : emissions while improving its performance has bene ts that could potentially change the direction the asphalt : industry moves in t...

Developing a trust-wide centralised approach to the use of TNP.

PubMed

Birchall, L; Street, L; Clift, H

2002-09-01

Use of topical negative pressure, also known as VAC, gradually increased throughout a trust following its success in a burns and plastic surgery unit. A trust-wide centralised approach set out to standardise its use and to reduce costs.

Continuing Professional Development via Social Media or Conference Attendance: A Cost Analysis

PubMed Central

Tunnecliff, Jacqueline; Morgan, Prue; Gaida, James; Keating, Jennifer; Clearihan, Lyn; Sadasivan, Sivalal; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Rivers, George; Ilic, Dragan

2017-01-01

Background Professional development is essential in the health disciplines. Knowing the cost and value of educational approaches informs decisions and choices about learning and teaching practices. Objective The primary aim of this study was to conduct a cost analysis of participation in continuing professional development via social media compared with live conference attendance. Methods Clinicians interested in musculoskeletal care were invited to participate in the study activities. Quantitative data were obtained from an anonymous electronic questionnaire. Results Of the 272 individuals invited to contribute data to this study, 150 clinicians predominantly from Australia, United States, United Kingdom, India, and Malaysia completed the outcome measures. Half of the respondents (78/150, 52.0%) believed that they would learn more with the live conference format. The median perceived participation costs for the live conference format was Aus $1596 (interquartile range, IQR 172.50-2852.00). The perceived cost of participation for equivalent content delivered via social media was Aus $15 (IQR 0.00-58.50). The majority of the clinicians (114/146, 78.1%, missing data n=4) indicated that they would pay for a subscription-based service, delivered by social media, to the median value of Aus $59.50. Conclusions Social media platforms are evolving into an acceptable and financially sustainable medium for the continued professional development of health professionals. When factoring in the reduced costs of participation and the reduced loss of employable hours from the perspective of the health service, professional development via social media has unique strengths that challenge the traditional live conference delivery format. PMID:28360023

Redefining the survival of the fittest: communication disorders in the 21st century.

PubMed

Ruben, R J

2000-02-01

To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication-based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.

Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach

PubMed Central

de Brantes, Francois; Rastogi, Amita; Painter, Michael

2010-01-01

Objective (or Study Question) To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness. Data Sources/Study Setting A claims database of 3.5 million commercially insured members under age 65. Study Design We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model. Principal Findings We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs. Conclusions By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent. PMID:20662949

Cost avoidance associated with optimal stroke care in Canada.

PubMed

Krueger, Hans; Lindsay, Patrice; Cote, Robert; Kapral, Moira K; Kaczorowski, Janusz; Hill, Michael D

2012-08-01

Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided. Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs). The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.

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

Healthcare technology: physician collaboration in reducing the surgical cost.

PubMed

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

An educational intervention to improve cost-effective care among medicine housestaff: a randomized controlled trial.

PubMed

Sommers, Benjamin D; Desai, Nihar; Fiskio, Julie; Licurse, Adam; Thorndike, Mary; Katz, Joel T; Bates, David W

2012-06-01

High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes. The authors conducted a clustered randomized controlled trial of 33 teams (96 residents) at an internal medicine residency program (2009-2010). The intervention was a 45-minute teaching session; residents reviewed the hospital bill of a patient for whom they had cared and discussed reducing unnecessary costs. Primary outcomes were laboratory, pharmacy, radiology, and total hospital costs per admission. Secondary measures were length of stay (LOS), intensive care unit (ICU) admission, 30-day readmission, and 30-day mortality. Multivariate adjustment controlled for patient demographics and health. A follow-up survey assessed resident attitudes three months later. Among 1,194 patients, there were no significant cost differences between intervention and control groups. In the intervention group, 30-day readmission was higher (adjusted odds ratio 1.51, P = .010). There was no effect on LOS or the composite outcome of readmission, mortality, and ICU transfer. In a subgroup analysis of 835 patients newly admitted during the study, the intervention group incurred $163 lower adjusted lab costs per admission (P = .046). The follow-up survey indicated persistent differences in residents' exposure to concepts of cost-effectiveness (P = .041). A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.

Analysis of nonformulary use of PPIs and excess drug cost in a Veterans Affairs population.

PubMed

Ajumobi, Adewale B; Vuong, Ronald; Ahaneku, Hycienth

2012-01-01

In the Veterans Affairs (VA) health care system, a formulary-based approach without beneficiary cost-share incentives is used to limit the pharmacy cost of proton pump inhibitors (PPIs). However, the effectiveness of this approach in reducing the cost of PPIs is unknown. To (a) compare cost differences between the formulary PPI (generic omeprazole) and nonformulary PPIs and (b) evaluate reasons for nonformulary PPI use in order to identify opportunities to increase formulary drug use and discourage unnecessary use of nonformulary PPIs. A list of patients with receipt of PPIs from July 1, 2008, through June 30, 2009, was obtained from the Loma Linda VA Healthcare System pharmacy. Subjects with receipt of at least 120 units (capsules or tablets) of any PPI in the study period were considered long-term users. Demographic information was collected. Pharmacy consult records were reviewed to identify reasons for nonformulary use and dosing regimen of the formulary PPI prior to the switch. Cost analysis was done based on the VA contract prices for the drugs at the time of the study. Of 58,605 unique patients seen in this VA health care system in the 12-month period from July 1, 2008, through June 30, 2009, 13,713 (23.4%) received a PPI, and of these, 10,483 (76.4%) received at least 120 PPI units and were defined as long-term users. Of the long-term users, 9,462 (90.3%) were on the formulary PPI generic omeprazole, and 1,021 were nonformulary PPI users. Use of nonformulary PPIs (esomeprazole, pantoprazole, lansoprazole, rabeprazole) accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI cost. This pattern resulted in $570,263 in excess spending (i.e., $570,263 would have been saved in the study period if the nonformulary PPI users had used the formulary drug). The most common reason for nonformulary long-term PPI use was persistent symptoms (n=901, 88.2%). Adverse reaction was cited by 111 (10.9%) of nonformulary PPI users, 33.3% (n=37) of whom reported diarrhea. Of those who switched to a nonformulary PPI due to persistent symptoms, 363 (40.3%) were on once-daily dosing prior to the switch; 379 (42.1%) were on twice-daily dosing; and 159 (17.6%) were transfers from other places in which prior dosing information was not available in the hospital pharmacy records. One-year PPI use prevalence was 23% in this VA population, and long-term use prevalence was 18%. Nonformulary PPI use accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI drug cost. Opportunities to reduce nonformulary PPI use in order to reduce overall expenditures on PPIs include verification of optimal formulary PPI use, titration to twice-daily dosing, and confirmation of adverse reaction as being attributable to PPI use.

Techno-economic Analysis of Acid Gas Removal and Liquefaction for Pressurized LNG

NASA Astrophysics Data System (ADS)

Lee, S. H.; Seo, Y. K.; Chang, D. J.

2018-05-01

This study estimated the life cycle cost (LCC) of an acid gas removal and a liquefaction processes for Pressurized LNG (PLNG) production and compared the results with the cost of normal LNG production. PLNG is pressurized LNG that is liquefied at a higher pressure and temperature than normal LNG. Due to the high temperature, the energy for liquefaction is reduced. The allowable CO2 concentration in PLNG is increased up to 3 mol% when the product pressure 25 bar. An amine process with 35 wt% of diethanolamine (DEA) aqueous solution and a nitrogen expansion cycle were selected for the acid gas removal and the liquefaction processes, respectively. Two types of CO2 concentration in the feed gas were investigated to analyze their impacts on the acid gas removal unit. When the CO2 concentration was 5 mol%, the acid gas removal unit was required for both LNG and PLNG production. However, the acid gas removal unit was not necessary in PLNG when the concentration was 0.5 mol% and the pressure was higher than 15 bar. The results showed that the LCC of PLNG was reduced by almost 35% relative to that of LNG when the PLNG pressure was higher than 15 bar.

Competition and primary care in the United States: separating fact from fancy.

PubMed

Siminoff, L

1986-01-01

Competitive strategies have been advocated as the solution for the economic ills of the U.S. economy. During the 1980s many economists and health care practitioners are arguing that a competitive strategy will bring down health care costs; these plans emphasize the existence of perverse incentives which reward cost reducing behavior with less revenue. Competitive strategies assume the existence of a "health care marketplace." Historically, the United States health care sector has not conformed to the ideal of the competitive market because of the special characteristics involved in the production and consumption of health care. Consumers have the least power in the health care sector and yet most competitive proposals are explicitly directed at changing consumer behavior, especially in the area of primary care. Much evidence indicates that competitive plans inhibit consumers from using primary care services, increase long-term health care costs, and ultimately require more government regulatory action.

Nuclear weapons modernization: Plans, programs, and issues for Congress

NASA Astrophysics Data System (ADS)

Woolf, Amy F.

2017-11-01

The United States is currently recapitalizing each delivery system in its "nuclear triad" and refurbishing many of the warheads carried by those systems. The plans for these modernization programs have raised a number of questions, both within Congress and among analysts in the nuclear weapons and arms control communities, about the costs associated with the programs and the need to recapitalize each leg of the triad at the same time. This paper covers four distinct issues. It begins with a brief review of the planned modernization programs, then addresses questions about why the United States is pursuing all of these modernization programs at this time. It then reviews the debate about how much these modernization programs are likely to cost in the next decade and considers possible changes that might reduce the cost. It concludes with some comments about congressional views on the modernization programs and prospects for continuing congressional support in the coming years.

Tanker Fuel Efficiency: Saving Through Receiver Fuel Planning

DTIC Science & Technology

2014-06-13

engage your weapon.” General James Mattis , 2003 Conclusions The current planning and execution of air refueling missions are costing the DOD...fuel cells, and bio fuels are being explored by scientists and engineers working to reduce the United States’ dependency on foreign oil (Harmon

19 CFR 10.913 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Peru Trade Promotion Agreement.... “Adjusted value” means the value determined in accordance with Articles 1 through 8, Article 15, and the... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

19 CFR 10.913 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. United States-Peru Trade Promotion Agreement.... “Adjusted value” means the value determined in accordance with Articles 1 through 8, Article 15, and the... revenues, expenses, costs, assets, and liabilities, the disclosure of information, and the preparation of...

Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle".

PubMed

Kansagra, Ankit; Andrzejewski, Chester; Krushell, Robert; Lehman, Andrew; Greenbaum, Jordan; Visintainer, Paul; McGirr, Joan; Mahoney, Kathleen; Cloutier, Darlene; Ehresman, Alice; Stefan, Mihaela S

Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.

Economic evaluation of nebulized magnesium sulphate in acute severe asthma in children.

PubMed

Petrou, Stavros; Boland, Angela; Khan, Kamran; Powell, Colin; Kolamunnage-Dona, Ruwanthi; Lowe, John; Doull, Iolo; Hood, Kerry; Williamson, Paula

2014-10-01

The aim of this study was to estimate the cost-effectiveness of nebulized magnesium sulphate (MgSO4) in acute asthma in children from the perspective of the UK National Health Service and personal social services. An economic evaluation was conducted based on evidence from a randomized placebo controlled multi-center trial of nebulized MgSO4 in severe acute asthma in children. Participants comprised 508 children aged 2-16 years presenting to an emergency department or a children's assessment unit with severe acute asthma across thirty hospitals in the United Kingdom. Children were randomly allocated to receive nebulized salbutamol and ipratropium bromide mixed with either 2.5 ml of isotonic MgSO4 or 2.5 ml of isotonic saline on three occasions at 20-min intervals. Cost-effectiveness outcomes were constructed around the Yung Asthma Severity Score (ASS) after 60 min of treatment; whilst cost-utility outcomes were constructed around the quality-adjusted life-year (QALY) metric. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves at alternative cost-effectiveness thresholds for either: (i) a unit reduction in ASS; or (ii) an additional QALY. MgSO4 had a 75.1 percent probability of being cost-effective at a GBP 1,000 (EUR 1,148) per unit decrement in ASS threshold, an 88.0 percent probability of being more effective (in terms of reducing the ASS) and a 36.6 percent probability of being less costly. MgSO4 also had a 67.6 percent probability of being cost-effective at a GBP 20,000 (EUR 22,957) per QALY gained threshold, an 8.5 percent probability of being more effective (in terms of generating increased QALYs) and a 69.1 percent probability of being less costly. Sensitivity analyses showed that the results of the economic evaluation were particularly sensitive to the methods used for QALY estimation. The probability of cost-effectiveness of nebulized isotonic MgSO4, given as an adjuvant to standard treatment of severe acute asthma in children, is less than 70 percent across accepted cost-effectiveness thresholds for an additional QALY.

Monopolistic competition and the health care sector.

PubMed

Hilsenrath, P

1991-07-01

The model of monopolistic competition is appropriate for describing the behavior of the health care sector in the United States. Uncertainty about quality of medical and related services promotes product differentiation especially when consumers do not bear the full costs of care. New technologies can be used to signal quality even when their clinical usefulness is unproven. Recent cost containment measures may reduce employment of ineffective technologies but may also inhibit the adaptation of genuinely useful developments.

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

ERIC Educational Resources Information Center

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

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

Music as therapy.

PubMed

Kemper, Kathi J; Danhauer, Suzanne C

2005-03-01

Music is widely used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through the autonomic nervous system. It also has indirect effects by modifying caregiver behavior. Music effectively reduces anxiety and improves mood for medical and surgical patients, for patients in intensive care units and patients undergoing procedures, and for children as well as adults. Music is a low-cost intervention that often reduces surgical, procedural, acute, and chronic pain. Music also improves the quality of life for patients receiving palliative care, enhancing a sense of comfort and relaxation. Providing music to caregivers may be a cost-effective and enjoyable strategy to improve empathy, compassion, and relationship-centered care while not increasing errors or interfering with technical aspects of care.

Can CER be an effective tool for change in the development and assessment of new drugs and technologies?

PubMed

Brixner, Diana I; Watkins, John B

2012-06-01

Comparative effectiveness research (CER) has been proposed in the United States as a way to compare new drugs and technologies with established alternatives and determine not just whether a therapy works, but how well it works compared to other options. To define the current use of CER in the development of new drugs and technologies and explore what is needed for this research approach to reduce or stabilize health care costs in the United States. In 2010, the Patient-Centered Outcomes Research Institute (PCORI) was established by the Patient Protection and Affordable Care Act (PPACA) to coordinate federally funded CER and recommend research priorities. Hochman and McCormick's (2010) evaluation of 328 randomized trials, observational studies, and meta-analyses involving medications published between June 2008 and September 2009 in 6 key journals showed that most published research did not fulfill the criteria of CER (defined as comparison to active treatment) and that most study design is driven by FDA requirements rather than the need to develop evidence to facilitates election of the most effective therapy. Since PPACA provides alternative funding for CER, it could encourage funding more studies to help determine which treatment delivers the best value per unit of investment from clinical, humanistic, and economic perspectives. Manufacturers may avoid CER because it increases product development costs, but a drug proven more effective is more likely to be accepted by formulary committees, increasing the drug's market share, whereas payers may reject or limit use of a new drug that performs less effectively in comparative studies. CER may not directly reduce expenditures for drugs and medical technologies. The results may vary widely from case to case; however, despite often significantly higher prices for new drugs, it is important to look beyond product costs to the overall impact on health care costs, including medical cost offsets that may occur through improved health or decreased morbidity. To truly decrease cost and improve quality, cost-effectiveness will have to be integrated into CER with the objective of prioritizing efficient therapies in the real-world health care system. If the methods and output of CER improve, the resulting cost-effectiveness ratios will also be more useful to the payer. CER should ultimately, therefore, be a useful tool to help patients, providers, and decision makers provide the most effective and most cost-effective interventions.

Greenridge Multi-Pollutant Control Project Preliminary Public Design Report

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

Connell, Daniel P

2009-01-12

The Greenidge Multi-Pollutant Control Project is being conducted as part of the U.S. Department of Energy's Power Plant Improvement Initiative to demonstrate an innovative combination of air pollution control technologies that can cost-effectively reduce emissions of SO{sub 2}, NO{sub x}, Hg, acid gases (SO{sub 3}, HCl, and HF), and particulate matter from smaller coal-fired electrical generating units (EGUs). The multi-pollutant control system includes a hybrid selective non-catalytic reduction (SNCR)/in-duct selective catalytic reduction (SCR) system to reduce NOx emissions by {ge}60%, followed by a Turbosorp{reg_sign} circulating fluidized bed dry scrubber system to reduce emissions of SO{sub 2}, SO{sub 3}, HCl, andmore » HF by {ge}95%. Mercury removal of {ge}90% is also targeted via the co-benefits afforded by the in-duct SCR, dry scrubber, and baghouse and by injection of activated carbon upstream of the scrubber, as required. The technology is particularly well suited, because of its relatively low capital and maintenance costs and small space requirements, to meet the needs of coal-fired units with capacities of 50-300 MWe. There are about 440 such units in the United States that currently are not equipped with SCR, flue gas desulfurization (FGD), or mercury control systems. These smaller units are a valuable part of the nation's energy infrastructure, constituting about 60 GW of installed capacity. However, with the onset of the Clean Air Interstate Rule, Clean Air Mercury Rule, and various state environmental actions requiring deep reductions in emissions of SO{sub 2}, NO{sub x}, and mercury, the continued operation of these units increasingly depends upon the ability to identify viable air pollution control retrofit options for them. The large capital costs and sizable space requirements associated with conventional technologies such as SCR and wet FGD make these technologies unattractive for many smaller units. The Greenidge Project aims to confirm the commercial readiness of an emissions control system that is specifically designed to meet the environmental compliance requirements of these smaller coal-fired EGUs. The multi-pollutant control system is being installed and tested on the AES Greenidge Unit 4 (Boiler 6) by a team including CONSOL Energy Inc. as prime contractor, AES Greenidge LLC as host site owner, and Babcock Power Environmental Inc. as engineering, procurement, and construction contractor. All funding for the project is being provided by the U.S. Department of Energy, through its National Energy Technology Laboratory, and by AES Greenidge. AES Greenidge Unit 4 is a 107 MW{sub e} (net), 1950s vintage, tangentially-fired, reheat unit that is representative of many of the 440 smaller coal-fired units identified above. Following design and construction, the multi-pollutant control system will be demonstrated over an approximately 20-month period while the unit fires 2-4% sulfur eastern U.S. bituminous coal and co-fires up to 10% biomass. This Preliminary Public Design Report is the first in a series of two reports describing the design of the multi-pollutant control facility that is being demonstrated at AES Greenidge. Its purpose is to consolidate for public use all available nonproprietary design information on the Greenidge Multi-Pollutant Control Project. As such, the report includes a discussion of the process concept, design objectives, design considerations, and uncertainties associated with the multi-pollutant control system and also summarizes the design of major process components and balance of plant considerations for the AES Greenidge Unit 4 installation. The Final Public Design Report, the second report in the series, will update this Preliminary Public Design Report to reflect the final, as-built design of the facility and to incorporate data on capital costs and projected operating costs.« less

Cardiac rehabilitation costs.

PubMed

Moghei, Mahshid; Turk-Adawi, Karam; Isaranuwatchai, Wanrudee; Sarrafzadegan, Nizal; Oh, Paul; Chessex, Caroline; Grace, Sherry L

2017-10-01

Despite the clinical benefits of cardiac rehabilitation (CR) and its cost-effectiveness, it is not widely received. Arguably, capacity could be greatly increased if lower-cost models were implemented. The aims of this review were to describe: the costs associated with CR delivery, approaches to reduce these costs, and associated implications. Upon finalizing the PICO statement, information scientists were enlisted to develop the search strategy of MEDLINE, Embase, CDSR, Google Scholar and Scopus. Citations identified were considered for inclusion by the first author. Extracted cost data were summarized in tabular format and qualitatively synthesized. There is wide variability in the cost of CR delivery around the world, and patients pay out-of-pocket for some or all of services in 55% of countries. Supervised CR costs in high-income countries ranged from PPP$294 (Purchasing Power Parity; 2016 United States Dollars) in the United Kingdom to PPP$12,409 in Italy, and in middle-income countries ranged from PPP$146 in Venezuela to PPP$1095 in Brazil. Costs relate to facilities, personnel, and session dose. Delivering CR using information and communication technology (mean cost PPP$753/patient/program), lowering the dose and using lower-cost personnel and equipment are important strategies to consider in containing costs, however few explicitly low-cost models are available in the literature. More research is needed regarding the costs to deliver CR in community settings, the cost-effectiveness of CR in most countries, and the economic impact of return-to-work with CR participation. A low-cost model of CR should be standardized and tested for efficacy across multiple healthcare systems. Copyright © 2017 Elsevier B.V. All rights reserved.

Reductions in invasive device use and care costs after institution of a daily safety checklist in a pediatric critical care unit.

PubMed

Tarrago, Rod; Nowak, Jeffrey E; Leonard, Christopher S; Payne, Nathaniel R

2014-06-01

In the critical care unit, complexity of care can contribute to both medical errors and increased costs, particularly when clinicians are forced to rely on memory. Checklists can be used to improve safety and reduce cost. A number of omission-related adverse events in 2010 prompted the development of a checklist to reduce the possibility of similar future events. The PICU Safety Checklist was implemented in the pediatric ICU (PICU) at Children's Hospitals and Clinics of Minnesota. During a 21-month period, the checklist was used to prompt the care team to address quality and safety items during rounds. The initial checklist was paper, with two subsequent versions being incorporated into the electronic medical record (EMR). The daily safety checklist was successfully implemented in the PICU. Work-flow improvements based on regular multidisciplinary feedback led to more consistent use of the checklist. Improvements on all quality and safety metrics were identified, including invasive device use, medication costs, antibiotic and laboratory test use, and compliance with standards of care. Staff satisfaction rates were > 80% for safety, communication, and collaboration. By using a daily safety checklist in the pediatric critical care unit, we improved quality and safety, as well as the collaborative culture among all clinicians. Incorporating the checklist into the EMR improved compliance and accountability, ensuring its application to all patients. Clinicians now often individually address many checklist items outside the formal rounding process, indicating that the checklist content has become part of their usual practice. A successful implementation showing tangible clinical improvements can lead to interest and adoption in other clinical areas within the institution.

Disease management positively affects patient quality of life.

PubMed

Walker, David R; Landis, Darryl L; Stern, Patricia M; Vance, Richard P

2003-04-01

Health care costs are spiraling upward. The population of the United States is aging, and many baby boomers will develop multiple chronic health conditions. Disease management is one method for reducing costs associated with chronic health conditions. Although these programs have been proven effective in improving patient health, detailed information about their effect on patient quality of life has been scarce. This article provides preliminary evidence that disease management programs for coronary artery disease, chronic obstructive pulmonary disease, diabetes, and heart failure lead to improved quality of life, which correlates with a healthier, more satisfied, and less costly patient.

Medical costs associated with non-Hodgkin's lymphoma in the United States during the first two years of treatment.

PubMed

Kutikova, Lucie; Bowman, Lee; Chang, Stella; Long, Stacey R; Arning, Michael; Crown, William H

2006-08-01

To determine the direct costs of medical care associated with aggressive and indolent non-Hodgkin's lymphoma (NHL) in the United States; to show how costs for aggressive NHL change over time by examining costs related to initial, secondary and palliative treatment phases; and to evaluate the economic consequences of treatment failure in aggressive NHL. A retrospective cohort analysis of 1999 - 2000 direct costs in newly diagnosed NHL patients and controls (subjects without any cancer) was conducted using the MarketScan medical and drug claims database of large employers across the United States. Treatment failure analysis was conducted for aggressive NHL patients, and was defined by the need for secondary treatment or palliative care after initial therapy. Cost of treatment failure was calculated as difference in regression-adjusted costs between patients with initial therapy only and patients experiencing initial treatment failure. Patients with aggressive (n = 356) and indolent (n = 698) NHL had significantly greater health service utilization and associated costs (all P < 05) than controls (n = 1068 for aggressive, n = 2094 for indolent). Mean monthly costs were 5871 dollars for aggressive NHL vs. 355 dollars for controls (P < 0001) and 3833 dollars for indolent NHL vs. 289 dollars for controls (P < 0001). The primary cost drivers were hospitalization (aggressive NHL = 44% of total costs, indolent NHL = 50%) and outpatient office visits (aggressive NHL = 39%, indolent NHL = 34%). For aggressive NHL, mean monthly initial treatment phase costs (10,970 dollars) and palliative care costs (9836 dollars) were higher than costs incurred during secondary phase (3302 dollars). The mean cost of treatment failure in aggressive NHL was 14,174 dollars per month, and 85,934 dollars over the study period. The treatment of NHL was associated with substantial health care costs. Patients with aggressive lymphomas tended to accrue higher costs, compared with those with indolent lymphomas. These costs varied over time, with the highest costs occurring during the initial treatment and palliative care phases. Treatment failure was the most expensive treatment pattern. New strategies to prevent or delay treatment failure in aggressive NHL could help reduce the economic burden of NHL.

Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units.

PubMed

Goldsack, Jennifer C; DeRitter, Christine; Power, Michelle; Spencer, Amy; Taylor, Cynthia L; Kim, Sofia F; Kirk, Ryan; Drees, Marci

2014-10-01

There is a large and growing body of evidence that methicillin-resistant Staphylococcus aureus (MRSA) screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant S aureus positive (MRSA+) patients admitted to 7 medical-surgical units of a large regional hospital, specifically to allow discontinuation of contact isolation. We conducted mixed-methods retrospective evaluation of a process improvement project that screened admitted patients with known MRSA+ status for continued MRSA colonization. Of those eligible patients on our institution's MRSA+ list who did complete testing, 80.2% (130/162) were found to be no longer colonized, and only 19.8% (32/162) were still colonized. Forty-one percent (13/32) of interviewed patients in contact isolation for MRSA reported that isolation had affected their hospital stay, and 28% (9/32) of patients reported emotional distress resulting from their isolation. Total cost savings of the program are estimated at $101,230 per year across the 7 study units. Our findings provide supporting evidence that a screening program targeting patients with a history of MRSA who would otherwise be placed in isolation has the potential to improve outcomes and patient experience and reduce costs. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Patient navigation for breast and colorectal cancer in 3 community hospital settings: an economic evaluation.

PubMed

Donaldson, Elisabeth A; Holtgrave, David R; Duffin, Renea A; Feltner, Frances; Funderburk, William; Freeman, Harold P

2012-10-01

The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States. A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs. After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved. The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States. Copyright © 2012 American Cancer Society.

Impact of automatic calibration techniques on HMD life cycle costs and sustainable performance

NASA Astrophysics Data System (ADS)

Speck, Richard P.; Herz, Norman E., Jr.

2000-06-01

Automatic test and calibration has become a valuable feature in many consumer products--ranging from antilock braking systems to auto-tune TVs. This paper discusses HMDs (Helmet Mounted Displays) and how similar techniques can reduce life cycle costs and increase sustainable performance if they are integrated into a program early enough. Optical ATE (Automatic Test Equipment) is already zeroing distortion in the HMDs and thereby making binocular displays a practical reality. A suitcase sized, field portable optical ATE unit could re-zero these errors in the Ready Room to cancel the effects of aging, minor damage and component replacement. Planning on this would yield large savings through relaxed component specifications and reduced logistic costs. Yet, the sustained performance would far exceed that attained with fixed calibration strategies. Major tactical benefits can come from reducing display errors, particularly in information fusion modules and virtual `beyond visual range' operations. Some versions of the ATE described are in production and examples of high resolution optical test data will be discussed.

Combining PCR with Microscopy to Reduce Costs of Laboratory Diagnosis of Buruli Ulcer

PubMed Central

Yeboah-Manu, Dorothy; Asante-Poku, Adwoa; Asan-Ampah, Kobina; Ampadu, Emelia Danso Edwin; Pluschke, Gerd

2011-01-01

The introduction of antibiotic therapy as first-line treatment of Buruli ulcer underlines the importance of laboratory confirmation of clinical diagnosis. Because smear microscopy has very limited sensitivity, the technically demanding and more expensive IS2404 diagnostic polymerase chain reaction (PCR) has become the main method for confirmation. By optimization of the release of mycobacteria from swab specimen and concentration of bacterial suspensions before smearing, we were able to improve the detection rate of acid-fast bacilli by microscopy after Ziehl–Neelsen staining. Compared with IS2404 PCR, which is the gold standard diagnostic method, the sensitivity and specificity of microscopy with 100 concentrated specimens were 58.4% and 95.7%, respectively. We subsequently evaluated a stepwise laboratory confirmation algorithm with detection of AFB as first-line method and IS2404 PCR performed only with those samples that were negative in microscopic analysis. This stepwise approach reduced unit cost by more than 50% to $5.41, and the total costs were reduced from $917 to $433. PMID:22049046

Bridging environmental and financial cost of dairy production: A case study of Irish agricultural policy.

PubMed

Chen, Wenhao; Holden, Nicholas M

2018-02-15

The Irish agricultural policy 'Food Harvest 2020' is a roadmap for sectoral expansion and Irish dairy farming is expected to intensify, which could influence the environmental and economic performance of Irish milk production. Evaluating the total environmental impacts and the real cost of Irish milk production is a key step towards understanding the possibility of sustainable production. This paper addresses two main issues: aggregation of environmental impacts of Irish milk production by monetization, to understand the real cost of Irish milk production, including the environmental costs; and the effect of the agricultural policy 'Food Harvest 2020' on total cost (combining financial cost and environmental cost) of Irish milk production. This study used 2013 Irish dairy farming as a baseline, and defined 'bottom', 'target' and 'optimum' scenarios, according to the change of elementary inputs required to meet agricultural policy ambitions. The study demonstrated that the three monetization methods, Stepwise 2006, Eco-cost 2012 and EPS 2000, could be used for aggregating different environmental impacts into monetary unit, and to provide an insight for evaluating policy related to total environmental performance. The results showed that the total environmental cost of Irish milk production could be greater than the financial cost (up to €0.53/kg energy corrected milk). The dairy expansion policy with improved herbage utilization and fertilizer application could reduce financial cost and minimize the total environmental cost of per unit milk produced. Copyright © 2017 Elsevier B.V. All rights reserved.

Department of Defense Strategic Sustainability Performance Plan FY 2012

DTIC Science & Technology

2012-01-01

electricity consumption by 2020. Over FYs 2012 and 2013, DON will determine which installations have the best opportunity to cost- effectively achieve net...continental United States, to more effectively track fuel consumption and monitor and reduce vehicle idling. With the support of other private and...biofuel is the most effective way to reduce fleet petroleum consumption . In locations where biofuel is not available, the fleet should consider

Artificial intelligence for turboprop engine maintenance

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

NONE

1995-01-01

Long-term maintenance operations, causing the unit to out of action, may seem economical - but they result in reduced operating readiness. Offsetting that concern, careless, hurried maintenance reduces margins of safety and reliability. Any tool that improves maintenance without causing a sharp increase in cost is valuable. Artificial intelligence (AI) is one of the tools. Expert system and neural networks are two different areas of AI that show promise for turboprop engine maintenance.

Cost effectiveness of a pentavalent rotavirus vaccine in Oman.

PubMed

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

2014-06-17

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

Cost effectiveness of a pentavalent rotavirus vaccine in Oman

PubMed Central

2014-01-01

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

A preliminary analysis of the reduction of chemotherapy waste in the treatment of cancer with centralization of drug preparation.

PubMed

Hyeda, Adriano; Costa, Elide Sbardellotto Mariano da

2015-08-01

chemotherapy is essential to treat most types of cancer. Often, there is chemotherapy waste in the preparation of drugs prescribed to the patient. Leftover doses result in toxic waste production. the aim of the study was to analyze chemotherapy waste reduction at a centralized drug preparation unit. the study was cross-sectional, observational and descriptive, conducted between 2010 and 2012. The data were obtained from chemotherapy prescriptions made by oncologists linked to a health insurance plan in Curitiba, capital of the state of Paraná, in southern Brazil. Dose and the cost of chemotherapy waste were calculated in each application, considering the dose prescribed by the doctor and the drug dosages available for sale. The variables were then calculated considering a hypothetical centralized drug preparation unit. there were 176 patients with a cancer diagnosis, 106 of which underwent treatment with intravenous chemotherapy. There were 1,284 applications for intravenous anticancer medications. There was a total of 63,824mg in chemotherapy waste, the cost of which was BRL 448,397.00. The average cost of chemotherapy waste per patient was BRL 4,607.00. In the centralized model, there was 971.80mg of chemotherapy waste, costing BRL 13,991.64. The average cost of chemotherapy waste per patient was BRL 132.00. the use of centralized drug preparation units may be a strategy to reduce chemotherapy waste.

Life-Cycle Cost and Environmental Assessment of Decentralized Nitrogen Recovery Using Ion Exchange from Source-Separated Urine through Spatial Modeling.

PubMed

Kavvada, Olga; Tarpeh, William A; Horvath, Arpad; Nelson, Kara L

2017-11-07

Nitrogen standards for discharge of wastewater effluent into aquatic bodies are becoming more stringent, requiring some treatment plants to reduce effluent nitrogen concentrations. This study aimed to assess, from a life-cycle perspective, an innovative decentralized approach to nitrogen recovery: ion exchange of source-separated urine. We modeled an approach in which nitrogen from urine at individual buildings is sorbed onto resins, then transported by truck to regeneration and fertilizer production facilities. To provide insight into impacts from transportation, we enhanced the traditional economic and environmental assessment approach by combining spatial analysis, system-scale evaluation, and detailed last-mile logistics modeling using the city of San Francisco as an illustrative case study. The major contributor to energy intensity and greenhouse gas (GHG) emissions was the production of sulfuric acid to regenerate resins, rather than transportation. Energy and GHG emissions were not significantly sensitive to the number of regeneration facilities. Cost, however, increased with decentralization as rental costs per unit area are higher for smaller areas. The metrics assessed (unit energy, GHG emissions, and cost) were not significantly influenced by facility location in this high-density urban area. We determined that this decentralized approach has lower cost, unit energy, and GHG emissions than centralized nitrogen management via nitrification-denitrification if fertilizer production offsets are taken into account.

Decentralization in Indonesia: lessons from cost recovery rate of district hospitals.

PubMed

Maharani, Asri; Femina, Devi; Tampubolon, Gindo

2015-07-01

In 1991, Indonesia began a process of decentralization in the health sector which had implications for the country's public hospitals. The public hospitals were given greater authority to manage their own personnel, finance and procurement, with which they were allowed to operate commercial sections in addition to offering public services. These public services are subsidized by the government, although patients still pay certain proportion of fees. The main objectives of health sector decentralization are to increase the ability of public hospitals to cover their costs and to reduce government subsidies. This study investigates the consequences of decentralization on cost recovery rate of public hospitals at district level. We examine five service units (inpatient, outpatient, operating room, laboratory and radiology) in three public hospitals. We find that after 20 years of decentralization, district hospitals still depend on government subsidies, demonstrated by the fact that the cost recovery rate of most service units is less than one. The commercial sections fail to play their role as revenue generator as they are still subsidized by the government. We also find that the bulk of costs are made up of staff salaries and incentives in all units except radiology. As this study constitutes exploratory research, further investigation is needed to find out the reasons behind these results. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Design architecture for multi-zone HVAC control systems from existing single-zone systems using wireless sensor networks

NASA Astrophysics Data System (ADS)

Redfern, Andrew; Koplow, Michael; Wright, Paul

2007-01-01

Most residential heating, ventilating, and air-conditioning (HVAC) systems utilize a single zone for conditioning air throughout the entire house. While inexpensive, these systems lead to wide temperature distributions and inefficient cooling due to the difference in thermal loads in different rooms. The end result is additional cost to the end user because the house is over conditioned. To reduce the total amount of energy used in a home and to increase occupant comfort there is a need for a better control system using multiple temperature zones. Typical multi-zone systems are costly and require extensive infrastructure to function. Recent advances in wireless sensor networks (WSNs) have enabled a low cost drop-in wireless vent register control system. The register control system is controlled by a master controller unit, which collects sensor data from a distributed wireless sensor network. Each sensor node samples local settings (occupancy, light, humidity and temperature) and reports the data back to the master control unit. The master control unit compiles the incoming data and then actuates the vent resisters to control the airflow throughout the house. The control system also utilizes a smart thermostat with a movable set point to enable the user to define their given comfort levels. The new system can reduce the run time of the HVAC system and thus decreasing the amount of energy used and increasing the comfort of the home occupations.

The Cost of Hematopoietic Stem-Cell Transplantation in the United States

PubMed Central

Broder, Michael S.; Quock, Tiffany P.; Chang, Eunice; Reddy, Sheila R.; Agarwal-Hashmi, Rajni; Arai, Sally; Villa, Kathleen F.

2017-01-01

Background Hematopoietic stem-cell transplantation (HSCT) requires highly specialized, resource-intensive care. Myeloablative conditioning regimens used before HSCT generally require inpatient stays and are more intensive than other preparative regimens, and may therefore be more costly. Objective To estimate the costs associated with inpatient HSCT according to the type of the conditioning regimen used and other potential contributors to the overall cost of the procedure. Method We used data from the Truven Health MarketScan insurance claims database to analyze healthcare costs for pediatric (age <18 years) and adult (age ≥18 years) patients who had autologous or allogeneic inpatient HSCT between January 1, 2010, and September 23, 2013. We developed an algorithm to determine whether conditioning regimens were myeloablative or nonmyeloablative/reduced intensity. Results We identified a sample of 1562 patients who had inpatient HSCT during the study period for whom the transplant type and the conditioning regimen were determinable: 398 patients had myeloablative allogeneic HSCT; 195 patients had nonmyeloablative/reduced-intensity allogeneic HSCT; and 969 patients had myeloablative autologous HSCT. The median total healthcare cost at 100 days was $289,283 for the myeloablative allogeneic regimen cohort compared with $253,467 for the nonmyeloablative/reduced-intensity allogeneic regimen cohort, and $140,792 for the myeloablative autologous regimen cohort. The mean hospital length of stay for the index (first claim of) HSCT was 35.6 days in the myeloablative allogeneic regimen cohort, 26.6 days in the nonmyeloablative/reduced-intensity allogeneic cohort, and 21.8 days in the myeloablative autologous regimen cohort. Conclusion Allogeneic HSCT was more expensive than autologous HSCT, regardless of the regimen used. Myeloablative conditioning regimens led to higher overall costs than nonmyeloablative/reduced-intensity regimens in the allogeneic HSCT cohort, indicating a greater cost burden associated with inpatient services for higher-intensity preparative conditioning regimens. Pediatric patients had higher costs than adult patients. Future research should involve validating the algorithm for identifying conditioning regimens using clinical data. PMID:29263771

Evaluating the Impacts of Real-Time Pricing on the Cost and Value of Wind Generation

DOE PAGES

Siohansi, Ramteen

2010-05-01

One of the costs associated with integrating wind generation into a power system is the cost of redispatching the system in real-time due to day-ahead wind resource forecast errors. One possible way of reducing these redispatch costs is to introduce demand response in the form of real-time pricing (RTP), which could allow electricity demand to respond to actual real-time wind resource availability using price signals. A day-ahead unit commitment model with day-ahead wind forecasts and a real-time dispatch model with actual wind resource availability is used to estimate system operations in a high wind penetration scenario. System operations are comparedmore » to a perfect foresight benchmark, in which actual wind resource availability is known day-ahead. The results show that wind integration costs with fixed demands can be high, both due to real-time redispatch costs and lost load. It is demonstrated that introducing RTP can reduce redispatch costs and eliminate loss of load events. Finally, social surplus with wind generation and RTP is compared to a system with neither and the results demonstrate that introducing wind and RTP into a market can result in superadditive surplus gains.« less

Cost-savings for biosimilars in the United States: a theoretical framework and budget impact case study application using filgrastim.

PubMed

Grewal, Simrun; Ramsey, Scott; Balu, Sanjeev; Carlson, Josh J

2018-05-18

Biosimilars can directly reduce the cost of treating patients for whom a reference biologic is indicated by offering a highly similar, lower priced alternative. We examine factors related to biosimilar regulatory approval, uptake, pricing, and financing and the potential impact on drug expenditures in the U.S. We developed a framework to illustrate how key factors including regulatory policies, provider and patient perception, pricing, and payer policies impact biosimilar cost-savings. Further, we developed a budget impact cost model to estimate savings from filgrastim biosimilars under various scenarios. The model uses publicly available data on disease incidence, treatment patterns, market share, and drug prices to estimate the cost-savings over a 5-year time horizon. We estimate five-year cost savings of $256 million, of which 18% ($47 million) are from reduced patient out-of-pocket costs, 34% ($86 million) are savings to commercial payers, and 48% ($123 million) are savings for Medicare. Additional scenarios demonstrate the impact of uncertain factors, including price, uptake, and financing policies. A variety or interrelated factors influence the development, uptake, and cost-savings for Biosimilars use in the U.S. The filgrastim case is a useful example that illustrates these factors and the potential magnitude of costs savings.

Study 2.6 operations analysis mission characterization

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1973-01-01

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

Secondary-care costs associated with lung cancer diagnosed at emergency hospitalisation in the United Kingdom.

PubMed

Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J

2017-10-01

Lung cancer diagnosis during emergency hospital admission has been associated with higher early secondary-care costs and lower longer-term costs than outpatient diagnoses. This retrospective cohort study analyses the secondary-care costs of 3274 consecutive patients with lung cancer. Patients diagnosed during emergency admissions incurred greater costs during the first month and had a worse prognosis compared with outpatient diagnoses. In patients who remained alive, costs after the first month were comparable between diagnostic routes. In addition to improving patient experience and outcome, strategies to increase earlier diagnosis may reduce the additional healthcare costs associated with this route to diagnosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

PubMed

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

2010-10-01

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

Revisiting the cost-effectiveness of universal cervical length screening: importance of progesterone efficacy.

PubMed

Jain, Siddharth; Kilgore, Meredith; Edwards, Rodney K; Owen, John

2016-07-01

Preterm birth (PTB) is a significant cause of neonatal morbidity and mortality. Studies have shown that vaginal progesterone therapy for women diagnosed with shortened cervical length can reduce the risk of PTB. However, published cost-effectiveness analyses of vaginal progesterone for short cervix have not considered an appropriate range of clinically important parameters. To evaluate the cost-effectiveness of universal cervical length screening in women without a history of spontaneous PTB, assuming that all women with shortened cervical length receive progesterone to reduce the likelihood of PTB. A decision analysis model was developed to compare universal screening and no-screening strategies. The primary outcome was the cost-effectiveness ratio of both the strategies, defined as the estimated patient cost per quality-adjusted life-year (QALY) realized by the children. One-way sensitivity analyses were performed by varying progesterone efficacy to prevent PTB. A probabilistic sensitivity analysis was performed to address uncertainties in model parameter estimates. In our base-case analysis, assuming that progesterone reduces the likelihood of PTB by 11%, the incremental cost-effectiveness ratio for screening was $158,000/QALY. Sensitivity analyses show that these results are highly sensitive to the presumed efficacy of progesterone to prevent PTB. In a 1-way sensitivity analysis, screening results in cost-saving if progesterone can reduce PTB by 36%. Additionally, for screening to be cost-effective at WTP=$60,000 in three clinical scenarios, progesterone therapy has to reduce PTB by 60%, 34% and 93%. Screening is never cost-saving in the worst-case scenario or when serial ultrasounds are employed, but could be cost-saving with a two-day hospitalization only if progesterone were 64% effective. Cervical length screening and treatment with progesterone is a not a dominant, cost-effective strategy unless progesterone is more effective than has been suggested by available data for US women. Until future trials demonstrate greater progesterone efficacy, and effectiveness studies confirm a benefit from screening and treatment, the cost-effectiveness of universal cervical length screening in the United States remains questionable. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-effectiveness development for the postoperative care of craniotomy patients: a safe transitions pathway in neurological surgery.

PubMed

Osorio, Joseph A; Safaee, Michael M; Viner, Jennifer; Sankaran, Sujatha; Imershein, Sarah; Adigun, Ezekiel; Weigel, Gabriela; Berger, Mitchel S; McDermott, Michael W

2018-05-01

OBJECTIVE The authors' institution is in the top 5th percentile for hospital cost in the nation, and the neurointensive care unit (NICU) is one of the costliest units. The NICU is more expensive than other units because of lower staff/patient ratio and because of the equipment necessary to monitor patient care. The cost differential between the NICU and Neuro transitional care unit (NTCU) is $1504 per day. The goal of this study was to evaluate and to pilot a program to improve efficiency and lower cost by modifying the postoperative care of patients who have undergone a craniotomy, sending them to the NTCU as opposed to the NICU. Implementation of the pilot will expand and utilize neurosurgery beds available on the NTCU and reduce the burden on NICU beds for critically ill patient admissions. METHODS Ten patients who underwent craniotomy to treat supratentorial brain tumors were included. Prior to implementation of the pilot, inclusion criteria were designed for patient selection. Patients included were less than 65 years of age, had no comorbid conditions requiring postoperative intensive care unit (ICU) care, had a supratentorial meningioma less than 3 cm in size, had no intraoperative events, had routine extubation, and underwent surgery lasting fewer than 5 hours and had blood loss less than 500 ml. The Safe Transitions Pathway (STP) was started in August 2016. RESULTS Ten tumor patients have utilized the STP (5 convexity meningiomas, 2 metastatic tumors, 3 gliomas). Patients' ages ranged from 29 to 75 years (median 49 years; an exception to the age limit of 65 years was made for one 75-year-old patient). Discharge from the hospital averaged 2.2 days postoperative, with 1 discharged on postoperative day (POD) 1, 7 discharged on POD 2, 1 discharged on POD 3, and 1 discharged on POD 4. Preliminary data indicate that quality and safety for patients following the STP (moving from the operating room [OR] to the neuro transitional care unit [OR-NTCU]) are no different from those of patients following the traditional OR-NICU pathway. No patients required escalation in level of nursing care, and there were no readmissions. This group has been followed for greater than 1 month, and there were no morbidities. CONCLUSIONS The STP is a new and efficient pathway for the postoperative care of neurosurgery patients. The STP has reduced hospital cost by $22,560 for the first 10 patients, and there were no morbidities. Since this pilot, the authors have expanded the pathway to include other surgical cases and now routinely schedule craniotomy patients for the (OR-NTCU) pathway. The potential cost reduction in one year could reach $500,000 if we reach our potential of 20 patients per month.

Improvement of General Electric’s Chilled Ammonia Process with the use of Membrane Technology

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

Muraskin, Dave; Dube, Sanjay; Baburao, Barath

General Electric Environmental Control Solutions (formerly Alstom Power Environmental Control Systems) set out to complete the Phase 1 award requirements for a Phase II renewal application for their project selected under DOE-FOA-0001190 “Small and Large Scale Pilots for Reducing the Cost of CO 2 Capture and Compression”. The project focus was to implement several improvement concepts utilizing membrane technology at the recipient’s Chilled Ammonia Process (CAP) CO 2 capture large-scale pilot plant. The goal was to lower the overall cost of technology. During the development of costs for the preliminary techno-economic assessment (TEA), it became clear that the capital andmore » operating costs of this concept were not economically attractive. All work related to a Phase II renewal application at that point was halted as GE made the decision not to submit a Phase II renewal application. Discussions with DOE resulted in a path towards useful information produced from the design and cost work already completed on the project. With the reverse osmosis (RO) unit providing most of the cost issues, GE would provide a sensitivity analysis of the RO unit with respect to project cost. This information would be included with the Techno-Economic Analysis along with the Technology Gap Analysis.« less

A CLIMATE-RESPONSIVE ADAPTIVE CONTROL FOR A COMBINATION PASSIVE SOLAR SHADING AND NATURAL VENTILATION

EPA Science Inventory

Currently, nations around the globe are facing striking concerns regarding energy consumption. In the United States, we face increasing demands that will cause increasing fuel prices thus ultimately higher-energy cost. The future could be eased by reduce energy consumption ...

Tax Reform and Individual Giving to Higher Education.

ERIC Educational Resources Information Center

Auten, Gerald E.; Rudney, Gabriel G.

1986-01-01

Higher education benefits from several United States tax law provisions, including deductibility of charitable contributions. Recent tax reform proposals could increase would-be donors' net cost by reducing tax incentives. This paper links lower tax rates to a significant future reduction in educational philanthropy. (18 references) (MLH)

Genomic selection in forage breeding: designing an estimation population

USDA-ARS?s Scientific Manuscript database

The benefits of genomic selection to livestock, crops and forest tree breeding can be extended to forage grasses and legumes. The main benefits expected are increased selection accuracy and reduced costs per unit of genotype evaluated and breeding cycle length. Aiming at designing a training populat...

Wind Energy Forecasting: A Collaboration of the National Center for Atmospheric Research (NCAR) and Xcel Energy

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

Parks, K.; Wan, Y. H.; Wiener, G.

2011-10-01

The focus of this report is the wind forecasting system developed during this contract period with results of performance through the end of 2010. The report is intentionally high-level, with technical details disseminated at various conferences and academic papers. At the end of 2010, Xcel Energy managed the output of 3372 megawatts of installed wind energy. The wind plants span three operating companies1, serving customers in eight states2, and three market structures3. The great majority of the wind energy is contracted through power purchase agreements (PPAs). The remainder is utility owned, Qualifying Facilities (QF), distributed resources (i.e., 'behind the meter'),more » or merchant entities within Xcel Energy's Balancing Authority footprints. Regardless of the contractual or ownership arrangements, the output of the wind energy is balanced by Xcel Energy's generation resources that include fossil, nuclear, and hydro based facilities that are owned or contracted via PPAs. These facilities are committed and dispatched or bid into day-ahead and real-time markets by Xcel Energy's Commercial Operations department. Wind energy complicates the short and long-term planning goals of least-cost, reliable operations. Due to the uncertainty of wind energy production, inherent suboptimal commitment and dispatch associated with imperfect wind forecasts drives up costs. For example, a gas combined cycle unit may be turned on, or committed, in anticipation of low winds. The reality is winds stayed high, forcing this unit and others to run, or be dispatched, to sub-optimal loading positions. In addition, commitment decisions are frequently irreversible due to minimum up and down time constraints. That is, a dispatcher lives with inefficient decisions made in prior periods. In general, uncertainty contributes to conservative operations - committing more units and keeping them on longer than may have been necessary for purposes of maintaining reliability. The downside is costs are higher. In organized electricity markets, units that are committed for reliability reasons are paid their offer price even when prevailing market prices are lower. Often, these uplift charges are allocated to market participants that caused the inefficient dispatch in the first place. Thus, wind energy facilities are burdened with their share of costs proportional to their forecast errors. For Xcel Energy, wind energy uncertainty costs manifest depending on specific market structures. In the Public Service of Colorado (PSCo), inefficient commitment and dispatch caused by wind uncertainty increases fuel costs. Wind resources participating in the Midwest Independent System Operator (MISO) footprint make substantial payments in the real-time markets to true-up their day-ahead positions and are additionally burdened with deviation charges called a Revenue Sufficiency Guarantee (RSG) to cover out of market costs associated with operations. Southwest Public Service (SPS) wind plants cause both commitment inefficiencies and are charged Southwest Power Pool (SPP) imbalance payments due to wind uncertainty and variability. Wind energy forecasting helps mitigate these costs. Wind integration studies for the PSCo and Northern States Power (NSP) operating companies have projected increasing costs as more wind is installed on the system due to forecast error. It follows that reducing forecast error would reduce these costs. This is echoed by large scale studies in neighboring regions and states that have recommended adoption of state-of-the-art wind forecasting tools in day-ahead and real-time planning and operations. Further, Xcel Energy concluded reduction of the normalized mean absolute error by one percent would have reduced costs in 2008 by over $1 million annually in PSCo alone. The value of reducing forecast error prompted Xcel Energy to make substantial investments in wind energy forecasting research and development.« less

Building America Case Study: Philadelphia Housing Authority Energy-Efficiency Turnover Protocols, Philadelphia, Pennsylvania

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

2016-02-01

Over one million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 public housing authorities (PHAs) across the country indicated that there is a high level of interest in developing low-cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with four PHAs to develop packages of energy efficiency retrofit measures the PHAs can cost-effectively implement with their own staffs in the normal course of housing operations at the time whenmore » units are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing, and measures that improve equipment efficiency. ARIES documented implementation in 18 housing units. Reductions in average air leakage were 16 percent and duct leakage reductions averaged 23 percent. Total source energy consumption savings due to implemented measures was estimated at 3-10 percent based on BEopt modeling with a simple payback of 1.6 to 2.5 years. Implementation challenges were encountered mainly related to required operational changes and budgetary constraints. Nevertheless, simple measures can feasibly be accomplished by PHA staff at low or no cost. At typical housing unit turnover rates, these measures could impact hundreds of thousands of units per year nationally.« less

Islip Housing Authority Energy Efficiency Turnover Protocols, Islip, New York (Fact Sheet)

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

Not Available

2014-08-01

More than 1 million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 PHAs across the country indicated that there is a high level of interest in developing low cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with two public housing authorities (PHAs) to develop packages of energy efficiency retrofit measures the PHAs can cost effectively implement with their own staffs in the normal course of housing operations atmore » the time when units are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing and measures that improve equipment efficiency. ARIES documented implementation in ten housing units. Reductions in average air leakage were 16-20% and duct leakage reductions averaged 38%. Total source energy consumption savings was estimated at 6-10% based on BEopt modeling with a simple payback of 1.7 to 2.2 years. Implementation challenges were encountered mainly related to required operational changes and budgetary constraints. Nevertheless, simple measures can feasibly be accomplished by PHA staff at low or no cost. At typical housing unit turnover rates, these measures could impact hundreds of thousands of unit per year nationally.« less

Public Housing: A Tailored Approach to Energy Retrofits

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

Dentz, J.; Conlin, F.; Podorson, D.

2016-02-18

Over one million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 public housing authorities (PHAs) across the country indicated that there is a high level of interest in developing low-cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with four PHAs to develop packages of energy efficiency retrofit measures the PHAs can cost-effectively implement with their own staffs in the normal course of housing operations at the time whenmore » units are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing, and measures that improve equipment efficiency. ARIES documented implementation in 18 housing units. Reductions in average air leakage were 16% and duct leakage reductions averaged 23%. Total source energy consumption savings due to implemented measures was estimated at 3-10% based on BEopt modeling with a simple payback of 1.6 to 2.5 years. Implementation challenges were encountered mainly related to required operational changes and budgetary constraints. Nevertheless, simple measures can feasibly be accomplished by PHA staff at low or no cost. At typical housing unit turnover rates, these measures could impact hundreds of thousands of units per year nationally.« less

Experimental Behavior of Fatigued Single Stiffener PRSEUS Specimens

NASA Technical Reports Server (NTRS)

Jegley, Dawn C.

2009-01-01

NASA, the Air Force Research Laboratory and The Boeing Company have worked to develop new low-cost, light-weight composite structures for aircraft. A Pultruded Rod Stitched Efficient Unitized Structure (PRSEUS) concept has been developed which offers advantages over traditional metallic structure. In this concept a stitched carbon-epoxy material system has been developed with the potential for reducing the weight and cost of transport aircraft structure by eliminating fasteners, thereby reducing part count and labor. By adding unidirectional carbon rods to the top of stiffeners, the panel becomes more structurally efficient. This combination produces a more damage tolerant design. This document describes the results of experimentation on PRSEUS specimens loaded in unidirectional compression in fatigue and to failure.

Time Is Money...and the Enemy of College Completion: Transform American Higher Education to Boost Completion and Reduce Costs. Testimony before the United States House of Representatives Subcommittee on Higher Education and Workforce Training

ERIC Educational Resources Information Center

Jones, Stan

2012-01-01

This paper presents Stan Jones' testimony before the United States House of Representatives Subcommittee on Higher Education and Workforce Training. In his testimony, he talks about a new American majority of students that is emerging on campuses, especially at community colleges. These students must delicately balance long hours at jobs they must…

Reduced Root Cortical Cell File Number Improves Drought Tolerance in Maize1[C][W][OPEN

PubMed Central

Chimungu, Joseph G.; Brown, Kathleen M.

2014-01-01

We tested the hypothesis that reduced root cortical cell file number (CCFN) would improve drought tolerance in maize (Zea mays) by reducing the metabolic costs of soil exploration. Maize genotypes with contrasting CCFN were grown under well-watered and water-stressed conditions in greenhouse mesocosms and in the field in the United States and Malawi. CCFN ranged from six to 19 among maize genotypes. In mesocosms, reduced CCFN was correlated with 57% reduction of root respiration per unit of root length. Under water stress in the mesocosms, genotypes with reduced CCFN had between 15% and 60% deeper rooting, 78% greater stomatal conductance, 36% greater leaf CO2 assimilation, and between 52% to 139% greater shoot biomass than genotypes with many cell files. Under water stress in the field, genotypes with reduced CCFN had between 33% and 40% deeper rooting, 28% lighter stem water oxygen isotope enrichment (δ18O) signature signifying deeper water capture, between 10% and 35% greater leaf relative water content, between 35% and 70% greater shoot biomass at flowering, and between 33% and 114% greater yield than genotypes with many cell files. These results support the hypothesis that reduced CCFN improves drought tolerance by reducing the metabolic costs of soil exploration, enabling deeper soil exploration, greater water acquisition, and improved growth and yield under water stress. The large genetic variation for CCFN in maize germplasm suggests that CCFN merits attention as a breeding target to improve the drought tolerance of maize and possibly other cereal crops. PMID:25355868

HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment—State of the Art and Future Directions

PubMed Central

Meyer-Rath, Gesine; Over, Mead

2012-01-01

Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the future. In past economic analyses of ART provision, costs were often assumed to vary by disease stage and treatment regimen, but for treatment as prevention, in particular, most analyses assume a uniform cost per patient. This approach disregards variables that can affect unit cost, such as differences in factor prices (i.e., the prices of supplies and services) and the scale and scope of operations (i.e., the sizes and types of facilities providing ART). We discuss several of these variables, and then present a worked example of a flexible cost function used to determine the effect of scale on the cost of a proposed scale-up of treatment as prevention in South Africa. Adjusting previously estimated costs of universal testing and treatment in South Africa for diseconomies of small scale, i.e., more patients being treated in smaller facilities, adds 42% to the expected future cost of the intervention. PMID:22802731

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

Horowitz, Kelsey A. W.; Fu, Ran; Woodhouse, Michael

This article examines current cost drivers and potential avenues to reduced cost for monolithic, glass-glass Cu(In,Ga)(Se,S)2 (CIGS) modules by constructing a comprehensive bottom-up cost model. For a reference case where sputtering plus batch sulfurization after selenization (SAS) is employed, we compute a manufacturing cost of $69/m2 if the modules are made in the United States at a 1 GW/year production volume. At 14% module efficiency, this corresponds to a manufacturing cost of $0.49/WDC and a minimum sustainable price (MSP) of $0.67/WDC. We estimate that MSP could vary within +/-20% of this value given the range of quoted input prices, andmore » existing variations in module design, manufacturing processes, and manufacturing location. Potential for reduction in manufacturing costs to below $0.40/WDC may be possible if average production module efficiencies can be increased above 17% without increasing $/m2 costs; even lower costs could be achieved if $/m2 costs could be reduced, particularly via innovations in the CIGS deposition process or balance-of-module elements. We present the impact on cost of regional factors, CIGS deposition method, device design, and price fluctuations. One metric of competitiveness-levelized cost of energy (LCOE) -- is also assessed for several U.S. locations and compared to that of standard multi-crystalline silicon (m(c-Si)) and cadmium telluride (CdTe).« less

Field Demonstration of a High-Efficiency Packaged Rooftop Air Conditioning Unit at Fort Gordon, Augusta, GA

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

Armstrong, Peter R.; Sullivan, Gregory P.; Parker, Graham B.

2006-03-31

As part of a larger program targeting the market transformation of packaged rooftop air conditioning, five high-efficiency rooftop air conditioning products were selected in 2002 by the U.S. Department of Energy (DOE) under the Unitary Air Conditioner (UAC) Technology Procurement (http://www.pnl.gov/uac). In February 2003, Fort Gordon in Augusta, Georgia was chosen as the demonstration site. With the goal of validating the field performance and operation of one of the awarded products, a 10-ton high-efficiency packaged rooftop unit (RTU) manufactured by Global Energy Group (GEG) was installed at Fort Gordon in October 2003. Following equipment installation, power metering, air- and refrigerant-sidemore » instrumentation was installed on the GEG RTU and a 4-year old typical-efficiency 20-ton RTU manufactured by AAON . The GEG and AAON units were instrumented identically and operated May through July, 2005, to observe performance under a range of conditions. Based on the data collected as part of this demonstration, the GEG equipment performed at least 8% better in stage-1 (single compressor running) cooling and at least 16% better in stage-2 (both compressors running) than the baseline AAON equipment. Performance comparisons are based on what we call application EER normalized to equivalent specific fan power. The full-load, specific-fan-power-normalized application EERs at ARI design conditions were 10.48 Btu/Wh for the GEG and 9.00 Btu/Wh for the baseline machine. With a cost premium of nearly 50%, and slightly higher maintenance costs, the life-cycle cost analysis shows that the GEG technology pays for itself--a positive net-present value (NPV)--only in climates and buildings with long cooling seasons. Manufacture of this equipment on a larger scale can be expected to reduce costs to the point where it is more broadly cost-effective. The assumed 10-ton baseline and new-technology unit costs are $3824.00 and $5525.00 respectively. If the new technology cost is assumed to drop as sales increase to $4674.50 for a 10-ton unit (i.e. the original cost difference is halved), the life-cycle costs improve. A grid of first cost, annual maintenance cost and electricity price is enumerated and the results presented in the report show the sensitivity of life cycle cost to these three financial parameters in each of eight different climates.« less

Reducing workers' compensation costs for latex allergy and litigation against glove manufacturing companies.

PubMed

Edlich, Richard F; Mason, Shelley S; Swainston, Erin; Dahlstrom, Jill J; Gubler, K; Long, William B

2009-01-01

It has been well documented in the medical literature that powdered medical gloves can have serious consequences to patients and health-care workers. Adverse reactions to natural latex gloves, such as contact dermatitis and urticaria, occupational asthma, and anaphylaxis, have been documented as a significant cause of Workers' Compensation claims among health-care workers. While the cost of examination and surgical gloves is significant, this factor must be considered with the total cost of Workers' Compensation claims and possible litigation bestowed upon hospitals and glove manufacturing companies. In the United States, Canada, Belgium, and Germany, medical leaders have documented the dangers of powdered latex gloves and have implemented transition programs that are reducing Workers' Compensation claims filed by health-care workers. While attorneys view litigation against powdered glove manufacturers as the "next big tort", the authors of this article were not able to document all compensation costs to disabled workers because many settlements do not allow the claimant to disclose this information.

Economic evaluation of influenza pandemic mitigation strategies in the us using a stochastic microsimulation transmission model

PubMed Central

Sander, Beate; Nizam, Azhar; Garrison, Louis P.; Postma, Maarten J.; Halloran, M. Elizabeth; Longini, Ira M.

2013-01-01

Objectives To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States. Methods We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination. Results In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to full TAP or prevaccination further improves health outcomes, but increases total cost to society by approximately $2700 per capita. Conclusion Full targeted antiviral prophylaxis is an effective and cost-saving measure for mitigating pandemic influenza. PMID:18671770

Energy efficiency opportunities in the brewery industry

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

Worrell, Ernst; Galitsky, Christina; Martin, Nathan

2002-06-28

Breweries in the United States spend annually over $200 Million on energy. Energy consumption is equal to 3-8% of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findings suggestmore » that there may still be opportunities to reduce energy consumption cost-effectively for breweries. Major brewing companies have and will continue to spend capital on cost effective measures that do not impact the quality of the beer. Further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies at individual breweries.« less

A low-cost solid–liquid separation process for enzymatically hydrolyzed corn stover slurries

DOE PAGES

Sievers, David A.; Lischeske, James J.; Biddy, Mary J.; ...

2015-07-01

Solid-liquid separation of intermediate process slurries is required in some process configurations for the conversion of lignocellulosic biomass to transportation fuels. Thermochemically pretreated and enzymatically hydrolyzed corn stover slurries have proven difficult to filter due to formation of very low permeability cakes that are rich in lignin. Treatment of two different slurries with polyelectrolyte flocculant was demonstrated to increase mean particle size and filterability. Filtration flux was greatly improved, and thus scaled filter unit capacity was increased approximately 40-fold compared with unflocculated slurry. Although additional costs were accrued using polyelectrolyte, techno-economic analysis revealed that the increase in filter capacity significantlymore » reduced overall production costs. Fuel production cost at 95% sugar recovery was reduced by $1.35 US per gallon gasoline equivalent for dilute-acid pretreated and enzymatically hydrolyzed slurries and $3.40 for slurries produced using an additional alkaline de-acetylation preprocessing step that is even more difficult to natively filter.« less

A Study of the Relationship between User Attitudes and the Success of the MAJCOM and AFRCE Work Information Management System.

DTIC Science & Technology

1984-09-01

subsystems including labor reporting, Prime BEEF (Base Engineer Emergency Forces) composition, work order control, material control, cost accounting...AirComan IL ARCE BallsticLangey AB,24 Misl Supr)-FC Norton AF CA ( Estr Region) - AFRCE (United Kingdom) Ruislip AB UK UntdSae0i Fre nErp * Ramstein AB...Air Force personnel and minimize information burden on users, providers, and handlers, thereby reducing the costs, labor and intensiveness, and time

Cost Analysis of a Transition to Green Vehicle Technology for Light Duty Fleet Vehicles in Public Works Department Naval Support Activity Monterey (PWD Monterey)

DTIC Science & Technology

2015-12-01

stewardship by reducing reliance on fossil fuels . The Navy is actively 17 developing and participating in energy, environmental and climate change ...maintenance and fuel costs. B. U.S./DOD OIL DEPENDENCE AND ITS IMPACT ON ENVIRONMENT The following section discusses the United States and DOD’s...usinventoryreport.html The Intergovernmental Panel on Climate Change suggests that increasing concentrations of GHGs could have caused the temperature increases over

Computer-aided fabrication of a zirconia 14-unit removable dental prosthesis: a technical report.

PubMed

Grösser, Julian; Sachs, Caroline; Stadelmann, Markus; Schweiger, Josef; Güthe, Jan-Frederik; Beuer, Florian

2014-01-01

Double crown systems with primary crowns made from zirconia are used to support removable dental prostheses (RDPs). However, the fabrication of RDPs is labor-intensive and costly. Manufacturing primary and secondary crowns from zirconia with a CAD/CAM system might simplify the fabrication protocol and reduce costs. Furthermore, only ceramic materials are used in this method, providing an RDP with the highest possible biocompatibility and greatest possible esthetics. This article describes the fabrication protocol step by step.

The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.

PubMed

Kesselheim, Aaron S; Avorn, Jerry; Sarpatwari, Ameet

The increasing cost of prescription drugs in the United States has become a source of concern for patients, prescribers, payers, and policy makers. To review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs. We reviewed the peer-reviewed medical and health policy literature from January 2005 to July 2016 for articles addressing the sources of drug prices in the United States, the justifications and consequences of high prices, and possible solutions. Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products. Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs. Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear. High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits. The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives; and more effectively educating patients, prescribers, payers, and policy makers about these choices.

Potential clinical and economic outcomes of active beta-D-glucan surveillance with preemptive therapy for invasive candidiasis at intensive care units: a decision model analysis.

PubMed

Pang, Y-K; Ip, M; You, J H S

2017-01-01

Early initiation of antifungal treatment for invasive candidiasis is associated with change in mortality. Beta-D-glucan (BDG) is a fungal cell wall component and a serum diagnostic biomarker of fungal infection. Clinical findings suggested an association between reduced invasive candidiasis incidence in intensive care units (ICUs) and BDG-guided preemptive antifungal therapy. We evaluated the potential cost-effectiveness of active BDG surveillance with preemptive antifungal therapy in patients admitted to adult ICUs from the perspective of Hong Kong healthcare providers. A Markov model was designed to simulate the outcomes of active BDG surveillance with preemptive therapy (surveillance group) and no surveillance (standard care group). Candidiasis-associated outcome measures included mortality rate, quality-adjusted life year (QALY) loss, and direct medical cost. Model inputs were derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of model results. In base-case analysis, the surveillance group was more costly (1387 USD versus 664 USD) (1 USD = 7.8 HKD), with lower candidiasis-associated mortality rate (0.653 versus 1.426 per 100 ICU admissions) and QALY loss (0.116 versus 0.254) than the standard care group. The incremental cost per QALY saved by the surveillance group was 5239 USD/QALY. One-way sensitivity analyses found base-case results to be robust to variations of all model inputs. In probabilistic sensitivity analysis, the surveillance group was cost-effective in 50 % and 100 % of 10,000 Monte Carlo simulations at willingness-to-pay (WTP) thresholds of 7200 USD/QALY and ≥27,800 USD/QALY, respectively. Active BDG surveillance with preemptive therapy appears to be highly cost-effective to reduce the candidiasis-associated mortality rate and save QALYs in the ICU setting.

Continuing Professional Development via Social Media or Conference Attendance: A Cost Analysis.

PubMed

Maloney, Stephen; Tunnecliff, Jacqueline; Morgan, Prue; Gaida, James; Keating, Jennifer; Clearihan, Lyn; Sadasivan, Sivalal; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Rivers, George; Ilic, Dragan

2017-03-30

Professional development is essential in the health disciplines. Knowing the cost and value of educational approaches informs decisions and choices about learning and teaching practices. The primary aim of this study was to conduct a cost analysis of participation in continuing professional development via social media compared with live conference attendance. Clinicians interested in musculoskeletal care were invited to participate in the study activities. Quantitative data were obtained from an anonymous electronic questionnaire. Of the 272 individuals invited to contribute data to this study, 150 clinicians predominantly from Australia, United States, United Kingdom, India, and Malaysia completed the outcome measures. Half of the respondents (78/150, 52.0%) believed that they would learn more with the live conference format. The median perceived participation costs for the live conference format was Aus $1596 (interquartile range, IQR 172.50-2852.00). The perceived cost of participation for equivalent content delivered via social media was Aus $15 (IQR 0.00-58.50). The majority of the clinicians (114/146, 78.1%, missing data n=4) indicated that they would pay for a subscription-based service, delivered by social media, to the median value of Aus $59.50. Social media platforms are evolving into an acceptable and financially sustainable medium for the continued professional development of health professionals. When factoring in the reduced costs of participation and the reduced loss of employable hours from the perspective of the health service, professional development via social media has unique strengths that challenge the traditional live conference delivery format. ©Stephen Maloney, Jacqueline Tunnecliff, Prue Morgan, James Gaida, Jennifer Keating, Lyn Clearihan, Sivalal Sadasivan, Shankar Ganesh, Patitapaban Mohanty, John Weiner, George Rivers, Dragan Ilic. Originally published in JMIR Medical Education (http://mededu.jmir.org), 30.03.2017.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

PubMed

Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

2017-09-19

Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.

Big data in health care: using analytics to identify and manage high-risk and high-cost patients.

PubMed

Bates, David W; Saria, Suchi; Ohno-Machado, Lucila; Shah, Anand; Escobar, Gabriel

2014-07-01

The US health care system is rapidly adopting electronic health records, which will dramatically increase the quantity of clinical data that are available electronically. Simultaneously, rapid progress has been made in clinical analytics--techniques for analyzing large quantities of data and gleaning new insights from that analysis--which is part of what is known as big data. As a result, there are unprecedented opportunities to use big data to reduce the costs of health care in the United States. We present six use cases--that is, key examples--where some of the clearest opportunities exist to reduce costs through the use of big data: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems. We discuss the types of insights that are likely to emerge from clinical analytics, the types of data needed to obtain such insights, and the infrastructure--analytics, algorithms, registries, assessment scores, monitoring devices, and so forth--that organizations will need to perform the necessary analyses and to implement changes that will improve care while reducing costs. Our findings have policy implications for regulatory oversight, ways to address privacy concerns, and the support of research on analytics. Project HOPE—The People-to-People Health Foundation, Inc.

Taguchi Approach to Design Optimization for Quality and Cost: An Overview

NASA Technical Reports Server (NTRS)

Unal, Resit; Dean, Edwin B.

1990-01-01

Calibrations to existing cost of doing business in space indicate that to establish human presence on the Moon and Mars with the Space Exploration Initiative (SEI) will require resources, felt by many, to be more than the national budget can afford. In order for SEI to succeed, we must actually design and build space systems at lower cost this time, even with tremendous increases in quality and performance requirements, such as extremely high reliability. This implies that both government and industry must change the way they do business. Therefore, new philosophy and technology must be employed to design and produce reliable, high quality space systems at low cost. In recognizing the need to reduce cost and improve quality and productivity, Department of Defense (DoD) and National Aeronautics and Space Administration (NASA) have initiated Total Quality Management (TQM). TQM is a revolutionary management strategy in quality assurance and cost reduction. TQM requires complete management commitment, employee involvement, and use of statistical tools. The quality engineering methods of Dr. Taguchi, employing design of experiments (DOE), is one of the most important statistical tools of TQM for designing high quality systems at reduced cost. Taguchi methods provide an efficient and systematic way to optimize designs for performance, quality, and cost. Taguchi methods have been used successfully in Japan and the United States in designing reliable, high quality products at low cost in such areas as automobiles and consumer electronics. However, these methods are just beginning to see application in the aerospace industry. The purpose of this paper is to present an overview of the Taguchi methods for improving quality and reducing cost, describe the current state of applications and its role in identifying cost sensitive design parameters.

Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants.

PubMed

Johnson, Tricia J; Patel, Aloka L; Bigger, Harold R; Engstrom, Janet L; Meier, Paula P

2015-01-01

Necrotizing enterocolitis (NEC) is a costly morbidity in very low birth weight (VLBW; <1,500 g birth weight) infants that increases hospital length of stay and requires expensive treatments. To evaluate the cost of NEC as a function of dose and exposure period of human milk (HM) feedings received by VLBW infants during the neonatal intensive care unit (NICU) hospitalization and determine the drivers of differences in NICU hospitalization costs for infants with and without NEC. This study included 291 VLBW infants enrolled in an NIH-funded prospective observational cohort study between February 2008 and July 2012. We examined the incidence of NEC, NICU hospitalization cost, and cost of individual resources used during the NICU hospitalization. Twenty-nine (10.0%) infants developed NEC. The average total NICU hospitalization cost (in 2012 USD) was USD 180,163 for infants with NEC and USD 134,494 for infants without NEC (p = 0.024). NEC was associated with a marginal increase in costs of USD 43,818, after controlling for demographic characteristics, risk of NEC, and average daily dose of HM during days 1-14 (p < 0.001). Each additional ml/kg/day of HM during days 1-14 decreased non-NEC-related NICU costs by USD 534 (p < 0.001). Avoidance of formula and use of exclusive HM feedings during the first 14 days of life is an effective strategy to reduce the risk of NEC and resulting NICU costs in VLBW infants. Hospitals investing in initiatives to feed exclusive HM during the first 14 days of life could substantially reduce NEC-related NICU hospitalization costs. © 2015 S. Karger AG, Basel.

Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Bigger, Harold R.; Engstrom, Janet L.; Meier, Paula P.

2015-01-01

Background Necrotizing enterocolitis (NEC) is a costly morbidity in very low birth weight (VLBW; <1500g birth weight) infants that increases hospital length of stay and requires expensive treatments. Objectives To evaluate the cost of NEC as a function of dose and exposure period of human milk (HM) feedings received by VLBW infants during the neonatal intensive care unit (NICU) hospitalization and determine the drivers of differences in NICU hospitalization costs for infants with and without NEC. Methods This study included 291 VLBW infants enrolled in an NIH-funded prospective observational cohort study between February 2008 and July 2012. We examined the incidence of NEC, NICU hospitalization cost, and cost of individual resources used during the NICU hospitalization. Results Twenty-nine (10.0%) infants developed NEC. The average total NICU hospitalization cost (in 2012 dollars) was $180,163 for infants with NEC and $134,494 for infants without NEC (p=0.024). NEC was associated with a marginal increase in costs of $43,818, after controlling for demographic characteristics, risk of NEC and average daily dose of HM during Days 1–14 (p<0.001). Each additional mL/kg/day of HM during Days 1–14 decreased non-NEC-related NICU costs by $534 (p<0.001). Conclusions Avoidance of formula and use of exclusive HM feedings during the first 14 days of life is an effective strategy to reduce the risk of NEC and resulting NICU costs in VLBW infants. Hospitals investing in initiatives to feed exclusive HM during the first 14 days of life could substantially reduce NEC-related NICU hospitalization costs. PMID:25765818

Full scale calcium bromide injection with subsequent mercury oxidation and removal within wet flue gas desulphurization system: Experience at a 700 MW coal-fired power facility

NASA Astrophysics Data System (ADS)

Berry, Mark Simpson

The Environmental Protection Agency promulgated the Mercury and Air Toxics Standards rule, which requires that existing power plants reduce mercury emissions to meet an emission rate of 1.2 lb/TBtu on a 30-day rolling average and that new plants meet a 0.0002 lb/GWHr emission rate. This translates to mercury removals greater than 90% for existing units and greater than 99% for new units. Current state-of-the-art technology for the control of mercury emissions uses activated carbon injected upstream of a fabric filter, a costly proposition. For example, a fabric filter, if not already available, would require a 200M capital investment for a 700 MW size unit. A lower-cost option involves the injection of activated carbon into an existing cold-side electrostatic precipitator. Both options would incur the cost of activated carbon, upwards of 3M per year. The combination of selective catalytic reduction (SCR) reactors and wet flue gas desulphurization (wet FGD) systems have demonstrated the ability to substantially reduce mercury emissions, especially at units that burn coals containing sufficient halogens. Halogens are necessary for transforming elemental mercury to oxidized mercury, which is water-soluble. Plants burning halogen-deficient coals such as Power River Basin (PRB) coals currently have no alternative but to install activated carbon-based approaches to control mercury emissions. This research consisted of investigating calcium bromide addition onto PRB coal as a method of increasing flue gas halogen concentration. The treated coal was combusted in a 700 MW boiler and the subsequent treated flue gas was introduced into a wet FGD. Short-term parametric and an 83-day longer-term tests were completed to determine the ability of calcium bromine to oxidize mercury and to study the removal of the mercury in a wet FGD. The research goal was to show that calcium bromine addition to PRB coal was a viable approach for meeting the Mercury and Air Toxics Standards rule for existing boilers. The use of calcium bromide injection as an alternative to activated carbon approaches could save millions of dollars. The technology application described herein has the potential to reduce compliance cost by $200M for a 700 MW facility burning PRB coal.

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

14 CFR 151.43 - United States share of project costs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false United States share of project costs. 151... United States share of project costs. (a) The United States share of the allowable costs of a project is... part, the United States share of the costs of an approved project for airport development (regardless...

Fiscal Year 2000 Unit Cost Report for the Illinois Public Community Colleges.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

This report shows net instructional unit costs from fiscal year 1995 through fiscal year 2000. The five sections are: (1) Comparison of Fiscal Year 2000 Net Instructional Unit Cost with Previous Years; (2) Net Instructional Unit Cost in Illinois Public Community Colleges Since Fiscal Year 1995; (3) Fiscal Year 2000 Net Instructional Unit Cost,…

Tracing contacts of TB patients in Malaysia: costs and practicality.

PubMed

Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Ali, Irfhan; Asif, Muhammad

2012-01-01

Tuberculin skin testing (TST) and chest X-ray are the conventional methods used for tracing suspected tuberculosis (TB) patients. The purpose of the study was to calculate the cost incurred by Penang General Hospital on performing one contact tracing procedure using an activity based costing approach. Contact tracing records (including the demographic profile of contacts and outcome of the contact tracing procedure) from March 2010 until February 2011 were retrospectively obtained from the TB contact tracing record book. The human resource cost was calculated by multiplying the mean time spent (in minutes) by employees doing a specific activity by their per-minute salaries. The costs of consumables, Purified Protein Derivative vials and clinical equipment were obtained from the procurement section of the Pharmacy and Radiology Departments. The cost of the building was calculated by multiplying the area of space used by the facility with the unit cost of the public building department. Straight-line deprecation with a discount rate of 3% was assumed for the calculation of equivalent annual costs for the building and machines. Out of 1024 contact tracing procedures, TST was positive (≥10 mm) in 38 suspects. However, chemoprophylaxis was started in none. Yield of contact tracing (active tuberculosis) was as low as 0.5%. The total unit cost of chest X-ray and TST was MYR 9.23 (2.90 USD) & MYR 11.80 (USD 3.70), respectively. The total cost incurred on a single contact tracing procedure was MYR 21.03 (USD 6.60). Our findings suggest that the yield of contact tracing was very low which may be attributed to an inappropriate prioritization process. TST may be replaced with more accurate and specific methods (interferon gamma release assay) in highly prioritized contacts; or TST-positive contacts should be administered 6H therapy (provided that the chest radiography excludes TB) in accordance with standard protocols. The unit cost of contact tracing can be significantly reduced if radiological examination is done only in TST or IRGA positive contacts.

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 in many homes. These conclusions are likely to apply to most developed countries, many with higher mean radon concentrations than the UK. PMID:19129153

Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them.

PubMed

Gray, Alastair; Read, Simon; McGale, Paul; Darby, Sarah

2009-01-06

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. Cost effectiveness analysis. United Kingdom. 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. 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. The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m(3)). 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/m(3) 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 pound11,400 ( euro12 200; $16,913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained pound36,800) nor effective in reducing lung cancer mortality. 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 in many homes. These conclusions are likely to apply to most developed countries, many with higher mean radon concentrations than the UK.

Performance-based maintenance of gas turbines for reliable control of degraded power systems

NASA Astrophysics Data System (ADS)

Mo, Huadong; Sansavini, Giovanni; Xie, Min

2018-03-01

Maintenance actions are necessary for ensuring proper operations of control systems under component degradation. However, current condition-based maintenance (CBM) models based on component health indices are not suitable for degraded control systems. Indeed, failures of control systems are only determined by the controller outputs, and the feedback mechanism compensates the control performance loss caused by the component deterioration. Thus, control systems may still operate normally even if the component health indices exceed failure thresholds. This work investigates the CBM model of control systems and employs the reduced control performance as a direct degradation measure for deciding maintenance activities. The reduced control performance depends on the underlying component degradation modelled as a Wiener process and the feedback mechanism. To this aim, the controller features are quantified by developing a dynamic and stochastic control block diagram-based simulation model, consisting of the degraded components and the control mechanism. At each inspection, the system receives a maintenance action if the control performance deterioration exceeds its preventive-maintenance or failure thresholds. Inspired by realistic cases, the component degradation model considers random start time and unit-to-unit variability. The cost analysis of maintenance model is conducted via Monte Carlo simulation. Optimal maintenance strategies are investigated to minimize the expected maintenance costs, which is a direct consequence of the control performance. The proposed framework is able to design preventive maintenance actions on a gas power plant, to ensuring required load frequency control performance against a sudden load increase. The optimization results identify the trade-off between system downtime and maintenance costs as a function of preventive maintenance thresholds and inspection frequency. Finally, the control performance-based maintenance model can reduce maintenance costs as compared to CBM and pre-scheduled maintenance.

7 CFR 2.65 - Administrator, Agricultural Research Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... States population and special high-risk groups; and (iii) Design and carry out methodological research... designed to reduce the cost of producing upland cotton in the United States (7 U.S.C. 1441 note). (16...: (i) Design and carry out periodic nationwide food consumption surveys to measure household food...

7 CFR 2.65 - Administrator, Agricultural Research Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... groups; and (iii) Design and carry out methodological research studies to develop improved procedures for... designed to reduce the cost of producing upland cotton in the United States (7 U.S.C. 1441 note). (16... Research Program. Included in this delegation is the authority to: (i) Design and carry out periodic...

7 CFR 2.65 - Administrator, Agricultural Research Service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... groups; and (iii) Design and carry out methodological research studies to develop improved procedures for... designed to reduce the cost of producing upland cotton in the United States (7 U.S.C. 1441 note). (16... Research Program. Included in this delegation is the authority to: (i) Design and carry out periodic...

7 CFR 2.65 - Administrator, Agricultural Research Service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... groups; and (iii) Design and carry out methodological research studies to develop improved procedures for... designed to reduce the cost of producing upland cotton in the United States (7 U.S.C. 1441 note). (16... Research Program. Included in this delegation is the authority to: (i) Design and carry out periodic...

7 CFR 2.65 - Administrator, Agricultural Research Service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... designed to reduce the cost of producing upland cotton in the United States (7 U.S.C. 1441 note). (16... this delegation is the authority to: (i) Design and carry out periodic nationwide food consumption surveys to measure household food consumption; (ii) Design and carry out a continuous, longitudinal...

The Online Frontier

ERIC Educational Resources Information Center

Sturgis, Ingrid

2012-01-01

In President Barack Obama's most recent State of the Union address, technology figured significantly as part of his plan to increase the number of college graduates and reduce the cost of education. With concern that the United States is losing its competitive edge because it is not producing enough graduates and minority students are reportedly…

Built structure identification in wildland fire decision support

Treesearch

David E. Calkin; Jon D. Rieck; Kevin D. Hyde; Jeffrey D. Kaiden

2011-01-01

Recent ex-urban development within the wildland interface has significantly increased the complexity and associated cost of federal wildland fire management in the United States. Rapid identification of built structures relative to probable fire spread can help to reduce that complexity and improve the performance of incident management teams. Approximate structure...

Controllable Grid Interface Test System | Energy Systems Integration

Science.gov Websites

Facility | NREL Controllable Grid Interface Test System Controllable Grid Interface Test System NREL's controllable grid interface (CGI) test system can reduce certification testing time and costs grid interface is the first test facility in the United States that has fault simulation capabilities

Evaluation of low-cost intersection countermeasures to reduce red-light-running violations : retro-reflective signal back plates.

DOT National Transportation Integrated Search

2013-11-01

Red light running has become a serious safety issue at signalized intersections throughout the : United States. One objective of this study was to identify the characteristics of red-light-running (RLR) : crashes and the drivers involved in those cra...

Interprofessionalism: Educating to Meet Patient Needs

ERIC Educational Resources Information Center

Kirch, Darrell G.; Ast, Cori

2015-01-01

Interprofessional teams in health care are showing promise in achieving the triple aim--providing better care for the individual patient, reducing costs, and improving population health. To complement current changes in health care delivery in the United States, there is a growing consensus among health professions educators that students should…

Evaluating ephemeral gully erosion impact on Zea mays L. yield and economics using AnnAGNPS

USDA-ARS?s Scientific Manuscript database

Ephemeral gully erosion causes serious water quality and economic problems in the Midwest United States. A critical barrier to soil conservation practice adoption is often the implementation cost, although it is recognized that erosion reduces farm income. Yet few, if any, understand the relationshi...

Challenges in Chemistry Graduate Education: A Workshop Summary

ERIC Educational Resources Information Center

National Academies Press, 2012

2012-01-01

Chemistry graduate education is under considerable pressure. Pharmaceutical companies, long a major employer of synthetic organic chemists, are drastically paring back their research divisions to reduce costs. Chemical companies are opening new research and development facilities in Asia rather than in the United States to take advantage of…

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.

Solid polymer electrolyte (SPE) fuel cell technology program, phase 1/1A. [design and fabrication

NASA Technical Reports Server (NTRS)

1975-01-01

A solid polymer electrolyte fuel cell was studied for the purpose of improving the characteristics of the technology. Several facets were evaluated, namely: (1) reduced fuel cell costs; (2) reduced fuel cell weight; (3) improved fuel cell efficiency; and (4) increased systems compatibility. Demonstrated advances were incorporated into a full scale hardware design. A single cell unit was fabricated. A substantial degree of success was demonstrated.

Portable in-woods pyrolysis: Using forest biomass to reduce forest fuels, increase soil productivity, and sequester carbon

Treesearch

Deborah Page-Dumroese; Mark Coleman; Greg Jones; Tyron Venn; R. Kasten Dumroese; Nathanial Anderson; Woodam Chung; Dan Loeffler; Jim Archuleta; Mark Kimsey; Phil Badger; Terry Shaw; Kristin McElligott

2009-01-01

We describe the use of an in-woods portable pyrolysis unit that converts forest biomass to bio-oil and the application of the byproduct bio-char in a field trial. We also discuss how in-woods processing may reduce the need for long haul distances of lowvalue woody biomass and eliminate open, currently wasteful burning of forest biomass. If transportation costs can be...

Effect of a Patient-Repositioning Device in an Intensive Care Unit On Hospital-Acquired Pressure Injury Occurences and Cost: A Before-After Study.

PubMed

Edger, Melinda

The principal aim of this study was to determine the hospital-acquired pressure injury (HAPI) rate before and after introduction of a repositioning device, measure staff-perceived level of exertion with device use, and assess return on investment. 1 group, before-and-after study. The sample comprised 717 patients cared for in a 17-bed intensive care unit. The study setting was the neonatal intensive care unit at Bon Secours Maryview Medical Center located in the mid-Atlantic United States (Portsmouth, Virginia). A safe patient-handling intervention was implemented as part of a quality improvement initiative. The effect of this system was measured using several outcome measures: (1) HAPI occurrences on the sacral area and buttocks, (2) perceived effort of use by staff, and (3) cost analysis. We used the validated Borg Scale to measure perceived exertion that was ranked on a scale from 6 to 20, where higher scores indicate greater exertion. Cost comparisons were completed before and after introduction of the patient-repositioning system. Cost analysis was determined using internal dollar amounts calculated for each stage of pressure injury. The return on investment was calculated by comparing the cost of HAPIs and the product after the intervention with the costs of HAPIs before the intervention. Analysis revealed a statistically significant reduction in HAPI occurrence from 1.3% to 0% (P = .004) when baseline manual repositioning (standard of care) was compared with use of the repositioning system. Caregivers reported significantly less exertion when using the repositioning device as compared with standard of care repositioning (P < .001). The return on investment was estimated to be $16,911. Use of a repositioning device resulted in significantly reduced HAPIs. Perceived exertion for repositioning the patient with a repositioning device was significantly less than repositioning with standard of care. A cost analysis estimated a return on investment as a result of the intervention on HAPI prevention.

Cost considerations of acute migraine treatment.

PubMed

Adelman, James U; Adelman, Leon C; Freeman, Marshall C; Von Seggern, Randal L; Drake, Jaclyn

2004-03-01

To provide medication price data and cost-reducing strategies for the acute treatment of migraine. Retail prices for common acute care medications were found at http://www.drugstore.com. Cost-reduction tactics were obtained from literature searches and clinical experience. Several strategies can reduce cost without sacrificing treatment outcome. In mild to moderate migraine, low-priced nonsteroidal anti-inflammatory drugs can be used as first-line medications due to their proven efficacy and favorable tolerability. For patients with more severe migraine, implementing a stratified care approach-using migraine-specific medications early in acute treatment-is cost-effective for most patients. Stratified care not only improves outcome and decreases disability, but also reduces cost. Pill splitting and early administration of triptans within an attack enhance their value. Supplying rescue medications, such as opioids, sedatives, and phenothiazines, can prevent emergency department visits. Minimizing multiple dosing of triptans and reducing utilization of expensive health care resources are key factors in reducing the cost of effective migraine treatment. An important affordability factor for patients with co-payments is the number of triptan pills per package. Sumatriptan, naratriptan, and frovatriptan each contain 9 tablets per package, while most other triptan packages contain 6. Current triptan retail prices (per unit) include: Amerge 1 and 2.5 mg, 17.78 dollars; Axert 6.25 and 12.5 mg, 16.31 dollars; Frova 2.5 mg, 13.89 dollars; Imitrex 50 mg, 14.96 dollars; Imitrex 100 mg, 14.41 dollars; Imitrex Nasal Spray 20 mg, 21.61 dollars; Imitrex SQ 6 mg, 50.26 dollars; Maxalt 5 and 10 mg, 15 dollars; Maxalt-MLT 5 and 10 mg, 15 dollars; Relpax 40 mg, 13.58 dollars; Zomig 2.5 mg, 13.67 dollars; Zomig 5 mg, 15.89 dollars; Zomig-ZMT 2.5 mg, 13.67 dollars; and Zomig-ZMT 5 mg, 15.89 dollars. Practitioners can optimize the use of health care dollars without compromising quality of care through awareness of cost-saving treatment strategies, as well as price variations among medications.

Green remediation: enhanced reductive dechlorination using recycled rinse water as bioremediation substrate

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

Dawson, Gaynor; McKeon, Tom

Enhanced reductive dechlorination (ERD) has rapidly become a remedy of choice for use on chlorinated solvent contamination when site conditions allow. With this approach, solutions of an organic substrate are injected into the affected aquifer to stimulate biological growth and the resultant production of reducing conditions in the target zone. Under the reducing conditions, hydrogen is produced and ultimately replaces chlorine atoms on the contaminant molecule causing sequential dechlorination. Under suitable conditions the process continues until the parent hydrocarbon precursor is produced, such as the complete dechlorination of trichloroethylene (TCE) to ethene. The process is optimized by use of amore » substrate that maximizes hydrogen production per unit cost. When natural biota are not present to promote the desired degradation, inoculates can be added with the substrate. The in-situ method both reduces cost and accelerates cleanup. Successful applications have been extended from the most common chlorinated compounds perchloroethylene (PCE) and TCE and related products of degradation, to perchlorate, and even explosives such as RDX and trinitrotoluene on which nitrates are attacked in lieu of chloride. In recent work, the process has been further improved through use of beverage industry wastewaters that are available at little or no cost. With material cost removed from the equation, applications can maximize the substrate loading without significantly increasing total cost. The extra substrate loading both accelerates reaction rates and extends the period of time over which reducing conditions are maintained. In some cases, the presence of other organic matter in addition to simple sugars provides for longer performance times of individual injections, thereby working in a fashion similar to emulsified vegetable oil. The paper discusses results of applications at three different sites contaminated with chlorinated ethylenes. The applications have included wastewaters of both natural fruit juices and corn syrup solutions from carbonated beverages. Cost implications include both the reduced cost of substrate and the cost avoidance of needing to pay for treatment of the wastewater. (authors)« less

Management of busbar costs and spending tradeoffs for the transition to competitive markets in electricity

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

Corio, M.R.; Boyd, G.

Competition is changing the fundamental basis for doing business in the electricity generation market. As the market moves toward competitive market conditions, electricity will be viewed increasingly as a commodity--not only supplied to customers within a utility`s service area, but brokered and marketed outside its area as well. With movement toward retail wheeling being considered in California, Michigan, and New York, it may soon become a reality as well. This means that a utility can no longer feel secure as the monopoly supplier of electricity within its own franchise area. To remain the main supplier in its current service areamore » and compete for customers in other service areas, utilities will need to understand and examine all the components of ``busbar costs`` at its generating units. As competition drives the market to marginal costs, generating units with costs exceeding the market clearing price for electricity may soon have a limited role in the generation market. As the industry evolves, competition in the marketplace will force uneconomic plants to reduce costs or go out of business. This paper discusses results of studies addressing the evaluation of cost effectiveness, benchmarking of cost-efficiency, and development of marginal cost curves for busbar costs based on the development and aggregation of the three key measures which determine the cost and level of output (generation): (1) reliability; (2) heat rate; and (3) planned outage factor.« less

Cost Analysis of Tuberculosis Diagnosis in Cambodia with and without Xpert® MTB/RIF for People Living with HIV/AIDS and People with Presumptive Multidrug-resistant Tuberculosis.

PubMed

Pallas, Sarah Wood; Courey, Marissa; Hy, Chhaily; Killam, Wm Perry; Warren, Dora; Moore, Brittany

2018-06-04

The Xpert ® MTB/RIF (Xpert) test has been shown to be effective and cost-effective for diagnosing tuberculosis (TB) under conditions with high HIV prevalence and HIV-TB co-infection but less is known about Xpert's cost in low HIV prevalence settings. Cambodia, a country with low HIV prevalence (0.7%), high TB burden, and low multidrug-resistant (MDR) TB burden (1.4% of new TB cases, 11% of retreatment cases) introduced Xpert into its TB diagnostic algorithms for people living with HIV (PLHIV) and people with presumptive MDR TB in 2012. The study objective was to estimate these algorithms' costs pre- and post-Xpert introduction in four provinces of Cambodia. Using a retrospective, ingredients-based microcosting approach, primary cost data on personnel, equipment, maintenance, supplies, and specimen transport were collected at four sites through observation, records review, and key informant consultations. Across the sample facilities, the cost per Xpert test was US$33.88-US$37.11, clinical exam cost US$1.22-US$1.84, chest X-ray cost US$2.02-US$2.14, fluorescent microscopy (FM) smear cost US$1.56-US$1.93, Ziehl-Neelsen (ZN) smear cost US$1.26, liquid culture test cost US$11.63-US$22.83, follow-on work-up for positive culture results and Mycobacterium tuberculosis complex (MTB) identification cost US$11.50-US$14.72, and drug susceptibility testing (DST) cost US$44.26. Specimen transport added US$1.39-US$5.21 per sample. Assuming clinician adherence to the algorithms and perfect test accuracy, the normative cost per patient correctly diagnosed under the post-Xpert algorithms would be US$25-US$29 more per PLHIV and US$34-US$37 more per person with presumptive MDR TB (US$41 more per PLHIV when accounting for variable test sensitivity and specificity). Xpert test unit costs could be reduced through lower cartridge prices, longer usable life of GeneXpert ® (Cepheid, USA) instruments, and increased test volumes; however, epidemiological and test eligibility conditions in Cambodia limit the number of specimens received at laboratories, leading to sub-optimal utilization of current instruments. Improvements to patient referral and specimen transport could increase test volumes and reduce Xpert test unit costs in this setting.

Economic and market issues on the sustainability of egg production in the United States: analysis of alternative production systems.

PubMed

Sumner, D A; Gow, H; Hayes, D; Matthews, W; Norwood, B; Rosen-Molina, J T; Thurman, W

2011-01-01

Conventional cage housing for laying hens evolved as a cost-effective egg production system. Complying with mandated hen housing alternatives would raise marginal production costs and require sizable capital investment. California data indicate that shifts from conventional cages to barn housing would likely cause farm-level cost increases of about 40% per dozen. The US data on production costs of such alternatives as furnished cages are not readily available and European data are not applicable to the US industry structure. Economic analysis relies on key facts about production and marketing of conventional and noncage eggs. Even if mandated by government or buyers, shifts to alternative housing would likely occur with lead times of at least 5 yr. Therefore, egg producers and input suppliers would have considerable time to plan new systems and build new facilities. Relatively few US consumers now pay the high retail premiums required for nonconventional eggs from hens housed in alternative systems. However, data from consumer experiments indicate that additional consumers would also be willing to pay some premium. Nonetheless, current data do not allow easy extrapolation to understand the willingness to pay for such eggs by the vast majority of conventional egg consumers. Egg consumption in the United States tends to be relatively unresponsive to price changes, such that sustained farm price increases of 40% would likely reduce consumption by less than 10%. This combination of facts and relationships suggests that, unless low-cost imports grew rapidly, requirements for higher cost hen housing systems would raise US egg prices considerably while reducing egg consumption marginally. Eggs are a low-cost source of animal protein and low-income consumers would be hardest hit. However, because egg expenditures are a very small share of the consumer budget, real income loss for consumers would be small in percentage terms. Finally, the high egg prices imposed by alternative hen housing systems raise complex issues about linking public policy costs to policy beneficiaries.

An Analysis of Unit Costs at a Consolidated Supply Depot

DTIC Science & Technology

1990-12-01

Not-For-Profit Setting,"The Accounting Review,July 1990. Horngren , C. T., Cost Accountinq:A Managerial Emphasis,3rd ed, Prentice-Hall Inc.,1972...sector has used concepts of unit costs for 4 decades. Any managerial or cost accounting text discusses in some length unit costs . For Defense contractors...the Cost Accounting Standards Board (CASB) provides guidance for contract costs . Unit costs include direct, indirect, and general and administrative

Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men

PubMed Central

Chen, Anders; Hoover, Karen W.; Kelly, Jane; Dowdy, David; Sharifi, Parastu; Sullivan, Patrick S.; Rosenberg, Eli S.

2017-01-01

Introduction Men who have sex with men (MSM) are disproportionately affected by HIV due to their increased risk of infection. Oral pre-exposure prophylaxis (PrEP) is a highly effictive HIV-prevention strategy for MSM. Despite evidence of its effectiveness, PrEP uptake in the United States has been slow, in part due to its cost. As jurisdictions and health organizations begin to think about PrEP scale-up, the high cost to society needs to be understood. Methods We modified a previously-described decision-analysis model to estimate the cost per quality-adjusted life-year (QALY) gained, over a 1-year duration of PrEP intervention and lifetime time horizon. Using updated parameter estimates, we calculated: 1) the cost per QALY gained, stratified over 4 strata of PrEP cost (a function of both drug cost and provider costs); and 2) PrEP drug cost per year required to fall at or under 4 cost per QALY gained thresholds. Results When PrEP drug costs were reduced by 60% (with no sexual disinhibition) to 80% (assuming 25% sexual disinhibition), PrEP was cost-effective (at <$100,000 per QALY averted) in all scenarios of base-case or better adherence, as long as the background HIV prevalence was greater than 10%. For PrEP to be cost saving at base-case adherence/efficacy levels and at a background prevalence of 20%, drug cost would need to be reduced to $8,021 per year with no disinhibition, and to $2,548 with disinhibition. Conclusion Results from our analysis suggest that PrEP drug costs need to be reduced in order to be cost-effective across a range of background HIV prevalence. Moreover, our results provide guidance on the pricing of generic emtricitabine/tenofovir disoproxil fumarate, in order to provide those at high risk for HIV an affordable prevention option without financial burden on individuals or jurisdictions scaling-up coverage. PMID:28570572

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Doing it right the first time: quality improvement and the contaminant blood culture.

PubMed

Weinbaum, F I; Lavie, S; Danek, M; Sixsmith, D; Heinrich, G F; Mills, S S

1997-03-01

The aim of the project was to determine whether the rate of contaminant blood cultures could be reduced by using a team of dedicated phlebotomists. Comparisons were made between adult patients requiring blood cultures for suspected bacteremia on medical and surgical units before and after the introduction and withdrawal of a dedicated blood culture team. The results showed that a significant reduction in the contaminant blood culture rate was achieved by the blood culture team (P < 0.001; chi(2) test). Therefore, in our experience, the rate of contaminant blood cultures can be reduced in a teaching hospital by using a team of dedicated phlebotomists. Calculations made with our data and those published by others suggest that cost savings from reducing false-positive blood cultures are greater than the cost of the blood culture team.

Proceedings of Conference XVIII: a workshop on "Continuing actions to reduce losses from earthquakes in the Mississippi Valley area," 24-26 May, 1982, St. Louis, Missouri

USGS Publications Warehouse

Gori, Paula L.; Hays, Walter W.; Kitzmiller, Carla

1983-01-01

payoff and trre lowest cost and effort requirements. These action plans, which identify steps that can be undertaken immediately to reduce losses from earthquakes in each of the seven States in the Mississippi Valley area, are contained in this report. The draft 5-year plan for the Central United States, prepared in the Knoxville workshop, was the starting point of the small group discussions in the St. Louis workshop which lead to the action plans contained in this report. For completeness, the draft 5-year plan for the Central United States is reproduced as Appendix B.

Occupation-specific absenteeism costs associated with obesity and morbid obesity.

PubMed

Cawley, John; Rizzo, John A; Haas, Kara

2007-12-01

To document the absenteeism costs associated with obesity and morbid obesity by occupation. Data from the Medical Expenditure Panel Survey for 2000-2004 are examined. The outcomes are probability of missing any work in the previous year and number of days of work missed in the previous year. Predictors include clinical weight classification, age, education, and race. Models are estimated separately by gender and occupation category. The probability of missing work in the past year, number of days missed, and costs of absenteeism rise with clinical weight classification for both women and men, and vary across occupation. Absenteeism costs associated with obesity total $4.3 billion annually in the United States. Substantial absenteeism costs are associated with obesity and morbid obesity. Employers should explore workplace interventions and health insurance expansions to reduce these costs.

State-level estimates of obesity-attributable costs of absenteeism.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg; Wang, Y Claire

2014-11-01

To provide state-level estimates of obesity-attributable costs of absenteeism among working adults in the United States. Nationally representative data from the National Health and Nutrition Examination Survey for 1998 to 2008 and from the Behavioral Risk Factor Surveillance System for 2012 are examined. The outcome is obesity-attributable workdays missed in the previous year because of health and their costs to states. Obesity, but not overweight, is associated with a significant increase in workdays absent, from 1.1 to 1.7 extra days missed annually compared with normal-weight employees. Obesity-attributable absenteeism among American workers costs the nation an estimated $8.65 billion per year. Obesity imposes a considerable financial burden on states, accounting for 6.5% to 12.6% of total absenteeism costs in the workplace. State legislatures and employers should seek effective ways to reduce these costs.

Time-driven activity-based costing of multivessel coronary artery bypass grafting across national boundaries to identify improvement opportunities: study protocol.

PubMed

Erhun, F; Mistry, B; Platchek, T; Milstein, A; Narayanan, V G; Kaplan, R S

2015-08-25

Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation reportedly costs less than $2000 to produce in India. The goals of the proposed study are to (1) identify the difference in the costs incurred to perform CABG surgery by three Joint Commission accredited hospitals with reputations for high quality and efficiency and (2) characterise the opportunity to reduce the cost of performing CABG surgery. We use time-driven activity-based costing (TDABC) to quantify the hospitals' costs of producing elective, multivessel CABG. TDABC estimates the costs of a given clinical service by combining information about the process of patient care delivery (specifically, the time and quantity of labour and non-labour resources utilised to perform each activity) with the unit cost of each resource used to provide the care. Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews. Unit costs were calculated as a capacity cost rate, measured as a $/min, for each resource consumed in CABG production. Multiplying together the unit costs and resource quantities and summing across all resources used will produce the average cost of CABG production at each site. We will conclude by conducting a variance analysis of labour costs to reveal opportunities to bend the cost curve for CABG production in the USA. All our methods were exempted from review by the Stanford Institutional Review Board. Results will be published in peer-reviewed journals and presented at scientific meetings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Radon abate: Who should pay

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

Henderson, Z.P.

Radon is blamed for thousands of deaths from lung cancer annually. This radioactive gas most often seeps into buildings through structural defects. The cost of protecting tenants and homeowners from the health risks of radon adds to the cost of housing, particularly for those who can least afford it. Tenants and people whose homes need repair are at higher risk for radon exposure than are people living in well-constructed and well-maintained homes. Renters are at particular risk, says Joseph Laquatra, associate professor of design and environmental analysis, because they are powerless to implement radon mitigation. Moreover, they could be hurtmore » financially if landlords were forced to upgrade buildings in an attempt to reduce radon levels. [open quotes]A balance has to be struck,[close quotes] Laquatra says, [open quotes]between making rental units safer and not reducing the availability of affordable housing for people with low incomes.[close quotes] In a study of housing in central and western New York State, Laquatra and Peter Chi, professor of consumer economics and housing, found that up to 66 percent of rental units had excessive radon levels, versus 41 percent of owner-occupied homes costing less than $40,000 and 36 percent of homes worth more than $40,000.« less

Bench-Scale Silicone Process for Low-Cost CO{sub 2} Capture

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

Wood, Benjamin; Genovese, Sarah; Perry, Robert

2013-12-31

A bench-scale system was designed and built to test an aminosilicone-based solvent. A model was built of the bench-scale system and this model was scaled up to model the performance of a carbon capture unit, using aminosilicones, for CO{sub 2} capture and sequestration (CCS) for a pulverized coal (PC) boiler at 550 MW. System and economic analysis for the carbon capture unit demonstrates that the aminosilicone solvent has significant advantages relative to a monoethanol amine (MEA)-based system. The CCS energy penalty for MEA is 35.9% and the energy penalty for aminosilicone solvent is 30.4% using a steam temperature of 395more » °C (743 °F). If the steam temperature is lowered to 204 °C (400 °F), the energy penalty for the aminosilicone solvent is reduced to 29%. The increase in cost of electricity (COE) over the non-capture case for MEA is ~109% and increase in COE for aminosilicone solvent is ~98 to 103% depending on the solvent cost at a steam temperature of 395 °C (743 °F). If the steam temperature is lowered to 204 °C (400 °F), the increase in COE for the aminosilicone solvent is reduced to ~95-100%.« less

Enhanced Recovery after Colorectal Surgery: Can We Afford Not to Use It?

PubMed

Jung, Andrew D; Dhar, Vikrom K; Hoehn, Richard S; Atkinson, Sarah J; Johnson, Bobby L; Rice, Teresa; Snyder, Jonathan R; Rafferty, Janice F; Edwards, Michael J; Paquette, Ian M

2018-04-01

Enhanced recovery pathways (ERPs) aim to reduce length of stay without adversely affecting short-term outcomes. High pharmaceutical costs associated with ERP regimens, however, remain a significant barrier to widespread implementation. We hypothesized that ERP would reduce hospital costs after elective colorectal resections, despite the use of more expensive pharmaceutical agents. An ERP was implemented in January 2016 at our institution. We collected data on consecutive colorectal resections for 1 year before adoption of ERP (traditional, n = 160) and compared them with consecutive resections after universal adoption of ERP (n = 146). Short-term surgical outcomes, total direct costs, and direct hospital pharmacy costs were compared between patients who received the ERP and those who did not. After implementation of the ERP, median length of stay decreased from 5.0 to 3.0 days (p < 0.01). There were no differences in 30-day complications (8.1% vs 8.9%) or hospital readmission (11.9% vs 11.0%). The ERP patients required significantly less narcotics during their index hospitalization (211.7 vs 720.2 morphine equivalence units; p < 0.01) and tolerated a regular diet 1 day sooner (p < 0.01). Despite a higher daily pharmacy cost ($477 per day vs $318 per day in the traditional cohort), the total direct pharmacy cost for the hospitalization was reduced in ERP patients ($1,534 vs $1,859; p = 0.016). Total direct cost was also lower in ERP patients ($9,791 vs $11,508; p = 0.004). Implementation of an ERP for patients undergoing elective colorectal resection substantially reduced length of stay, total hospital cost, and direct pharmacy cost without increasing complications or readmission rates. Enhanced recovery pathway after colorectal resection has both clinical and financial benefits. Widespread implementation has the potential for a dramatic impact on healthcare costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Reduction of costs for anemia-management drugs associated with the use of ferric citrate

PubMed Central

Thomas, Anila; Peterson, Leif E

2014-01-01

Background Ferric citrate is a novel phosphate binder which has the potential to reduce usage of erythropoietin-stimulating agents (ESAs) and intravenous (IV) iron used for anemia management during hemodialysis (HD) among patients with end-stage renal disease (ESRD). Currently, the potential health care cost savings on a national scale due to the use of ferric citrate in ESRD are undetermined. Methods Per-patient-per-year costs of ESAs (Epogen® and Aranesp® [Amgen Inc., CA, USA]) and IV iron (Venofer® [American Regent, Inc., NY, USA] and Ferrlecit® [Sanofi US, Bridgewater, NJ, USA]) were based on RED BOOK™ (Truven Health Analytics New York, NY, USA) costs combined with the Centers for Medicare and Medicaid Services (CMS) base rate and actual usage in 2011 for the four drugs. The annual number of outpatients undergoing HD in the US was based on frequencies reported by the USRDS (United States Renal Data System). Monte Carlo uncertainty analysis was performed to determine total annual costs and cost reduction based on ferric citrate usage. Results Total annual cost of ESAs and IV iron for anemia management in ESRD determined by Monte Carlo analysis assuming CMS base rate value was 5.127 (3.664–6.260) billion USD. For actual utilization in 2011, total annual cost of ESAs and IV iron was 3.981 (2.780–4.930) billion USD. If ferric citrate usage reduced ESA utilization by 20% and IV iron by 40%, then total cost would be reduced by 21.2% to 4.038 (2.868–4.914) billion USD for the CMS base rate, and by 21.8% to 3.111 (2.148–3.845) billion USD, based on 2011 actual utilization. Conclusion It is likely that US health care costs for anemia-management drugs associated with ESRD among HD patients can be reduced by using ferric citrate as a phosphate binder. PMID:24899820

Comparison of prescription drug costs in the United States and the United Kingdom, Part 1: statins.

PubMed

Jick, Hershel; Wilson, Andrew; Wiggins, Peter; Chamberlin, Douglas P

2012-01-01

To compare the annual cost of statins in the United States and in the United Kingdom. Matched-cohort cost analysis. U.K. General Practice Research Database (GPRD), and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database. We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 280,000 people aged 55-64 years from each country in 2005 were prescribed at least one drug. Of these, 91,474 (33%) in the U.S. were prescribed a statin compared with 68,217 (24%) in the U.K. After excluding those who did not receive statins continuously or who switched statins during the year, there remained 61,470 in the U.S. and 45,788 in the U.K. who were prescribed a single statin preparation continuously during 2005 (annual statin users). We estimated and compared drug costs (presented in 2005 U.S. dollars) separately in the two countries. Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $313 for generic lovastatin to $1428 for nongeneric simvastatin. In the U.K., annual costs/patient ranged from $164 for generic simvastatin to $509 for nongeneric atorvastatin. The total annual cost of the continuous receipt of statins in the U.S. was $64.9 million compared with $15.7 million in the U.K. In June 2006, after our study results were analyzed, the U.S. Food and Drug Administration approved generic simvastatin. We thus derived cost estimates for simvastatin use during 2006 and found that more than 60% of simvastatin users switched to the generic product, which reduced the cost/pill by more than 50%. The cost paid for statins in the U.S. for people younger than 65 years, who were insured by private companies, was approximately 400% higher than comparable costs paid by the government in the U.K. Available generic statins were substantially less expensive than those that were still under patent in both countries. © 2012, Pharmacotherapy Publications, Inc.

A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

PubMed

Harris, G T; Olukoga, I A

2005-04-01

To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.

Stimulating learning-by-doing in advanced biofuels: effectiveness of alternative policies

NASA Astrophysics Data System (ADS)

Chen, Xiaoguang; Khanna, Madhu; Yeh, Sonia

2012-12-01

This letter examines the effectiveness of various biofuel and climate policies in reducing future processing costs of cellulosic biofuels due to learning-by-doing. These policies include a biofuel production mandate alone and supplementing the biofuel mandate with other policies, namely a national low carbon fuel standard, a cellulosic biofuel production tax credit or a carbon price policy. We find that the binding biofuel targets considered here can reduce the unit processing cost of cellulosic ethanol by about 30% to 70% between 2015 and 2035 depending on the assumptions about learning rates and initial costs of biofuel production. The cost in 2035 is more sensitive to the speed with which learning occurs and less sensitive to uncertainty in the initial production cost. With learning rates of 5-10%, cellulosic biofuels will still be at least 40% more expensive than liquid fossil fuels in 2035. The addition of supplementary low carbon/tax credit policies to the mandate that enhance incentives for cellulosic biofuels can achieve similar reductions in these costs several years earlier than the mandate alone; the extent of these incentives differs across policies and different kinds of cellulosic biofuels.

Research and application of key technology of electric submersible plunger pump

NASA Astrophysics Data System (ADS)

Qian, K.; Sun, Y. N.; Zheng, S.; Du, W. S.; Li, J. N.; Pei, G. Z.; Gao, Y.; Wu, N.

2018-06-01

Electric submersible plunger pump is a new generation of rodless oil production equipment, whose improvements and upgrades of key technologies are conducive to its large-scale application and reduce the cost and improve the efficiency. In this paper, the operating mechanism of the unit in-depth study, aimed at the problems existing in oilfield production, to propose an optimization method creatively, including the optimal design of a linear motor for submersible oil, development of new double-acting load-relief pump, embedded flexible closed-loop control technology, research and development of low-cost power cables. 90 oil wells were used on field application, the average pump inspection cycle is 608 days, the longest pump check cycle has exceeded 1037 days, the average power saving rate is 45.6%. Application results show that the new technology of optimization and upgrading can further improve the reliability and adaptability of electric submersible plunger pump, reduce the cost of investment.

Applications systems verification and transfer project. Volume 1: Operational applications of satellite snow cover observations: Executive summary. [usefulness of satellite snow-cover data for water yield prediction

NASA Technical Reports Server (NTRS)

Rango, A.

1981-01-01

Both LANDSAT and NOAA satellite data were used in improving snowmelt runoff forecasts. When the satellite snow cover data were tested in both empirical seasonal runoff estimation and short term modeling approaches, a definite potential for reducing forecast error was evident. A cost benefit analysis run in conjunction with the snow mapping indicated a $36.5 million annual benefit accruing from a one percent improvement in forecast accuracy using the snow cover data for the western United States. The annual cost of employing the system would be $505,000. The snow mapping has proven that satellite snow cover data can be used to reduce snowmelt runoff forecast error in a cost effective manner once all operational satellite data are available within 72 hours after acquisition. Executive summaries of the individual snow mapping projects are presented.

A wide-angle camera module for disposable endoscopy

NASA Astrophysics Data System (ADS)

Shim, Dongha; Yeon, Jesun; Yi, Jason; Park, Jongwon; Park, Soo Nam; Lee, Nanhee

2016-08-01

A wide-angle miniaturized camera module for disposable endoscope is demonstrated in this paper. A lens module with 150° angle of view (AOV) is designed and manufactured. All plastic injection-molded lenses and a commercial CMOS image sensor are employed to reduce the manufacturing cost. The image sensor and LED illumination unit are assembled with a lens module. The camera module does not include a camera processor to further reduce its size and cost. The size of the camera module is 5.5 × 5.5 × 22.3 mm3. The diagonal field of view (FOV) of the camera module is measured to be 110°. A prototype of a disposable endoscope is implemented to perform a pre-clinical animal testing. The esophagus of an adult beagle dog is observed. These results demonstrate the feasibility of a cost-effective and high-performance camera module for disposable endoscopy.

The ventilation problem in schools: literature review

DOE PAGES

Fisk, W. J.

2017-07-06

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

The ventilation problem in schools: literature review

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

Fisk, W. J.

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

Return on Investment of a Work-Family Intervention: Evidence From the Work, Family, and Health Network.

PubMed

Barbosa, Carolina; Bray, Jeremy W; Dowd, William N; Mills, Michael J; Moen, Phyllis; Wipfli, Brad; Olson, Ryan; Kelly, Erin L

2015-09-01

To estimate the return on investment (ROI) of a workplace initiative to reduce work-family conflict in a group-randomized 18-month field experiment in an information technology firm in the United States. Intervention resources were micro-costed; benefits included medical costs, productivity (presenteeism), and turnover. Regression models were used to estimate the ROI, and cluster-robust bootstrap was used to calculate its confidence interval. For each participant, model-adjusted costs of the intervention were $690 and company savings were $1850 (2011 prices). The ROI was 1.68 (95% confidence interval, -8.85 to 9.47) and was robust in sensitivity analyses. The positive ROI indicates that employers' investment in an intervention to reduce work-family conflict can enhance their business. Although this was the first study to present a confidence interval for the ROI, results are comparable with the literature.

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

Sievers, David A.; Lischeske, James J.; Biddy, Mary J.

Solid-liquid separation of intermediate process slurries is required in some process configurations for the conversion of lignocellulosic biomass to transportation fuels. Thermochemically pretreated and enzymatically hydrolyzed corn stover slurries have proven difficult to filter due to formation of very low permeability cakes that are rich in lignin. Treatment of two different slurries with polyelectrolyte flocculant was demonstrated to increase mean particle size and filterability. Filtration flux was greatly improved, and thus scaled filter unit capacity was increased approximately 40-fold compared with unflocculated slurry. Although additional costs were accrued using polyelectrolyte, techno-economic analysis revealed that the increase in filter capacity significantlymore » reduced overall production costs. Fuel production cost at 95% sugar recovery was reduced by $1.35 US per gallon gasoline equivalent for dilute-acid pretreated and enzymatically hydrolyzed slurries and $3.40 for slurries produced using an additional alkaline de-acetylation preprocessing step that is even more difficult to natively filter.« less

Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study.

PubMed

Frank, Steven M; Wasey, Jack O; Dwyer, Ian M; Gokaslan, Ziya L; Ness, Paul M; Kebaish, Khaled M

2014-07-05

A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery. In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods. Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (-2.0 ± 2.2 vs. -3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost. The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

The economic efficiency and equity of government policies on brucellosis: comparative insights from Albania and the United States of America.

PubMed

Peck, D; Bruce, M

2017-04-01

Brucellosis is a zoonotic bacterial disease that causes recurring febrile illness in humans, as well as reproductive failure and reduced milk production in livestock. The cost of brucellosis is equal to the sum of lost productivity of humans and animals, as well as private and public expenditures on brucellosis surveillance, prevention, control and treatment. In Albania, Brucella abortus and B. melitensis affect humans, cattle and small ruminants. In the United States, B. abortus affects cattle and wild ungulates in the Greater Yellowstone Area. These two case studies illustrate the importance of place-specific context in developing sustainable and effective brucellosis mitigation policies. Government regulations and mitigation strategies should be designed with consideration of all costs and benefits, both to public agencies and private stakeholders. Policy-makers should, for example, weigh the benefits of a regulation that increases epidemiological certainty against the costs of compliance for producers and households. The distribution of costs and benefits amongst public agencies and private individuals can have important implications for a policy's economic efficiency and equity quite apart from their total magnitude.

Cost Analysis of an Air Brayton Receiver for a Solar Thermal Electric Power System in Selected Annual Production Volumes

NASA Technical Reports Server (NTRS)

1981-01-01

Pioneer Engineering and Manufacturing Company estimated the cost of manufacturing and Air Brayton Receiver for a Solar Thermal Electric Power System as designed by the AiResearch Division of the Garrett Corporation. Production costs were estimated at annual volumes of 100; 1,000; 5,000; 10,000; 50,000; 100,000 and 1,000,000 units. These costs included direct labor, direct material and manufacturing burden. A make or buy analysis was made of each part of each volume. At high volumes special fabrication concepts were used to reduce operation cycle times. All costs were estimated at an assumed 100% plant capacity. Economic feasibility determined the level of production at which special concepts were to be introduced. Estimated costs were based on the economics of the last half of 1980. Tooling and capital equipment costs were estimated for ach volume. Infrastructure and personnel requirements were also estimated.

The vacuum system reform and test of the super-critical 600mw unit

NASA Astrophysics Data System (ADS)

Yan, Tao; Wan, Zhonghai; Lu, Jin; Chen, Wen; Cai, Wen

2017-11-01

The deficiencies of the designed vacuum system of the super-critical unit is pointed out in this paper, and then it is reformed by the steam ejector. The experimental results show that the vacuum of the condenser can be improved, the coal consumption can be reduced and the plant electricity consumption can be lowered dramatically at a small cost of the steam energy consumption. Meanwhile, the water-ring vacuum pumps cavitation problems can be solved.

Building Technologies Office FY 2017 Budget At-A-Glance

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

None

2016-03-01

Buildings and homes use more than 73% of the electrical energy consumed in the United States. They also consume 40% of the nation’s total energy, with an annual energy bill of $430 billion. These energy bills can be cost effectively reduced by 20%–50% or more through various energy-efficient technologies and techniques. The Building Technologies Office (BTO) will continue to develop and demonstrate advanced building efficiency technologies and practices to make buildings in the United States more efficient, affordable, and comfortable.

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

PubMed

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

2015-05-01

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

Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States.

PubMed

Miller, T R; Levy, D T

2000-06-01

The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats, child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

Costs of hospitalization for stroke patients aged 18-64 years in the United States.

PubMed

Wang, Guijing; Zhang, Zefeng; Ayala, Carma; Dunet, Diane O; Fang, Jing; George, Mary G

2014-01-01

Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type. Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke. We analyzed the costs after stratifying the hospitalizations by stroke type (hemorrhagic, ischemic, and other strokes) and diagnosis status (primary and secondary). We employed regressions to estimate the impact of event type and diagnosis status on costs while controlling for major potential confounders. Among the 97,374 hospitalizations (average cost: $20,396 ± $23,256), the number with ischemic, hemorrhagic, or other strokes was 62,637, 16,331, and 48,208, respectively, with these types having average costs, in turn, of $18,963 ± $21,454, $32,035 ± $32,046, and $19,248 ± $21,703. A majority (62%) of the hospitalizations had stroke listed as a secondary diagnosis only. Regression analysis found that, overall, hemorrhagic stroke cost $14,499 more than ischemic stroke (P < .001). For hospitalizations with a primary diagnosis of ischemic stroke, those with a secondary diagnosis of ischemic heart disease (IHD) had costs that were $9836 higher (P < .001) than those without IHD. The costs of hospitalizations involving stroke are high and vary greatly by type of stroke, diagnosis status, and comorbidities. These findings should be incorporated into cost-effective strategies to reduce the impact of stroke. Published by Elsevier Inc.

The financial performance of labor and delivery units.

PubMed

von Gruenigen, Vivian E; Powell, Diane M; Sorboro, Susan; McCarroll, Michelle L; Kim, Unhee

2013-07-01

Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physician-centric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality cost-effective care for sustainability, especially in obstetrics. Copyright © 2013 Mosby, Inc. All rights reserved.

Small Scale Solar Cooling Unit in Climate Conditions of Latvia: Environmental and Economical Aspects

NASA Astrophysics Data System (ADS)

Jaunzems, Dzintars; Veidenbergs, Ivars

2010-01-01

The paper contributes to the analyses from the environmental and economical point of view of small scale solar cooling system in climate conditions of Latvia. Cost analyses show that buildings with a higher cooling load and full load hours have lower costs. For high internal gains, cooling costs are around 1,7 €/kWh and 2,5 €/kWh for buildings with lower internal gains. Despite the fact that solar cooling systems have significant potential to reduce CO2 emissions due to a reduction of electricity consumption, the economic feasibility and attractiveness of solar cooling system is still low.

Alcoa World Alumina: Plant-Wide Assessment at Arkansas Operations Reveals More than$900,000 in Potential Annual Savings

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

Not Available

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of$925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at$271,200. The average payback period for all five projects would be approximately 8 months.

Alcoa World Alumina: Plant Wide Assessment at Arkansas Operation Reveals More than $900,000 in Potential Annual Savings

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

None

2003-07-01

The plant-wide energy-efficiency assessment performed in 2001 at the Alcoa World Alumina Arkansas Operations in Bauxite, Arkansas, identified seven opportunities to save energy and reduce costs. By implementing five of these improvements, the facility can save 15,100 million British thermal units per year in natural gas and 8.76 million kilowatt-hours per year in electricity. This translates into approximate annual savings of $925,300 in direct energy costs and non-fuel operating and maintenance costs. The required capital investment is estimated at $271,200. The average payback period for all five projects would be approximately 8 months.

Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience.

PubMed

Tan, S G; Lim, S H; Malathi, I

1995-11-01

A 1 year prospective study on routine gowning before entering a neonatal unit was conducted in a maternity hospital in Singapore. This study was done based on previous work by Donowitz, Haque and Chagla and Agbayani et al., as there have been no known studies done in Singapore. The aim of the study was to test the hypothesis that routine gowning before entering a neonatal nursery does not reduce nosocomial infection and mortality rate. A total of 212 neonates from the neonatal intensive care unit (NICU) and 1694 neonates from the neonatal special care unit (NSCU) were studied. Neonates admitted during the 1 year study were assigned to the gowning (control) and no routine gowning (trial) group on every alternate 2 months. The hospital infection control nurse provided data on nosocomial infection. The overall nosocomial infection rate in the NICU was 24% (25 of 104 admissions) during gowning periods compared to 16.6% (18 of 108 admissions) when plastic aprons were not worn before entry. In the NSCU, the overall infection rate was 1.5% (12 of 800 admissions) during gowning periods compared to 2.1% (19 of 894 admissions) when no gown was worn before entry. Results of the study found no significant differences in the incidences of nosocomial infection and mortality in the neonates. The cost of gowns used during the no routine gowning periods was S$2012.8 compared to S$3708 used during the routine gowning procedure. The investigators recommend that routine gowning before entering a neonatal unit is not essential and cost effective for the purpose of reducing infection. Rather the focus should be on adequate handwashing by all hospital personnel and visitors before handling neonates.

Anticipating and controlling mask costs within EDA physical design

NASA Astrophysics Data System (ADS)

Rieger, Michael L.; Mayhew, Jeffrey P.; Melvin, Lawrence S.; Lugg, Robert M.; Beale, Daniel F.

2003-08-01

For low k1 lithography, more aggressive OPC is being applied to critical layers, and the number of mask layers with OPC treatments is growing rapidly. The 130 nm, process node required, on average, 8 layers containing rules- or model-based OPC. The 90 nm node will have 16 OPC layers, of which 14 layers contain aggressive model-based OPC. This escalation of mask pattern complexity, coupled with the predominant use of vector-scan e-beam (VSB) mask writers contributes to the rising costs of advanced mask sets. Writing times for OPC layouts are several times longer than for traditional layouts, making mask exposure the single largest cost component for OPC masks. Lower mask yields, another key factor in higher mask costs, is also aggravated by OPC. Historical mask set costs are plotted below. The initial cost of a 90 nm-node mask set will exceed one million dollars. The relative impact of mask cost on chip depends on how many total wafers are printed with each mask set. For many foundry chips, where unit production is often well below 1000 wafers, mask costs are larger than wafer processing costs. Further increases in NRE may begin to discourage these suppliers' adoption to 90 nm and smaller nodes. In this paper we will outline several alternatives for reducing mask costs by strategically leveraging dimensional margins. Dimensional specifications for a particular masking layer usually are applied uniformly to all features on that layer. As a practical matter, accuracy requirements on different features in the design may vary widely. Take a polysilicon layer, for example: global tolerance specifications for that layer are driven by the transistor-gate requirements; but these parameters over-specify interconnect feature requirements. By identifying features where dimensional accuracy requirements can be reduced, additional margin can be leveraged to reduce OPC complexity. Mask writing time on VSB tools will drop in nearly direct proportion to reduce shot count. By inspecting masks with reference to feature-dependent margins, instead of uniform specifications, mask yield can be effectively increased further reducing delivered mask expense.

Investing in rangeland restoration in the Arid West, USA: countering the effects of an invasive weed on the long-term fire cycle.

PubMed

Epanchin-Niell, Rebecca; Englin, Jeffrey; Nalle, Darek

2009-01-01

In large areas of the arid western United States, much of which are federally managed, fire frequencies and associated management costs are escalating as flammable, invasive cheatgrass (Bromus tectorum) increases its stronghold. Cheatgrass invasion and the subsequent increase in fire frequency result in the loss of native vegetation, less predictable forage availability for livestock and wildlife, and increased costs and risk associated with firefighting. Revegetation following fire on land that is partially invaded by cheatgrass can reduce both the dominance of cheatgrass and its associated high fire rate. Thus restoration can be viewed as an investment in fire-prevention and, if native seed is used, an investment in maintaining native vegetation on the landscape. Here we develop and employ a Markov model of vegetation dynamics for the sagebrush steppe ecosystem to predict vegetation change and management costs under different intensities and types of post-fire revegetation. We use the results to estimate the minimum total cost curves for maintaining native vegetation on the landscape and for preventing cheatgrass dominance. Our results show that across a variety of model parameter possibilities, increased investment in post-fire revegetation reduces long-term fire management costs by more than enough to offset the costs of revegetation. These results support that a policy of intensive post-fire revegetation will reduce long-term management costs for this ecosystem, in addition to providing environmental benefits. This information may help justify costs associated with revegetation and raise the priority of restoration in federal land budgets.

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

Sullivan, W.N.

This report summarizes measured performance of residential geothermal heat pumps (GHP`s) that were installed in family housing units at Ft. Hood, Texas and at Selfridge Air National Guard base in Michigan. These units were built as part of a joint Department of Defense/Department of Energy program to evaluate the energy savings potential of GHP`s installed at military facilities. At the Ft. Hood site, the GHP performance was compared to conventional forced air electric air conditioning and natural gas heating. At Selfridge, the homes under test were originally equipped with electric baseboard heat and no air conditioning. Installation of the GHPmore » systems at both sites was straightforward but more problems and costs were incurred at Selfridge because of the need to install ductwork in the homes. The GHP`s at both sites produced impressive energy savings. These savings approached 40% for most of the homes tested. The low cost of energy on these bases relative to the incremental cost of the GHP conversions precludes rapid payback of the GHP`s from energy savings alone. Estimates based on simple payback (no inflation and no interest on capital) indicated payback times from 15 to 20 years at both sites. These payback times may be reduced by considering the additional savings possible due to reduced maintenance costs. Results are summarized in terms of 15 minute, hourly, monthly, and annual performance parameters. The results indicate that all the systems were working properly but several design shortcomings were identified. Recommendations are made for improvements in future installations at both sites.« less

Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

PubMed

Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

2014-09-01

An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P < 0.001) and effective antibiotic therapy (89.7 h versus 32 h, P < 0.001). Patients in the pre-intervention period had increased duration of hospitalization compared to those in the intervention period (23.3 days versus 15.3 days, P = 0.0001) and longer intensive care unit length of stay (16 days versus 10.7 days, P = 0.008). Mortality among patients during the intervention period was lower (21% versus 8.9%, P = 0.01) and our study intervention remained a significant predictor of survival (OR, 0.3; 95% confidence interval [CI], 0.12-0.79) after multivariate logistic regression. Mean hospital costs for each inpatient survivor were reduced $26,298 in the intervention cohort resulting in an estimated annual cost savings of $2.4 million (P = 0.002). Integration of rapid identification and susceptibility techniques with antimicrobial stewardship resulted in significant improvements in clinical and financial outcomes for patients with bloodstream infections caused by antibiotic-resistant Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

47 CFR 51.511 - Forward-looking economic cost per unit.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Forward-looking economic cost per unit. 51.511... (CONTINUED) INTERCONNECTION Pricing of Elements § 51.511 Forward-looking economic cost per unit. (a) The forward-looking economic cost per unit of an element equals the forward-looking economic cost of the...

Design and Evaluation of a Net Zero Energy Low-Income Residential Housing Development in Lafayette, Colorado

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

Dean, J.; VanGeet, O.; Simkus, S.

This report outlines the lessons learned and sub-metered energy performance of an ultra low energy single family ranch home and duplex unit, called the Paradigm Pilot Project and presents the final design recommendations for a 153-unit net zero energy residential development called the Josephine Commons Project. Affordable housing development authorities throughout the United States continually struggle to find the most cost-effective pathway to provide quality, durable, and sustainable housing. The challenge for these authorities is to achieve the mission of delivering affordable housing at the lowest cost per square foot in environments that may be rural, urban, suburban, or withinmore » a designated redevelopment district. With the challenges the U.S. faces regarding energy, the environmental impacts of consumer use of fossil fuels and the increased focus on reducing greenhouse gas emissions, housing authorities are pursuing the goal of constructing affordable, energy efficient and sustainable housing at the lowest life-cycle cost of ownership. This report outlines the lessons learned and sub-metered energy performance of an ultra-low-energy single family ranch home and duplex unit, called the Paradigm Pilot Project and presents the final design recommendations for a 153-unit net zero energy residential development called the Josephine Commons Project. In addition to describing the results of the performance monitoring from the pilot project, this paper describes the recommended design process of (1) setting performance goals for energy efficiency and renewable energy on a life-cycle cost basis, (2) using an integrated, whole building design approach, and (3) incorporating systems-built housing, a green jobs training program, and renewable energy technologies into a replicable high performance, low-income housing project development model.« less

Unit cost of Mohs and Dermasurgery Unit.

PubMed

Wanitphakdeedecha, R; Nguyen, T H; Chen, T M

2010-04-01

Appropriate pricing for medical services of not-for-profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas-MD Anderson Cancer Center, Houston, TX from the healthcare provider's perspective. MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients' statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow-up visit, consultation, Mohs and non-Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU.

Cost and Effectiveness of Decontamination Strategies in Radiation Contaminated Areas in Fukushima in Regard to External Radiation Dose

PubMed Central

Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

2013-01-01

The objective of the present study is to evaluate the cost and effectiveness of decontamination strategies in the special decontamination areas in Fukushima in regard to external radiation dose. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, analysis of cost and effectiveness suggests that decontamination costs for agricultural areas account for approximately 80% of the total decontamination cost, of which approximately 60% is associated with storage. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans. PMID:24069398

Cost and effectiveness of decontamination strategies in radiation contaminated areas in Fukushima in regard to external radiation dose.

PubMed

Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

2013-01-01

The objective of the present study is to evaluate the cost and effectiveness of decontamination strategies in the special decontamination areas in Fukushima in regard to external radiation dose. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, analysis of cost and effectiveness suggests that decontamination costs for agricultural areas account for approximately 80% of the total decontamination cost, of which approximately 60% is associated with storage. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans.

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.

PubMed

Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M

2015-07-01

Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.

Productivity cost benefit to employers of treating migraine with rizatriptan: a specific worksite analysis and model.

PubMed

Gerth, William C; Sarma, Syam; Hu, X Henry; Silberstein, Stephen D

2004-01-01

Employers in the United States might not be aware of the productivity costs of migraine or the extent to which those costs can be reduced by optimal treatment. An economic model was developed to enable employers to estimate the productivity costs of migraine to their company and the savings that will accrue if those patients who suffer from migraine are treated with rizatriptan. Analyses were run for both a major financial services corporation and a representative U.S. company. The major financial services corporation, with 87,821 employees, is projected to lose 538 person-years annually, at an estimated cost of 23.8 million dollars. A representative U.S. company with 10,000 employees is projected to lose 46.0 person-years of productive effort annually as a result of migraine, valued at approximately 1.94 million dollars. The value of the annual work loss avoided if migraine is treated with rizatriptan is projected at 10.3 million dollars for the financial services corporation and 841,000 dollars for the representative U.S. company. There is a substantial productivity cost burden of migraine from a U.S. employer perspective. These productivity costs can be reduced significantly by treating migraine headaches with rizatriptan.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

PubMed

Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

2018-01-01

The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.

Autonomous Flight Safety System - Phase III

NASA Technical Reports Server (NTRS)

2008-01-01

The Autonomous Flight Safety System (AFSS) is a joint KSC and Wallops Flight Facility project that uses tracking and attitude data from onboard Global Positioning System (GPS) and inertial measurement unit (IMU) sensors and configurable rule-based algorithms to make flight termination decisions. AFSS objectives are to increase launch capabilities by permitting launches from locations without range safety infrastructure, reduce costs by eliminating some downrange tracking and communication assets, and reduce the reaction time for flight termination decisions.

Public Housing: A Tailored Approach to Energy Retrofits

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

Dentz, Jordan; Conlin, Francis; Podorson, David

2014-06-01

More than 1 million HUD-supported public housing units provide rental housing for eligible low-income families across the country. A survey of over 100 public housing authorities (PHAs) across the country indicated that there is a high level of interest in developing low-cost solutions that improve energy efficiency and can be seamlessly included in the refurbishment process. Further, PHAs, have incentives (both internal and external) to reduce utility bills. ARIES worked with two PHAs to develop packages of energy efficiency retrofit measures the PHAs can cost effectively implement with their own staffs in the normal course of housing operations when unitsmore » are refurbished between occupancies. The energy efficiency turnover protocols emphasized air infiltration reduction, duct sealing and measures that improve equipment efficiency. ARIES documented implementation 10 ten housing units. Total source energy consumption savings was estimated at 6%-10% based on BEopt modeling with a simple payback of 1.7 to 2.2 years. At typical housing unit turnover rates, these measures could impact hundreds of thousands of units per year nationally.« less

National Economic Value Assessment of Plug-in Electric Vehicles: Volume I

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

Melaina, Marc; Bush, Brian; Eichman, Joshua

The adoption of plug-in electric vehicles (PEVs) can reduce household fuel expenditures by substituting electricity for gasoline while reducing greenhouse gas emissions and petroleum imports. A scenario approach is employed to provide insights into the long-term economic value of increased PEV market growth across the United States. The analytic methods estimate fundamental costs and benefits associated with an economic allocation of PEVs across households based upon household driving patterns, projected vehicle cost and performance attributes, and simulations of a future electricity grid. To explore the full technological potential of PEVs and resulting demands on the electricity grid, very high PEVmore » market growth projections from previous studies are relied upon to develop multiple future scenarios.« less

Receipt of outpatient cardiac rehabilitation among heart attack survivors--United States, 2005.

PubMed

2008-02-01

Each year, approximately 865,000 persons in the United States have a myocardial infarction (i.e., heart attack). In 2007, direct and indirect costs of heart disease were estimated at approximately $277.1 billion. Cardiac rehabilitation, an essential component of recovery care after a heart attack, focuses on cardiovascular risk reduction, promoting healthy behaviors, reducing death and disability, and promoting an active lifestyle for heart attack survivors. Current guidelines from the American Heart Association (AHA) and the American Association of Cardiovascular and Pulmonary Rehabilitation emphasize the importance of cardiac rehabilitation, which reduces morbidity and mortality, improves clinical outcomes, enhances psychological recovery, and decreases the risk for secondary cardiac events. To estimate the prevalence of receipt of outpatient cardiac rehabilitation among heart attack survivors in 21 states and the District of Columbia (DC), data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) were assessed. The results of that assessment indicated that 34.7% of BRFSS respondents who had experienced a heart attack participated in outpatient cardiac rehabilitation. Outpatient cardiac rehabilitation for eligible patients after a heart attack is an essential component of care that should be incorporated into treatment plans. Increasing the number of persons who participate in cardiac rehabilitation services also can reduce health-care costs for recurrent events and reduce the burden on families and caregivers of patients with serious sequelae.

A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice.

PubMed

Jani, Meghna; Gavan, Sean; Chinoy, Hector; Dixon, William G; Harrison, Beverley; Moran, Andrew; Barton, Anne; Payne, Katherine

2016-12-01

To identify and quantify resource required and associated costs for implementing TNF-α inhibitor (TNFi) drug level and anti-drug antibody (ADAb) tests in UK rheumatology practice. A microcosting study, assuming the UK National Health Service perspective, identified the direct medical costs associated with providing TNFi drug level and ADAb testing in clinical practice. Resource use and costs per patient were identified via four stages: identification of a patient pathway with resource implications; estimation of the resources required; identification of the cost per unit of resource (2015 prices); and calculation of the total costs per patient. Univariate and multiway sensitivity analyses were performed using the variation in resource use and unit costs. Total costs for TNFi drug level and concurrent ADAb testing, assessed using ELISAs on trough serum levels, were £152.52/patient (range: £147.68-159.24) if 40 patient samples were tested simultaneously. For the base-case analysis, the pre-testing phase incurred the highest costs, which included booking an additional appointment to acquire trough blood samples. The additional appointment was the key driver of costs per patient (67% of the total cost), and labour accounted for 10% and consumables 23% of the total costs. Performing ELISAs once per patient (rather than in duplicate) reduced the total costs to £133.78/patient. This microcosting study is the first assessing the cost of TNFi drug level and ADAb testing. The results could be used in subsequent cost-effectiveness analyses of TNFi pharmacological tests to target treatments and inform future policy recommendations. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.

[Reorganization of the interdisciplinary emergency unit at the university clinic of Göttingen].

PubMed

Blaschke, Sabine; Müller, Gerhard A; Bergmann, Günther

2008-04-01

Configuration of the interdisciplinary emergency unit within the university clinic of Göttingen was successfully reorganized during the past two years. All emergencies except traumatologic, gynecologic and pediatric emergencies are treated within this functional unit which is guided by the center of internal medicine. It is organized in a three shift operation manner over a period of 24 hours. Due to a close interdisciplinary collaboration between different departments patients receive optimal diagnostic and therapeutic treatment within a short period of time. To improve processes within the emergency department a series of measures were taken including the -establishment of an intermediate care unit for unstable patients, setting up of special diagnostic and therapeutic units for the acute coronary syndrome as well as stroke, implementation of standardized clinical pathways, establishment of an electronic data processing network in close communication with all diagnostic entities, introduction of a quality assurance system and reduction of medical costs. Reorganization measures lead to a substantial optimization and acceleration of emergency proceedings and thus, provides optimal patient care around the clock. In addition, medical costs could clearly be reduced at the interface between preclinical and clinical emergency medicine.

Backscattered EM-wave manipulation using low cost 1-bit reflective surface at W-band

NASA Astrophysics Data System (ADS)

Taher Al-Nuaimi, Mustafa K.; Hong, Wei; He, Yejun

2018-04-01

The design of low cost 1-bit reflective (non-absorptive) surfaces for manipulation of backscattered EM-waves and radar cross section (RCS) reduction at W-band is presented in this article. The presented surface is designed based on the reflection phase cancellation principle. The unit cell used to compose the proposed surface has an obelus (division symbol of short wire and two disks above and below) like shape printed on a grounded dielectric material. Using this unit cell, surfaces that can efficiently manipulate the backscattered RCS pattern by using the proposed obelus-shaped unit cell (as ‘0’ element) and its mirrored unit cell (as ‘1’ element) in one surface with a 180°  ±  35° reflection phase difference between their reflection phases are designed. The proposed surfaces can generate various kinds of backscattered RCS patterns, such as single, three, or four lobes or even a low-level (reduced RCS) diffused reflection pattern when those two unit cells are distributed randomly across the surface aperture. For experimental characterization purposes, a 50  ×  50 mm2 surface is fabricated and measured.

The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?

PubMed Central

Baird, Katherine E

2016-01-01

Background: This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. Method: The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. Results: The results show the risk of large medical expenses in the United States is 1.5–4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. Conclusion: Recent health care reforms can be expected to reduce Americans’ catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures—larger than can be expected—if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have. PMID:26985389

VAR and generalized impulse response analysis of manufacturing unit labor costs

NASA Astrophysics Data System (ADS)

Ewing, Bradley T.; Thompson, Mark A.

2008-04-01

This paper examines the relationship among manufacturing unit labor costs in the United States, United Kingdom, and Canada. The analysis is conducted within the context of an economic system utilizing the recently developed method of generalized impulse response analysis to simulate the responses of the cost series to disturbances. The results indicate that, while unit labor costs do not share a common stochastic trend, there are significant responses in the unit labor costs of each country to shocks in the costs of other countries that are not captured by standard interpretation of the multiple-equation model results. The findings indicate the presence of significant linkages among unit labor costs in the countries studied. The results are consistent with the economic environment of manufacturing operations being characterized by a competitive, integrated marketplace.

Public/Private Partnership--A Cost Effective Model for Child Day Care Services.

ERIC Educational Resources Information Center

Alisberg, Helene R.

Trends suggest that 11 million children in the United States will need day care services by 1995. Presently, corporations provide child care support through subsidies to low income employees or through community facilities, parent education, and information and referral (I & R) services. Such support results in reduced rates of absenteeism and…

Off-Line Catalog Production.

ERIC Educational Resources Information Center

OCLC Online Computer Library Center, Inc., Dublin, OH.

The Ohio College Library Center's off-line catalog system is a limited technique for production of card catalogs. Unlike the on-line system, it cannotmake the resources of a region available to users in an individual institution, and it does not have the potential for significantly reducing rate of rise of library per-unit costs. In short, it is…

Advanced Reciprocating Engine Systems (ARES): Raising the Bar on Engine Technology with Increased Efficiency and Reduced Emissions, at Attractive Costs

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

None

This is a fact sheet on the U.S. Department of Energy's (DOE) Advanced Reciprocating Engine Systems program (ARES), which is designed to promote separate, but parallel engine development between the major stationary, gaseous fueled engine manufacturers in the United States.

Hardware for Accelerating N-Modular Redundant Systems for High-Reliability Computing

NASA Technical Reports Server (NTRS)

Dobbs, Carl, Sr.

2012-01-01

A hardware unit has been designed that reduces the cost, in terms of performance and power consumption, for implementing N-modular redundancy (NMR) in a multiprocessor device. The innovation monitors transactions to memory, and calculates a form of sumcheck on-the-fly, thereby relieving the processors of calculating the sumcheck in software

Understanding the End User Perspective: A Multiple-Case Study of Successful Health Information Technology Implementation

ERIC Educational Resources Information Center

Behravesh, Bardia

2010-01-01

The United States continues to lag behind other countries in its adoption of health information technology. A failure to increase adoption will jeopardize the nation's ability to reduce medical errors, address the rapid growth of healthcare costs, and enact effective healthcare reform. Health information technology (HIT) implementation success…

Growth-promoting technologies decrease the carbon footprint, ammonia emissions, and costs of California beef production systems

USDA-ARS?s Scientific Manuscript database

Improved animal performance is suggested as one of the most effective mitigation strategies to reduce greenhouse gas (GHG) and ammonia (NH3) emissions from livestock production per unit of product produced. However, little information exists on the effects of increased animal productivity on the net...

Automotive Stirling Engine Development Program

NASA Technical Reports Server (NTRS)

Nightingale, N.; Ernst, W.; Richey, A.; Simetkosky, M.; Antonelli, M. (Editor)

1982-01-01

Activities performed on Mod I engine testing and test results; the manufacture, assembly, and test of a Mod I engine in the United States; design initiation of the Mod I-A engine system; transient performance testing; Stirling reference engine manufacturing and reduced size studies; components and subsystems; and the study and test of low cost alloys are summarized.

From sink to source: Regional variation in U.S. forest carbon futures

Treesearch

Dave Wear; John W. Coulston

2015-01-01

The sequestration of atmospheric carbon (C) in forests has partially offset C emissions in the United States (US) and might reduce overall costs of achieving emission targets, especially while transportation and energy sectors are transitioning to lower-carbon technologies. Using detailed forest inventory data for the conterminous US, we estimate...

Current Trends in Commercial Energy Codes

ERIC Educational Resources Information Center

Sebesta, James J.; Diemer, Robert; Ierardi, James

2013-01-01

Buildings consume approximately 40 percent of the energy used in the U.S., and efficiency is widely recognized to be the most effective means for containing demand and reducing use. Institutions of higher education make up a significant proportion of building area and annual energy and facility-related costs in the United States. The national…

Innovation and Productivity in Higher Education.

ERIC Educational Resources Information Center

Tuma, David T., Ed.

A concern shared by private and public institutions of higher education in the United States is how to provide quality education at reduced cost, in the face of rising expenses, changing social values, and falling enrollments. A compilation of essays by innovators in college-level instruction deals with this topic by addressing: general issues and…

Conservation of strategic metals

NASA Technical Reports Server (NTRS)

Stephens, J. R.

1982-01-01

A long-range program in support of the aerospace industry aimed at reducing the use of strategic materials in gas turbine engines is discussed. The program, which is called COSAM (Conservation of Strategic Aerospace Materials), has three general objectives. The first objective is to contribute basic scientific understanding to the turbine engine technology bank so that our national security is not jeopardized if our strategic material supply lines are disrupted. The second objective is to help reduce the dependence of United States military and civilian gas turbine engines on worldwide supply and price fluctuations in regard to strategic materials. The third objective is, through research, to contribute to the United States position of preeminence in the world gas turbine engine markets by minimizing the acquisition costs and optimizing the performance of gas turbine engines. Three major research thrusts are planned: strategic element substitution; advanced processing concepts; and alternate material identification. Results from research and any required supporting technology will give industry the materials technology options it needs to make tradeoffs in material properties for critical components against the cost and availability impacts related to their strategic metal content.

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

PubMed

Faul, Mark; Wald, Marlena M; Rutland-Brown, Wesley; Sullivent, Ernest E; Sattin, Richard W

2007-12-01

A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs ($262 million), annual rehabilitation costs ($43 million) and lifetime societal costs ($3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be $61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Low cost and thin metasurface for ultra wide band and wide angle polarization insensitive radar cross section reduction

NASA Astrophysics Data System (ADS)

Ameri, Edris; Esmaeli, Seyed Hassan; Sedighy, Seyed Hassan

2018-05-01

A planar low cost and thin metasurface is proposed to achieve ultra-wideband radar cross section (RCS) reduction with stable performance with respect to polarization and incident angles. This metasurface is composed of two different artificial magnetic conductor unit cells arranged in a chessboard like configuration. These unit cells have a Jerusalem cross pattern with different thicknesses, which results in wideband out-phase reflection and RCS reduction, consequently. The designed metasurface reduces RCS more than 10-dB from 13.6 GHz to 45.5 GHz (108% bandwidth) and more than 20-dB RCS from 15.2 GHz to 43.6 GHz (96.6%). Moreover, the 10-dB RCS reduction bandwidth is very stable (more than 107%) for both TE and TM polarizations. The good agreement between simulations and measurement results proves the design, properly. The ultra-wide bandwidth, low cost, low profile, and stable performance of this metasurface prove its high capability compared with the state-of-the-art references.

Taxation of United States general aviation

NASA Astrophysics Data System (ADS)

Sobieralski, Joseph Bernard

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

A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.

PubMed

Cavarocchi, N C; Wallace, S; Hong, E Y; Tropea, A; Byrne, J; Pitcher, H T; Hirose, H

2015-03-01

The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes. A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared. During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events. We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes. © The Author(s) 2014.

Pipe Crawler{reg_sign} internal piping characterization system - deactivation and decommissioning focus area. Innovative Technology Summary Report

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

NONE

1998-02-01

Pipe Crawler{reg_sign} is a pipe surveying system for performing radiological characterization and/or free release surveys of piping systems. The technology employs a family of manually advanced, wheeled platforms, or crawlers, fitted with one or more arrays of thin Geiger Mueller (GM) detectors operated from an external power supply and data processing unit. Survey readings are taken in a step-wise fashion. A video camera and tape recording system are used for video surveys of pipe interiors prior to and during radiological surveys. Pipe Crawler{reg_sign} has potential advantages over the baseline and other technologies in areas of cost, durability, waste minimization, andmore » intrusiveness. Advantages include potentially reduced cost, potential reuse of the pipe system, reduced waste volume, and the ability to manage pipes in place with minimal disturbance to facility operations. Advantages over competing technologies include potentially reduced costs and the ability to perform beta-gamma surveys that are capable of passing regulatory scrutiny for free release of piping systems.« less

Evaluation of the cost effectiveness of exenatide versus insulin glargine in patients with sub-optimally controlled Type 2 diabetes in the United Kingdom

PubMed Central

Woehl, Anette; Evans, Mark; Tetlow, Anthony P; McEwan, Philip

2008-01-01

Objective Exenatide belongs to a new therapeutic class in the treatment of diabetes (incretin mimetics), allowing glucose-dependent glycaemic control in Type 2 diabetes. Randomised controlled trial data suggest that exenatide is as effective as insulin glargine at reducing HbA1c in combination therapy with metformin and sulphonylureas; with reduced weight but higher incidence of adverse gastrointestinal events. The objective of this study is to evaluate the cost effectiveness of exenatide versus insulin glargine using RCT data and a previously published model of Type 2 diabetes disease progression that is based on the United Kingdom Prospective Diabetes Study; the perspective of the health-payer of the United Kingdom National Health Service. Methods The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 1,000 subjects aged over 40 years with sub-optimally-controlled Type 2 diabetes, following initiation of either exenatide, or insulin glargine, in addition to oral hypoglycaemic agents. Sensitivity analysis for a higher treatment discontinuation rate in exenatide patients was applied to the cohort in three different scenarios; (1) either ignored or (2) exenatide-failures excluded or (3) exenatide-failures switched to insulin glargine. Analyses were undertaken to evaluate the price sensitivity of exenatide in terms of relative cost effectiveness. Baseline cohort profiles and effectiveness data were taken from a published randomised controlled trial. Results The relative cost-effectiveness of exenatide and insulin glargine was tested under a variety of conditions, in which insulin glargine was dominant in all cases. Using the most conservative of assumptions, the cost-effectiveness ratio of exenatide vs. insulin glargine at the current UK NHS price was -£29,149/QALY (insulin glargine dominant) and thus exenatide is not cost-effective when compared with insulin glargine, at the current UK NHS price. Conclusion This study evaluated the relative cost effectiveness of insulin glargine versus exenatide in the management of Type 2 diabetes using a published model. Given no significant difference in glycaemic control and applying the additional effectiveness of exenatide over insulin glargine, with respect to weight loss, and using the current UK NHS prices, insulin glargine was found to be dominant over exenatide in all modelled scenarios. With current clinical evidence, exenatide does not appear to represent a cost-effective treatment option for patients with Type 2 diabetes when compared to insulin glargine. PMID:18694484

Rising Costs of COPD and the Potential for Maintenance Therapy to Slow the Trend

PubMed Central

Blanchette, Christopher M.; Gross, Nicholas J.; Altman, Pablo

2014-01-01

Background Chronic obstructive pulmonary disease (COPD) affects an estimated 14% of adults in the United States between the ages of 40 and 79 years. This progressive disease is characterized by persistent airflow limitation. The management of patients with COPD is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. Objective To examine the peer-reviewed literature on the impact of maintenance therapy on the direct treatment costs of patients with COPD in the United States. Methods PubMed was searched for articles written in English that were published between 2000 and 2013, using the search terms “COPD,” “economics,” “exacerbation,” “maintenance,” and related terms. Articles reporting the results of longitudinal studies of the costs associated with the management of patients with COPD, the costs associated with hospitalizations for acute exacerbations of COPD, and randomized clinical trials evaluating the effects of maintenance therapy on the incidence of COPD exacerbations were included in this review. Results The search identified a total of 277 articles, and 11 of these articles were deemed appropriate for inclusion in this review. The direct healthcare costs for patients with COPD increased by 38% between 1987 and 2007, and continued to increase by approximately 5% annually between 2006 and 2009. The costs associated with hospital admissions for patients with COPD accounted for the largest absolute increase ($2289 per admission in constant 2007 US dollars). Recent estimates suggest that the aggregate costs associated with the treatment of acute exacerbations are between $3.2 billion and $3.8 billion, and that annual healthcare costs are 10-fold greater for patients with COPD associated with acute exacerbations than for patients with COPD but without exacerbations. The results of 2 large clinical trials of maintenance therapy, including a long-acting cholinergic antagonist or a long-acting beta-2 agonist, showed a 16% to 17% reduction in the incidence of exacerbations compared with placebo. Nevertheless, maintenance therapy remains underutilized, with only 30% to 35% of patients with COPD in private and public health insurance plans receiving prescriptions for maintenance therapy. Conclusions The treatment of acute exacerbations of COPD remains the major driver of increasing healthcare costs associated with this condition. The appropriate use of maintenance therapy has been shown to reduce the incidence of exacerbations and has the potential to reduce overall costs associated with the management of patients with COPD. PMID:24991394

Potential Cost-Effective Opportunities for Methane Emission Abatement

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

Warner, Ethan; Steinberg, Daniel; Hodson, Elke

2015-08-01

The energy sector was responsible for approximately 84% of carbon dioxide equivalent (CO 2e) greenhouse gas (GHG) emissions in the U.S. in 2012 (EPA 2014a). Methane is the second most important GHG, contributing 9% of total U.S. CO 2e emissions. A large portion of those methane emissions result from energy production and use; the natural gas, coal, and oil industries produce approximately 39% of anthropogenic methane emissions in the U.S. As a result, fossil-fuel systems have been consistently identified as high priority sectors to contribute to U.S. GHG reduction goals (White House 2015). Only two studies have recently attempted tomore » quantify the abatement potential and cost associated with the breadth of opportunities to reduce GHG emissions within natural gas, oil, and coal supply chains in the United States, namely the U.S. Environmental Protection Agency (EPA) (2013a) and ICF (2014). EPA, in its 2013 analysis, estimated the marginal cost of abatement for non-CO 2 GHG emissions from the natural gas, oil, and coal supply chains for multiple regions globally, including the United States. Building on this work, ICF International (ICF) (2014) provided an update and re-analysis of the potential opportunities in U.S. natural gas and oil systems. In this report we synthesize these previously published estimates as well as incorporate additional data provided by ICF to provide a comprehensive national analysis of methane abatement opportunities and their associated costs across the natural gas, oil, and coal supply chains. Results are presented as a suite of marginal abatement cost curves (MACCs), which depict the total potential and cost of reducing emissions through different abatement measures. We report results by sector (natural gas, oil, and coal) and by supply chain segment - production, gathering and boosting, processing, transmission and storage, or distribution - to facilitate identification of which sectors and supply chain segments provide the greatest opportunities for low cost abatement.« less

Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

PubMed

Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

2017-12-01

Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

Cost analytic model to determine the least costly inpatient erythropoiesis stimulating therapy regimen.

PubMed

Sikand, Harminder; Decter, Adam; Greco, Tina; Watson, Sue H; Kang, Yoon Jun; Mody, Samir H; Piech, Catherine Tak; Duh, Mei Sheng; Naeem, Ayesha

2008-01-01

Unlike in outpatient settings, the comparative costs of epoetin alpha (EPO) and darbepoetin alpha (DARB) have not been evaluated broadly from the inpatient hospital perspective. To develop a cost analytic model comparing hospital inpatient costs for erythropoiesis stimulating therapies within the nephrology and oncology settings. A cost analytic model incorporating erythropoietic drug, pharmacy, and nursing costs was developed from the inpatient hospital perspective to evaluate comparative costs of EPO and DARB. Erythropoietic drug costs were calculated using unit wholesale acquisition cost multiplied by the number of units or micrograms while comparing the following dosing regimens: EPO 3 times weekly, EPO once weekly, and DARB once weekly. Pharmacy costs included dispensing and delivery costs, while nursing costs incorporated administration time costs; all were calculated by estimated fractional hours per activity multiplied by hourly wages. The total frequency of erythropoiesis stimulating therapy administrations was determined based on the average hospital length of stay. The first erythropoiesis stimulating therapy dose was assumed to occur on day 3 of hospitalization. For total inpatient costs, a weighted average was calculated across disease states. One-way sensitivity analyses were conducted by varying length of stay, day of initial erythropoiesis stimulating therapy dose, pharmacy and nursing costs, and once-weekly DARB dose. EPO 3 times weekly was the least costly regimen across all disease states evaluated. Threshold analysis indicated that the cost of once-weekly DARB regimens would have to be reduced by 37% to equal the cost of EPO 3 times weekly for an average length of stay. Sensitivity analyses did not considerably affect the results. EPO 3 times weekly was found to be the least costly erythropoiesis stimulating therapy regimen for nephrology and oncology inpatients for the average length of stay as well as most other lengths of stay considered. Once-weekly EPO was the least costly erythropoiesis stimulating therapy regimen for several other lengths of stay, while once-weekly DARB was never found to be the least costly regimen.

Interactive chemistry management system (ICMS); Field demonstration results at United Illuminating

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

Noto, F.A.; Farrell, D.M.; Lombard, E.V.

1988-01-01

The authors report on a field demonstration of the interactive chemistry management system (ICMS) performed in the late summer of 1987 at the New Haven Harbor Station of United Illuminating Co. This demonstration was the first installation of the ICMS at an actual plant site. The ICMS is a computer-based system designed to monitor, diagnose, and provide optional automatic control of water and steam chemistry throughout the steam generator cycle. It is one of the diagnostic modules that comprises CE-TOPS (combustion engineering total on-line performance system), which continuously monitors operating conditions and suggests priority actions to increase operation efficiency, extendmore » the performance life of boiler components and reduce maintenance costs. By reducing the number of forced outages through early identification of potentially detrimental conditions, diagnosis of possible causes, and execution of corrective actions, improvements in unit availability and reliability will result.« less

Effect of stress management interventions on job stress among nurses working in critical care units.

PubMed

Light Irin, C; Bincy, R

2012-01-01

Stress in nurses affects their health and increases absenteeism, attrition rate, injury claims, infection rates and errors in treating patients. This in turn significantly increases the cost of employment in healthcare units. Proper management of stress ensures greater efficiency at work place and improved wellbeing of the employee. Therefore, a pre-experimental study was conducted among 30 Critical Care Unit nurses working inMedical College Hospital, Thiruvananthapuram, (Kerala) to assess the effect of stress management interventions such as Job Stress Awareness, Assertiveness Training, Time Management, andProgressive Muscle Relaxation on job stress. The results showed that caring for patients, general job requirements and workload were the major sources of stress for the nurses. The level of severe stress was reduced from 60 percent to 20 percent during post-test. The Stress Management Interventions were statistically effective in reducing the stress of nurses at p<0.001 level.

Economic and Environmental Assessment of Seed and Rhizome Propagated Miscanthus in the UK.

PubMed

Hastings, Astley; Mos, Michal; Yesufu, Jalil A; McCalmont, Jon; Schwarz, Kai; Shafei, Reza; Ashman, Chris; Nunn, Chris; Schuele, Heinrich; Cosentino, Salvatore; Scalici, Giovanni; Scordia, Danilo; Wagner, Moritz; Clifton-Brown, John

2017-01-01

Growth in planted areas of Miscanthus for biomass in Europe has stagnated since 2010 due to technical challenges, economic barriers and environmental concerns. These limitations need to be overcome before biomass production from Miscanthus can expand to several million hectares. In this paper, we consider the economic and environmental effects of introducing seed based hybrids as an alternative to clonal M. x giganteus ( Mxg ). The impact of seed based propagation and novel agronomy was compared with current Mxg cultivation and used in 10 commercially relevant, field scale experiments planted between 2012 and 2014 in the United Kingdom, Germany, and Ukraine. Economic and greenhouse gas (GHG) emissions costs were quantified for the following production chain: propagation, establishment, harvest, transportation, storage, and fuel preparation (excluding soil carbon changes). The production and utilization efficiency of seed and rhizome propagation were compared. Results show that new hybrid seed propagation significantly reduces establishment cost to below £900 ha -1 . Calculated GHG emission costs for the seeds established via plugs, though relatively small, was higher than rhizomes because fossil fuels were assumed to heat glasshouses for raising seedling plugs (5.3 and 1.5 kg CO 2 eq. C Mg [dry matter (DM)] -1 ), respectively. Plastic mulch film reduced establishment time, improving crop economics. The breakeven yield was calculated to be 6 Mg DM ha -1 y -1 , which is about half average United Kingdom yield for Mxg ; with newer seeded hybrids reaching 16 Mg DM ha -1 in second year United Kingdom trials. These combined improvements will significantly increase crop profitability. The trade-offs between costs of production for the preparation of different feedstock formats show that bales are the best option for direct firing with the lowest transport costs (£0.04 Mg -1 km -1 ) and easy on-farm storage. However, if pelleted fuel is required then chip harvesting is more economic. We show how current seed based propagation methods can increase the rate at which Miscanthus can be scaled up; ∼×100 those of current rhizome propagation. These rapid ramp rates for biomass production are required to deliver a scalable and economic Miscanthus biomass fuel whose GHG emissions are ∼1/20th those of natural gas per unit of heat.

Economic and Environmental Assessment of Seed and Rhizome Propagated Miscanthus in the UK

PubMed Central

Hastings, Astley; Mos, Michal; Yesufu, Jalil A.; McCalmont, Jon; Schwarz, Kai; Shafei, Reza; Ashman, Chris; Nunn, Chris; Schuele, Heinrich; Cosentino, Salvatore; Scalici, Giovanni; Scordia, Danilo; Wagner, Moritz; Clifton-Brown, John

2017-01-01

Growth in planted areas of Miscanthus for biomass in Europe has stagnated since 2010 due to technical challenges, economic barriers and environmental concerns. These limitations need to be overcome before biomass production from Miscanthus can expand to several million hectares. In this paper, we consider the economic and environmental effects of introducing seed based hybrids as an alternative to clonal M. x giganteus (Mxg). The impact of seed based propagation and novel agronomy was compared with current Mxg cultivation and used in 10 commercially relevant, field scale experiments planted between 2012 and 2014 in the United Kingdom, Germany, and Ukraine. Economic and greenhouse gas (GHG) emissions costs were quantified for the following production chain: propagation, establishment, harvest, transportation, storage, and fuel preparation (excluding soil carbon changes). The production and utilization efficiency of seed and rhizome propagation were compared. Results show that new hybrid seed propagation significantly reduces establishment cost to below £900 ha-1. Calculated GHG emission costs for the seeds established via plugs, though relatively small, was higher than rhizomes because fossil fuels were assumed to heat glasshouses for raising seedling plugs (5.3 and 1.5 kg CO2 eq. C Mg [dry matter (DM)]-1), respectively. Plastic mulch film reduced establishment time, improving crop economics. The breakeven yield was calculated to be 6 Mg DM ha-1 y-1, which is about half average United Kingdom yield for Mxg; with newer seeded hybrids reaching 16 Mg DM ha-1 in second year United Kingdom trials. These combined improvements will significantly increase crop profitability. The trade-offs between costs of production for the preparation of different feedstock formats show that bales are the best option for direct firing with the lowest transport costs (£0.04 Mg-1 km-1) and easy on-farm storage. However, if pelleted fuel is required then chip harvesting is more economic. We show how current seed based propagation methods can increase the rate at which Miscanthus can be scaled up; ∼×100 those of current rhizome propagation. These rapid ramp rates for biomass production are required to deliver a scalable and economic Miscanthus biomass fuel whose GHG emissions are ∼1/20th those of natural gas per unit of heat. PMID:28713395

Evaluation of phase separator number in hydrodesulfurization (HDS) unit

NASA Astrophysics Data System (ADS)

Jayanti, A. D.; Indarto, A.

2016-11-01

The removal process of acid gases such as H2S in natural gas processing industry is required in order to meet sales gas specification. Hydrodesulfurization (HDS)is one of the processes in the refinery that is dedicated to reduce sulphur.InHDS unit, phase separator plays important role to remove H2S from hydrocarbons, operated at a certain pressure and temperature. Optimization of the number of separator performed on the system is then evaluated to understand the performance and economics. From the evaluation, it shows that all systems were able to meet the specifications of H2S in the desired product. However, one separator system resulted the highest capital and operational costs. The process of H2S removal with two separator systems showed the best performance in terms of both energy efficiency with the lowest capital and operating cost. The two separator system is then recommended as a reference in the HDS unit to process the removal of H2S from natural gas.

Discussion of Carbon Emissions for Charging Hot Metal in EAF Steelmaking Process

NASA Astrophysics Data System (ADS)

Yang, Ling-zhi; Jiang, Tao; Li, Guang-hui; Guo, Yu-feng

2017-07-01

As the cost of hot metal is reduced for iron ore prices are falling in the international market, more and more electric arc furnace (EAF) steelmaking enterprises use partial hot metal instead of scrap as raw materials to reduce costs and the power consumption. In this paper, carbon emissions based on 1,000 kg molten steel by charging hot metal in EAF steelmaking is studied. Based on the analysis of material and energy balance calculation in EAF, the results show that 146.9, 142.2, 137.0, and 130.8 kg/t of carbon emissions are produced at a hot metal ratio of 0 %, 30 %, 50 %, and 70 %, while 143.4, 98.5, 65.81, and 31.5 kg/t of carbon emissions are produced at a hot metal ratio of 0 %, 30 %, 50 %, and 70 % by using gas waste heat utilization (coal gas production) for EAF steelmaking unit process. However, carbon emissions are increased by charging hot metal for the whole blast furnace-electric arc furnace (BF-EAF) steelmaking process. In the condition that the hot metal produced by BF is surplus, as carbon monoxide in gas increased by charging hot metal, the way of coal gas production can be used for waste heat utilization, which reduces carbon emissions in EAF steelmaking unit process.

Cost comparison of unit dose and traditional drug distribution in a long-term-care facility.

PubMed

Lepinski, P W; Thielke, T S; Collins, D M; Hanson, A

1986-11-01

Unit dose and traditional drug distribution systems were compared in a 352-bed long-term-care facility by analyzing nursing time, medication-error rate, medication costs, and waste. Time spent by nurses in preparing, administering, charting, and other tasks associated with medications was measured with a stop-watch on four different nursing units during six-week periods before and after the nursing home began using unit dose drug distribution. Medication-error rate before and after implementation of the unit dose system was determined by patient profile audits and medication inventories. Medication costs consisted of patient billing costs (acquisition cost plus fee) and cost of medications destroyed. The unit dose system required a projected 1507.2 hours less nursing time per year. Mean medication-error rates were 8.53% and 0.97% for the traditional and unit dose systems, respectively. Potential annual savings because of decreased medication waste with the unit dose system were $2238.72. The net increase in cost for the unit dose system was estimated at $615.05 per year, or approximately $1.75 per patient. The unit dose system appears safer and more time-efficient than the traditional system, although its costs are higher.

PowerFilm PowerShade Fixed Site Solar System Cost Reduction Plan

DTIC Science & Technology

2014-07-31

2337 230’^ St Ames, lA 50014 JL’Olt^lO:pi𔄁oq7 j pageii Executive summary Power film and its partners have developed a Generation II PowerShade...which meets or exceeds the goals of this development contract, increasing power and improving the ROI of the power shade significantly while improving a...number of the human factors. Comparing the Gen II 1.8 KW PowerShade to the equivalent power Gen I unit (Gen I Medium), The cost has been reduced

Not ''just'' pump and treat

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

Angleberger, K; Bainer, R W

2000-12-12

The Lawrence Livermore National Laboratory (LLNL) has been consistently improving the site cleanup methods by adopting new philosophies, strategies and technologies to address constrained or declining budgets, lack of useable space due to a highly industrialized site, and significant technical challenges. As identified in the ROD, the preferred remedy at the LLNL Livermore Site is pump and treat, although LLNL has improved this strategy to bring the remediation of the ground water to closure as soon as possible. LLNL took the logical progression from a pump and treat system to the philosophy of ''Smart Pump and Treat'' coupled with themore » concepts of ''Hydrostratigraphic Unit Analysis,'' ''Engineered Plume Collapse,'' and ''Phased Source Remediation,'' which led to the development of new, more cost-effective technologies which have accelerated the attainment of cleanup goals significantly. Modeling is also incorporated to constantly develop new, cost-effective methodologies to accelerate cleanup and communicate the progress of cleanup to stakeholders. In addition, LLNL improved on the efficiency and flexibility of ground water treatment facilities. Ground water cleanup has traditionally relied on costly and obtrusive fixed treatment facilities. LLNL has designed and implemented various portable ground water treatment units to replace the fixed facilities; the application of each type of facility is determined by the amount of ground water flow and contaminant concentrations. These treatment units have allowed for aggressive ground water cleanup, increased cleanup flexibility, and reduced capital and electrical costs. After a treatment unit has completed ground water cleanup at one location, it can easily be moved to another location for additional ground water cleanup.« less

The role of informed consent in patient complaints: Reducing hidden health system costs and improving patient engagement through shared decision making.

PubMed

Posner, Karen L; Severson, Julie; Domino, Karen B

2015-09-01

Patient complaints about physicians are strongly associated with malpractice risk. Physicians at high risk for lawsuits tend to have poor communication skills and are more commonly the subject of patient complaints about communication issues. If a malpractice action does not arise, patient complaints nonetheless represent significant prelitigation transaction costs for the healthcare system that have not been previously quantified. Informed consent complaints represent a unique constellation of clinical communication skills clearly tied to malpractice risk. The goal of this study was to measure institutional resource consumption allocated to informed consent (IC) complaints, which are both costly and preventable. We compared IC complaints to other complaints about medical care in a single medical center in the United States, estimating the absolute and relative burden of IC deficiencies within this healthcare system. Resource consumption for the resolution of IC complaints far exceeded their proportional representation of complaints, representing half of all complaints, while disproportionately absorbing two-thirds of staff time devoted to complaint resolution. Complaint resolution represents an unrecognized remediable cost and an underappreciated opportunity for reducing waste in healthcare. We suggest that healthcare systems can reduce costs and elevate their patient-centered care practices by improving patient-provider communication during medical decision making via engagement strategies such as shared decision making. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

PubMed

Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

2016-04-01

Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, p<0.01). This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom12

PubMed Central

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-01-01

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39–79 y from the European Prospective Investigation into Cancer and Nutrition–Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom–based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed. PMID:25926505

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom.

PubMed

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-07-01

The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website. Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed.

Time-driven activity-based costing: A dynamic value assessment model in pediatric appendicitis.

PubMed

Yu, Yangyang R; Abbas, Paulette I; Smith, Carolyn M; Carberry, Kathleen E; Ren, Hui; Patel, Binita; Nuchtern, Jed G; Lopez, Monica E

2017-06-01

Healthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis. Triage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016. Total personnel and consumable costs were determined using TDABC methodology. The post-intervention TDABC model featured 6 phases of care, 33 processes, and 19 personnel types. Our interventions reduced duration and costs in the emergency department (-41min, -$23) and pre-operative floor (-57min, -$18). While post-anesthesia care unit duration and costs increased (+224min, +$41), the same-day discharge protocol eliminated post-operative floor costs (-$306). Our model incorporating all three interventions reduced total direct costs by 11% ($2753.39 to $2447.68) and duration of hospitalization by 51% (1984min to 966min). Time-driven activity-based costing can dynamically model changes in our healthcare delivery as a result of process improvement interventions. It is an effective tool to continuously assess the impact of these interventions on the value of appendicitis care. II, Type of study: Economic Analysis. Copyright © 2017 Elsevier Inc. All rights reserved.

Ecosystem services altered by human changes in the nitrogen cycle: a new perspective for US decision making.

PubMed

Compton, Jana E; Harrison, John A; Dennis, Robin L; Greaver, Tara L; Hill, Brian H; Jordan, Stephen J; Walker, Henry; Campbell, Holly V

2011-08-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and compare the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of $28 per kg NO(x)-N). Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (<$2.2-56 per kg N). In the current Chesapeake Bay restoration effort, for example, the collection of available damage costs clearly exceeds the projected abatement costs to reduce N loads to the Bay ($8-15 per kg N). Explicit consideration and accounting of effects on multiple ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution. Published 2011. This article is a US Government work and is in the public domain in the USA.